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Rapid urbanization worldwide, poses numerous environmental challenges between escalating land use land cover (LULC) changes and groundwater quality dynamics. The main objective of this study was to investigate the dynamics of groundwater quality and LULC changes in Sargodha district, Punjab, Pakistan. Groundwater hydrochemistry reveals acceptable pH levels (<8) but total dissolved solids (TDS), electrical conductivity (EC) and HCO3- showed dynamic fluctuations by exceeding WHO limits. Piper diagrams, indicated dominance by magnesium and bicarbonate types, underscoring the influence of natural processes and anthropogenic activities. Major ion relationships in 2010, 2015, and 2021 showed a high correlation (R2 > 0.85) between Na+ and Cl-, suggesting salinization. whereas, the poor correlation (<0.17) between Ca2+ and HCO3- does not support calcite dissolution as the primary process affecting groundwater composition. The examination of nitrate contamination in groundwater across the years 2010, 2015, and 2021 was found to be high in the municipal sewage zone, suggesting a prevailing issue of nitrate contamination attributed to urban activities. The Nitrate Pollution Index (NPI) reveals a concerning trend, with a higher proportion of samples classified under moderate to high pollution categories in 2015 and 2021 compared to 2010. The qualitative assessment of nitrate concentration on spatiotemporal scale showed lower values in 2010 while a consistent rise from 2015 to 2021 in north-east and western parts of district. Likewise, NPI was high in the north-eastern and south-western regions in 2010, then reduced in subsequent years, which may be attributed to effective waste management practices and alterations in agricultural practices. The health risk assessment of 2010 indicated Total Health Hazard Quotient (THQ) within the standard limit, while in 2015 and 2021, elevated health risk was observed. This study emphasizes the need to use multiple approaches to groundwater management for sustainable land use planning and regulations that prioritize groundwater quality conservation.
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INTRODUCTION: The relationship between type 2 diabetes mellitus (T2DM) and pathological responses after neoadjuvant chemotherapy (NACT) is controversial. In this study, we aim to determine the association of pathological responses in breast cancer women with T2DM after receiving NACT. METHODS: Medical records of breast cancer women with T2DM who received NACT from January 2016 to January 2021 at the medical center in the Gujranwala Institute of Nuclear Medicine and Radiotherapy, Pakistan, were identified and retrieved retrospectively. Variables, including pathological responses, diabetes status, and other clinical data, were collected. Patients were grouped as diabetic and nondiabetic based on the doctor's diagnosis or the diabetic's medication history recorded upon the breast cancer diagnosis. Factors influencing the pathological complete response (pCR) were determined using multivariate logistic regression utilizing IBM SPSS Statistics (version 20). RESULTS: A total of 1372 patient files who received NACT and breast cancer surgery from January 2016 to January 2021 were selected. Out of 1372 breast cancer women receiving NACT, 345 (25.1%) had pre-existing diabetes, while 1027 (74.85%) were without pre-existing diabetes. The most common molecular subtypes of breast cancer were luminal A and B. Two hundred fifty-eight patients (18.8%) had a pCR after receiving NACT. The pCR in diabetic patients was 3.9%, and in nondiabetes, 14.9%. Most women had a pathological partial response (pPR) after the NACT 672 (48.9%). The pPR in diabetic patients was 11.0%, and in nondiabetic patients, it was 38.0%. In nondiabetics, the odds of achieving pPR increase more than pathological no response after the NACT with odd ratio: 1.71 (95% confidence interval: 1.24-2.37). The probability of pCR in patients with luminal B was 1.67 times higher than that in patients with triple-negative breast cancer with odd ratio: 1.67, 95% confidence interval (1.00-2.79), P = 0.05. CONCLUSIONS: The results of the study show that T2DM may have an adverse impact on pCR and pPR following NACT and surgery. Further investigation is needed to explore how changes in blood glucose levels over time impact pathological responses.
