Tag: nevin manimala

Environ Sci Pollut Res Int. 2025 Jan 14. doi: 10.1007/s11356-024-35817-y. Online ahead of print.

ABSTRACT

Wastewater treatment plant (WWTP) is a sustainable technique for making wastewater reusable for non-potable purposes. However, in developing countries, most conventional WWTPs are not equipped to trap all pharmaceutical residues (PRs) and pharmaceutically active chemicals (PhACs). This study aims to perform non-target screening of these contaminants in wastewater and explore health and environmental hazards and the removal efficiency of a WWTP in Malaysia. At Indah Water WWTP, a total of 28 wastewater samples (i.e., 2 L each of 14 influent and 14 effluent) were collected every day for a week from February to April 2023. The supernatant of the centrifuged sample was analyzed with the LCMS-QTOF system. Chromatographic profiles were analyzed, and the compounds were annotated using the METLIN database. Categorical data were statistically analyzed with SPSS 29.0 using a chi-square test and continuous variables using paired t-test and multiple regression. PRs like micronutrient (9, 2.3%) and PhACs like lipid (83, 20.8%) were more frequent. Detection frequencies of PRs and PhACs were 72 (18%) and 328 (82%), respectively. Efficiency of WWTP was 36.4 to 100% for PRs removal (mean ± SD: 65.85 ± 56.43%) and 20 to 100% for PhACs removal (mean ± SD: 49.30 ± 55.94%). A total of 943 (mean ± SD: 67.36 ± 43.28) and 400 (mean ± SD: 28.57 ± 32.44) unique PRs and PhACs were recorded. A total of 40 (10%) PRs and PhACs had the potential to irritate eyes, skin, and respiratory tract, and 46 (11.5%) chemicals needed to be avoided from being discharged into the environment. Though WWTP was 98.0% compliant with environmental standards, its efficiency should still be increased to remove the full range of PRs and PhACs. The research has implications for SDGs 6 and 14.

PMID:39808258 | DOI:10.1007/s11356-024-35817-y

Clin Toxicol (Phila). 2025 Jan 14:1-9. doi: 10.1080/15563650.2024.2437119. Online ahead of print.

ABSTRACT

INTRODUCTION: Many patients acutely self-poisoned with organophosphorus insecticides have co-ingested ethanol. Currently, profenofos 50% emulsifiable concentrate (EC50) is commonly ingested for self-harm in Sri Lanka. Clinical experience suggests that ethanol co-ingestion makes management more difficult. Therefore, we aimed to determine the relationships between plasma ethanol concentration, plasma profenofos concentration and its toxicokinetics, and clinical outcome in acute profenofos self-poisoning.

METHODS: Demographic and clinical data, including a history of ethanol ingestion and blood samples, were prospectively collected from all cases of acute poisoning with profenofos EC50 presenting to Teaching Hospital Peradeniya, Sri Lanka, over four years. Plasma samples were analyzed by gas chromatography-mass spectrometry to quantify the ethanol (n = 99) and profenofos (n = 30 [15 with ethanol, 15 without ethanol]) concentrations. The PKSolver program was used to calculate the toxicokinetic parameters.

RESULTS: Of 99 patients (male 78/99) with acute profenofos self-poisoning, 50 reported a history of ethanol co-ingestion. Plasma from 44 of 99 profenofos-poisoned patients had detectable ethanol concentrations. No statistical difference was observed between the mortality in the ethanol group and the no ethanol group (5/44 [11.4%] versus 3/55 [5.5%]; P = 0.461). Similarly, the median half-lives of plasma profenofos absorption in the ethanol and no ethanol groups (0.1 h and 0.1 h, respectively; time 0-24 h) were not statistically different (P = 0.6594). However, the median half-life of plasma profenofos elimination was significantly longer in the ethanol group than the no ethanol group (23.1 h and 9.9 h, respectively; time 0-24 h; P = 0.0002). According to the regression analysis, the half-life of plasma profenofos elimination was longer by 29.4 h in the ethanol group (P = 0.013).

DISCUSSION: No significant differences in outcomes, including death and endotracheal intubation rates, were found between those who did and did not co-ingest ethanol. No differences were found in toxicokinetic variables between the ethanol and no ethanol groups, but the ethanol group had a longer elimination half-life.

CONCLUSION: The co-ingestion of ethanol leads to a slowing of the elimination kinetics of profenofos. However, the study did not reveal a significant impact of ethanol co-ingestion on clinical outcomes.

PMID:39807620 | DOI:10.1080/15563650.2024.2437119

Environ Sci Technol. 2025 Jan 14;59(1):103-118. doi: 10.1021/acs.est.4c07753. Epub 2024 Dec 30.

ABSTRACT

Enteropathogens are major contributors to mortality and morbidity, particularly in settings with limited access to water, sanitation, and hygiene infrastructure. To assess transmission pathways associated with enteropathogen infection, we measured household environmental conditions and assayed 22 enteropathogens using TaqMan Array Cards in stool samples from 276 six-month-old children living in communities along a rural-urban gradient in Northern Ecuador. We utilized multivariable models, risk factor importance, and distance-based statistical methods to test factors associated with infection. Most children (89%) carried at least one pathogen, and 72% carried two or more. Bacterial infections (82% of participants) were more common than viruses (58%) or parasites (9.1%). Infants living in the urban site had decreased infection risks compared to those in rural locations. Improved water and sanitation were most predictive of reduced infection risk. Improved water was associated with decreased enterotoxigenic E. coli prevalence, and improved sanitation was associated with lower prevalence of any infection and specifically norovirus. Animal exposure was associated with increased Salmonella prevalence. Children measured during the rainy season had fewer viral and more bacterial infections. Identifying environmental exposures associated with specific pathogen outcomes provides insights into transmission pathways, which contribute critical information for developing effective strategies to improve child health.

PMID:39807583 | DOI:10.1021/acs.est.4c07753

Palliat Support Care. 2025 Jan 14;23:e15. doi: 10.1017/S1478951524001548.

ABSTRACT

OBJECTIVES: Advance care planning (ACP) supports communication and medical decision-making and is best conceptualized as part of the care planning continuum. Black older adults have lower ACP engagement and poorer quality of care in serious illness. Surrogates are essential to effective ACP but are rarely integrated in care planning. Our objective was to describe readiness, barriers, and facilitators of ACP among seriously ill Black older adults and their surrogates.

METHODS: We used an explanatory sequential mixed methods study design. The setting was 2 ambulatory specialty clinics of an academic medical center and 1 community church in Northern California, USA. Participants included older adults and surrogates. Older adults were aged 60+, self-identified as Black, and had received care at 1 of the 2 clinics or were a member of the church congregation. Surrogates were aged 18+ and could potentially make medical decisions for the older adult. The validated ACP engagement survey was used to assess confidence and readiness for ACP. What “matters most” and barriers and facilitators to ACP employed questions from established ACP materials and trials. Semi-structured interviews were conducted after surveys to further explain survey results.

RESULTS: Older adults (N = 30) and surrogates (N = 12) were confident that they could engage in ACP (4.1 and 4.7 out of 5), but many were not ready for these conversations (3.1 and 3.9 out of 5). A framework with 4 themes – illness experience, social connections, interaction with health providers, burden – supports identification of barriers and facilitators to ACP engagement.

SIGNIFICANCE OF RESULTS: We identified barriers and facilitators and present a framework to support ACP engagement. Future research can assess the impact of this framework on communication and decision-making.

PMID:39807567 | DOI:10.1017/S1478951524001548

Palliat Support Care. 2025 Jan 14;23:e14. doi: 10.1017/S1478951524001524.

ABSTRACT

OBJECTIVES: Wishes to hasten death (WTHDs) are common in patients with serious illness. The Schedule of Attitudes Toward Hastened Death (SAHD) is a validated 20-item instrument for measuring WTHD. Two short versions have also been developed based on statistical item selection. However, all existing versions show some limitations with potential for improvement. This study aims to develop and initially validate a theory-driven and statistically sound SAHD short version based on a large multinational sample to advance the WTHD assessment in different countries and with different legislations.

METHODS: A 3-step procedure was carried out including (1) theory-driven item selection, (2) exploratory, and (3) confirmatory factor analysis. We used a data set collected between 1998 and 2020 across 3 different countries (Germany, Spain, USA). Participants were N = 1156 complete cases (n = 181 German, n = 101 Spanish and n = 874 US) of severely ill adult in- and outpatients. They had to be ≥18 years and give informed consent.

RESULTS: The exploratory factor analysis revealed that 10 of 11 items previously selected theory-driven loaded on either of 2 factors: (1) WTHD and (2) internal locus of control. These factors showed good to excellent reliability according to Cronbach’s α and McDonald’s Ω, as well as an excellent fit of our data as an overall model for the total sample.

SIGNIFICANCE OF RESULTS: The developed SAHD-10 represents a reliable and valid alternative to the SAHD and an efficient means to measure and further investigate a WTHD in cross-cultural clinical and research settings.

PMID:39807560 | DOI:10.1017/S1478951524001524

Emergencias. 2024 Dec;36(6):438-446. doi: 10.55633/s3me/061.2024.

ABSTRACT

OBJECTIVE: To evaluate the social, epidemiological, and clinical characteristics of patients brought to Spanish pediatric emergency departments (EDs) after suicide attempts by poisoning. A secondary objective was to identify risk factors for moderate-severe poisoning.

METHODS: Prospective multicenter cohort study. We included patients under the age of 18 years who were brought to 20 Spanish pediatric EDs after attempting suicide between January 2021 and June 2022. Case histories were reviewed and the patients were interviewed. A Poisoning Severity Score of 2 or more was classified as moderate-severe.

RESULTS: A total of 592 episodes were studied; 541 of the patients (91.4%) were girls. The median (P25-P75) age was 14.6 years (13.6-15.7 years). A psychiatric diagnosis had been made in 417 (70.4%), 334 (56.4%) had attempted suicide previously, and 409 (69.1%) had been victims of bullying. Medications were ingested by 584 (98.6%). The most often used were benzodiazepines (used by 222; 37.5%) and paracetamol (by 187; 31.6%). Fifty-three poisonings were classified as moderate-severe. A mental health evaluation was carried out in 585 cases (98.8%). Odds ratios (ORs) indicated that higher risk of moderate-severe poisoning was associated with having an adjustment disorder (OR, 3.2; P25-P75, 1.1-9.0; P = .027), using opioids (OR, 6.4; P25-P75, 1.2-35.4; P = .032), and taking of antidiabetic drugs (OR, 27.6; P25-P75, 1.2-634.9; P = .038). Being a victim of bullying (OR, 0.4; P25-P75, 0.2-0.8; P = .013] and using nonsteroidal anti-inflammatory drugs (OR, 0.3; P25-P75, 0.1-0.8; P = .020) decreased risk.

CONCLUSIONS: Pediatric ED visits for suicide attempts by poisoning occur mainly in adolescent girls, and a majority have a medical history of a psychiatric diagnosis, prior suicide attempts, or self-harm behaviors. They have also often experienced bullying. Characteristics that distinguish patients with moderate-severe poisoning are the presence of an adjustment disorder and the use of opioids and antidiabetic drugs, which confer risk for greater severity.

PMID:39807549 | DOI:10.55633/s3me/061.2024

Emergencias. 2024 Dec;36(6):425-437. doi: 10.55633/s3me/105.2024.

ABSTRACT

OBJECTIVE: To describe the characteristics of patients diagnosed with acute heart failure (AHF) in emergency departments (EDs) who develop cardiogenic shock (CS) not associated with ST-segment elevation acute coronary syndrome (STACS).

METHODS: Information for patients diagnosed with AHF in 23 Spanish EDs and registered between 2009 and 2019 were included for analysis if the patients developed symptoms consistent with CS. We described baseline clinical characteristics related to cardiac decompensation and CS, as well as 30-day mortality.

RESULTS: A total of 15 920 cases of AHF were diagnosed; 179 of the patients developed CS (prevalence, 1.1%; 95% CI, 0.2%-3.2%). The median age was 82 years, and 53% were women. The most common causes of SC were valve disease and coronary disease. Prior episodes of AHF had occurred in 76%. More than 40% presented with severely deteriorated baseline functional and respiratory status. Treatment for CS was started in the ED in 75%, CS was refractory in 22%, and palliative measures were taken in 13%. Patients who developed CS had lower mean arterial pressure and worse New York Heart Association classifications at baseline, valve disease, and non-STACS. They had been transferred in an advanced life support ambulance, had severe hyponatremia, and less often had lower extremity edema than patients who did not develop CS. Thirty-day mortality was 38.5% (95% CI, 31.3%-45.7%); 21 of these patients died in the ED (12% of those with CS). Mortality was related to age 80 years or older (adjusted [aHR], 1.977; 95% CI, 1.169-3.343), hypertension (aHR, 2.123; 95% CI, 1.035-4.352), anemia (aHR, 2.262; 95% CI, 1.029-4.970), signs of low cardiac output (aHR, 1.877; 95% CI, 1.150-3.062), and a glomerularfiltration rate less than 30 mL/min/1.73 m2 (aHR, 1.758; 95% CI, 1.051-2.939).

CONCLUSIONS: CS occurring outside a context of STACS is uncommon in ED patients with AHF and is related to poorer functional class. More of these patients have valve disease, hyponatremia, and non-STACS as a precipitant. Nearly 40% die in hospital. Almost a third die in the ED.

PMID:39807548 | DOI:10.55633/s3me/105.2024

J Chem Theory Comput. 2025 Jan 14;21(1):79-87. doi: 10.1021/acs.jctc.4c01249. Epub 2024 Dec 30.

ABSTRACT

Self-diffusion coefficients, D*, are routinely estimated from molecular dynamics simulations by fitting a linear model to the observed mean squared displacements (MSDs) of mobile species. MSDs derived from simulations exhibit statistical noise that causes uncertainty in the resulting estimate of D*. An optimal scheme for estimating D* minimizes this uncertainty, i.e., it will have high statistical efficiency, and also gives an accurate estimate of the uncertainty itself. We present a scheme for estimating D* from a single simulation trajectory with a high statistical efficiency and accurately estimating the uncertainty in the predicted value. The statistical distribution of MSDs observable from a given simulation is modeled as a multivariate normal distribution using an analytical covariance matrix for an equivalent system of freely diffusing particles, which we parametrize from the available simulation data. We use Bayesian regression to sample the distribution of linear models that are compatible with this multivariate normal distribution to obtain a statistically efficient estimate of D* and an accurate estimate of the associated statistical uncertainty.

PMID:39807535 | DOI:10.1021/acs.jctc.4c01249

Heliyon. 2024 Dec 12;11(1):e41210. doi: 10.1016/j.heliyon.2024.e41210. eCollection 2025 Jan 15.

ABSTRACT

Physical properties were studied in commercial plantation of balsa established in Costa Rica. Among other variables studied, physical properties varied mainly for tree age, spacing, stand density, diameter, and height of trees, which we named dasometric conditions. The aim of this study was (i) to determine the variation of specific gravity (SG), air-dry density (AD), green density (GD), and green moisture content (GMC), (ii) to know the site effect and dasometric conditions on these properties, and (iii) to establish the relationship between the four physical properties. The results showed that: SG from 0.08 to 0.21, AD from 90 to 250 kg/m³, GD varied 203-274 kg/m³, and GMC from 38.8 to 137.1 %. Tree age affected statistically all physical properties, it was positively correlated with SG, AD, and GD, but negatively correlated with GMC. Diameter breast height and total height were weakly correlated with SG and AD, respectively. Commercial height and stand density were highly correlated with SG and AD, besides stand density was positively correlated with GMC. AD was positively correlated with SG and GD but negatively correlated with GMC. According to the results, balsa tree plantations exhibited significant variation in physical properties (SG, AD, GD, and GMC) in trees aged between 30 and 40 months and this variation was primarily attributed to the site-specific growth conditions, mainly temperature and precipitation. These wood properties can be selected by site and growing conditions.

PMID:39807519 | PMC:PMC11728954 | DOI:10.1016/j.heliyon.2024.e41210

Heliyon. 2024 Dec 9;11(1):e40982. doi: 10.1016/j.heliyon.2024.e40982. eCollection 2025 Jan 15.

ABSTRACT

BACKGROUND: Transvenous pacemakers (TVP) and leadless pacemakers (LP) are two reliable permanent modalities for the treatment of heart rhythm disorders. Several observational studies explored the safety and efficacy of the two devices. The aim of this meta-analysis study is to present a comparative analysis of the safety of leadless versus transvenous pacemakers.

METHODS: The study protocol was registered in PROSPERO registry (CRD42024520647). A comprehensive and systematic search was conducted across PubMed, Embase, Cochrane Library, Web of Science and ClinicalTrials.gov, spanning from inception until just before the final analysis. SPSS was used for statistical analysis. Relative risks (RR) and odds ratio (OR) were used to evaluate the outcomes with a 95 % confidence interval (CI).

RESULTS: Nineteen studies met the inclusion criteria and were analyzed, in which the overall effect estimate showed increased risk of major complications in the TVP group (LogOR = -0.27, 95 % CI: [-0.63, 0.10]) compared to the LP group. Among the nineteen studies, seven studies showed that TVP significantly increase the risk of reintervention (LogOR = -0.73, 95 % CI: [-1.15, -0.31]) and thirteen studies showed a higher risk of mortality among patients receiving TVP (Cohen’s d = -0.11, 95 % CI: [-0.22, 0.01]) compared to those receiving LP. Conversely, a higher risk of pericardial effusion or tamponade and thromboembolic events was among patients receiving LP with (LogOR = 1.01, 95 % CI: [0.55, 1.46]) and (LogOR = 0.45, 95 % CI: [-0.33, 1.23]) respectively.

CONCLUSION: This study showed that leadless pacemakers tend to be safer compared to transvenous pacemakers, with reduced risks of major complications, reintervention, generator malfunction, device or lead dislodgement, pneumothorax and hemothorax, infections rates, and mortality. However, higher odds of cardiac perforation and tamponade and thromboembolic events were observed among patients receiving LP. The lack of both randomized clinical trials and long term follow up studies limits our assessment and emphasizes the need for ongoing investigation to understand the extended complications associated with these devices amidst advancing technology.

PMID:39807515 | PMC:PMC11728922 | DOI:10.1016/j.heliyon.2024.e40982