Potential health concerns due to elevated nitrate concentrations in groundwater of villages of Vadodara and Chhota Udaipur districts of Gujarat, India.

In an attempt to assess the groundwater quality of Vadodara and Chhota Udaipur districts and check its suitability for drinking purposes, a total of 162 samples (50 samples during pre-monsoon season and 54 samples during post-monsoon season from Vadodara district and 29 samples during both pre- and post-monsoon seasons from Chhota Udaipur district) were collected from 63 villages of both the districts for pre-monsoon and post-monsoon seasons during 2016-17. The analysis was carried out for physicochemical characteristics and the analytical results have been interpreted by graphical representation, correlation and regression analysis and water quality index so that the quality of groundwater can be easily understood. The analytical results were then compared with the Indian Standards Drinking Water-Specification (Second Revision). From this study, it is concluded that the overall groundwater quality of the region is comparatively good; however, elevated nitrate levels resulted in many of the samples having raised concern and the necessity to make all possible efforts to improve the quality of groundwater wherever deteriorated.

Percutaneous closure of multiple ventricular septal defects: simultaneous use of muscular ventricular septal defect device and Multi-Fenestrated Septal Occluder - "Cribriform" to close residual ventricular septal defects after complex cardiac surgery in a child.

A male child, with d-transposition of great arteries, a large perimembranous ventricular septal defect, multiple additional ventricular septal defects, small muscle-bound right ventricle, and severe pulmonary stenosis with confluent, moderate-sized branch pulmonary arteries, underwent an emergency right modified Blalock-Taussig shunt on day 15 of life and réparation à l'étageventriculaire procedure with ventricular septal defect closure with takedown of the Blalock-Taussig shunt at 2.5 years of age. On follow-up, he showed a moderate residual upper ventricular septal defect and multiple apical ventricular septal defects, mild mid-right pulmonary artery stenosis, free pulmonary regurgitation, and right ventricular dysfunction. Surgical re-intervention was deemed extremely risky, the upper muscular ventricular septal defect was closed using an 8-mm Amplatzer Muscular Ventricular Septal Defect Occluder Device, and an 18 mm Amplatzer Multi-Fenestrated Septal Occluder - Cribriform was used for the multiple apical muscular ventricular septal defects. After 1 year, his right pulmonary artery stenosis worsened, for which right pulmonary artery angioplasty was carried out using an 8×20 mm cutting balloon followed by a 10×20 mm Tyshak II balloon. This is the only case reported for the paediatric age group using a cribriform septal occluder device for percutaneous closure of multiple apical ventricular septal defects.