Risk surveillance with spatial distribution of Organochlorine Pesticides (OCPs) from sedimentary samples of Chenab River

A pioneering study employed a holistic geostatistical approach to predict the spatial variability of a non sampled area in the Chenab River, Pakistan, using kriging interpolation for organochlorine pesticide (OCP)-polluted risk zones. The Present research intended to investigate the carcinogenic and non-carcinogenic human health risks, contamination levels, and spatial variation of OCPs in the Chenab River, Pakistan. The residual OCP content in sediment samples (n = 120) ranged from 0.056 to 32.14 ng/g. DDE and α-HCH were prevalent among all the samples analyzed, with mean concentrations of 15.84 ± 8.02 and 12.45 ± 6.72 ng/g, respectively. The order of magnitude of OCPs in sediment samples was DDTs > α-HCH > chlorothalonil > heptachlor > endosulfan > aldrin > dieldrin. The findings of the single (SPI) and Nemerow (Nel) pollution index of α-HCH, heptachlor, and aldrin depicted the Chenab River as a serious pollution risk zone. The outcomes of the Pearson correlation coefficient analysis represent the positive correlation among all OCPs, revealing the common origin. Distribution trends showed substantially higher (p < 0.05) contents of analyzed OCPs along the downstream zone. With regards to USEPA human health hazard assessment model, the estimated non-carcinogenic (ΣHI) and non-carcinogenic (ΣTCR) risk ranged from 1.1 × 10-5 to 1.0 × 10-1, 4.0 × 10-8 to 3.2 × 10-4 respectively. TCR >10-4 illustrated a substantial cancer health risk posed by α-HCH, heptachlor, aldrin, and dieldrin in the downstream zone. We recommend the urgent cessation of the ongoing discharge of OCPs into the Chenab River, which needs to be highlighted owing to the significant cancer risk to public health to ensure the good health and wellbeings.

Is ethnicity a risk factor for mortality in major trauma? A single-centred cohort study

INTRODUCTION

Many studies have found varying health outcomes in patients from different minority ethnic groups. There has been limited research into the outcomes in major trauma dependent on ethnicity. The aim was to analyse whether ethnicity was an independent risk factor for 30-day mortality in patients presenting to a major trauma centre when adjusting for confounders.

METHODS

This was a retrospective review of all patients presenting to a single major trauma centre from 2010 to 2020. Data were collected on patient demographics and variables including mechanism and injury severity score. Logistic regression was used to determine significant predictors of mortality.

RESULTS

There were 10,668 data sets with ethnicity data; of these 9,098 were of White ethnicity, 1,143 were Asian and 427 were classified as Black. The 30-day mortality rate was 7.76% for White ethnicities, 6.91% for Asian ethnicity and 5.15% for people of Black ethnicity. On multivariate logistic regression, ethnicity (p = 0.076) was not associated with 30-day mortality. Age, Injury Severity Score (ISS), Probability of Survival (PS) score, shock and Glasgow Coma Scale (GCS; p < 0.001) were associated with 30-day mortality. White ethnicity had an odds ratio (OR) of mortality of 1.16 (95% confidence interval [CI] 0.658-2.040) (p = 0.609) compared with Black ethnicity and an OR of 0.74 (95% CI 0.546-1.001) (p = 0.050) compared with Asian patients. Black patients had an OR of mortality of 0.65 (95% CI 0.351-1.193) (p = 0.164) compared with the Asian population.

CONCLUSION

Ethnicity is not a significant risk factor for 30-day mortality in trauma patients.

Disinfection by methylthionine chloride and chitosan in combination with Photo radiation therapy on caries affected dentin nano hardness, adhesive integrity, and bond failure

OBJECTIVE

The aim of the study was to assess the disinfection efficacy, bond integrity, and nano hardness of caries-affected dentin (CAD) surface bonded to resin cement when disinfected with chlorhexidine (CHX), Methylene blue activated by Photodynamic therapy (MB-PDT), chitosan, silver diamine fluoride (SDF), chitosan activated by PDT, and SDF-diode laser against S. mutans.

MATERIALS AND METHODS

A total of 60 human mandibular molars were extracted non-traumatically and gathered using ICDAS criteria. The dentin surface was prepared, leaving CAD to receive a disinfection procedure. After inoculation with S. mutans, the CAD samples were divided into six groups and disinfected with various disinfectants (n = 10) CHX, MB-PDT, chitosan, chitosan-PDT, SDF, and SDF+ diode laser. Survival rates of S. mutans were analyzed following the restoration of samples with resin cement via the etch and rinse method to assess SBS. Also, nano hardness was analyzed. Statistical analysis was performed by using the ANOVA and the Tukey multiple test (p<0.05). The Kruskal-Wallis test was used to evaluate the change in survival rate.

RESULTS

Related to the survival rates, the SDF+ diode laser displayed the highest reduction in S. mutans levels and chitosan presented the lowest level of disinfection. The intergroup comparison revealed that CHX and chitosan-PDT displayed comparable outcomes of S. mutans survival rate to that of SDF+ diode laser (p>0.05). Likewise, MB-PDT and SDF displayed a comparable survival rate of S. mutans to Chitosan disinfection (p>0.05). Considering SBS and nano hardness, the highest SBS and NH were exhibited by the SDF+ diode laser, and the lowest SBS and NH values were exhibited by MB-PDT. The intragroup comparison revealed that CAD specimens disinfected with Chitosan-PDT showed comparable SBS and NH values to the SDF+ diode laser (p>0.05). CHX, chitosan, and SDF exhibited bond values and NH comparable to MB-PDT (p<0.05).

CONCLUSIONS

Synergistic use of Silver diamine fluoride with diode laser and chitosan activated by PDT can be used as an alternative to CHX for controlling S. mutans growth, promoting enhanced bond efficacy and nano hardness for bonding resin cement to the caries-affected dentin.

COMPARISON BETWEEN PRE- AND POST-OPERATIVELY BOTOX INJECTION IN SECONDARY WOUNDS HEALING

Tension impacts wound healing and scarring. Tissue stress reduces blood flow and promotes fibroblastic response in wound treatment. Botox injections reduce tension. A total of 18 male albino rats weighing 250-350 grams each got 1 IU of Botox and saline injected into a subcutaneous muscle in the center of each 1.5 CM two circles with 4.5 CM a gap between them. Group A seven days pre-operatively; group B, after wound incidence. The study compared Botox-treated wounds to those treated immediately after surgery. Group A animals were surgery-ready after 7 days, removed full-thickness skin. Group B got Botox and saline in separate cages following full-thickness skin excision. Each group had three equal subgroups. Each group had immunohistochemistry tests on days 3, 7, and 14. and histological test on day 14 only, Skin biopsies following euthanasia showed significant variations between A and B groups. On day three, the group A showed increase significantly MMP-9 expression than B group. On day 7, the group A displayed a significant increase CD31 expression, suggesting significant new blood vessel development than group B. On day 14, both groups showed strong MMP-9 and CD31 expression, demonstrated greater endothelial cell, and keratinocyte proliferation resulted in very well re-epithelialization. Botox injection before surgery improved wound healing and reduced fibrosis and scarring.

Corrigendum to "Cartesian Control of Sit-to-Stand Motion Using Head Position Feedback"

[This corrects the article DOI: 10.1155/2020/1979342.].

Green synthesized silver nanoparticles using the plant-based reducing agent Matricaria chamomilla induce cell death in colorectal cancer cells

OBJECTIVE

There is a need to treat cancer cells with safe and natural nanoparticles to avoid the side effects of chemotherapeutic agents. Chamomile is considered a safe, natural plant with anticancer activity. We synthesize simple, inexpensive, and eco-friendly silver nanoparticles (SNs) using Chamomile (CHM) to tune their anticancer properties.

MATERIALS AND METHODS

SN-CHM was synthesized by reducing 1 mM silver nitrate aqueous solution in 100 mL with the aqueous ethanolic flower extract of CHM (18 mg/mL, w/v). The reaction proceeded overnight at 600 rpm and 28°C. SN-CHM was characterized for their % yield, average diameter, charge, morphology, and silver release. Moreover, SN-CHM was investigated for its antioxidant and anticancer activities at 200 µg/mL and 5 mg/ mL, respectively.

RESULTS

A 59.12% yield and a uniform SN-CHM size of 115 ± 3.1 nm with a ζ-potential of -27.67 ± (-3.92) mv were observed. The UV-visible absorption showed shifts from 379.5 to 383.5 nm for CHM and SN-CHM, respectively. Moreover, Ag+ was ultimately released from SN-CHM after 5 h. Fourier Transform Infrared Spectroscopy (FT-IR) showed characteristic absorption peaks of CHM and produced SN-CHM. Furthermore, SN-CHM showed moderate antioxidant activity. SN-CHM inhibited the % viability of SW620 and HT-29 cell lines at 20 μM. SN-CHM may also greatly upregulate the apoptotic gene BAX while considerably downregulating the anti-apoptotic genes BCL2 and BCL-Xl.

CONCLUSIONS

CHM can be a safe soft drink, especially when conjugated with Ag ions as anticancer NPs. SN-CHM is considered potent anticancer activity against SW620, and HT-29 cell lines.

Distribution, bioaccumulation, and health risk assessment of organochlorines across the riverine ecosystem of Punjab Province, Pakistan

This study was designed to assess the distribution of organochlorines (OCs) in fish species, their spatio-temporal variations, bioaccumulation potential, and associated human health risks via dietary intake. The levels of twenty-three organochlorine pesticides (OCPs) and thirty-five polychlorinated biphenyls (PCBs) were analyzed in six fish species collected from the riverine ecosystem of Punjab Province, Pakistan. The results indicated that the mean levels of Σ23OCPs were 74.1 ng/g ww and 184 ng/g ww, and for Σ35PCBs the levels were 38.8 ng/g ww and 74.8 ng/g ww in herbivorous and carnivorous fish species, respectively. The most abundant contaminants in all fish species were DDTs (65%) and HCHs (14%) among OCPs and heavier PCB congeners (62%) among PCBs. As for dioxin-like PCBs, the WHO toxic equivalency values (ng TEQ/g ww) were in the range of 0.21 (Cyprinus Carpio) to 2.38 (Rita Rita), exceeding the maximum allowable limit of 0.004 ng TEQ/g, ww by the European Commission. Spatio-temporal analysis indicated relatively higher OC levels in winter season with elevated concentrations in fish samples from industrial zone. The bioconcentration factor (L/kg) values ranged from 723 to 2773 for PCBs and 315 to 923 for OCPs in all fish species, with higher levels were reported in carnivorous species. The human health risk assessment at both 50th and 95th percentiles revealed the absence of any significant non-carcinogenic risk as calculated HR was less than 1. However, the critical carcinogenic risk was found to be associated for most of the contaminants, signifying the dietary exposure to OCPs and PCBs might pose the public health concern.

Comprehensive GIS based risk surveillance of organochlorine pesticides (OCPs) in edible fish species of River Chenab, Pakistan

The present study was conducted to evaluate Carcinogenic (TR) and non-carcinogenic (THQ) human health risk of organochlorine pesticides (OCPs) in three edible fish species (Labeo boga, Channa marulius and Wallago attu) of River Chenab, Pakistan using USEPA human health risk assessment model. Holistic GIS (Geographic information system) based Geo-Statistical approach has been employed for the first time in River Chenab, Pakistan to categorize contaminated risk zones of OCPs based on single pollution index. The ∑OCPs concentrations in fish species were ranged from 5.09 to 414 ng/g with the prevalence of dieldrin. Results of single pollution index of DDE, aldrin, dieldrin and ∑endosulfan revealed River Chenab as polluted and risk zone area. Distribution pattern assessed significantly higher (p < 0.05) concentrations of OCPs in downstream area suggesting substantial pollution of surrounded industrial region. The human health risk assessment depicted no harmful non-carcinogenic (THQ) risk except for ΣOCPs concentration of C. marulius. Significant carcinogenic (TR) health risk exhibited by all examined OCPs from maximum of the studied sites. Therefore, the high carcinogenic human health risk had highlighted an immediate removal of continuous disposal of OCPs in the River Chenab.

THE IMPACT OF ALOE VERA GEL ON REMINERALIZATION OF THE TOOTH AND ITS EFFECT AGAINST ENTEROCOCCUS FAECALIS: AN IN VITRO STUDY

The Aloe vera plant is a cactus-like plant in the Liliacea family that has been known and utilized for its medical benefits. It has been attempted to be used as a remineralizing agent and shows an antibacterial effect. Aim of the study - assessment of the remineralizing effect of solution of saturated Aloe vera gel compared to distal water by microhardness Vickers test and Densometric X-Ray Analysis and effect of Aloe vera gel against Enterococcus faecalis. 10 extracted permanent molars were used in this in vitro study. each tooth enrolls in Teflon tape and only the enamel of the occlusal surface was exposed to a demineralizing solution (acid etch) for 45 seconds in-vitro and randomly assigned to two groups: Group 1 was treated with distal water; group 2 was treated with Aloe vera gel. All groups except the control baseline group were treated with their respective remineralizing solution for 10 days. Vicker's Microhardness Number (VHN) and Densometric X-Ray Analysis were carried out at baseline, post-demineralization and later post 10 days of remineralization. The antibacterial effect of Aloe vera gel was assessed by the disc diffusion method. The filter paper was immersed in 20µl of different concentrations of Aloe vera gel extract as fresh Aloe vera (100 %) and (50 % and 25 %) diluted with de-ionized water after that the disc was distributed in a plate containing the E. faecalis. Antibiotics disc of Augmentin (Amoxicillin and Clavulanic acid 30ug) were also poured in the same plate and incubated at 37°C for 24 hours and the zone of inhibition of antibiotic was measured for comparison with a zone of inhibition of filter paper saturated with Aloe vera gel. Densitometric X-Ray Analysis and Microhardness Number (VHN) evaluation showed improvement in the enamel density and the surface hardness after remineralization. The mean value in the group treated with Aloe vera solution was higher than the recorded mean value for the group treated with distal water. There was a significant difference between Aloe vera solution and distal water. Significant (p-value≤0.05) after 10 days. The antibacterial effect showed that E. faecalis was resistant to Aloe vera gel in different concentrations compared with Augmentin (Amoxicillin and Clavulanic acid 30ug). Aloe vera gel could be used for caries prevention in terms of safety and efficiency. While E. faecalis show resistance activity against Aloe vera gel.

Ecological and human health hazards; integrated risk assessment of organochlorine pesticides (OCPs) from the Chenab River, Pakistan

Carcinogenic hazards to human health were investigated through oral and dermal exposure to organochlorine pesticides (OCPs) from water samples (n = 120) of River Chenab, Pakistan. The Pioneering study aimed to employ an integrated geographic information system (GIS) based geostatistical method for the determination of pollution load by GC-ECD from water of River Chenab. The residual levels of OCPs detected from water samples ranged from 0.54 to 122 ng L^-1 with significant prevalence of DDE and α-HCH. Results of the Nemerrow pollution index (NeI), single pollution index (SPI), and comprehensive pollution index (CPI) reflected the downstream zone a stern pollution risk zone. The spatial distribution pattern through geostatistical approaches also revealed significantly higher (p < 0.05) OCP levels in the downstream zone. Risk quotient (RQ_CCC) of surface water quality with respect to heptachlor epitomized a high level of risk (RQ_CCC > 1). Non-carcinogenic human health risk (Σ HQ) assessment ranged from 8.39 × 10^-9 to 1.7 × 10^-3, which represented a marginal risk through oral and dermal exposure. However, carcinogenic risks by oral exposure route were ranged from 3.57 × 10^-11 to 4.46 × 10^-6. Estimated cancer risk (ΣCR) exhibited a considerable carcinogenic risk posed by heptachlor, α-HCH and dieldrin. It is suggested to employ an immediate mitigation strategy for the constant discharge of OCPs in the studied area.

Integrative Evaluation of the Ecological Hazards by Microplastics and Heavy Metals in Wetland Ecosystem

This study was performed to evaluate the impact of microplastics and heavy metals (Pb, Cd, Cr, Cu, Zn, Ni) on sediments, water, aquatic plants (Pistia stratiotes, Alternanthera philoxeroides, and Ipomoea carnea), and fish (Labeo rohita) samples collected from five different sites in the Bajwat wetlands in Sialkot, Pakistan. The concentrations of Pb, Cd, and Cr were above the permissible limits devised by WHO in all the ecosystem components (i.e. sediments, water, plants, and fish) at all sites. The maximum amount of microplastic particles (2317 microplastic particles per kg of sediments) was recorded at Site 1. The filaments were the most commonly found type of microplastics. Plants and fish samples also showed considerable concentration of metals. The multivariate statistical analysis revealed anthropogenic sources of elevated concentrations of metal elements which could cause adverse biological effects in the ecosystem.

Ecological health risk assessment of microplastics and heavy metals in sediments, water, hydrophytes (Alternanthera philoxeroides, Typha latifolia, and Ipomoea carnea), and fish (Labeo rohita) in Marala wetlands in Sialkot, Pakistan

For the ecological risk assessment of heavy metals and microplastics in Marala wetlands in Sialkot, Pakistan, samples of sediments, water, aquatic plants (Alternanthera philoxeroides, Typha latifolia, and Ipomoea carnea), and fish (Labeo rohita) were studied from five different locations. Pb, Cd, and Cr concentrations were above permissible limits devised by WHO in sediments and water at most of sites. High concentrations of Cd were recorded in water samples compared to sediments with maximum values recorded at Site-2 (52.08 ± 9.55 mg kg-1) and Site-5 (62.29 ± 10.12 mg kg-1). The maximum concentrations of Cr (7.23 ± 0.40 mg kg-1) and Pb (22.87 ± 0.83 mg kg-1) were found at Site-4 in water samples. The maximum abundance of microplastics (3047 pieces kg-1 of sediments) was at Site-1 with filaments in the highest proportion among the other types. Zn, Ni, and Cu remained generally low in concentrations in both sediments and waters. Plants showed accumulation of heavy metals, notably the amount of Cd (33.36 ± 0.26 mgkg-1) and Ni (163.3 ± 1.30 mgkg-1) absorbed by T. latifolia and A. philoxeroides, respectively were high. Also, photosynthetic pigments in plants seemed to be affected. However, estimated daily intake (EDI) and provisional tolerable weekly intake (PTWI) calculations for the human population consuming fish from this wetland remained below the FAO/WHO limits. PCA analysis revealed the anthropogenic origin of metals that might be causing adverse effects on the biota which depend on this wetland for their food.

Organochlorines in the riverine ecosystem of Punjab province, Pakistan: contamination status, seasonal variation, source apportionment, and ecological risk assessment

The aim of the present study was to determine the occurrence, spatio-temporal variations, source apportioning, and ecological risk assessment of selected PCBs and OCPs in surface water and sediments collected riverine environment of Punjab province, Pakistan. The concentration of ΣOCPs (water: 64-455 ng/L; sediments: 117-616 ng/g) and ΣPCBs (water: 2-132 ng/L; sediments: 3.27-200 ng/g) was found comparatively higher than the levels reported from other parts of the world. The higher concentrations of DDTs and HCHs were detected in both studied matrices, whereas among PCBs, CB-28, 49 and CB-37, 82 were dominant in water and sediments, respectively. The isomeric ratios including α-HCH/γ-HCH, (DDE + DDD) / DDTs, and α /β-endosulfan reflected the recent use of lindane, technical DDT, and endosulfan in the study area. The WHO-TEQ values of DL-PCBs ranged from 3.6 × 10^-6 to 0.115 ng/L and 8.7 × 10^-6 to 0.157 ng/g in surface water and sediments in both seasons, respectively. The spatial variation analysis revealed that the sites in the industrial and agricultural zones were highly contaminated. The OCPs and PCBs fluxes to downstream areas were estimated to be 12.4 tons/year and 1.9 tons/year, respectively. The significant ecological risks were estimated to be posed by OCPs and PCBs, as their levels in 67% and 62% of surface water and sediment samples were exceeding the threshold limits, highlighting effects to ecological integrities.

Prospect of herbal medication as prevention against COVID variants

Personal immunity frolicked an essential role in combating COVID-19 impacts on human health individually and collectively in community. Literature represented the fact about food or nutritional supplements are certified to protect against diseases; this was the reason behind public trust on certain plants and other commercial products to boost up immunity against coronavirus disease. Present study was conducted to observe the attitude of common public towards natural herbs in treating various diseases and to assess the possible potential of herbal medication in prevention of negative impacts of different variants of COVID-19 on human health at herbal clinic named "Pakistan Matab". Results concluded that most of the patients (About 80%) avoided COVID-19 testing even on experiencing major symptoms and they preferred herbal medication. Patients who died by COVID-19 were also experiencing different diseases like liver and Kideny malfunctioning; old age was another significant factor in this case. About 90% of patients were COVID symptomatic and 10% were carrying other diseases during observational study period at herbal clinic. Study represented that patients who visited clinic, have a faith on herbal medication with about 60% of patients in favor of vaccine and allopathic medication in combination with herbal treatment. Study investigated that vaccine was only for one type of variant and use of herbal medicines could be better option to boost up immunity against various COVID variants.

The bidirectional relationship between growth and appetite regulation in the first year of life

 

Childhood obesity is a public health crisis. Even though appetite traits in infancy were associated with childhood adiposity, whether early weight gain can influence later appetite has not been researched. Our aim was to prospectively examine the bidirectional association between growth and appetite traits during the first year of life. We followed up 450 healthy term infants for 12 months (m). Appetite traits at 4 weeks (wk), 6m and 12m were assessed using the Baby and Child Eating Behaviour Questionnaires. Infant feeding, anthropometric, socioeconomic and demographic data were also collected. Infant weight-for-age z-scores (WFAZ) were calculated using the WHO 2006 growth reference. Growth was assessed as conditional WFAZ change (cWFAZc) by saving the residuals from linear regression models of WFAZ at each successive time point versus WFAZ at the earlier time point. Multivariable linear regression was used to analyse bidirectional associations between cWFAZc (0-4wk, 4wk-6m, 6-12m) and appetite traits Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE) at 4wk, 6m and 12m. All models were adjusted for relevant confounders. At 4wk, SR score was associated with lower (β:-0.16; 95% CI:-0.28,-0.03), and FR score with higher (β:0.10; 95% CI:0.01,0.19) cWFAZc from 4wk to 12m. SR score at 6m was inversely associated with cWFAZc from 6-12m (β:-0.09; 95% CI:-0.16,-0.01). Conversely, higher cWFAZc between 4wk-6m was associated with higher EF (β:0.10; 95% CI:0.01,0.19) and FR (β:0.16; 95% CI:0.04,0.29) scores at 12m. cWFAZc between 6m-12m was inversely associated with SR at 12m (β:-0.18; 95% CI:-0.35,-0.01). Our results suggest that the growth acceleration hypothesis, where faster growth in infancy leads to later obesity, may be mediated by an up-regulation of appetite traits at 12m. This highlights the public health importance of avoiding growth acceleration in infancy as a way to curb the childhood obesity epidemic.

Key messages

• Weight gain in early infancy impacts appetite regulation in the first year of life and up-regulation of appetite traits at 12 months predisposes to childhood obesity.

• Avoiding growth acceleration in infancy can decrease the risk for childhood obesity.

The quality of reporting in cardiac MRI artificial intelligence segmentation studies - a systematic review

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by an NIHR AI Award, AI_AWARD01706. This research was also funded in part, by the Wellcome Trust [Grant number 205188/Z/16/Z ].

Background

There has been a rapid increase in the number of Artificial Intelligence (AI) studies of cardiac MRI (CMR) segmentation. AI has huge potential to improve image analysis assessments. However, advancement and clinical translation in this field depend on researchers presenting their work in a transparent and reproducible manner.

Purpose

This systematic review aimed to evaluate the quality of reporting in AI studies involving CMR segmentation.

Methods

MEDLINE and EMBASE databases were searched for AI CMR segmentation studies on 18/11/2021. The flow of study inclusion is shown in Figure 1. Any AI method to segment any cardiac structure on CMR was eligible for inclusion. Each study was assessed for compliance with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM).

Results

70 studies were included in the qualitative analysis. Studies were published between 2015 to 2021, with the majority (71%) published in 2020 and 2021. Most studies were performed in Europe (33%), China (27%) and the USA (26%). Short-axis sections were segmented in 70% of studies and most commonly included both ventricles (51%) or the left ventricle alone (30%). 20 different architecture implementations were represented. Figure 2 summarises the most relevant CLAIM domains to AI segmentation. The training sample eligibility criteria, demographics and clinical characteristics were not reported in 47% and 81% of studies, respectively. Ground truth annotations, source of the annotations and annotation tool were absent in 31%, 36% and 51% of studies respectively. Preprocessing steps and software libraries and packages used in training were not included in 27% and 24%. Details on the training approach including the number of models trained and method of selecting the final model were missing in 20% and 17% of the studies. Methods of validation or testing on external data, inter- and intra- rater variability and failure analysis were unreported in 57%, 63% and 74%, respectively.

Conclusion

This systematic review highlights important gaps in the AI literature of CMR studies. We identified key items missing in the dataset description, model development, validation and testing that limit the transparency, reproducibility and hence validity of published AI studies. This review may support closer adherence to established frameworks for reporting standards.

Nutritional status, antioxidant activity and total phenolic content of different fruits and vegetables' peels

The present study assessed nutritional status, antioxidant activity, and total phenolic content in fruits, i.e., mango (Mangifera indica), apple (Malus domestica), and vegetable, i.e., bottle gourd (Lagenaria siceraria), and ridge gourd (Luffa acutangula) peels. The antioxidant activity and total phenolic content (TPC) were evaluated by using methanol extracts along with 2, 2-diphenyl-1-picrylhydrazyl (DPPH), Folin-Ciocalteu (FC) assay, respectively having Butylated hydroxytoluene (BHT) and Gallic acid (GA) as standard. The TPC and antioxidant activity in the peels ranged from 20 mg GAE/g to 525 mg GAE/g and 15.02% to 75.95%, respectively, which revealed that investigated fruit and vegetable peels are rich source of phytochemical constituents. Bottle gourd peels exhibited the highest value of DPPH compared to the rest of the peels included in the study. Likewise, mango peels had the highest TPC as compared to the rest of the fruit peels. This research showed that the utilization of agricultural wastes should be promoted at commercial level to achieve the nutritional benefit at zero cost and minimize the generation of biological waste.

Development of people with disabilities (PWD)-friendly module for bakery production

People with disabilities (PWDs) are often excluded from the surrounding community due to their physical or mental health deficiencies. This special group needs special care to enable them to have equal opportunities in all aspects. This project aims to develop PWDfriendly modules specially designed to train and build PWD skills on basic bakeries products including pizza bread, red bean bun, sausage bread and “paung” bread (plain bun). Considering their disabilities in reading for most of the PWD, the modules are more focused on visual presentations rather than instructions. To access the functioning of the modules, direct practical experience was conducted in a series of workshops in community-based rehabilitation (CBR). The effectiveness of the modules was evaluated in terms of their feasibility and acceptability including colour scheme, language used, skills and knowledge enhancement, user friendly and attractiveness level. Most of the respondents either strongly agreed or agreed on the components of feasibility and acceptability of the PWD-friendly modules. The modules were said to user friendly, helpful and recommended to be used by others. Not only these modules could improve the PWD skills on bakeries products for commercialization but also increased their motivation and self-confidence to get involved with the community.

Simultaneous malignant hyperthermia reactions in two siblings during living donor liver transplantation

We report a case of simultaneous malignant hyperthermia reactions occurring in two siblings during living donor liver transplantation. This report highlights the conflicting goals in the clinical management of liver transplantation and malignant hyperthermia, including the use of total intravenous anaesthesia and dantrolene in the face of the potential for drug-induced hepatotoxicity in the remnant liver or transplanted liver graft, as well as cautious fluid management needed for liver transplantation balanced against the liberal fluid therapy required to prevent acute kidney injury associated with malignant hyperthermia. The logistical challenges of managing this emergency in two closely related patients are discussed, including rapid preparation of two vapour-free anaesthesia machines, the need for availability of additional dantrolene and the requirement for additional personnel. Prompt recognition, immediate removal of the triggering agents and conversion to total intravenous anaesthesia helped to curtail the malignant hyperthermic reactions in our patients, both of whom made a full recovery.

Health risk assessment by toxic metals in little egrets (Egretta garzetta) and food chain contaminations

This study analysed heavy metals from little egret (Egretta garzetta). Egret’s Eggs, egg shells, food (fish and insects), blood, meat samples (thigh, liver, and chest), water, soil and sediments samples were collected from the two selected sites of the study area. Samples were analysed on flame atomic absorption spectrometer after acid digestion. Detected metals were found almost inline of concentrations when compared with the both sites. Among detected metals Mn was found higher in concentration (µg/g) i.e. 18.509 followed by Zn i.e. 9.383, Ni, Cu, Pb and Cd. Sediment exhibited higher levels (µg/g) of metals (25.061) followed by the meat (19.044) egrets food (18.825), excreta (16.26), blood serums (4.577), eggs (3.626) and water samples (2.432).The level of metals in sediments of the study are showed environmental concerns. Health risks were also investigated that were compared to guidelines of WHO and FAO threshold limits. It was found a marginal health risk to life through detected metals. This study revealed that little egret are good bio-indicator for the screening and investigation of contaminates presence in the environment.

Development & application of Conceptual Framework Model (CFM) for environmental risk assessment of contaminated lands

Dumping sites are the most common types of contaminated lands as they pollute the environment. Environmental management of contaminated sites cannot be delivered effectively and efficiently without robust holistic & integrated risk assessment. Previous studies reveal the absence of a risk assessment model that holistically integrates all essential factors progressively and categorically. The study aimed to develop a holistic & integrated Conceptual Framework Model (CFM) for environmental risk assessment and to apply developed CFM on real-world existing Mahmood Booti Open Dumping Site (MBODS). CFM developed in this study had three main tiers i.e., baseline study, hazard identification & exposure assessment, and risk estimation. For the application of CFM, baseline data were collected and assessed. Water, leachate & soil samples were collected within 1000 m across the site and analyzed for physio-chemical parameters and heavy metals to estimate risk. Results of applied CFM depicted that Physico-chemical analysis of leachate, water, and soil revealed significant pollution levels. Heavy metal analysis exhibited that Ni, Pb, Mn, and Cr levels exceeded the allowable limits of the "World Health Organization" in leachate, water, and soil samples. It also revealed the existence of metals at the source (dumping site itself), pathway, and receptor of the dumping site. Eⁱ _r value for Ni, Pb and Cd from the study area manifested a serious probable risk to ecological integrities. Results for PERI from dumpsite demonstrated a serious ecological risk. It can be concluded that although Mahmood Booti dumping site has been at post-closure stage, it is a momentous source of hazardous toxic contaminants to the nearby inhabitants. The work presented in this paper may reproduce repeatedly to create site-specific risk assessment models of other contaminated lands in a cost-effective, consistent and cohesive manner. Application of CFM at Mahmood Booti Dumping site described detailed risk assessment which helps further in risk management.

471 LET’S TALK DEMENTIA

Introduction

By 2021 over one million people will be living with dementia (1) costing the government an estimated £30bn a year (2). However, cognitive decline is often misdiagnosed or missed completely in hospital admissions, resulting in delays in detection and treatment for patients. Quick and simple screening tools such as the Abbreviated Mental Test Score (AMTS) could help provide early detection and faster treatment times for such patients. Data from Queen Elizabeth Hospital Kings Lynn showed that only 56.8% of patients over the age of 75 were being assessed for cognitive function on admission, while the national targets are set at 90%.

Methods

A multi-cycle, trust wide, quality improvement project was used to improve screening outcomes for dementia in QEHKL. A baseline measure of screening was taken by QEHKL coding department. Five PDSA (Plan Do Study Act) cycles were undertaken, implementing interventions to aid screening at each stage. Examples include improved medical clerking booklets, trust wide education and allocated ward ‘Dementia Champions’. Performance was assessed by auditors, through patient notes and discharge letters.

Results

Over a 4-month period, 432 patient notes were inspected on six medical wards. Results after interventions showed a significant rise in Dementia Screening from 58.7% to 89.8%. AMTS completion was 70.7% in September 2020 on medical wards which improved to 85.7% in November 2020. Results were collected during the COVID-19 pandemic however, COVID wards were excluded.

Conclusion

The QI project has highlighted that education and accessible tools can improve cognitive screening numbers. An important note is, due to increased pressures during the COVID pandemic it is plausible that screening rates were adversely affected. Despite this, our figures still show positive improvement. The next cycle of our project includes surgical wards and we expect by the time of presentation to have this data to show.

Organochlorine pesticides (OCPs) in air-conditioner filter dust of indoor urban setting: Implication for health risk in a developing country

This preliminary investigation highlights the occurrence of organochlorine pesticides (OCPs) in the indoor environment of a megacity, Lahore, Pakistan using the dust ensnared by air-conditioner filters. The Σ₁₆ OCPs concentration ranged from 7.53 to 1272.87 ng/g with the highest percent contribution by ΣDDT (dichlorodiphenyltrichloroethane; 87.21%) and aldrin (6.58%). The spatial variation of OCPs profile revealed relatively higher concentration from homes near to agricultural and abandoned DDT manufacturing sites. Calculated isomer ratios revealed historic sources of hexachlorocyclohexanes (HCHs) and the fresh input of technical DDT and chlordane by the dwellers. The air conditioner dust was helpful to better understand the health risk in the indoor environment. So far a high lifetime cancer risk (10^-3 ) was predicted for toddlers via accidental ingestion, inhalation, and dermal exposure. Similarly, the non-carcinogenic risk-based hazard quotient was found to be high for toddlers (6.94) and within the permissible limit (<1) for adults.

Assessment of risk management and control measures against coronavirus disease

This article presents the COVID-19 situation and control measures taken by the Government of Pakistan. Two waves of pandemic are faced globally and similar in the study area. We have investigated the risk management decision in two phases. Primarily, strict lockdown was observed from March 2020 to July 2020 and smart lockdown was enforced from August 2020 to December 2020. It has been studied that during strict lockdown, COVID cases reduced gradually but reopening of institutes and smart lockdown strategy resulted gradual increase in confirmed cases and death rates. During first wave of COVID-19 in Pakistan, a total confirmed number of patients of COVID-19 were 263,496 till 18th of July 2020 with total deaths of 5,568 people and 204,276 recoveries, while total number of COVID-19 patients reached 555,511 till 9th of February 2021 with total deaths of 12,026 people. Province of Sindh was affected badly with total number of 251,434 COVID-19 cases followed by Punjab Province with total number of 161,347 COVID-19 till 9th of February 2020.

Human Health Risk Assessment by Dietary Intake and Spatial Distribution Pattern of Polybrominated Diphenyl Ethers and Dechloran Plus from Selected Cities of Pakistan

A class of intractable bio accumulative halogenated compounds polybrominated diphenyl ethers (PBDEs) was studied. Specifically, PBDEs and dechloran plus (DP) contamination in wheat and the assaulted environment—agricultural soil and dust—from metropolitan cities of Pakistan was the focus. The exposure of brominated flame retardants (BFRs) to humans, their probable toxicological impact on health, source apportionment, and the spatial tendency of BFRs were studied. Chromatographic analysis was performed, and concentrations (ng g⁻¹) of ΣPBDE and ΣDP in soil, dust, and cereal crops were estimated in a range from 0.63 to 31.70 n.d. to 6.32 and n.d. to 3.47, respectively, and 0.11 to 7.05, n.d. to 4.56 and 0.05 to 4.95, respectively. Data analysis of source apportionment reflected that the existence of solid and e-waste sites, long-range transport, urban and industrial fraction can be the potential source of PBDE and DP pollution. Moreover, potential hazardous risks to human health across the study area via the dietary intake of cereal foods were deemed trifling, and were gauged on the basis of existing toxicological data.

COVID-19 and frequent use of hand sanitizers; human health and environmental hazards by exposure pathways

Till date no medication or vaccine is available to cope with the COVID-19 infection and infection rate is increasing drastically across the globe. Only preventive measures and healthy life style with efficient immune system have been suggested by WHO to fight and stay safe from COVID-19. WHO recommended alcohol based hand sanitizers for frequent hand hygiene, which are mainly made up from ethanol, isopropyl alcohols, hydrogen peroxides in different combinations. These preparations may become toxic to human health and environment when misused. These chemicals have known toxic and hazardous impact on environment when released by evaporation. In early five months of 2020, American Association of Poison Control Center reported 9504 alcoholic hand sanitizer exposure cases in children under the age of 12 years and recognized that even a small amount of alcohol can cause alcohol poisoning in children that is responsible for confusion, vomiting and drowsiness, and in severe cases, respiratory arrest and death. Furthermore, frequent usage of said hand sanitizers has reported increased chance of antimicrobial resistance and chance of other viral diseases. Current review is designed with main objective to highlight the toxic and serious health risks to human health and environment by frequent using hand hygiene products with alcohols based formulations.

Toward a uniform pathway in managing incidental lung nodules on computerised tomography [CT] coronary angiography; for a cost effective and safe outcome

Background

National Institute for Health and Care Excellence guidelines (NICE CG95) recommends computed tomography coronary angiography [CTCA] as the first line investigation for all patients with suspected typical or atypical angina irrespective of pre-test probability due to its excellent performance and cost effectiveness. However previous cost effectiveness analyses have not factored in the burden of lung nodules [LN] or extracardiac incidentalomas, which are commonly identified on CTCA.

Purpose

As we increasingly detect LN on CTCA scans, it is prudent that a uniform pathway is followed for surveillance of LN. The British Thoracic Society (BTS) has enabled evidence-based development of an algorithm for the management of LN which defines a cut off LN size of ≥5mm requiring further follow up. We aimed to assess the compliance of LN follow up in our patients according to radiology recommendation on CTCA reports and also to assess how well these recommendations adhere to BTS guidelines.

Method

117 patients who underwent CTCA as the initial diagnostic investigation were retrospectively identified from the rapid access chest pain clinic database. Data was collected during a 1 year period between January - December 2017. Data was analysed to determine whether appropriate surveillance pathway was followed for repeat imaging. According to BTS guidelines, nodules ≥5mm should have a systematic work up for surveillance and hence we have stratified our data based on the nodule size. In case of multiple nodules, the largest nodule size was considered.

Results

Out of 117 patients, 77% patients were female with average age 57.8±9.0 years. 40% patients were found to have incidental LN with an average size of 4.63±1.92mm; 44% had a history of cigarette smoking.

Among patient with nodules, 22 (19%) had CT thorax to assess interval change and interestingly 16 (73%) had persisting LN; whereas in 4 (18%), the LN resolved and only 2 (9%) showed increase in LN size. Repeat CT chest was advised for these 2 patients; 1 was advised to undergo biopsy which eventually ruled out malignancy. 6 patients (5%) from group 1 were recommended for repeat CT despite having LN size &lt;5mm.

In the remaining 25 patients (21%) with LN, 15 (60%) did not have further surveillance imaging even though this was recommended by the reporting radiologist. Of these only 3 (12%) had LN ≥5mm which qualified for surveillance CT.

Conclusion

CTCA frequently detects incidentalomas especially LN which cannot be overlooked and require further imaging irrespective of the primary presentation. Our findings also suggest a discrepancy on surveillance CT recommendation against the current BTS guidelines, with potential significant impact on the overall cost effectiveness of CTCA. A systematic approach to LN surveillance could be best achieved with a multidisciplinary team approach (e.g. referral pathway to nodule MDT) and adherence to a standard guideline.

Lung nodule surveillance following CTCA

Funding Acknowledgement

Type of funding source: None

Midwifery leadership, advocacy and action to improve maternal health in PNG

Background

The SDG target for maternal mortality is less than 70 per 100,000 live births; in Papua New Guinea, it is estimated to be 145. PNG will require significant resources and strong leadership to meet the 2030 target. The PNG Midwifery Leadership Buddy Program (Buddy Program), funded and coordinated by Rotary, offers an innovative model to improve maternal health, which may be transferable to other low-middle-income countries.

Objectives

The Buddy Program aims to build midwifery leadership resulting in improved outcomes in PNG. As partners, midwives from PNG and Australia undertake leadership training in Port Moresby and enter a reciprocal peer support relationship. Over 12 months, they support each other in their professional roles and progress a quality improvement project.

Results

Three cohorts of midwives (18 from each country), have participated in the leadership training and the first group has completed 12 months of peer support. Participants have reported increased confidence for leadership, action and advocacy. There has been some communication challenges and variation in expectations, predominately due to cultural differences. The Buddy Program has resulted in a number of tangible projects including the introduction of family planning education at a local school and University, introduction of respectful care in pregnancy charter and increased surveillance and treatment of pregnant women with anaemia. Interestingly, a number of participants have continued to support each other beyond the initial 12-month commitment.

Conclusions

Supportive partnerships that grow midwifery leadership hold significant potential to increase the quality of maternity care and reduce preventable maternal deaths in low-middle-income countries.

Key messages

Midwifery leadership plays a vital role in addressing the SDG targets for maternal health. The Buddy Program offers an innovative model to progress the agenda for universal access to quality maternity care.

Cartesian Control of Sit-to-Stand Motion Using Head Position Feedback

Sit-to-stand (STS) motion is an indicator of an individual's physical independence and well-being. Determination of various variables that contribute to the execution and control of STS motion is an active area of research. In this study, we evaluate the clinical hypothesis that besides numerous other factors, the central nervous system (CNS) controls STS motion by tracking a prelearned head position trajectory. Motivated by the evidence for a task-oriented encoding of motion by the CNS, we adopt a robotic approach for the synthesis of STS motion and propose this scheme as a solution to this hypothesis. We propose an analytical biomechanical human CNS modeling framework where the head position trajectory defines the high-level task control variable. The motion control is divided into low-level task generation and motor execution phases. We model CNS as STS controller and its Estimator subsystem plans joint trajectories to perform the low-level task. The motor execution is done through the Cartesian controller subsystem that generates torque commands to the joints. We do extensive motion and force capture experiments on human subjects to validate our analytical modeling scheme. We first scale our biomechanical model to match the anthropometry of the subjects. We do dynamic motion reconstruction through the control of simulated custom human CNS models to follow the captured head position trajectories in real time. We perform kinematic and kinetic analyses and comparison of experimental and simulated motions. For head position trajectories, root mean square (RMS) errors are 0.0118 m in horizontal and 0.0315 m in vertical directions. Errors in angle estimates are 0.55 rad, 0.93 rad, 0.59 rad, and 0.0442 rad for ankle, knee, hip, and head orientation, respectively. RMS error of ground reaction force (GRF) is 50.26 N, and the correlation between ground reaction torque and the support moment is 0.72. Low errors in our results validate (1) the reliability of motion/force capture methods and anthropometric technique for customization of human models and (2) high-level task control framework and human CNS modeling as a solution to the hypothesis. Accurate modeling and detailed understanding of human motion can have significant scope in the fields of rehabilitation, humanoid robotics, and virtual characters' motion planning based on high-level task control schemes.

Phytoremediation potential of Pistia stratiotes and Eichhornia crassipes to remove chromium and copper

Phytoremediation is a cost-effective and eco-friendly process to remove heavy metals from water. A small-scale experiment was conducted to determine the phytoremediation efficiency of two macrophytes, i.e. Pistia stratiotes and Eichhornia crassipes for the removal of chromium and copper from the prepared metal solutions of different concentrations (2, 4, 6, 8 mg/L) for a period of one month. Both aquatic macrophytes showed different efficiency for the removal and accumulation of Chromium (Cr) and Copper (Cu). The dry biomass of both macrophytes increased over the period of time. The average accumulation of chromium in roots and leaves of P. stratiotes was 85 mg, 56 mg and copper was 96 mg and 70 mg, respectively whereas the average accumulation of chromium in roots and leaves of E. crassipes was 90 mg, 53 mg and copper was 86 mg, 50 mg, respectively. Higher absorbance of metals was observed in roots as compared to the leaves of both macrophytes. The concentration of metals in the solution significantly decreased from day 1 to day 30. The results of one-way ANOVA showed that removal of Cr was significantly (p < .05) greater in E. crassipes and removal of Cu was significantly (p < .05) greater in P. stratiotes.

Effect of walnut shell biochars on soil quality, crop yields, and weed dynamics in a 4-year field experiment

The introduction of biochar has been extensively tested under short-term greenhouse or field studies mainly in sandy or acidic soils, while its effects on soil properties, crop plants, and weed species especially in neutral or alkaline soils are still not well understood. Therefore, this study focused on relatively long effects of two walnut shell biochars (5 t ha^-1) on soil nutrient dynamics, two crop plants (wheat and lentil) growth and developments, and weed growth dynamics over 4 years (2014-2017). Applied biochar added once at the beginning of the experiment while planted crops were supplied with macro-nutrients and sprayed with pesticides according to conventional requirements of the region. Biochars improved soil properties by 10-23% during the first and second years while positive effects of biochars on weed growth were drastically higher (60-78% higher weed density) during the whole period of this study most likely due to increase in bioavailability of nutrient shortly after biochar amendment and indirect positive effects of biochars on soil physical properties as well. Consequently, biochar macro- and micro-nutrient will be utilized by weed plants with higher efficacy compared with crop plants.

Screening of human health risk to infants associated with the polychlorinated biphenyl (PCB) levels in human milk from Punjab Province, Pakistan

This study assessed the polychlorinated biphenyl (PCB) levels in human milk and its associated health risk to infants from rural and urban settings of five districts of Punjab Province, Pakistan. The ∑₃₄PCB concentrations ranged from 30.9 to 68.3 ng g^-1 on lipid weight (l.w.) basis. The ∑₈DL-PCB concentrations were ranged from 0.29 to 1.35 ng g^-1 l.w., (mean 6.2 ± 8.7 ng g^-1 l.w.), with toxicity equivalent to polychlorinated dibenzodioxins (PCDDs) ranging from 8.58 × 10^-6 to 0.05 ng TEQ g^-1 l.w. The spatial trend of PCB levels in human milk revealed higher bioaccumulative levels for urban mothers as compared with rural counterparts. The estimated daily intake (EDI) values of DL-PCBs to infants through trans-mammary transfer were considerably higher than tolerable daily intake limits established by WHO (i.e., 1-4 pg TEQ kg^-1 bw) and other globally recognized organizations. Similarly, the hazard quotient values for TEQ ∑₈DL-PCBs (range 1.21 to 79.87) were far above the benchmark value of 1 at all the sampling sites, indicating the high levels of adverse health risks to infants in the region through breast milk consumption. The ∑₃₄PCB levels were found to be negatively correlated with mother' age (r = -0.31; p = 0.02), parity (r = - 0.85; p = 0.001), and infant' birth weight (r = - 0.73; p = 0.01). The present study suggests undertaking comprehensive public health risk assessment studies and firm regulatory measures to safeguard human health risks.

Assessment of polychlorinated biphenyls (PCBs) in the Himalayan Riverine Network of Azad Jammu and Kashmir

The emission of polychlorinated biphenyls (PCBs) in South Asian countries is one of the great environmental concerns and has resulted in the contamination of surrounding high altitude regions such as Azad Jammu and Kashmir (AJK), Pakistan. This first investigation of Polychlorinated Biphenyl (PCBs) concentrations in the ambient air, water and surface soil was conducted along the extensive stream network in the AJK valley of the Himalayan Region. In 2014, surface soil samples were taken and passive air and water samplers were deployed along the four main rivers, namely Jhelum, Neelum, Poonch and Kunhar, and analysed for PCBs (33 congeners) using GC-MS/MS. The ∑₃₃PCBs concentrations ranged from 31.17 to 175.2 (mean ± SD: 81 ± 46.4 pg/L), ND to 1908 (1054 ± 588.5 pg/g), and 29.8 to 94.4 (52.9 ± 22.7 pg/m³) in surface water, soil and air matrices, respectively. The levels of dioxin-like PCBs (∑₈DL-PCBs) contributed considerably towards the total PCBs concentrations: 60.63% (water), 43.87% (air) and 13.76% (soil). The log transformed air-water fugacity (log fa/fw) ratios ranged from -9.37 to 2.58; with 86.3% of the sampling sites showing net volatilization of selected PCB congeners. Similarly, the fugacity fractions for air-soil exchange exhibited narrow variation (0.8 to < 1) indicating net volatilization of PCBs. The ecological risk assessment showed low potential ecological risks (E_rⁱ  = 1.58-7.63) associated with PCB contamination. The present findings provide baseline data that suggest cold trapping of POPs in the remote mountainous areas of Pakistan and can support environmental management of POPs at the regional level. This pioneer investigation campaign to assess the PCBs concentrations in Himalayan Riverine Network of Azad Jammu and Kashmir, Pakistan helps to develop baseline data of PCBs from the strategically important riverine environment that would help in future regional as well as global ecological studies. However, the effects of temperature variations on the sampling rates of chemicals across a wide spectrum of volatility along the elevation gradient were not taken under consideration for PCBs atmospheric concentrations.

Blocking FcRn in humans reduces circulating IgG levels and inhibits IgG immune complex-mediated immune responses

The neonatal crystallizable fragment receptor (FcRn) functions as an intracellular protection receptor for immunoglobulin G (IgG). Recently, several clinical studies have reported the lowering of circulating monomeric IgG levels through FcRn blockade for the potential treatment of autoimmune diseases. Many autoimmune diseases, however, are derived from the effects of IgG immune complexes (ICs). We generated, characterized, and assessed the effects of SYNT001, a FcRn-blocking monoclonal antibody, in mice, nonhuman primates (NHPs), and humans. SYNT001 decreased all IgG subtypes and IgG ICs in the circulation of humans, as we show in a first-in-human phase 1, single ascending dose study. In addition, IgG IC induction of inflammatory pathways was dependent on FcRn and inhibited by SYNT001. These studies expand the role of FcRn in humans by showing that it controls not only IgG protection from catabolism but also inflammatory pathways associated with IgG ICs involved in a variety of autoimmune diseases.

1,4-Diazepines: A Review on Synthesis, Reactions and Biological Significance

Background:

1,4-Diazepines are two nitrogen containing seven membered heterocyclic compounds and associated with a wide range of biological activities. Due to its medicinal importance, scientists are actively involved in the synthesis, reactions and biological evaluation of 1,4-diazepines since number of decades.

Objective:

The primary purpose of this review is to discuss the synthetic schemes and reactivity of 1,4- diazepines. This article also describes biological aspects of 1,4-diazepine derivatives, that can be usefully exploited for the pharmaceutical sector.

Conclusion:

This review summarizes the abundant literature on synthetic routes, chemical reactions and biological attributes of 1,4-diazepine derivatives. We concluded that 1,4-diazepines have significant importance due to their biological activities like antipsychotic, anxiolytic, anthelmintic, anticonvulsant, antibacterial, antifungal and anticancer. 1,4-diazepine derivatives with significant biological activities could be explored for potential use in the pharmaceutical industries.

P1876Atrial fibrillation related symptoms and cardiovascular outcomes

Background

Comprehensive information on the impact of atrial fibrillation (AF)-related symptoms and quality of life (QoL) on adverse outcomes is sparse.

Purpose

We aimed to investigate whether AF-related symptoms and/or QoL are associated with cardiovascular outcomes in a large cohort of AF patients.

Methods

A total of 3902 participants with documented AF from two nationwide prospective cohort studies in Switzerland were included. Information on AF-related symptoms was assessed yearly by standardized questionnaires, QoL was quantified using a visual analog scale (0–100, with higher scores indicating better QoL). The primary endpoint was a composite of stroke and systemic embolism. The secondary endpoint was a composite of cardiovascular death, hospitalization for heart failure and myocardial infarction. We assessed associations using multivariable, time-updated Cox proportional-hazards models including age, sex, study cohort, history of heart failure, hypertension, diabetes, prior stroke, prior myocardial infarction, vascular disease and prior catheter ablation for AF as covariates.

Results

Mean age was 72 years, and 72% were male. The median QoL score was 75 points, and 2572 (66%) participants had AF-related symptoms. Symptomatic individuals were younger (71 vs 75 years) and had more often paroxysmal AF (29 vs 23%) (p for both <0.001). The most frequent symptoms were palpitations (42%), dyspnea (25%) and fatigue (18%). In multivariable, time-updated models, the hazard ratio (HR) was 1.24 (95% confidence intervals (CI) 0.72; 2.11, p=0.43) for the primary endpoint and HR 0.83 (95% CI 0.65; 1.06, p=0.14) for the secondary endpoint in symptomatic vs non-symptomatic individuals. There was a significant, inverse association for a 5-point increase in the QoL score with both the primary (HR 0.94 (95% CI 0.88; 0.99), p=0.04) and secondary (HR 0.91 (95% CI 0.88; 0.93), p<0.0001) endpoints.

Conclusions

AF-related symptoms are not associated with adverse cardiovascular events in AF patients. In contrast, QoL is inversely associated with to adverse cardiovascular outcomes.