Geographical distribution of radon and associated health risks in drinking water samples collected from the Mulazai area of Peshawar, Pakistan.

Geospatial methods, such as GIS and remote sensing, map radon levels, pinpoint high-risk areas and connect geological traits to radon presence. These findings direct health planning, focusing tests, mitigation, and policies where radon levels are high. Overall, geospatial analyses offer vital insights, shaping interventions and policies to reduce health risks from radon exposure. There is a formidable threat to human well-being posed by the naturally occurring carcinogenic radon (222Rn) gas due to high solubility in water. Under the current scenario, it is crucial to assess the extent of 222Rn pollution in our drinking water sources across various regions and thoroughly investigate the potential health hazards it poses. In this regard, the present study was conducted to investigate the concentration of 222Rn in groundwater samples collected from handpumps and wells and to estimate health risks associated with the consumption of 222Rn-contaminated water. For this purpose, groundwater samples (n = 30) were collected from handpumps, and wells located in the Mulazai area, District Peshawar. The RAD7 radon detector was used as per international standards to assess the concentration of 222Rn in the collected water samples. The results unveiled that the levels of 222Rn in the collected samples exceeded the acceptable thresholds set by the US Environmental Protection Agency (US-EPA) of 11.1 Bq L-1. Nevertheless, it was determined that the average annual dose was below the recommended limit of 0.1 mSv per year, as advised by both the European Union Council and the World Health Organization. In order to avoid the harmful effects of such excessive 222Rn concentrations on human health, proper ventilation and storage of water in storage reservoirs for a long time before use is recommended to lower the 222Rn concentration.

The development and evaluation of a homemade laparoscopic endotrainer using the IDEAL framework and MISTELS scoring system: a pilot study.

BACKGROUND: A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines. METHODS: The validated modified (MISTELS) score was used to test the reliability of a low-cost laparoscopic trainer with commonly found components built by surgeons. Basic household materials including a cellular phone (camera source), wifi (linking source) and freely available webcam apps were used for construction. Five basic laparoscopic skills were performed by general surgery resident volunteers with minimal (1-6 months') laparoscopic surgery experience and tested and retested based on efficiency and precision. To determine interrater reliability, two trained observers scored all subjects. The Cronbach alpha test was used to test for internal consistency between tasks. The Interclass correlation coefficient is used for test and retest reliability. RESULTS: 15 (80% male, mean age 28 ± 5 years) residents were included. The interrater and test-retest reliabilities for the total scores of the basic laparoscopic skills tests were 0.952 (95% CI, 0.895-0.981) and 0.64 (95% CI, 0.35-0.77), respectively. The Cronbach Alpha for the first assessment test and retest was 0.83. The MISTELS metrics had excellent reliability, exceeding the threshold level of 0.8. CONCLUSION: It is possible to assemble a low-cost, reliable trainer at home to enhance laparoscopic skills during residency.

Impact of transportation infrastructure and urbanization on environmental pollution: evidence from novel wavelet quantile correlation approach.

In terms of achieving sustainable development goals (SDGs), the developing economies are facing many issues, and one of the key issues is environmental degradation. Being a developing economy, Pakistan is also experiencing thought-provoking impacts of global warming and still far away from the ideal track of sustainable development. For addressing environment-related issue and achieving the targets of SDGs, a policy-level reorientation might be necessary. In this view, this study investigates the impact of economic growth, transport infrastructure, urbanization, financial development, and renewable energy consumption on CO2 emissions by using the data of Pakistan during 1990-2020. For this purpose, we use novel wavelet quantile correlation approach. The empirical results of wavelet quantile correlation approach demonstrate that economic growth, transport infrastructure, urbanization, and financial development are responsible for environmental pollution. Whereas, result also claims that renewable energy consumption is a useful tool for reducing environmental pollution in Pakistan. Moreover, the results of FMOLS approach show that 1% increase in economic growth, transportation infrastructure, urbanization, and financial development increases CO2 emissions by 0.240, 0.010, 0.478, and 0.102%, respectively. However, 1% increase in renewable energy usage reduces CO2 emission by 1.083%. Based on the empirical outcomes, this study proposes comprehensive policy framework for achieving the targets of SDG 7 (clean energy), SDG 8 (economic growth), SDG 11 (sustainable cities and communities), and SDG 13 (climate action).

The RIPASA score is sensitive and specific for the diagnosis of acute appendicitis in a western population.

AIM: The definitive diagnosis of acute appendicitis (AA) requires histopathological examination. Various clinical diagnostic scoring systems attempt to reduce negative appendectomy rates. The most commonly used in Western Europe and the USA is the Alvarado score. The Raja Isteri Pengiran Anak Saleha appendicitis (RIPASA) score achieves better sensitivity and specificity in Asian and Middle Eastern populations. We aimed to determine the diagnostic accuracy of the RIPASA score in Irish patients with AA. METHODS: All patients who presented to our institution with right iliac fossa pain and clinically suspected AA between January 1 and December 31, 2015, were indentified from our hospital inpatient enquiry database and retrospectively studied. Operating theatre records and histology reports confirmed those who underwent a non-elective operative procedure and the presence or absence of AA. SPSS version 22 was used for statistical analysis. Standard deviation is provided where appropriate. RESULTS: Two hundred eight patients were included in the study (106/51% male, mean age 22.7 ± 9.2 years). One hundred thirty-five (64.9%) had histologically confirmed AA (mean symptom duration = 36.19 ± 15.90 h). At a score ≥7.5, the previously determined score most likely associated with AA in Eastern populations, the RIPASA scoring system demonstrated a sensitivity of 85.39%, specificity of 69.86%, positive predictive value of 84.06%, negative predictive value of 72.86% and diagnostic accuracy of 80% in our cohort. CONCLUSION: The RIPASA score is a useful tool to aid in the diagnosis of acute appendicitis in the Irish population. A score of ≥7.5 provides sensitivity and specificity exceeding that previously documented for the Alvarado score in Western populations. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: This is the first study evaluating the utility of the RIPASA score in predicting acute appendicitis in a Western population. At a value of 7.5, a cut-off score suggestive of appendicitis in the Eastern population, RIPASA demonstrated a high-sensitivity, specificity, positive predictive value and diagnostic accuracy in our cohort and was more accurate than the commonly used Alvarado score.

Laparoscopic total extraperitoneal repair of preoperatively diagnosed bilateral obturator and incidental bilateral femoral herniae.

Obturator hernia (OH), a rare type of hernia, is associated with high morbidity and mortality. Diagnosis is often delayed as clinical symptoms are typically non-specific. OH is frequently associated with other occult inguinopelvic herniae. Early diagnosis is vital to decrease morbidity and mortality. We report the case of a 75-year-old woman who presented to the surgical outpatients' department with non-specific bilateral groin pain radiating to the thighs. CT of the pelvis demonstrated bilateral OH with no radiological evidence of bowel obstruction. Semiurgent elective laparoscopic total extraperitoneal mesh repair was performed. Intraoperative findings confirmed bilateral obturator herniae as well as incidental bilateral femoral herniae. This case highlights the need for a high index of suspicion for such concomitant hernias that, in the presence of OH, may only be identified intraoperatively.

CSF fistulas after transsphenoidal pituitary surgery--a solved problem?

OBJECTIVE: Transsphenoidal surgery has been the gold standard for intra- and suprasellar lesions as well as some extrasellar pathologies for more than 40 years. This approach, with proper surgical expertise, is very safe with a low morbidity and mortality rate. However, as with every surgical treatment, complications can occur and may result in serious consequences for the patient. The goal of this article is to focus on cerebrospinal fluid (CSF) fistulas after transsphenoidal surgery and discuss possible risk factors and treatment options, including less common procedures in persistent CSF fistulas. METHODS: Over a period of 24 months, 339 consecutive patients underwent a total of 363 transsphenoidal surgeries for different pathologies in our institution. There were 282 patients with pituitary adenomas and 57 patients with nonadenomateous lesions. RESULTS: CSF fistulas occurred in total of six patients (1.77%), most frequently after surgery for nonadenomateous lesions (7%). The rate was only 0.7% after surgery for pituitary adenomas. In three patients, a simple resurgery with repacking of the sella using muscle, fat, and fibrin glue was performed. All three patients received a lumbar drainage for 5 days as well. All three patients had recurrent CSF fistulas despite surgical repair, requiring multiple resurgeries. In two patients, the implantation of a ventriculoperitoneal (vp) shunt with programmable valve for continuous lowering of the CSF pressure was required. In both patients, the vp shunt was explanted 2 to 3 months after the last proven rhinorrhea. Out of the 339, 2 patients developed meningitis due to CSF fistulas (0.59%). CONCLUSIONS: CSF fistulas continue to present a problem after transsphenoidal surgery and require sophisticated technical measures to treat this complication. Failure after repair can occur and necessitates more intense treatment modalities. The usage of the transsphenoidal approach in other skull base lesions leads to higher rates of CSF fistulas and subsequently higher frequency of meningitis.