Elevated drinking water manganese and fetal and child health and development

Manganese (Mn) is an essential element that functions as a cofactor in the metabolism of carbohydrates and proteins, and it is also incorporated in antioxidants such as superoxide dismutase. In general, intake of Mn mainly occurs via food. Additional or excess exposure might occur via drinking water, as elevated concentrations of Mn in ground water are prevalent worldwide. In recent years, several studies have shown associations between Mn concentrations in drinking water and adverse health effects in children. A few studies have concerned early-life exposure, but these have mostly been cross sectional in design or with a very short follow-up of the children. Prospective studies which follow the children from early intrauterine life to childhood and explore associated adverse effects are lacking. The overall aim of the present thesis was to assess the potential effects of Mn exposure via drinking water during pregnancy and early-life on fetal outcomes (spontaneous abortion and perinatal mortality), size at birth, and child development (cognitive function and behavior). These prospective cohort studies were nested in a population-based trial involving food and micronutrient supplementation (Maternal and Infant Nutrition Interventions in Matlab; MINIMat), conducted from November 2001 to October 2003, in 4,436 pregnant women in Matlab, Bangladesh. A subsample of the children born within the MINIMat trial was selected for longitudinal follow-up of growth and development until 10 years of age. In Matlab, 70% of the drinking water wells contained high concentration of arsenic (>10 µg/L, mostly in shallow wells), a potent toxicant and carcinogen. To reduce the exposure to arsenic the inhabitants were recommended to install deeper wells. Later we revealed that over 40% of the wells (mainly deeper well >50 m), contained >400 µg Mn/L (previous WHO guideline value). The Mn exposure in the present studies was assessed by the concentrations in drinking water used by the mothers during pregnancy and by the children at 5 and 10 years of age, and measured by inductively coupled plasma mass spectrometry. The median water Mn concentration has increased from about 200 µg/L during pregnancy to 339 µg/L when the children were 10 years old, whereas the arsenic concentrations decreased (median from 33 to 2.3 µg/L) during the same period. This is probably due to the ongoing installation of deeper wells. In early pregnancy (n=1,875), women in the highest tertile of water Mn concentrations (median=1,292 µg/L) had an approximately 35% reduced risk (Odds Ratio = 0.65, 95% CI 0.43, 0.99) of spontaneous abortion, compared with women in the lowest tertile (median=56 µg/L). This is possibly related to the role of Mn in the placental antioxidant defense. Elevated water Mn concentrations were not related to any increased risk of perinatal mortality. The newborns (n=1,177) to mothers in the highest tertile of water Mn (median=1,495 µg/L) were on average 0.5 cm shorter (0.20 SD) compared to those in the lowest tertile (median 56 µg/L). The association was strongest in the girls, but apparent also in the boys of mothers with low hemoglobin (Hb) values (<114 g/L), likely due to higher absorption of Mn at low iron status. The findings indicate that elevated levels of Mn in drinking water during pregnancy may impair fetal growth. The association between erythrocyte Mn concentrations and size at birth was less apparent. The prenatal Mn exposure, but not the postnatal, was associated with aggravation of the difficult behavior at 10 years of age (n=1,295). For each increase of one mg Mn/L, the difficult behavior scores increased by 0.5 points (0.13 SD) in boys and 0.7 points (0.18 SD) in girls of mothers with anemia (Hb<110 g/L). Associations of water Mn (especially at 5 years) with boys´ cognitive function were generally inverse (effect size ~0.15 SD per mg/L of water Mn). In girls, there was a positive association of maternal water Mn below 3 mg/L with cognitive function and pro-social behavior. However, a tendency of inverse associations with cognitive function were observed at higher Mn concentrations (>3 mg/L) and in girls of mothers with anemia. Early-life appeared to be a particularly susceptible period to inverse effects on development by elevated water Mn concentrations, although the effect differed by outcome, time-point of exposure and child gender. In conclusion, the Mn concentrations in well water varied widely. Elevated concentrations during pregnancy appeared to be protective for early fetal loss. On the other hand, the exposure during pregnancy decreased fetal growth and impaired the children´s cognitive function and worsened their difficult behavior, especially in children of anemic women. Thus, Mn concentration in drinking water is an important public health concern worldwide. However, in arsenic contaminated areas, the benefit of deep wells with less arsenic is most likely higher than the modest adverse effects of Mn. In order to reduce the exposure to arsenic and Mn through well water, screening for both elements by sediment color tools could be done during installation of new wells, as well as digging wells in aquifers that are low in both arsenic and Mn (deeper than 100 m). As Mn absorption tends to be higher in anemic women, existing routine programs, including assessment of anemia during pregnancy and supplementation with iron and folic acid, should be strengthened. Also, screening and treating children with anemia can be proposed as an important public health intervention

Association of sickle cell disease with anthropometric indices among under-five children: evidence from 2018 Nigeria Demographic and Health Survey

Background: Malnutrition continues to affect under-five children in Africa to an overwhelming proportion. The situation is further compounded by the burden of sickle cell disease (SCD). However, association of SCD with stunting, wasting, and underweight in a nationally representative sample of under-five children remains unexplored.We aimed to describe prevalence of undernutrition by sickle cell status, to evaluate its association with growthfaltering ascertained by anthropometric indices, and to explore mediating role of hemoglobin. Methods: We availed data from the 2018 Nigeria Demographic and Health Survey (DHS) and the sample comprised 11,233 children aged 6–59 months who were successfully genotyped for SCD. The DHS employeda two-stage, stratified sampling strategy. SickleSCAN rapid diagnostic test was used for SCD genotyping. Zscoresof length/height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ) were computedagainst the 2006 World Health Organization Child Growth Standards. We fitted logistic regression models to evaluate association of SCD with stunting, wasting, and underweight. Mediation analysis was performed tocapture the indirect effect of and proportion of total effect mediated through hemoglobin level in SCD-anthropometric indices association. Results: Prevalences of stunting, wasting, and underweight among children with SCD were 55.4% (54.5–56.4), 9.1% (8.6–9.7), and 38.9% (38.0–39.8), respectively. The odds of stunting were 2.39 times higher (adjusted odds ratio (aOR) 2.39, 95% CI:1.26–4.54) among sickle children than those with normal hemoglobin. SCD was also significantly associated withunderweight (aOR 2.64, 95% CI: 1.25–5.98), but not with wasting (aOR: 1.60, 95% CI 0.85–3.02). Association of SCD with all three anthropometric indices was significantly mediated through hemoglobin level: for SCD-HAZ, the adjusted indirect effect(aIE) was − 0.328 (95% CI: − 0.387, − 0.270); for SCD-WHZ, the aIE was − 0.080 (95% CI: − 0.114, − 0.050); and for SCD-WAZ, the aIE was − 0.245 (95% CI: − 0.291, − 0.200). Conclusion: We presented compelling evidence of the negative impact of SCD on anthropometric indices of nutritional status of under-five children. Integration of a nutrition-oriented approach into a definitive SCD care package and its nationwide implementation could bring promising results by mitigating the nutritional vulnerability of children with SCD

Kinetic Study and Thermal Decomposition Behavior of Lignite Coal

A thermogravimetric analyzer was employed to investigate the thermal behavior and extract the kinetic parameters of Canadian lignite coal. The pyrolysis experiments were conducted in temperatures ranging from 298 K to 1173 K under inert atmosphere utilizing six different heating rates of 1, 6, 9, 12, 15, and 18 K min−1, respectively. There are different techniques for analyzing the kinetics of solid-state reactions that can generally be classified into two categories: model-fitting and model-free methods. Historically, model-fitting methods are broadly used in solid-state kinetics and show an excellent fit to the experimental data but produce uncertain kinetic parameters especially for nonisothermal conditions. In this work, different model-free techniques such as the Kissinger method and the isoconversional methods of Ozawa, Kissinger-Akahira-Sunose, and Friedman are employed and compared in order to analyze nonisothermal kinetic data and investigate thermal behavior of a lignite coal. Experimental results showed that the activation energy values obtained by the isoconversional methods were in good agreement, but Friedman method was considered to be the best among the model-free methods to evaluate kinetic parameters for solid-state reactions. These results can provide useful information to predict kinetic model of coal pyrolysis and optimization of the process conditions

Relationship of Anthropometric Indicators of General and Abdominal Obesity with Hypertension and Their Predictive Performance among Albanians: A Nationwide Cross-Sectional Study

Anthropometric indicators of general and abdominal obesity can predict cardiovascular disease outcomes. Their performance in predicting hypertension (HTN) varies across populations. We aimed to analyze the relationship of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (CI) with HTN, to examine their predictive performance and to determine their optimal cut-offs in a nationally representative sample of Albanians aged 15–59 years (n = 20,635). Logistic regression models were fitted and sex-specific receiver-operating characteristic (ROC) curves were constructed. The indicators were positively associated with HTN. Sex modified the relationships, as associations appeared significantly stronger among females than males in the highest categories of the indicators. The area under ROC curves (AUCs) for BMI were 0.729 (95% confidence interval (CI): 0.720–0.738) among females and 0.648 (95% CI: 0.633–0.663) among males, and AUCs for WHtR were 0.725 (95% CI: 0.716–0.734) among females and 0.637 (95% CI: 0.622–0.652) among males. However, the AUCs for BMI and WHtR did not differ significantly among females (p = 0.279) and males (p = 0.227). BMI outperformed WC and CI in both sexes. The optimal BMI cut-offs were 27.0 kg/m2 among females and 25.6 kg/m2 among males, and that for WHtR were 0.53 among females and 0.54 among males. BMI and WHtR demonstrated similar discriminatory power, and the identified cut-offs may inform initiatives for structured HTN screening in Albania

Dietary patterns and indicators of cardiometabolic risk among rural adolescents: A cross-sectional study at 15-year follow-up of the MINIMat cohort

BackgroundDiet being a modifiable factor, its relationship with cardiometabolic risk is of public health interest. The vast majority of studies on associations of dietary patterns with cardiometabolic risk indicators among adolescents are from high-income countries and urban settings. We sought to describe dietary patterns and examine their associations with selected cardiometabolic risk indicators–waist circumference (WC), systolic blood pressure, fasting lipid profile and insulin resistance–along with its gender stratification among adolescents in a low-income, rural setting.MethodsThis cross-sectional study utilized data from the 15-year follow-up of the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort in southeast Bangladesh. The children who were born as singletons to the mothers randomized in the MINIMat trial and had valid birth anthropometrics were eligible for the follow-up. We employed a single, qualitative 24-hour recall to assess diet. Dietary patterns were derived from simple K-means cluster analysis, and calculation of dietary diversity score (DDS) using a validated instrument. Anthropometric parameters and systolic blood pressure were recorded. Fasting plasma triglyceride, total cholesterol, low- and high-density lipoproteins, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Three right-skewed outcome variables were natural log (Ln) transformed: WC, triglyceride and HOMA-IR. Omnibus and gender-specific multiple linear regression models were fitted.ResultsAmong 2,253 adolescents (52.1% girls, 7.1% overweight/obese), we identified four diet clusters: Traditional, Fish-dominant, Meat-dominant, and High-variety. No significant associations were found between the clusters and indicators. On gender-stratification, triglyceride levels were lower among boys in the Fish-dominant (Ln-triglyceride βadjusted: −0.09; 95% confidence interval (CI): −0.15, −0.02) and Meat-dominant (Ln-triglyceride βadjusted: −0.08; 95% CI: −0.15, −0.004) clusters than among boys in the Traditional cluster. Compared to boys in the bottom quartile of DDS, boys in the top quartile had 2.1 mm of Hg (95% CI: 0.5, 3.6) higher systolic blood pressure and 1.9% (95% CI: 0.01–3.8%) higher WC.ConclusionWhile statistically significant, the gender-specific differences in triglyceride, systolic blood pressure, and waist circumference across dietary patterns were small. Associations between dietary patterns and cardiometabolic risk indicators may require a time lag beyond mid-adolescence to manifest in a rural setting. Prospective studies are warranted to delineate the magnitude and direction of those associations

Community-based Health Workers Achieve High Coverage in Neonatal Intervention Trials: A Case Study from Sylhet, Bangladesh

A large proportion of four million neonatal deaths occur each year during the first 24 hours of life. Research is particularly needed to determine the efficacy of interventions during the first 24 hours. Large cadres of community-based workers are required in newborn-care research both to deliver these interventions in a standardized manner in the home and to measure the outcomes of the study. In a large-scale community-based efficacy trial of chlorhexidine for cleansing the cord in north-eastern rural Bangladesh, a two-tiered system of community-based workers was established to deliver a package of essential maternal and newborn-care interventions and one of three umbilical cord-care regimens. At any given time, the trial employed approximately 133 community health workers—each responsible for 4–5 village health workers and a population of approximately 4,000. Over the entire trial period, 29,760 neonates were enrolled, and 87% of them received the intervention (their assigned cord-care regimen) within 24 hours of birth. Approaches to recruitment, training, and supervision in the study are described. Key lessons included the importance of supportive processes for community-based workers, including a strong training and field supervisory system, community acceptance of the study, consideration of the setting, study objectives, and human resources available

Antibiotic susceptibility pattern of fish pathogens : A new approach of emerging the bacterial resistance through biofilm formation in in-vitro condition

Background: The ability of many bacteria to adhere on the host surfaces and forming biofilms has major implications in a wide variety of industries including the food industry, where biofilms may create a persistent source of contamination. In the same environmental condition, the multiple bacterial species can closely interact with each other and may easily enhance their drug resistance capability, which finally increases the multidrug resistant (MDR) attribute of the species. Objective: The present study examined whether the mixed-species biofilm possesses any impact on the enhancement of the antibiotic resistance of the planktonic or single-cell bacterial isolates present in the fish samples. Methods: In this regard, Cyprinus rubrofuscus (Koi), Heteropneustes fossilis (Shing) and Mystus vittatus (Tengra) fishes were collected and subjected to form an in vitro biofilm by shaking condition into the wise bath. The drug-resistant pattern was determined by the Kirby Bauer technique. Results: All the samples exhibited a huge array (up to 10(7) cfu/ml or g) of bacteria such as E. coli, Klebsiella spp., Vibrio spp., Salmonella spp., Proteus spp. and Staphylococcus spp. The isolates from both the bulk samples and their corresponding biofilms were subjected to antibiogram assay using antibiotics such as Ampicillin (10 mu g), Erythromycin (15 mu g), Streptomycin (STP 10 mu g), Oxacillin (10 mu g), Nalidixic acid (30 mu g). Before biofilm formation, few of the isolates were found to be sensitive and few were resistant against the antibiotics. But when the species were isolated from the biofilm the sensitive one acquired drug resistance and resistant strain unveiled more resistance towards the same antibiotics. The present study revealed extensive bacterial contamination in fish samples among those some were resistant against the supplied drugs. Conclusion: After the formation of multi-species biofilm, the isolates became more resistant against the same drugs that is alarming for consumers and major obstacles to maintain sustainable health. (C) 2021 The Authors. Published by Elsevier B.V. on behalf of King Saud University.Peer reviewe

Community-based Health Workers Achieve High Coverage in Neonatal Intervention Trials: A Case Study from Sylhet, Bangladesh

A large proportion of four million neonatal deaths occur each year during the first 24 hours of life. Research is particularly needed to determine the efficacy of interventions during the first 24 hours. Large cadres of community-based workers are required in newborn-care research both to deliver these interventions in a standardized manner in the home and to measure the outcomes of the study. In a large-scale community-based efficacy trial of chlorhexidine for cleansing the cord in north-eastern rural Bangladesh, a two-tiered system of community-based workers was established to deliver a package of essential maternal and newborn-care interventions and one of three umbilical cord-care regimens. At any given time, the trial employed approximately 133 community health workers-each responsible for 4-5 village health workers and a population of approximately 4,000. Over the entire trial period, 29,760 neonates were enrolled, and 87% of them received the intervention (their assigned cord-care regimen) within 24 hours of birth. Approaches to recruitment, training, and supervision in the study are described. Key lessons included the importance of supportive processes for community-based workers, including a strong training and field supervisory system, community acceptance of the study, consideration of the setting, study objectives, and human resources available