Prevalence of and Risk Factors for Lead Poisoning in Young Children in Bangladesh

Lead poisoning is a major public-health problem in Bangladesh. A cross-sectional study was conducted to determine the extent of and risk factors for elevated blood lead levels (BLLs) in children in Bangladesh during September 2007–July 2009. The study included 919 children aged less than 16 years. The children were recruited from six urban locations in Dhaka and one rural area in Chirirbandar, Dinajpur. In total, 495 (54%) children had high BLLs (>10 µg/dL), with higher BLLs observed among children aged 5-9 years compared to children of other ages (p<0.001). The BLLs among children in urban Dhaka were significantly higher than those in rural areas (13.45±8.21 µg/dL vs 7.29±6.25 µg/dL, p<0.001). The high BLLs correlated with low body mass index (r=-0.23, p<0.001) and low haemoglobin status (r=-0.10, p=0.02). On bivariate analysis, proximity to industry (p<0.001), drinking-water from municipal supply or tubewell (p<0.001), brass or lead water-taps (p<0.001), use of melamine plate (p=0.001), and indigenous medicinal (kabiraji) treatments (p=0.004) significantly correlated with higher BLLs. Proximity to industry and the use of indigenous medicines remained significant predictors of high BLLs after controlling for the confounders. Several risk factors appropriate for future educational interventions to prevent exposure to lead poisoning were identified.Key words: Child, Cross-sectional studies, Lead poisoning, Risk factors, Bangladesh     

Incidence of Fanconi anaemia in phenotypically normal aplastic anaemia patients in West Bengal

Objectives: Fanconi anaemia (FA) is a rare inherited bone marrow failure and autosomal recessive blood disorder. FA patients have a higher risk of cancer, including acute myeloid leukaemia and squamous cell carcinoma. Maximum, but not all, affected individuals have one or more somatic abnormalities, including skin, skeletal, genitourinary, gastrointestinal, cardiac and neurological anomalies, etc. Positive stress cytogenetics has immense implications for the treatment and management of FA. The aim of our study was to find out the incidence of FA in the population of phenotypically normal aplastic anaemia (AA) patients in West Bengal.

Methods: Ethical clearances were obtained from the corresponding institutional committees. A total of 117 AA cases was selected. Stress cytogenetics was performed from peripheral venous blood (PVB) samples of 63 AA patients (age?≤?50 years) and 63 age- and sex-matched healthy individual (control) using Mitomycin C (MMC).

Results: Out of 63 AA patients, 6 (9.25%) cases showed positive stress cytogenetics suggestive of FA, which is statistically significant (p-value – 0.000532), analysed by chi-square test.

Discussion: A considerable percentage of patients showing sensitivity towards MMC, even if they are phenotypically normal and did not have any distinguishable features which are generally found in FA.

Conclusion: This observation may indicate that stress cytogenetics analysis of phenotypically normal AA patients (≤50 years) is essential for the improvement of the treatment procedure.     

Preparation and Enhancing Properties of pH-Sensitive Hydrogel in Light of Gum Ghatti-cl-poly(acrylic acid)/ – o-MWCNT for Sodium Diclofenac Drug Release

Gum ghatti (GG) is used as a biopolymer, acrylic acid (AA) is used as a synthetic monomer, ammonium persulphate (APS) is used as an initiator, and methylene bis-acrylamide (MBA) is used as a cross-linker in the current study to create gum ghatti-cl-poly(acrylic acid)-o-MWCNT hydrogels. The –o-MWCNT (0, 10, 20, 30, 40, and 50 mg) is added to the hydrogel as a filler. Fourier transform infrared (FTIR), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), and X-ray diffraction (XRD) analyses are used to characterize the crosslinked hydrogels. The successful polymerization of the graft is confirmed by these spectroscopic studies. Sodium diclofenac (SD) as a model drug is utilized. Swelling tests are also conducted at pH 6.8 on all prepared hydrogels. In a similar manner, all hydrogel preparations are subjected to an in vitro study at neutral (pH 7.4), acidic (pH 1.2), and basic (pH 9.2) mediums, and a higher drug release is observed at pH 7.4. The Higuchi model, the Korsmeyer–Peppas model, and various zero-order and first-order kinetics are utilized in the investigation of the drug release order mechanism from the hydrogels. The drug release data favor the Korsmeyer–Peppas model, which describes the “n” diffusion exponent that controls the drug release mechanism from synthesized hydrogels. The “n” values control the Fickian diffusion (Case-I diffusional) like coupled diffusion (0.45 ≤ n). According to the results presented here, GGAACNT-based hydrogels can be used in biomedical fields, especially for controlled drug release.     

Ambulatory follow-up among publicly insured children discharged from the emergency department

Background

While children discharged from the emergency department (ED) are frequently advised to follow up with ambulatory care providers, the extent to which this occurs is unknown. We sought to characterize the proportion of publicly insured children who have an ambulatory visit following ED discharge, identify factors associated with ambulatory follow-up, and evaluate the association of ambulatory follow-up with subsequent hospital-based health care utilization.

Methods

We performed a cross-sectional study of pediatric (<18 years) encounters during 2019 included in the IBM Watson Medicaid MarketScan claims database from seven U.S. states. Our primary outcome was an ambulatory follow-up visit within 7 days of ED discharge. Secondary outcomes were 7-day ED return visits and hospitalizations. Logistic regression and Cox proportional hazards were used for multivariable modeling.

Results

We included 1,408,406 index ED encounters (median age 5 years, IQR 2–10 years), for which a 7-day ambulatory visit occurred in 280,602 (19.9%). Conditions with the highest proportion of 7-day ambulatory follow-up included seizures (36.4%); allergic, immunologic, and rheumatologic diseases (24.6%); other gastrointestinal diseases (24.5%); and fever (24.1%). Ambulatory follow-up was associated with younger age, Hispanic ethnicity, weekend ED discharge, ambulatory encounters prior to the ED visit, and diagnostic testing performed during the ED encounter. Ambulatory follow-up was inversely associated with Black race and ambulatory care–sensitive or complex chronic conditions. In Cox models, ambulatory follow-up was associated with a higher hazard ratio (HR) of subsequent ED return (HR range 1.32–1.65) visit and hospitalization (HR range 3.10–4.03).

Conclusions

One-fifth of children discharged from the ED have an ambulatory visit within 7 days, which varied by patient characteristics and diagnoses. Children with ambulatory follow-up have a greater subsequent health care utilization, including subsequent ED visit and/or hospitalization. These findings identify the need to further research the role and costs associated with routine post-ED visit follow-up.     

Mortality and morbidity following operative management of tibial shaft fractures in octogenarians

Purpose

As the geriatric population continues to grow, the incidence of tibial shaft fractures in octogenarians is projected to increase. There is significant variation in the functional and physiologic status within the geriatric population. The purpose of this study is to compare the complications following operative treatment of tibial shaft fractures for patients who are 65- to79-year-old compared to patients who are 80- to 89-year-old.

Methods

Data were collected through the National Surgical Quality Improvement Program database for the years 2007–2018. All isolated tibial shaft fractures that were treated with open reduction internal fixation (ORIF) or intramedullary nail (IMN) were identified. Patients were divided into a 65- to 79-year-old group and an 80-to 89-year-old group. Primary and secondary outcomes were studied and included 30-day mortality. Univariate and multivariate analyses were performed with a significance set at p  <  0.05.

Results

In total, 434 patients with tibial shaft fractures were included in the study. Of these, 333 were 65- to 79-year-old and 101 were 80- to 89-year-old (Table 1). On multivariate analysis, there was no significant difference in complication rates between the two cohorts.

Conclusion

After controlling for demographics and comorbidities, age was not independently associated with 30-day mortality or any other peri-operative complications between patients aged 80 to 89 and patients aged 65 to 79 following operative management of tibial shaft fractures. In appropriately selected octogenarian patients, operative management of tibial shaft fractures represents a relatively safe treatment modality that may promote early rehabilitation.

     

A revised estimate of twin concordance in systemic lupus erythematosus

Objective. Based on a small clinical series and previously published case reports, concordance for systemic lupus erythematosus (SLE) among monozygous (MZ) twins has been reported to be as high as 69%. Using a larger and less biased sample, we provide another estimate of this percentage. Methods. We established a registry of twins with SLE, based upon self-reports and information provided by the patients' physicians. We used DNA fingerprinting to validate the reported zygosity in a sample of these twins. Results. Of 107 twin pairs meeting the American College of Rheumatology 1982 revised criteria for the diagnosis of SLE, 24% of 45 MZ pairs and 2% of 62 dizygous (DZ) pairs were concordant. The frequency distributions of diagnostic criteria and disease symptoms in the SLE patients were similar to those in other published reports of SLE patients. Zygosity was confirmed by DNA fingerprinting in a subsample of 15 self-described MZ twins and 7 self-described DZ twins. AH individuals had correctly predicted their zygosity. Conclusion. MZ concordance for SLE is similar to that for other autoimmune diseases and is much lower than previously believed.