10 research outputs found
The Effect of Non-fluoride Factors on Risk of Dental Fluorosis: Evidence from Rural Populations of the Main Ethiopian Rift
Elevated level of fluoride (Fâ) in drinking water is a well-recognized risk factor of dental fluorosis (DF). While considering optimization of region-specific standards for Fâ, it is reasonable, however, to consider how local diet, water sourcing practices, and non-Fâ elements in water may be related to health outcomes. In this study, we hypothesized that non-Fâ elements in groundwater and lifestyle and demographic characteristics may be independent predictors or modifiers of the effects of Fâ on teeth. Dental examinations were conducted among 1094 inhabitants from 399 randomly selected households of 20 rural communities of the Ziway-Shala lake basin of the Main Ethiopian Rift. DF severity was evaluated using the Thylstrup-Fejerskov Index (TFI). Household surveys were performed and water samples were collected from community water sources. To consider interrelations between the teeth within individual (in terms of DF severity) and between Fâ and non-Fâ elements in groundwater, the statistical methods of regression analysis, mixed models, and principal component analysis were used. About 90% of study participants consumed water from wells with Fâ levels above the WHO recommended standard of 1.5 mg/l. More than 62% of the study population had DF. Fâ levels were a major factor associated with DF. Age, sex, and milk consumption (both cowâs and breastfed) were also statistically significantly (p \u3c 0.05) associated with DF severity; these associations appear both independently and as modifiers of those identified between Fâ concentration and DF severity. Among 35 examined elements in groundwater, Ca, Al, Cu, and Rb were found to be significantly correlated with dental health outcomes among the residents exposed to water with excessive Fâ concentrations. Quantitative estimates obtained in our study can be used to explore new water treatment strategies, water safety and quality regulations, and lifestyle recommendations which may be more appropriate for this highly populated region
Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28â2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65â3·22], p\textless0·0001), American Society of Anesthesiologists grades 3â5 versus grades 1â2 (2·35 [1·57â3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01â2·39], p=0·046), emergency versus elective surgery (1·67 [1·06â2·63], p=0·026), and major versus minor surgery (1·52 [1·01â2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research
Arsenic exposure from groundwater in Union County, North Carolina
Arsenic contamination of groundwater is a global problem affecting human health. The highest concentrations occur overseas in areas such as Bangladesh, India, Vietnam, and Thailand. The United States is not immune and also has hotspots of arsenic in dangerously high concentrations. The focus of this project was to evaluate the extent and concentration of arsenic in one such area, Union County, North Carolina, and to attempt to use arsenic in toenails as a biomarker of exposure. Arsenic concentration above the EPAâs maximum contaminant level (MCL) of 10ppb was found in 22 out of 64 households tested (34%). The measurement of arsenic in toenails was successfully used as a biomarker of exposure. Data showed that men had a greater sensitivity to arsenic and their nail data had better correlation. Children also showed a greater sensitivity. Out of 69 participants in the toenail-biomarker study, 4 had arsenic concentrations in their toenails above a level deemed safe. Based on these results it is evident that arsenic contamination of drinking water in Union County is an issue of concern
Isotopic Imprints of Mountaintop Mining Contaminants
Mountaintop
mining (MTM) is the primary procedure for surface coal
exploration within the central Appalachian region of the eastern United
States, and it is known to contaminate streams in local watersheds.
In this study, we measured the chemical and isotopic compositions
of water samples from MTM-impacted tributaries and streams in the
Mud River watershed in West Virginia. We systematically document the
isotopic compositions of three major constituents: sulfur isotopes
in sulfate (ÎŽ<sup>34</sup>S<sub>SO4</sub>), carbon isotopes
in dissolved inorganic carbon (ÎŽ<sup>13</sup>C<sub>DIC</sub>), and strontium isotopes (<sup>87</sup>Sr/<sup>86</sup>Sr). The
data show that ÎŽ<sup>34</sup>S<sub>SO4</sub>, ÎŽ<sup>13</sup>C<sub>DIC</sub>, Sr/Ca, and <sup>87</sup>Sr/<sup>86</sup>Sr measured
in saline- and selenium-rich MTM impacted tributaries are distinguishable
from those of the surface water upstream of mining impacts. These
tracers can therefore be used to delineate and quantify the impact
of MTM in watersheds. High Sr/Ca and low <sup>87</sup>Sr/<sup>86</sup>Sr characterize tributaries that originated from active MTM areas,
while tributaries from reclaimed MTM areas had low Sr/Ca and high <sup>87</sup>Sr/<sup>86</sup>Sr. Leaching experiments of rocks from the
watershed show that pyrite oxidation and carbonate dissolution control
the solute chemistry with distinct <sup>87</sup>Sr/<sup>86</sup>Sr
ratios characterizing different rock sources. We propose that MTM
operations that access the deeper Kanawha Formation generate residual
mined rocks in valley fills from which effluents with distinctive <sup>87</sup>Sr/<sup>86</sup>Sr and Sr/Ca imprints affect the quality
of the Appalachian watersheds
Isotopic Imprints of Mountaintop Mining Contaminants
Mountaintop
mining (MTM) is the primary procedure for surface coal
exploration within the central Appalachian region of the eastern United
States, and it is known to contaminate streams in local watersheds.
In this study, we measured the chemical and isotopic compositions
of water samples from MTM-impacted tributaries and streams in the
Mud River watershed in West Virginia. We systematically document the
isotopic compositions of three major constituents: sulfur isotopes
in sulfate (ÎŽ<sup>34</sup>S<sub>SO4</sub>), carbon isotopes
in dissolved inorganic carbon (ÎŽ<sup>13</sup>C<sub>DIC</sub>), and strontium isotopes (<sup>87</sup>Sr/<sup>86</sup>Sr). The
data show that ÎŽ<sup>34</sup>S<sub>SO4</sub>, ÎŽ<sup>13</sup>C<sub>DIC</sub>, Sr/Ca, and <sup>87</sup>Sr/<sup>86</sup>Sr measured
in saline- and selenium-rich MTM impacted tributaries are distinguishable
from those of the surface water upstream of mining impacts. These
tracers can therefore be used to delineate and quantify the impact
of MTM in watersheds. High Sr/Ca and low <sup>87</sup>Sr/<sup>86</sup>Sr characterize tributaries that originated from active MTM areas,
while tributaries from reclaimed MTM areas had low Sr/Ca and high <sup>87</sup>Sr/<sup>86</sup>Sr. Leaching experiments of rocks from the
watershed show that pyrite oxidation and carbonate dissolution control
the solute chemistry with distinct <sup>87</sup>Sr/<sup>86</sup>Sr
ratios characterizing different rock sources. We propose that MTM
operations that access the deeper Kanawha Formation generate residual
mined rocks in valley fills from which effluents with distinctive <sup>87</sup>Sr/<sup>86</sup>Sr and Sr/Ca imprints affect the quality
of the Appalachian watersheds
Arsenic exposure of rural populations from the Rift Valley of Ethiopia as monitored by keratin in toenails
The effect of non-fluoride factors on risk of dental fluorosis: Evidence from rural populations of the Main Ethiopian Rift
Is perioperative COVID-19 really associated with worse surgical outcomes? A nationwide COVIDSurg propensity-matched analysis
BACKGROUND: Patients undergoing surgery with perioperative COVID-19 are suggested to have worse outcomes, but whether this is COVID-related or due to selection bias remains unclear. We aimed to compare the postoperative outcomes of patients with and without perioperative COVID-19. METHODS: Patients with perioperative COVID-19 diagnosed within 7 days before or 30 days after surgery between February and July 2020 from 68 US hospitals in COVIDSurg, an international multicenter database, were 1:1 propensity score matched to patients without COVID-19 undergoing similar procedures in the 2012 American College of Surgeons National Surgical Quality Improvement Program database. The matching criteria included demographics (e.g., age, sex), comorbidities (e.g., diabetes, chronic obstructive pulmonary disease, chronic kidney disease), and operation characteristics (e.g., type, urgency, complexity). The primary outcome was 30-day hospital mortality. Secondary outcomes included hospital length of stay and 13 postoperative complications (e.g., pneumonia, renal failure, surgical site infection). RESULTS: A total of 97,936 patients were included, 1,054 with and 96,882 without COVID-19. Prematching, COVID-19 patients more often underwent emergency surgery (76.1% vs. 10.3%, p < 0.001). A total of 843 COVID-19 and 843 non-COVID-19 patients were successfully matched based on demographics, comorbidities, and operative characteristics. Postmatching, COVID-19 patients had a higher mortality (12.0% vs. 8.1%, p = 0.007), longer length of stay (6 [2-15] vs. 5 [1-12] days), and higher rates of acute renal failure (19.3% vs. 3.0%, p < 0.001), sepsis (13.5% vs. 9.0%, p = 0.003), and septic shock (11.8% vs. 6.0%, p < 0.001). They also had higher rates of thromboembolic complications such as deep vein thrombosis (4.4% vs. 1.5%, p < 0.001) and pulmonary embolism (2.5% vs. 0.4%, p < 0.001) but lower rates of bleeding (11.6% vs. 26.1%, p < 0.001). CONCLUSION: Patients undergoing surgery with perioperative COVID-19 have higher rates of 30-day mortality and postoperative complications, especially thromboembolic, compared with similar patients without COVID-19 undergoing similar surgeries. Such information is crucial for the complex surgical decision making and counseling of these patients. (J Trauma Acute Care Surg. 2023;94: 513-524. Copyright (C) 2023 American Association for the Surgery of Trauma.)LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level IV
Outcomes and Their State-level Variation in Patients Undergoing Surgery With Perioperative SARS-CoV-2 Infection in the USA. A Prospective Multicenter Study
Objective: To report the 30-day outcomes of patients with perioperative SARS-CoV-2 infection undergoing surgery in the USA.
Background: Uncertainty regarding the postoperative risks of patients with SARS-CoV-2 exists.
Methods: As part of the COVIDSurg multicenter study, all patients aged â„17 years undergoing surgery between January 1 and June 30, 2020 with perioperative SARS-CoV-2 infection in 70 hospitals across 27 states were included. The primary outcomes were 30-day mortality and pulmonary complications. Multivariable analyses (adjusting for demographics, comorbidities, and procedure characteristics) were performed to identify predictors of mortality.
Results: A total of 1581 patients were included; more than half of them were males (n = 822, 52.0%) and older than 50 years (n = 835, 52.8%). Most procedures (n = 1261, 79.8%) were emergent, and laparotomies (n = 538, 34.1%). The mortality and pulmonary complication rates were 11.0 and 39.5%, respectively. Independent predictors of mortality included age â„70 years (odds ratio 2.46, 95% confidence interval [1.65-3.69]), male sex (2.26 [1.53-3.35]), ASA grades 3-5 (3.08 [1.60-5.95]), emergent surgery (2.44 [1.31-4.54]), malignancy (2.97 [1.58-5.57]), respiratory comorbidities (2.08 [1.30-3.32]), and higher Revised Cardiac Risk Index (1.20 [1.02-1.41]). While statewide elective cancelation orders were not associated with a lower mortality, a sub-analysis showed it to be associated with lower mortality in those who underwent elective surgery (0.14 [0.03-0.61]).
Conclusions: Patients with perioperative SARS-CoV-2 infection have a significantly high risk for postoperative complications, especially elderly males. Postponing elective surgery and adopting non-operative management, when reasonable, should be considered in the USA during the pandemic peaks