Variation in urban snow quality indicated by three seasonal sampling surveys conducted in Luleå (Sweden) within a span of 27 years.

Concentrations of total suspended solids (TSS), trace metals (Cu, Cd, Cr, Zn, Cd, Pb), Na and 16 US EPA priority PAHs in urban snow were studied in the City of Luleå in Northern Sweden. Snow was sampled at six central urban and suburban sites with various traffic intensities, in three sampling surveys (1994-95, 2002-03, 2020-21), repeated for three ages of the urban snow cover of 40, 80, and 120 days, respectively. The older data, from the 1994-95 and 2002-03 surveys, were obtained from the existing literature. The concentrations and mass loads of TSS and most trace metals studied (Zn, Cu, Pb, and Cd) varied with time. TSS, Zn, and Cu showed slightly higher concentrations and mass loads in the 2003 (TSS avg = 2300 µg/L, Zn avg = 620 µg/L and Cu avg = 250 µg/L) and 2021 (TSS avg = 1500 µg/L, Zn avg = 530 µg/L and Cu avg = 220 µg/L) sampling surveys, compared to the 1995 survey (TSS avg = 620 µg/L, Zn avg = 240 µg/L and Cu avg = 97 µg/L). However, no evident trend was observed between the 2003 and 2021 sampling surveys. The highest concentrations of Pb and Cd were observed in snow samples from the 1994-95 sampling survey (Pb max = 570 µg/L, Cd max = 4.6 µg/L). Results indicated higher concentrations of the pollutants studied in the city centre, compared to the residential suburbs, and in areas with heavier traffic, where concentrations of metals correlated well with traffic intensity. Fractionation analysis of trace metals indicated that Zn, Cu and Pb occurred mostly in the particulate-bound phase (>0.45 µm) containing the most of Zn, Cu, and Pb mass, at 80, 84 and 94% of the total, respectively. Over 50% of the dissolved phase of Zn and Cu was in the truly dissolved fraction (<3000 MWCO). Concentrations of PAHs also increased with traffic intensity, with pyrene being the most frequently detected PAH, likely because of the strength of sources and various physical processes influencing the snowbanks development and causing spatial and temporal variations in pollutant concentrations.

Effectiveness of an oral health education intervention among 6-12-year-old children: A cluster randomized controlled trial.

OBJECTIVES: Literature on the effectiveness of theory-based oral health education on the oral hygiene of children is limited. We aimed to determine the effectiveness of an health behaviour theory-based school oral health education intervention on 1) oral hygiene and 2) oral health-related knowledge, attitude and practices among 6-12-year-old children in Kerala, India. METHODS: Cluster randomized controlled trial. Sixteen class divisions (clusters) were randomized into intervention and control groups of 225 and 228 children respectively. Primary and secondary outcomes were plaque score as measured using the simplified oral hygiene index (OHI-S) and oral health-related knowledge, attitude and practices respectively. The intervention group received structured oral health education classes for three months and materials including pamphlets. Children in the control group were not given the classes or materials. RESULTS: Post-intervention OHI-S scores in the intervention group and control groups were 1.65 and 2.17 respectively (difference = -0.52, 95%CI -0.86, -0.18). All the secondary outcomes improved in the intervention group compared to the control group. CONCLUSIONS: The intervention improved the oral hygiene status, oral health-related knowledge, attitude and practices of the children. Longer term follow-up and economic appraisal are needed to help policymakers plan and develop OHEI based on health behaviour theories.

Pesticide residues in fresh fruits imported into the United Arab Emirates.

Pesticides are a major public health issue connected with excessive use because they negatively impact health and the environment. Pesticide toxicity has been connected to various human illnesses by means of pesticide exposure in direct or indirect ways. A total of 4513 samples of imported fresh fruits were collected from Dubai ports between 2018 to 2020. Their contamination by pesticides was evaluated using gas chromatography combined with mass spectrometry (GC-MS/MS) and liquid chromatography-mass spectrometry (LC-MS/MS). The display of monitoring results was based on the Maximum Residue Limit (MRL) standard as per the procedures of the European Union. Eighty-one different pesticide residues were detected in the tested fruit samples. In 73.2% of the samples, the pesticide levels were ≥ MRL, while 26.8% were > MRL standards. Chlorpyrifos, carbendazim, cypermethrin, and azoxystrobin were the most frequently detected pesticides in more than 150 samples. Longan (81.4%) and rambutan (66.7%) showed the highest number of imported samples with multiple pesticide residues > MRL. These results highlight the need to continuously monitor pesticide residues in fruits, particularly samples imported into the United Arab Emirates (UAE). Fruit samples with residues > MRL are considered unfit for consumption and prevented from entering commerce in the UAE.

Response of phytoplankton community and size classes to green Noctiluca bloom in the northern Arabian Sea.

A comprehensive analysis on the phytoplankton ecology with special reference to different phytoplankton size classes was carried out at green Noctiluca scintillans (hereafter Noctiluca) bloom and non-bloom locations in offshore waters of the northern Arabian Sea. At the bloom locations, green Noctiluca represented a dense mono-specific proliferation with average cell density of 10.16 ±â€¯5.806 × 104 cells-L-1 and relative abundance share of 98.63%. Active photosynthesis through prasinophytic endosymbiont was depicted from net community production magnitude reaching 85.26 mgC/m3/Day under low prey abundance. Parallel swarming of Porpita porpita, a voracious copepod feeder signified the competitive advantage of Noctiluca to have the phytoplankton prey. Average concentration of picophytoplankton biomass was eleven times lower in surface waters of non-bloom stations in comparison to bloom. Higher N:P ratio in subsurface waters of non-bloom stations signified non-utilization of nitrogenous nutrients. Green Noctiluca bloom onset subsequent to diatom rich conditions was evident from spatio-temporal ocean colour satellite imageries.

Financial Impact of Incidental Radiologic Findings During Living Kidney Donor Evaluation.

Living kidney donor (LKD) transplantation is an important alternative for the end-stage renal disease population and is preferred due to superior outcomes when compared with dialysis or deceased donor transplantation. LKD evaluation includes a computed tomography angiogram (CTA) for assessment of renal and renovascular anatomy. Incidental nonrenal findings are frequently noted during the CTAs, and these may have variable clinical significance. These incidental findings lead to further testing, procedures, and referrals, which incur additional cost. We conducted a retrospective analysis of the incidental findings noted during CTA of 632 LKDs evaluated at our institution from 2008 to 2013. All extrarenal findings were categorized as pulmonary, hepatic, pancreatic-biliary, adrenal, bowel, gynecologic, and miscellaneous. Further testing, diagnostic procedures, referrals, and management were determined based on chart review. Our results showed that there were 525 extrarenal incidental findings in 632 potential living donors. Appropriate clinical follow-up was required in 20% at an additional cost of US dollars (USD) 63,035. Additional cost per incidental finding requiring follow-up was USD 407 ± 818. The median cost for follow-up was USD 168 (168-317). The detection of findings during imaging leads to apprehension for the donor and contribute to additional costs. Appropriate counseling is warranted prior to evaluation of the LKD.

Prospective phase II study of the efficacy of transcutaneous electrical nerve stimulation in post-radiation patients.

AIMS: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) delivered using an extra-oral device in patients with radiation-induced xerostomia. MATERIALS AND METHODS: Thirty oral cavity and oropharyngeal cancer patients post-adjuvant (n = 26) or definitive radiotherapy (n = 4) were enrolled in this study. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for 5 min into graduated tubes using the low forced spitting method. The TENS unit was then activated and stimulated saliva was collected for an additional 5 min. The difference between unstimulated and stimulated saliva output was measured using the paired t-test. Linear regression was used to determine factors significantly influencing the improvement in salivary output. RESULTS: Twenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted. The mean unstimulated saliva flow was 0.056 ml/min and the mean stimulated saliva flow was 0.12 ml/min with a median increase of 0.06 ml/min. The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow. CONCLUSION: Extra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia. TENS therapy may be useful as an effective supportive treatment modality in post-radiated oral cancer patients.

IGFBP-5 enhances epithelial cell adhesion and protects epithelial cells from TGFß1-induced mesenchymal invasion.

TGFß1 is a major fibrotic factor and its actions involve induction of epithelial cell death, together with the stimulation and transdifferentiation of fibroblasts into collagen- and fibronectin-secreting myofibroblasts. These actions of TGFß1 are also consistent with a pro-metastatic role, by aiding epithelial cell escape through mesenchymal tissues. Recently IGFBP-5 has been described as a pro-fibrotic (pro-metastatic?) agent and the aim of this study was to compare and contrast the actions of IGFBP-5 with TGFß1. We used NMuMG cells and cloned stable epithelial and mesenchymal lines from the parent cells. TGFß1 induced apoptosis and/or EMT in the epithelial cells, whereas it enhanced mesenchymal cell survival and migration. IGFBP-5, in contrast, enhanced both cell-cell and cell-ECM adhesion and also improved wound closure in epithelial cells whereas, in mesenchymal cells, IGFBP-5 decreased adhesion and migration. Furthermore, IGFBP-5 was able to antagonise the actions of TGFß1. In a co-culture model simulating epithelial-mesenchymal boundaries, IGFBP-5 was able to antagonise the disruptive transgressions induced by TGFß1. Overall, these findings suggest that IGFBP-5 is important in maintaining epithelial-mesenchymal boundaries and thus may limit metastasis and fibrosis by inducing an orderly repair mechanism, very distinct from the fibrotic disruption induced by TGFß1. A role for IGFBP-5 in the inhibition of metastasis is supported by immunohistochemical studies of breast cancer microarrays, where we show that elevated IGFBP-5 expression is associated with increased disease-free survival.

The impact of tax policies on living organ donations in the United States.

In an effort to increase living organ donation, fifteen states passed tax deductions and one a tax credit to help defray potential medical, lodging and wage loss costs between 2004 and 2008. To assess the impact of these policies on living donation rates, we used a differences-in-differences strategy that compares the pre- and postlegislation change in living donations in states that passed legislation against the same change in those states that did not. We found no statistically significant effect of these tax policies on donation rates. Furthermore, we found no evidence of any lagged effects, differential impacts by gender, race or donor relationship, or impacts on deceased donation. Possible hypotheses to explain our findings are: the cash value of the tax deduction may be too low to defray costs faced by donors, lack of public awareness about the existence of these policies, and that states that were proactive enough to pass tax policy laws may have already depleted donor pools with previous interventions.

Gastrointestinal tract perforation following blunt abdominal trauma: an institution's experience.

PURPOSE: Traumatic perforation of the gastrointestinal tract (GIT) poses numerous challenges for surgeons worldwide. We aimed to review our institution's experience and highlight the pertinent issues in managing this problem. METHODS: A retrospective review was performed for all patients with perforation of the GIT following traumatic blunt injuries. RESULTS: Twenty-one patients, with a median age of 40 years, formed the study group, all of whom underwent surgery. Four patients were sent straight to the operating theater from the emergency department due to hemodynamic instability, while another two patients had pneumoperitoneum on their X-rays. Computed tomography (CT) scan was performed in 15 patients, with the findings of pneumoperitoneum (n = 7, 46.7%) and free fluid without solid organ injury (n = 9, 60.0%) being the most common result. The jejunum (n = 11, 52.4%) and ileum (n = 5, 23.8%) were the most common sites of perforation. Direct repair was performed in 9 (42.9%) patients, while resection of the perforated segment(s) was performed in the remaining 12 (57.1%) patients. Other associated intra-abdominal injuries included mesenteric (n = 6, 28.6%) and splenic lacerations (n = 4, 19.0%). Surgery was performed within 8 h of the accident in only 11 patients (52.4%). Some of the complications included wound infection (n = 7, 33.3%) and intra-abdominal abscesses (n = 3, 14.3%). Two patients underwent relook laparotomy after an initial damage control laparotomy. CONCLUSION: Prompt and early surgery for traumatic gastrointestinal perforation is advised. Any abnormal CT scans warrants either surgery or close monitoring. Direct repair of the perforation is preferred, if possible.

Chronic pain and its impact on quality of life following a traumatic rib fracture.

PURPOSE: Traumatic rib fractures account for 7-40 % of trauma admissions and most of them heal spontaneously and do not contribute to disability. The prevalence of chronic pain and its impact on quality of life following a traumatic rib fracture has not been studied adequately. METHODS: A retrospective review of electronic medical records of all the traumatic rib fracture admissions from January 2007 to December 2008 was conducted. This was followed up with a brief telephonic survey of the following questions: (1) Do you have pain following the trauma? (2) If YES, how severe is your pain from a score of zero to ten? (3) Does the pain affect your life style? (4) Does the pain affect your work? (5) Do you need to take regular pain medications? RESULTS: One hundred and two patients responded to the survey and 23 patients (22.5 %) complained of chronic persistent pain. In patients with pain, six patients (26 %) had chronic pain that required regular use of analgesics, eight patients (35 %) complained of impairment of work life, and three patients (13 %) complained of impairment of personal quality of life. Chronic pain was not related to age, number of ribs fractured, flail chest, hemothorax and/or pneumothorax, chest tube insertion, or Injury Severity Score (ISS). CONCLUSION: This study confirms the high incidence of chronic pain after a traumatic rib fracture. While the majority of the patients can manage this pain without interference of their quality of life, a few do suffer from life style/work interference and may have to resort to regular analgesic usage.

Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years.

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Chromobacterium violaceum sepsis in an infant.

Chromobacterium violaceum is a rare pathogen that can cause potentially fatal infections in humans. Till date, 150 cases are reported worldwide including 7 from India. We report a 6 month old infant who presented with high grade fever, respiratory distress and multiple vesicular skin lesions. Chromobacterium violaceum was isolated from blood, bone marrow aspirate and from skin lesions. Infant responded to treatment with piperacillin and ciprofloxacin, and is doing well on follow up.

Coronary artery dilatation in Incomplete Kawasaki disease.

We conducted this study to compare the incidence of coronary artery dilatation in children with Incomplete and Classical Kawasaki disease, diagnosed as per AHA criteria. Subjects were included on a retrospective review of records (2002-2007); those with a discharge diagnosis of Kawasaki disease were enrolled. A total of 29 patients were identified (3.1 per 1000 pediatric admissions), out of which 22 were boys (median age: 4.8 years; range: 4 months-11 years). Seventeen (58.6%) had Classical KD and twelve (41.4%) children had Incomplete KD. All children received IVIG and underwent echocardiography. Coronary involvement was more in Incomplete KD (11/12 = 91.6%) as compared to Classical KD (7/17= 41.1%). The sensitivity, specificity and predictive value of AHA criteria to detect coronary artery dilatation was 39%, 9%, and 41%, respectively. We conclude that children presenting with Incomplete Kawasaki disease are at a higher risk of coronary artery abnormalities.

Management of diaphragmatic rupture from blunt trauma.

INTRODUCTION: Diagnosis of diaphragmatic rupture is difficult, and delays could result in a catastrophic outcome. We reviewed our institution's management of patients with diaphragmatic rupture after blunt trauma. METHODS: All patients in this study were treated at Tan Tock Seng Hospital, Singapore, from March 2002 to October 2008. Patients with penetrating injuries were excluded. The parameters included age, mechanism of injury, haemodynamic status at admission, Glasgow coma scale (GCS) score, injury severity score (ISS), imaging studies, location of diaphragmatic injuries, associated injuries and outcome. RESULTS: 14 patients with a median age of 38 years formed the study group. Vehicular-related incidents accounted for 71.4 percent of the injuries. The median GCS score on admission was 14 (range 3-15), while the median systolic blood pressure and heart rate were 94 (range 50-164) mmHg and 110 (range 76-140) beats per minute, respectively. The median ISS was 41 (range 14-66). All had chest radiographs performed in the emergency department, six (42.9 percent) had computed tomography performed before surgery, while the remaining eight (57.1 percent) were sent straight to the operating theatre from the emergency department. There were five (35.7 percent) right-sided and nine (64.3 percent) left-sided diaphragmatic ruptures. The mortality rate was 35.7 percent. Some of the associated injuries included eight (57.1 percent) splenic lacerations, five (35.7 percent) haemothorax and lung injuries, four (28.6 percent) bone fractures and three (21.4 percent) liver lacerations. 12 (85.7 percent) patients underwent repair of the diaphragmatic rupture using interrupted polypropylene suture, while the remaining two (14.3 percent) were too haemodynamically unstable to undergo definitive treatment. Advanced age, haemodynamic instability and raised ISS were associated with mortality. CONCLUSION: An accurate diagnosis of diaphragmatic rupture in trauma patients is difficult, and a thorough examination of both the hemidiaphragms is mandatory during emergency laparotomy for these patients. Those with more severe injuries and decreased physiological reserves usually fare worse.

Altruistic living donors: evaluation for nondirected kidney or liver donation.

A program was established within our regional procurement organization to permit evaluation of altruistic living donors (LD) interested in nondirected kidney or liver segment donation prior to transplant center referral. During the initial 30 months of program operations, 731 donor inquiries were received of which 131 individuals called back after review of mailed information materials. Forty-seven candidates initiated and 19 completed the evaluation process. Seven underwent donation to include six kidneys and one liver segment, five are actively pending donation, five were excluded from donation following transplant center evaluation and two took no further action after their intended liver recipients received deceased donor (DD) transplants. Psychological evaluation of these 19 candidates found them to be free of psychopathology, highly cooperative and self-directed. They did not exhibit attention-seeking or religious motivations for their actions. All seven donors and recipients continue to do well postoperatively. This evaluation program has made possible large-scale screening and education of prospective altruistic LD within the general population and also provides a unique opportunity to further our understanding of those individuals interested in living-nondirected donation.

An intelligent tutoring system for trauma management (Trauma-Teach): a preliminary report.

Trauma-Teach is an interactive software for tutoring surgical trainees on medical trauma management procedures. Users of the system interact with a virtual patient suffering from trauma injuries. The task of the user is to stabilise the virtual patient, discover the underlying injuries and decide on an appropriate management plan. Artificial intelligence techniques are used to simulate the patient's pulmonary and cardiovascular systems in real time, determine the responses and results of treatments and diagnostics accordingly, model the patient deterioration if wrong actions are taken, and give a measure of reality to the system by selecting actual trauma cases from the hospital's database.

Tolerability and efficacy of single dose diethylcarbamazine (DEC) alone or co-administration with Ivermectin in the clearance of Wuchereria bancrofti microfilaraemia in Pondicherry, South India.

The tolerability and efficacy of single dose DEC (12mg/kg body weight) or co-administration of DEC (6mg/kg body weight) with Ivermectin (200 or 400 mcg/kg of body weight) was studied in 60 asymptomatic W. bancrofti microfilariae (Mf) carriers following a double blind randomized design. The drugs were tolerated well. The incidence of adverse reactions of DEC (85.0%), DEC + Ivermectin 200mcg (95.0%) and DEC + Ivermectin 400mcg (100%) did not vary significantly (P>0.05). The mean score of adverse reaction intensity due to DEC + Ivermectin 200mcg (1.41) was significantly higher compared to DEC (0.61) (P<0.05). However, there was no significant difference between and DEC +Ivermectin 400mcg (0.89) and DEC + Ivermectin 200mcg (1.41) and DEC + Ivermectin 400mcg and DEC. The major adverse reactions were fever, headache and myalgia in all groups. The incidence and intensity of the adverse reactions were maximum between 24 to 48 hours of post therapy. The haematological and biochemical parameters did not vary significantly between pre and 7-day post therapy values in any of the study groups (P>0.05). Efficacy was measured in terms of proportion of cases clearing microfilaraemia completely and reduction in geometric mean parasite density in comparison to pre therapy levels. At the end of one year, DEC with Ivermectin 400mcg group showed significantly higher efficacy in complete clearance of Mf (94.4%) than that of DEC with Ivermectin 200mcg (60.0%) or DEC alone (52.6%) (P<0.05). However, no significant difference was observed in reduction of geometric mean Mf density (99.9%, 99.7%, 99.5% respectively). In all the groups, the tolerability and efficacy of the drugs were independent of host age and gender.

Management delays for early gastric cancer in a country without mass screening.

BACKGROUND/AIMS: To examine the symptoms of early gastric cancer and the time scale of management delays in a country without a mass screening program. METHODOLOGY: Retrospective review of 44 patients with early gastric cancer. RESULTS: Epigastric pain (63.3%) and gastrointestinal hemorrhage (27.3%) were the main symptoms found. Total delay was made up of patient delay (48.6%), doctor delay (25.5%) and treatment delay (25.9%). Median patient delay (from symptom onset to medical consult) was 30 days (inter-quartile range 2 to 365). Patient delay of more than 6 months was associated with patients aged 50 and younger (P = 0.04) and those presenting with pain (P = 0.05). Median doctor delay (consult to diagnosis) was 21 days (1 to 35) and median treatment delay (diagnosis to surgery) was 8 days (2 to 21). Doctor delay of more than 6 months was associated with a negative gastroscopy or barium meal in the previous 12 months (P = 0.03). CONCLUSIONS: The detection of early gastric cancer at the symptomatic-detectable stage is possible and this potential window for diagnosis can be more than 1 year for up to one third of cases. Efforts to reduce management delays should be aimed at public education and improving the quality and accessibility of endoscopic evaluation.

Hepatocyte growth factor inhibits apoptosis after ischemic renal injury in rats.

Several studies have determined that growth factors, including hepatocyte growth factor (HGF), have a crucial role in the regenerative process of renal tubules after ischemic or toxic insult. Recent research has ascertained that as well as necrotic cell death, there is evidence of apoptosis after an acute renal injury. We attempted to determine the effect of HGF on apoptosis after ischemic renal injury in rats. We administered HGF or vehicle to 12 rats after ischemic insult and compared them with 6 sham-operated controls. Rats were killed at 48 hours, and histopathologic assessments were performed on the renal tissue. The microscale autoradiographic method was used for qualitative analysis of DNA fragmentation. This method was chosen over the widely used ethidium bromide-staining method because it increases the sensitivity of detection of apoptotic DNA. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling histopathologic staining was used to identify apoptosis in situ. Apoptotic changes were clearly shown by electron microscopy in vehicle-treated animals. Despite showing profound evidence of tubular necrosis, apoptotic changes were markedly reduced in HGF-treated animals compared with vehicle-treated animals. DNA-laddering analysis further confirmed the antiapoptotic effect of HGF. To our knowledge, this is the first in vivo illustration of the inhibitory activity of a growth factor on apoptosis in the setting of tubular necrosis. The role of apoptosis in the setting of acute renal failure has not been elucidated; thus, additional research is necessary to determine the significance of these findings.

Tolerability and efficacy of single-dose diethyl carbamazine (DEC) or ivermectin in the clearance of Wuchereria bancrofti microfilaraemia in Pondicherry, south India.

In a double blind design the tolerability and efficacy of single-dose DEC (6 mg/kg/body weight) or ivermectin (400 microg/kg/body weight) was studied in 30 asymptomatic W. bancrofti parasite carriers each. Although both drugs were tolerated well, the adverse reaction score (DEC 0.5; ivermectin 1.5) and overall incidence (DEC 65.0%; ivermectin 93.3%) were significantly higher in the ivermectin group. Major adverse reactions were fever, headache and myalgia, all of which peaked on the second day post-therapy. Efficacy was measured in terms of proportion of cases clearing parasitaemia and reduction in mean parasite density compared to pre-therapy levels. Although at the end of one year the ivermectin group showed a significantly higher efficacy (34.8%, 97.0%) compared to DEC (8.3%, 83.8%), at the end of the second year there was no significant difference in efficacy between the drugs (73.7%, 99.5% for ivermectin; 47.8%, 98.9% for DEC). The tolerability and efficacy of the two drugs were not significantly different between gender, age and weight classes of patients.