Application of machine learning and multivariate approaches for assessing microplastic pollution and its associated risks in the urban outdoor environment of Bangladesh.

Microplastics (MPs) are an emerging global concern due to severe toxicological risks for ecosystems and public health. Therefore, this is the first study in Bangladesh to assess MP pollution and its associated risks for ecosystems and human health in the outdoor urban environment using machine learning and multivariate approaches. The occurrences of MPs in the urban road dust were 52.76 ± 20.24 particles/g with high diversity, where fiber shape (77%), 0.1-0.5 mm size MPs (75%), blue color (26%), and low-density polyethylene (24%) polymer was the dominating MPs category. Pollution load index value (1.28-4.42), showed severe pollution by MPs. Additionally, the contamination factor (1.00-5.02), and Nemerow pollution index (1.38-5.02), indicate moderate to severe MP pollution. The identified polymers based on calculated potential ecological risk (2248.52 ± 1792.79) and polymer hazard index (814.04 ± 346.15) showed very high and high risks, respectively. The occurrences of MPs could effectively be predicted by random forest, and support random vector machine, where EC, salinity, pH, OC, and texture classes were the influencing parameters. Considering the human health aspect, children and adults could be acutely exposed to 19259.68 and 5777.90 MP particles/ year via oral ingestion. Monte-Carlo-based polymers associated cancer risk assessment results indicate moderate risk and high risk for adults and children, respectively, where children were more vulnerable than adults for MP pollution risks. Overall assessment mentioned that Dhaka was the most polluted division among the other divisions.

Black carbon derived PET plastic bottle waste and rice straw for sorption of Acid Red 27 dye: Machine learning approaches, kinetics, isotherm and thermodynamic studies.

This study focuses on the probable use of PET waste black carbon (PETWBC) and rice straw black carbon (RSBC) as an adsorbent for Acid Red 27 (AR 27) adsorption. The prepared adsorbent is characterized by FE-SEM and FT-IR. Batch adsorption experiments were conducted with the influencing of different operational conditions namely time of contact (1-180 min), AR 27 concentration (5-70 mg/L), adsorbent dose (0.5-20 g/L), pH (2-10), and temperature (25-60°C). High coefficient value [PETWBC (R2 = 0.94), and RSBC (R2 = 0.97)] of process optimization model suggesting that this model was significant, where pH and adsorbent dose expressively stimulus removal efficiency including 99.88, and 99.89% for PETWBC, and RSBC at pH (2). Furthermore, the machine learning approaches (ANN and BB-RSM) revealed a good association between the tested and projected value. Pseudo-second-order was the well-suited kinetics, where Freundlich isotherm could explain better equilibrium adsorption data. Thermodynamic study shows AR 27 adsorption is favourable, endothermic, and spontaneous. Environmental friendliness properties are confirmed by desorption studies and satisfactory results also attain from real wastewater experiments. Finally, this study indicates that PETWBC and RSBC could be potential candidates for the adsorption of AR 27 from wastewater.

Receptor model-based sources and risks appraisal of potentially toxic elements in the urban soils of Bangladesh.

Rapid urbanization and industrial development have prompted potentially toxic elements (PTEs) in urban soil in Bangladesh, which is a great concern for ecological and public health matters. The present study explored the receptor-based sources, probable human health and ecological risks of PTEs (As, Cd, Pb, Cr, Ni, and Cu) in the urban soil of the Jashore district, Bangladesh. The USEPA modified method 3050B and atomic absorption spectrophotometers were used to digest and evaluate the PTEs concentration in 71 soil samples collected from eleven different land use areas, respectively. The concentration ranges of As, Cd, Pb, Cr, Ni, and Cu in the studied soils were 1.8-18.09, 0.1-3.58, 0.4-113.26, 0.9-72.09, 2.1-68.23, and 3.82-212.57 mg/kg, respectively. The contamination factor (CF), pollution load index (PLI), and enrichment factor (EF) were applied to evaluate the ecological risk posed by PTEs in soils. Soil quality evaluation indices showed that Cd was a great contributor to soil pollution. The PLI values range was 0.48-2.82, indicating base levels to continuous soil degradation. The positive matrix factorization (PMF) model showed that As (50.3 %), Cd (38.8 %), Cu (64.7 %), Pb (81.8 %) and Ni (47.2 %) were derived from industrial sources and mixed anthropogenic sources, while Cr (78.1 %) from natural sources. The highest contamination was found in the metal workshop, followed by the industrial area, and brick filed site. Soil from all land use types revealed moderate to high ecological risk after evaluating probable ecological risks, and the descending order of single metal potential ecological risk was Cd > As > Pb > Cu > Ni > Cr. Ingestion was the primary route of exposure to potentially toxic elements for both adults and children from the study area soil. The overall non-cancer risk to human health is caused by PTEs for children (HI=0.65 ± 0.1) and adults (HI=0.09 ± 0.03) under USEPA safe limit (HI>1), while the cancer risks from exclusively ingesting As through soil were 2.10E-03 and 2.74E-04 for children and adults, respectively, exceeding the USEPA acceptable standard (>1E-04).

Arsenic, iron, and manganese in groundwater and its associated human health risk assessment in the rural area of Jashore, Bangladesh.

This study investigated groundwater pollution and potential human health risks from arsenic, iron, and manganese in the rural area of Jashore, Bangladesh. Study results show that the mean value of groundwater pH is 7.25 ± 0.31, with a mean conductivity of 633.94 ± 327.41 µs/cm, while about 73, 97, and 91% of groundwater samples exceeded the Bangladesh drinking water standard limits for As, Fe, and Mn, respectively. Groundwater pollution evaluation indices, including the heavy metal pollution index, the heavy metal evaluation index, the degree of contamination, and the Nemerow pollution index, show that approximately 97, 82, 100, and 100% of samples are in the high degree of pollution category, respectively. Spatial distribution exhibited that the study area is highly exposed to As (73%), Fe (82%), and Mn (46%). In the case of non-carcinogenic health risk via oral exposure, about 94% of samples suggest a high category of risk for infants, and 97% of samples are found to be at high risk for children and adults. The carcinogenic risk of arsenic via an oral exposure pathway suggests that approximately 97% of the samples are found to be at high risk for infants, and all of the samples are at high risk for both adults and children.

Human health risk assessment of elevated and variable iron and manganese intake with arsenic-safe groundwater in Jashore, Bangladesh.

Groundwater through hand-operated tubewell (a type of water well) tapping is the main source of drinking water in Bangladesh. This study investigated iron and manganese concentration in groundwater across Jashore district-one of the worst arsenic contaminated area in Bangladesh. One working tubewell that had been tested previously for arsenic and marked safe (green) was selected from each unions of the district. Results revealed that approximately 73% and 87% of groundwater samples exceeded the limits for iron and manganese in Bangladesh drinking water, respectively. Additionally, spatial distribution of iron and manganese indicate that only 5% of the total surface area of groundwater is covered by safe level of iron and manganese. Human health risk due to ingestion of iron and manganese through drinking water was evaluated using hazard quotients (HQ) for adults and children. The result of the health risk assessment revealed that the non-carcinogenic health risks due to ingestion of iron (HQ up to 1.446 for adults and 0.590 for children) and manganese (HQ up to 2.459 for adults and 1.004 for children) contaminated groundwater are much higher among adults than children. On the basis of occurrences, spatial distribution and health risk assessment results, the area can be categorized as a high-risk zone for iron and manganese-related problems and needs special attention in order to protect public health of local residents.

Significance of Pulmonary Hypertension in Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most prevalent hereditary cardiac disease characterized by the presence of left ventricular and/or septal hypertrophy in the absence of other underlying cardiac disorders. Patients of HCM have a broad range of clinical presentation from being asymptomatic to severely ill condition requires hospitalization and urgent management. Broadly, HCM is classified in two variants: obstructive and nonobstructive. The mainstay of diagnosis is through echocardiography. As HCM chiefly affect the left heart, pulmonary hypertension (PH) is an expected complication of this disease. Though the existence of PH in HCM is known for a long time, its clinical significance, underlying mechanism, and prognostic impact in HCM have been revealed by few recent studies. Specifically, studies have shown increased events of thromboembolism, atrial fibrillation, and heart failure in patients with HCM and PH. These studies elucidated the underlying mechanism of PH in HCM--a rise of pressure in the precapillary and postcapillary pulmonary vasculature. In addition to left ventricular involvement, studies have shown right ventricular involvement and the association of left and right ventricular dysfunction in these patients. Further, it has been shown that surgical intervention to reduce septal thickness improves survival in pharmacotherapy nonresponders and the presence of PH does not increase mortality in these patients. We present a comprehensive review exploring the prevalence, underlying mechanisms, and impact of PH on HCM.

Sodium Glucose Co-transporter 2 Inhibitors and Heart Failure.

Sodium-glucose co-transporter 2 (SGLT2) receptors are primarily located in the proximal convoluted tubule of the nephron. These receptors are responsible for almost 90% to 95% of tubular reabsorption of the glucose in the nephron. In patients with diabetes mellitus, due to upregulation of SGLT2 receptors, glucose reabsorption is further increased. The Food and Drug Administration approved SGLT2 inhibitors, such as canagliflozin, empagliflozin, dapagliflozin, and ertugliflozin, for the treatment of type 2 diabetes. In addition to their positive effect on blood glucose, additional cardioprotective and renoprotective functions have been demonstrated in major trials such as EMPA-REG OUTCOME, CANVAS, DECLARE-TIMI-58, and CREDENCE. Unlike other antihyperglycemic drugs, reduction in hospitalization for heart failure (HF) was also seen as a class effect with this group, mechanisms of which are probably multifactorial. Subgroup analysis from these major trials indicated a reduction in progression of nephropathy and HF readmission with SGLT2 inhibitors. Although this unique property of canagliflozin was further analyzed in the CREDENCE trial, similar trials for empagliflozin (EMPERIAL-Reduced and EMPERIAL-Preserved) and dapagliflozin (DAPA-HF) are currently underway. Recently released phase III results from DAPA-HF trial indicate that dapagliflozin shows significant reduction in death due to cardiovascular causes and hospitalization in HF compared with the placebo, in both diabetics and nondiabetics. In this review article, the authors attempt to explore the possible underlying molecular mechanisms and data from existing trials pertaining to the HF related outcomes associated with SGLT2 inhibitors.

Cardiovascular Toxicities of Immune Checkpoint Inhibitors: JACC Review Topic of the Week.

Immune checkpoint inhibitors (ICIs) have been an important therapeutic advance in the field of cancer medicine, resulting in a significant improvement in survival of patients with advanced malignancies. Recent reports provided greater insights into the incidence of cardiovascular adverse events (CVAEs) with ICI use. Myocarditis is the most common CVAE associated with ICI. Pericardial diseases, Takotsubo syndrome, arrhythmias, and vasculitis constitute other significant AEs. Physicians should be aware of these infrequent, but potentially fatal toxicities associated with ICIs as their therapeutic use becomes widespread with a myriad of approvals by the U.S. Food and Drug Administration. Management involves prompt administration of high-dose corticosteroids and discontinuation of ICIs in severe myocarditis. This review summarizes the most updated evidence on epidemiology, pathophysiological mechanisms, and management strategies of various CVAEs associated with ICIs. Highlights from recent guidelines published by National Comprehensive Cancer Network on ICI-related CV toxicities have also been incorporated.

Peculiar mechanical complication of myocardial infarction.

A 58-year-old man presented to the chest pain unit with crescendo angina over 24 hours and worsening dyspnoea of 10 hours duration. He was a known diabetic and hypertensive on regular treatment for 10 years and a habitual smoker with over 15 pack-years smoking duration. Examination revealed a profusely diaphoretic and dyspnoeic (respiratory rate of 45/min) individual with a blood pressure of 100/60 mm Hg and heart rate of 124 beats/min. He was hypoxic and his oxygen saturation in the ambient air was 64%. His jugular venous pressure was elevated with a prominent V wave. Cardiovascular examination revealed a harsh grade IV/VI systolic murmur over the lower left parasternal border. There were bilateral extensive crepitations heard over the lung fields. ECG on admission revealed presence of Q wave and ST elevation in leads II and III, aVF with ST depression in I and aVL. X-ray chest showed normal cardiac shadow and features of grade III pulmonary venous hypertension. Transthoracic echocardiography is shown in figure 1.Figure 1Transthoracic echocardiogram short axis view at mid cavity level, 2D (A) and colour Doppler (B) image. QUESTION: What is the most likely diagnosis?A. Left ventricular (LV) true aneurysmB. LV pseudoaneurysmC. LV pseudo-pseudoaneurysmD. Ventricular septal rupture (VSR)E. LV free wall rupture.

Fourteen-year-old boy with decreased appetite and pedal swelling.

CLINICAL INTRODUCTION: A 14-year-old boy presented with history of decreased appetite and bilateral swelling of feet for 6 months. He did not give any associated history of orthopnoea or paroxysmal nocturnal dyspnoea. He was born by a normal delivery after a non-consanguineous marriage. He had an unremarkable birth and childhood health history. There was no family history of significant cardiovascular illness or sudden death. Clinical examination showed an average built boy with elevated jugular venous pressure with prominent v wave and bilateral pitting pedal oedema. Cardiovascular examination showed normal first (S1) and second (S2) heart sounds and a short early systolic murmur over tricuspid region. Other systems examination was remarkable for soft tender hepatomegaly.ECG showed sinus rhythm with tall, peaked p waves. Chest X-ray revealed enlargement along the right cardiac border. Transthoracic echocardiographic images are shown in figure 1A (apical four-chamber view) and figure 1B (tricuspid inflow Doppler). There was no colour Doppler evidence of interatrial shunt.heartjnl;105/5/405/F1F1F1Figure 1(A) Transthoracic echocardiographic apical four-chamber view. (B) Tricuspid inflow continuous wave Doppler image. QUESTION: What is the most likely diagnosis of his condition? Endomyocardial fibrosis (EMF)Ebstein's anomalyArrhythmogenic right ventricular dysplasia (ARVD)Idiopathic dilatation of right atriumRestrictive cardiomyopathy.

Dengue fever with encephalitis: a rare phenomenon.

The clinical profile and presentation of patients with dengue fever may differ from asymptomatic infection to the dreadful complications like dengue shock syndrome. However, neurological complications are very rare. Dengue encephalitis occurs by a direct involvement of central nervous system by the dengue virus which is an extremely rare complication. A 33-year-old man presented with fever, vomiting and severe headache. He had one episode of generalised tonic-clonic seizure followed by an altered sensorium on the day of admission to the hospital. The diagnosis of dengue fever was confirmed by dengue serology (IgM) and (NS1) antigen assay. MRI brain was suggestive of encephalitis. Thus, the patient was treated symptomatically and discharged in stable condition with minimal neurological deficit.

Ranolazine: Multifaceted Role beyond Coronary Artery Disease, a Recent Perspective.

Ranolazine is a piperazine derivative approved as an antianginal. Primarily used as a second-line antianginal in stable coronary artery disease. Ranolazine blocks the late Na + current and prevents the rise of cytosolic calcium. It decreases myocardial wall tension and improves coronary blood flow. Ranolazine is effective in atrial fibrillation (AF) as an adjunct to electrical or pharmacological cardioversion. It can be used in combination with amiodarone or dronedarone. It has also been used in AF arising after coronary artery bypass grafting surgery. Role of ranolazine is also being evaluated in pulmonary arterial hypertension, diastolic dysfunction, and chemotherapy-induced cardiotoxicity. Ranolazine has some anti-glycemic effect and has shown a reduction of hemoglobin A1c in multiple trials. The antianginal effect of ranolazine has also been seen to be more in patients with diabetes compared to those without diabetes. Ranolazine is being evaluated in patients with the peripheral arterial disease with intermittent claudication and hypertrophic cardiomyopathy. Pilot studies have shown that ranolazine may be beneficial in neurological conditions with myotonia. The evidence-base on the use of ranolazine in various conditions is rapidly increasing with results of further trials eagerly awaited. Accumulating evidence may see ranolazine in routine clinical use for many conditions beyond its traditional role as an antianginal.

A dairy worker with fever and an abnormal echocardiogram.

DESCRIPTION OF THE CASE: A 38-year-old male presented with history of progressively increasing dyspnoea of 25 days duration. He gave history of low -grade fever associated with malaise and weight loss over the preceding 6 months. He worked in the dairy industry in the Middle East and returned to India owing to his illness. On clinical examination, he was found to be tachypneic and cachectic. Jugular venous pressure was raised with a prominent 'a' wave. There was a short early diastolic murmur over the aortic area. His blood investigations, including renal and liver function tests, were normal. Three sets of blood cultures were sterile. Two-dimensional trans-thoracic and trans-oesophageal echocardiography revealed thickened bicuspid aortic valve cusps, with moderate eccentric aortic regurgitation and an abnormal structure posterior to the left ventricular outflow tract and aorta (figure 1A-C). A small vegetation was seen attached to the fused right-left aortic cusp (supplementary figure 1). The patient was started on appropriate intravenous antibiotics and antifailure medications, and was referred for early surgical treatment.Figure 1(A) Transthoracic echocardiography parasternal long axis view. (B) Transesophageal echocardiography (mid esophageal level) long axis view. (C) Transthoracic echocardiography parasternal short axis view.10.1136/heartasia-2017-010915.supp1Supplementary Figure 1. QUESTION: Identify the structure depicted in the images (figure 1A-C).Answer options:Cor triatriatumAortic dissectionLeft atrial pseudoaneurysmPseudoaneurysm of the mitral aortic inter-valvular fibrosaAortic root abscess.