Sexually transmitted infections and associated risk factors among the transgender population of Pakistan.

BACKGROUND: Transgender (TG) people are key drivers for sexually transmitted infections (STIs) all over the world. There is substantial evidence that STIs are associated with an increased likelihood of risky sexual behavior however little is known about the prevalence of STIs (HIV, HBV, HCV, and Syphilis) among HIV infected transgender population in Pakistan. METHODS: The current study investigated the seroprevalence of four STIs and associated socio-demographic risk factors among TGs of Punjab, Pakistan from July 2019 to June 2021. The samples were tested serologically and final confirmation was done through PCR for HIV, HBV, and HCV. RESULTS: A total of 1,562 transgenders cross-sectional descriptive records of the Punjab AIDS Control Program (PACP) were reviewed during the period from July 2019 to June 2021. The serological results evidenced that 533 (34.1%) had one pathogen, 309 (19.8%) had two or more (multiple) infections. The most predominant mono-infection among the transgender population was Syphilis 324 (20.7%) followed by HCV 114 (7.3%), HIV 69 (4.4%), and HBV 26 (1.7%). The highest proportions of Infections were found in TG residing in urban areas (68.6%) as compared to rural areas (31.4%). The seropositivity of all STIs was predominantly increased in Sex worker TGs i-e 55%, 46.5%, 38.5%, and 41.8% in HIV, HBV, HCV, and Syphilis respectively. Among 280 HIV-infected Transgender, 177 (63.2%) had Syphilis co-infections. While 87 (31%) and 47 (16.8%) HIV-infected individuals had HC and HBV co-infection respectively. CONCLUSION: Transgender is neglected population group in society. All STIs were predominantly common among sex worker transgenders, Illiterate educational groups, and TGs residing in urban areas. There is a need to spread awareness about STIs, preventive strategies, and facilitation to health care programs in this high-risk population group.

Inhibitor and Activator: Dual Role of Subsurface Sulfide Enables Selective and Efficient Electro-Oxidation of Methanol to Formate on CuS@CuO Core-Shell Nanosheet Arrays.

Selective electro-oxidation of aliphatic alcohols into value-added carboxylates at lower potentials than that of the oxygen evolution reaction (OER) is an environmentally and economically desirable anode reaction for clean energy storage and conversion technologies. However, it is challenging to achieve both high selectivity and high activity of the catalysts for the electro-oxidation of alcohols, such as the methanol oxidation reaction (MOR). Herein, a monolithic CuS@CuO/copper-foam electrode for the MOR with superior catalytic activity and almost 100% selectivity for formate is reported. In the core-shell CuS@CuO nanosheet arrays, the surface CuO directly catalyzes MOR, while the subsurface sulfide not only serves as an inhibitor to attenuate the oxidative power of the surface CuO to achieve selective oxidation of methanol to formate and prevent over-oxidation of formate to CO2 but also serves as an activator to form more surface O defects as active sites and enhances the methanol adsorption and charge transfer to achieve superior catalytic activity. CuS@CuO/copper-foam electrodes can be prepared on a large scale by electro-oxidation of copper-foam at ambient conditions and can be readily utilized in clean energy technologies.

Human exposure to toxic elements through facial cosmetic products: Dermal risk assessment.

Facial cosmetics are the most commonly consumed product, mainly by the women from all over the world irrespective of their age. The facial cosmetics may be contaminated with several toxic elements, which can get absorb on to the facial skin and migrate to the blood vessels. Hence the absorbed toxic elements can cause further adverse effects on the human body. The present study aims to assess the toxic element contents (arsenic, lead, nickel, mercury, and cadmium) in commonly consumed facial cosmetics (face powder, foundation, lightning creams, moisturizer, eye shadow, lipsticks, eyeliner, blush, mascara, sunscreen) and to carry out the risk assessment through different methods. The dermal risk was evaluated as SED, NOAEL, MoS, HQ and ILCR, which is linked with the exposure of selected toxic elements. The total CDDE for all selected elements in facial cosmetic products was found in increasing order as follow: face powder > foundation > lightning creams > moisturizer > eye shadow > lipsticks > eyeliner > blush > mascara > sunscreen. The HQ and HI values for selected elements were found to be < 1 in all facial cosmetics. Whereas the probable MoS of selected toxic elements in all facial cosmetics except eyeliner were found to be 3-4 folds lower than the minimum value of 100 regulated by the WHO.

In situ grown oxygen-vacancy-rich copper oxide nanosheets on a copper foam electrode afford the selective oxidation of alcohols to value-added chemicals.

Selective oxidation of low-molecular-weight aliphatic alcohols like methanol and ethanol into carboxylates in acid/base hybrid electrolytic cells offers reduced process operating costs for the generation of fuels and value-added chemicals, which is environmentally and economically more desirable than their full oxidation to CO2. Herein, we report the in-situ fabrication of oxygen-vacancies-rich CuO nanosheets on a copper foam (CF) via a simple ultrasonication-assisted acid-etching method. The CuO/CF monolith electrode enables efficient and selective electrooxidation of ethanol and methanol into value-added acetate and formate with ~100% selectivity. First principles calculations reveal that oxygen vacancies in CuO nanosheets efficiently regulate the surface chemistry and electronic structure, provide abundant active sites, and enhance charge transfer that facilitates the adsorption of reactant molecules on the catalyst surface. The as-prepared CuO/CF monolith electrode shows excellent stability for alcohol oxidation at current densities >200 mA·cm2 for 24 h. Moreover, the abundant oxygen vacancies significantly enhance the intrinsic indicators of the catalyst in terms of specific activity and outstanding turnover frequencies of 5.8k s-1 and 6k s-1 for acetate and formate normalized by their respective faradaic efficiencies at an applied potential of 1.82 V vs. RHE.

Deep-eutectic-solvent-based dispersive and emulsification liquid-liquid microextraction methods for the speciation of selenium in water and determining its total content levels in milk formula and cereals.

Rapid and environmentally friendly ultrasound-assisted dispersive liquid-liquid microextraction (US-DLLµE) and vortex assisted-emulsification liquid-liquid microextraction (VA-ELLµE) methods are proposed for the speciation of selenium in domestic and mineral water samples. A deep eutectic solvent (DES) prepared with different ratios of choline chloride and phenol is used as an extractant for hydrophobic tetravalent Se complexed with diethyldithiocarbamate in different water samples. The total inorganic Se species levels in water samples were determined via reducing Se(vi) to Se(iv), using sodium thiosulphate as a reducing agent. The total Se levels in formula milk and cereal samples were determined after microwave acid digestion. The different heating steps in GFAAS were also optimized. The analytical parameters for US-DLLµE and VA-ELLµE, including pH, the volume of complexing agent, the ultrasound and vortex mixing shaking times, and the volume and composition of the deep eutectic solvent, were optimized. The accuracies of both methods were confirmed based on the analysis of a certified reference material (CRM) BCR 189 (wholemeal flour). The enhancement factor (EF) and limit of detection (LOD) for Se(iv) via US-DLLµE were found to be 90.8 and 0.029 µg L-1, respectively, whereas an EF of 81.8 and LOD of 0.036 µg L-1 were obtained via VA-ELLµE. The % relative standard deviation (%RSD) values obtained based on the analysis of six replicate standards under the optimized conditions for US-DLLµE and VA-ELLµE were found to be 4.2 and 5.8%, respectively. The optimized methods were applied to different drinking water samples, and acid-digested milk formula and baby cereal food samples.

Evaluate the exposure of toxic metals via drinking water and smoking nonbranded cigarette in malnourished women by modified single/two-step cloud point extraction.

Presently, the exposure of heavy metals (cadmium and lead) was determined in biological sample (serum) of women (pregnant and nonpregnant) who belong to low socioeconomic group (malnutrition). The cadmium (Cd) and lead (Pb) were determined in drinking water and locally produced cigarette (bidi), smoking by women of childbearing age. The preconcentration of heavy metals in serum, water, and tobacco of bidi were carried out by cloud point extraction at single and two-step methods before determination by atomic absorption spectrometry with flame mode. The Cd and Pb in the water- and acid-digested serum and tobacco samples were treated with a complexing reagent 1-(2-pyridylazo)-2-naphthol (PAN). The hydrophobic complex of Cd and Pb was entrapped in Triton X-114. For the first step, the entrapped analytes in Triton X-114 was diluted with alcoholic acid (0.2 mol/L of HNO3) and subjected to FAAS, whereas for the second step of CPE, the surfactant-rich analyte was subjected to the second round of enrichment method. Lastly, the analyte was back-extracted in acidic solution (0.2 mol/L) and analyzed by FAAS. The all significant variable was optimized for optimal recovery of Cd and Pb. The recommended single/two-step cloud point extraction method was validated by simultaneously evaluated matrices matched certified reference materials of water, serum, and tobacco. The resulted data indicated that the groundwater samples contained elevated concentrations of Cd and Pb than recommended values for drinking water by WHO, while the contents of Cd and Pb were observed about two-fold higher in nonbranded cigarette (bidi) than branded cigarette. It was observed that there were about 3 to 4 times higher concentrations of both toxic metals in blood serum of smoker malnourished women group than in referent nonsmoker women. Graphical abstract.

Geochemical exposure of heavy metals in environmental samples from the vicinity of old gas mining area in northern part of Sindh Pakistan. Adverse impact on children.

In early nineteen century, a gas field was operational in southern part of Sindh, Pakistan for power production. The plant was completely un-operational for last three decades, whereas all wastage and raw materials are still dumped there, which might be the source to contaminate the ground water. The most of the workers population still living in different villages nearby the gas field. In present study, evaluated the undesirable effects of the toxic metals (lead and cadmium) via consuming groundwater for drinking and other domestic purpose especially in children of ≤5.0 years. For comparative purpose groundwater of nonindustrial area (nonexposed) was also analysed and their impact on age matched children was carried out. Biological samples (scalp hair and blood) were collected from children of exposed and nonexposed areas. The Cd and Pb in scalp hair and blood samples were carried out by graphite furnace atomic absorption spectrometry. Whereas, Cd and Pb in groundwater obtained from both areas were determined prior to applied preconcentration method as reported in our previous works. The Cd and Pb contents in the groundwater of villages of exposed area were found in the range of 5.18-10.9 and 19.9-69.5 µg/L, respectively. Whereas, the groundwater of nonexposed area contains Cd and Pb in the range of 1.79-3.78 and 5.07-24.3 µg/L, respectively. It was observed that the concentrations of Cd and Pb in scalp hair and blood samples of children belongs to exposed area have ≥2.0 fold higher than the resulted data attained for age matched control children, indicating as the exposure biomarkers of toxic metals. The children belong to exposed area have poor health, anemic and low body mass index (<13 kg/m2). A significant positive correlations among Cd and Pb concentrations in biological samples of exposed subjects and groundwater was observed (p < 0.01).

An environmental friendly enrichment method for microextraction of cadmium and lead in groundwater samples: Impact on biological sample of children.

A novel ionic liquid-based vortex assisted dispersive liquid-liquid micro extraction procedure(IL-VADLLµE) was proposed for the enrichment of toxic metals, cadmium (Cd) and lead (Pb) in different types of water samples, domestic treated and groundwater (tube well and hand pump). Whereas, the concentration of both toxic metals was also determined in the scalp hair of children (age ranged 1-3 years), drinking contaminated groundwater termed as exposed group, whereas for comparative purposes scalp hair of age matched children consumed domestically treated water, named as non-exposed group. To preconcentrate the trace levels of Cd and Pb, a green chelating agent, l-cysteine (2-amino-3-sulfhydrylpropanoic acid) was used for complexation, an ionic liquid, 1-butyl-3-methylimidazolium hexafluorophosphate [BMIM] [PF6] utilized as extractant and hexafluorophosphate ion (PF6-) as anion pairing agent, which facilitate the enrichment of hydrophobic complexes of analytes into the acceptor phase. Various operative features for the IL-VADLLµE method like pH of standards/samples, volume of ionic liquid and sample solution, concentration of ligand, ion pair reagent and ionic liquid, vortex and electrical shaking time (for comparative purpose), were thoroughly optimized. The projected method was effectively applicable to assess the Cd and Pb in trace level in real water sample (surface and groundwater) and scalp hair samples of children belongs to exposed and non-exposed areas. The high contents of both toxic metals in scalp hair samples of children consuming groundwater indicate that the adverse impacts of both toxic metals especially Pb on the general health as well as neuron and skeletal problem, from child hood.

A rapid ultrasonic energy assisted preconcentration method for simultaneous extraction of lead and cadmium in various cosmetic brands using deep eutectic solvent: A multivariate study.

An innovative ultrasonic assisted microextraction method using a deep eutectic solvent for entrapping the organ metallic complexes was developed to pre-concentrate the trace quantities of cadmium (Cd) and lead (Pb) in lipsticks and eye shadows of different brands prior to flame atomic absorption spectrometry analysis. A deep eutectic solvent (DES) was used in this study, prepared by mixing metal salt (ZnCl2) and hydrogen bond donors such as (acetamide) in different ratio. The different branded cosmetic items, lipstick and eye shadows, obtained from local market and subjected to acid digestion prior to application of proposed ultrasonic assisted microextraction method based on deep eutectic solvent (UAµE-DES) with the aid of mechanical and ultrasound energies. Ammonium pyrrolidine dithiocarbamate was used as a ligand to made hydrophobic complexes of Cd and Pb, entrapped in DES in the presence of aprotic solvent. The seven variables, mixing ratio of ZnCl2 and Acetamide, DES volume, Ultrasound and Conventional shaking time, pH, tetrahydrofuran and complexing reagent volume were optimized by multivariate approach for the optimum recovery of Cd and Pb from real cosmetic items. The resulted data indicates that ultrasound energy assisted extraction time, volume of DES and pH were most significant variables. The precision and validity of developed procedure were checked by the spiked known certified standards in real samples. The resulted data indicated that the lipsticks have different glittering colors contains high contents of Pb and Cd, whereas dark colors of eye shadows contain high level of both elements.

Ultrasonically Dispersed Ionic Liquid-Based Microextraction of Lead in Biological Samples of Malnourished Children Prior to Analysis by Flame Atomic Absorption Spectrometry.

In the present study, a simple ultrasonically dispersed modified liquid-phase microextraction method was developed for the extraction of lead (Pb) from blood and scalp hair samples of malnourished children (MNC). The complexation of Pb was executed by means of the complexing agent, ammonium pyrrolidinedithiocarbamate (APDC), whereas extraction was carried out through the ionic liquid (IL), 1-butyl-3-methylimidazolium hexafluorophosphate. Ultrasound energy was used for the dispersion and extraction of the metal complex into an IL because it enhances the extraction of the metal complex into infinite IL drops at a temperature range of 40-80°C for 1-5 min. After sonication, the enriched analyte phase was separated by centrifugation. Nitric acid (HNO3; 0.5-2 mol/L) was added to the IL-enriched phase to back-extract the analyte into the acidic aqueous phase and analyzed by flame atomic absorption spectrometry. Various experimental parameters that affect the efficiency of the proposed method, such as volume of IL, concentration of the complexing agent, pH, ultrasonication time and temperature, and concentration of HNO3, were optimized. The enhancement factor was calculated as 70. The LOD for Pb ions was found to be 0.19 µg/L, with an RSD of <5%. Accuracy was ensured by applying the procedure to a certified reference material for whole blood and scalp hair. The developed procedure was successfully applied for the analysis of the concentration of Pb ion in whole-blood and scalp hair samples of MNC from different areas of Sindh, Pakistan. The concentration of Pb among MNC was 2-fold higher than the referent.

Application of ultrasonically modified cloud point extraction method for simultaneous enrichment of cadmium and lead in sera of different types of gallstone patients.

A novel and greener ultrasonically assisted/modified cloud point extraction procedure for the simultaneous preconcentration of lead and cadmium in serum samples of different types of gallstone patients was developed. The chelates of the under study metals, formerly formed with 8-hydroxyquinoline, were extracted in the micelles of a nonionic surfactant prior to analysis by flame atomic absorption spectrometer (FAAS). After the arrival of the cloud point, the critical micellar mass produced was homogenously dispersed in the aqueous phase with the help of ultrasound energy. The reliability of the developed procedure was tested by relative standard deviation (% RSD), which was found to be <5%. The performance of the proposed procedure was checked by applying to certified reference material and spiking standard in real samples. All the experimental parameters were optimized. The developed procedure of Um-CPE was applied successfully for the analysis of the target heavy metals in serum samples of different types of gallstone patients and referents. The higher levels of the understudy metals were observed in the patients as compared to the referents but the levels of the both metal were found to be considerably higher in patients with pigmented gallstones.

Variation of calcium, copper and iron levels in serum, bile and stone samples of patients having different types of gallstone: A comparative study.

BACKGROUND: Epidemiological data among the human population has shown a significantly increased incidence of gallstone (GS) disease worldwide. It was studied that some essential (calcium) and transition elements (iron and copper) in bile play an important role in the development of GS. METHOD: The estimation of calcium, copper and iron were carried out in the serum, gall bladder bile and different types of GS (cholesterol, mixed and pigmented) of 172 patients, age ranged 20-55years. For comparative purpose age matched referents not suffering from GS diseases were also selected. Biliary concentrations of calcium (Ca), iron (Fe) and copper (Cu) were correlated with their concentrations in serum and different types of GS samples. The ratio of Ca, Fe and Cu in bile with serum was also calculated. Understudy metals were determined by flame atomic absorption spectroscopy after acid decomposition of matrices of selected samples. RESULTS: The Ca concentrations in serum samples were significantly higher in patients with pigmented GS as compared to controls (p<0.005), whereas for patients having cholesterol and mixed GS the concentrations were on the lower side. Biliary Ca concentrations of patients were found to be higher than controls, but difference was significant for pigmented GS patients (p>0.001). The contents of Cu and Fe in serum and bile of all patients (except female cholesterol GS patient have low serum iron concentration) were found to be higher than control, but difference was significant in those patients who have pigmented GS. The concentration of Ca, Fe and Cu in different types GS were found in the order, Pigmented>mixed>cholesterol. The bile/serum ratio for Ca, Cu and Fe was found to be significantly higher in pigmented GS patients. Gall bladder bile was slightly alkaline in patients as compared to referents. The density of bile was found to be higher in patients as compared to the referents. Various functional groups present in different types of GS samples were confirmed by Fourier transform infra-red spectroscopy. CONCLUSION: The higher density and pH of bile, elevated concentrations of transition elements in all types of biological samples (serum, bile and GS), could be an important factor for the formation of different types of GS.

Ultrasonic energy enhanced the efficiency of advance extraction methodology for enrichment of trace level of copper in serum samples of patients having neurological disorders.

An innovative dual dispersive ionic liquid based on ultrasound assisted microextraction (UDIL-µE), for the enrichment of trace levels of copper ion (Cu2+), in serum (blood) of patients suffering from different neurological disorders. The enriched metal ions were subjected to flame atomic absorption spectrometry (FAAS). In the UDIL-µE method, the extraction solvent, ionic liquid, 1-butyl-3-methylimidazolium hexafluorophosphate [C4mim][PF6], was dispersed into the aqueous samples using an ultrasonic bath. The(PAN) 1-(2-pyridylazo)-2-naphthol was used as ligand for the complexation of Cu ion in IL (as extracting solvent). The various variables such as sonication time, pH, concentration of complexing agent, time and rate of centrifugation, IL volume that affect the extraction process were optimized. The enhancement factor (EF) and detection limit (LOD) was found under favorable condition was 31 and 0.36µgL-1, respectively. Reliability of the proposed method was checked by relative standard deviation (%RSD), which was found to be <5%. The accuracy of developed procedure was assured by using certified reference material (CRM) of blood serum. The developed procedure was applied successfully to the analysis of concentration of Cu ion in blood serum of different neurological disorders subjects and referents of same age group. It was observed that the levels of Cu ion was two folds higher in serum samples of neurological disorders patients as related to normal referents of same age group.

Molecular and phenotypic characterization of the vancomycin-resistant gene in bacterial isolates acquired from catheter tips.

Gram-positive bacteria, particularly Staphylococcus aureus is a significant pathogen, not only in the hospital setting but the community also. S. aureus is a major cause of serious hospital and community-acquired infections, particularly in the colonized individuals. The emergence of vancomycin-resistant S. aureus (VRSA) strains has led to global concerns about treatments for staphylococcal infections. Until now, few strains of VRSA have been reported worldwide. The conventional disk diffusion method for determination of vancomycin sensitivity often misclassifies intermediately susceptible isolates to fully sensitive. However, non-automated minimum inhibitory concentration (MIC) detection methods are the gold standards. Hence there is a dire need of some advanced methods for rapid detection of VRSA strains. In the present study, Gram-positive clinical isolates were collected from different wards of K.G.M.U.  Hospital, among them, 12 bacterial isolates were identified as Staphylococcus aureus and 18 isolates as Klebsiella spp. Genomic DNA of S. aureus was isolated and used as template in PCR for detection of the presence of van A and van X gene based on a given protocol. Nosocomial infections have an impact on morbidity and probably on mortality as well, and pose a significant economic burden. Rapid molecular identification of antibiotic-resistant strains undoubtedly helps to prevent the hospital-induced infections.

Correlation of Cadmium and Magnesium in the Blood and Serum Samples of Smokers and Non-Smokers Chronic Leukemia Patients.

It was studied that cancer-causing processes are related with the disproportions of essential and toxic elements in body tissues and fluid. The purpose of the current study was to evaluate the levels of magnesium (Mg) and cadmium (Cd) in serum and blood samples of smokers and nonsmokers who have chronic myeloid (CML) and lymphocytic (CLL) leukemia, age ranged 31-50 years. For comparative study, age-matched smokers and nonsmoker males were chosen as controls/referents. The levels of elements in patient were analyzed before any treatment by atomic absorption spectrophotometer, after microwave assisted acid digestion. The validation of the method was done by using certified reference materials of serum and blood samples. The resulted data indicated that the adult male smokers and nonsmokers have two- to fourfold higher levels of Cd in the blood and sera samples as compared to the referents (p < 0.01), whereas two- to threefold lower levels of Mg was found in blood and serum samples of both types of leukemia patients as related to referent values. The resulted data indicates significant negative correlation among Mg and Cd in leukemia patients and smoker referents. Further studies are needed to clarify the role of these elements in pathogenesis of chronic leukemia.

Chromium Exposure in the Adult Population, Consuming Different Types of Smokeless Tobacco Products in Pakistan.

The pervasive smokeless tobacco (SLT) consumption and diseases related to its use is a hot topic for the public discussion. In this study, concentrations of chromium (Cr) were measured in different SLT products [snuff (dry and moist), mainpuri, and gutkha] offered and used in Pakistan. The current study was also designed to assess the Cr levels in the biological (scalp hair and blood) samples of male and female subjects, age ranged from 25 to 60 years, chewing different SLT products. For comparative purpose, the healthy persons of the same age group, who did not consume any SLT products, were selected as referents. The concentrations of Cr in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials (CRMs). The resulted data indicated that the adult persons, who consumed different SLT products, have 2-3 fold higher levels of Cr in biological samples as compared to referent subjects (p < 0.01). The persons, who chew/sniff different SLT products, have 50-80 and 42-82 % higher levels of Cr in their scalp hair and blood samples as related to referents. The daily intake of Cr is lower as compared to the recommended value of 50-200 µg/day. It was expected that 10 g consumption of various kinds of SLT products (snuff, mainpuri, and gutkha) may subsidize 21.2-220, 17.7-122, and 18.4-273 % of the recommended daily intake of Cr, respectively.

Vortex-assisted ionic liquid-based dispersive liquid-liquid microextraction for assessment of chromium species in artificial saliva extract of different chewing tobacco products.

A novel dispersive liquid-liquid microextraction (ILDLLµE) method using an extracting solvent (ionic liquid) and dispersant (Triton X-114) was developed for the separation and preconcentration of hexavalent chromium (Cr6+) in artificial saliva extract (ASE) of chewing tobacco products, gutkha, and mainpuri (n = 23). In the proposed method, the extraction of Cr6+ was accomplished by using ammonium pyrrolidinedithiocarbamate (APDC) as complexing agent and 1-butyl-3-methylimidazolium hexafluorophosphate [C4MIM] [PF6] as extracting solvent. The tiny droplet of metal chelate was then dispersed into TX-114 emulsion, using vortex mixer. Various parameters such as concentration of APDC, pH of the solution, volume of [C4MIM] [PF6], and TX-114 as well as extraction time were studied. Under the most favorable conditions, the limit of detection was found to be 0.068 µg/L with the relative standard deviation <5 %. The enrichment factor of developed method was found as 62.5, and method has been effectively applied for the analysis of Cr species in artificial saliva extract of gutkha and mainpuri products. The Cr6+ was quantitatively recovered (<97 %) under optimal conditions, while the recovery of trivalent specie (Cr3+), at the same experimental conditions, was observed to be <5 %. The Cr3+ was determined by the difference of total Cr and Cr6+ in artificial saliva extract of selected STP. Health risks associated with the intake of total Cr in gutkha and mainpuri were assessed in terms of estimated daily intake, such as carcinogenic and noncarcinogenic risks. Estimated daily intake of Cr via chewing 10 g/day of gutkha and mainpuri was found to be below the maximum tolerable daily intake, whereas the calculated risk of cancer for Cr was observed in the acceptable range of 10E-6-10E-4, except some brands of gutkha. Graphical Abstract ᅟ.

The effects of arsenic contaminated drinking water of livestock on its total levels in milk samples of different cattle: Risk assessment in children.

This work was carried out to evaluate the arsenic (As) levels in milk samples of different milch animals, sheep, goats, cows, buffaloes and camels in Tharparkar, Pakistan. The concentration of As in the milk samples of cows, buffalos, sheep, goats and camels were observed in the range of 15.1-18.4, 2.6-7.7, 25.7-33.2, 10.5-37.3 and 6.6-13.7 µg/L, respectively. The levels of As in livestock drinking water of each farms/flocks was found in the range of 238-2000 µg L-1. A positive correlation with Pearson correlation coefficients, ranged as, 0.926-0.974 (p = 0.001-0.011) was observed between the As concentration in milk samples of cattle and in corresponding drinking water of farms/flocks. The high bio-transfer factor of As was occurred in the milk samples of sheep. The content of As in scalp hair of children was observed to be elevated, who consumed milk of lower cattle (sheep and goat) than cow and camel. The As content in scalp hair directly proportional to the age of children. The hazardous quotient value of As due to consumption of milk was observed in decreasing order as, sheep > goats > camels > cows. The total hazardous quotient or noncarcinogenic risk values for children consuming the milk of sheep, goat, cow and camels were found >1 of reference dose for As, creates adverse effects on health in childhood stage. The children of all three age group have higher carcinogenic risk factor who are consuming milk of goat and sheep than larger cattle.

Offering mental health services in a conflict affected region of Pakistan: who comes, and why?

BACKGROUND: North West Pakistan is an area ravaged by conflict and population displacement for over three decades. Recently, drone attacks and military operations have aggravated underlying mental disorders, while access to care is limited. Among patients attending a mental health clinic integrated in district hospital conducted by psychologists; we describe service utilization, patient characteristics, presenting complaints, morbidity patterns, and follow-up details. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective study using routinely collected programme data was conducted from February to December 2012. A total of 1545 consultations were conducted for 928 patients (86% females). There were 71(8%) children and adolescents. An increase was observed from February to July, followed by a decline. 163 new patients (18%) were on psychotropic medication at presentation. The most common morbidity in females (36%) were symptoms of adjustment disorders and acute reactions. Depression and anxiety were common in both genders while post traumatic disorder was frequent in males (21%). Out of the 928 new patients, 639(69%) had a follow up visit planned with their psychologist, but only 220(34%) new patients returned for a follow up visit. CONCLUSION: In a district hospital, mental health services managed by psychologists were well attended. There is a need to consider widening the current package of care to cater to the diversity of mental health disorders, gender difference, children and adolescents. Standardized diagnostic and monitoring tools would also need to be adapted accordingly and to assess patient progress. Innovative approaches to tackle the problem of the low return rate are needed.