The presence of toxic metals in popular farmed fish species and estimation of health risks through their consumption

This study concerns an assessment of essential and toxic metals (Zn, Cu, As, Cr and Cd) in some popular farm fishes which are largely consumed by the populations of the Southern region in Bangladesh. Three different species of fish (T. nilotica, P. pangasius and L. rohita) were collected from four representative farms located in the Fatickchari, Hathazari, Patiya and Raozan Upazila of Chittagong district. Flame Atomic Absorption Spectrometer (FAAS) and Graphite Furnace Atomic Absorption Spectrometer (GFAAS) were used to measure the metal concentrations. The order of concentration of metals in flesh was Zn > Cu > Cr > As > Cd with values of 16.205 +/- 0.303 > 0.874 +/- 0.037 > 0.590 +/- 0.05 >0.042 +/- 0.003 > 0.004 +/- 0.00 (mg/kg dw) in T. nilotica, 20.324 +/- 0.697 > 1.035 +/- 0.050> 0.577 +/- 0.074> 0.045 +/- 0.005 > 0.006 +/- 0.000 (mg/kg dw) in P. pangasius and 22.270 +/- 0.745 > 0.953 +/- 0.525 > 0.623 +/- 0.060 > 0.035 +/- 0.002 > 0.004 +/- 0.000 (mg/kg dw) in L. rohita. Measured data lie within the permissible limits recommended by WHO/FAO. Potential metal toxicity to human health following the consumption of the studied fishes was estimated via a number of hazard parameters: Daily intake of metal (DIM), Target hazard quotient (THQ), Hazard index (HI) and Target risk (TR), all of the data show values within the recommended level given by regulatory bodies. Estimated TR for potential carcinogenic metals As, Cr and Cd were found in the range (10_6 - 10_5), which lies within the US-EPA risk range of 10_6 - 10_4. Note that, fish consumption forms a minor part of the total diet while the US-EPA risk range is for the dietary intake from all foods. Therefore the estimated risk may not be totally neglected. Moreover, considering the non-biodegradability of toxic metals and their potential uptake in fish tissues, reduction in metal supplementation in fish feed should be introduced and periodic monitoring of fish may help to mitigate non-essential metal toxicity to consumers

Diagnostic accuracy of TI-RADS classification in differentiating benign and malignant thyroid nodules-a study from Southern Punjab, Pakistan

Background and Objective: Thyroid imaging reporting and data system (TI-RADS) is developed to determine the risk of malignancy in patients with thyroid nodules. The aim of this study was to determine the diagnostic accuracy of TI-RADS classification for diagnosing malignant thyroid nodules taking Fine needle aspiration cytology (FNAC) as a gold standard in the local population. Methods: In this cross-sectional validation study, 201 patients presenting with thyroid nodules at the Department of Radiology, Bakhtawar Amin Hospital Multan, Pakistan from July 2020 to December 2020 were included. In all patients, thyroid nodules were evaluated on grey scale (B-mode) modality. TI-RADS score was calculated for each patient. Patients with TI-RADS score 4 and 5 were labelled as having malignant nodules. After that FNAC samples were taken and sent for histopathologic evaluation of thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TI-RADS taking FNAC as a gold standard were determined. Results: The mean age of the patients was 47.8 &plusmn; 4.5 years; there were 129 (67.2%) women and 72 (35.82%) men. There were 42 patients who tested true positive and 36 patients tested false positive and 12 patients were false negative and 111 patients true negative. The TIRADS sensitivity was 77.8%, specificity was 75.5%, PPV was 53.8%, and NPV 90.2%. the diagnostic accuracy was 76.1%. Conclusion: Differentiating benign thyroid nodules from malignant using the TI-RADS score has a high diagnostic accuracy. Our study results support the TIRADS as a first-line imaging evaluation for diagnosis of thyroid malignancy.</p

Impact of COVID-19 on Pregnancy and Childbirth: A Systematic Review of Recent Evidence

Background and Objective: There is a high suspicion that SARS-CoV-2 might be transmitted vertically from mother to fetus and causes clinically significant infection. This review evaluates the pathogenesis, risk factors, diagnosis and management strategies in pregnant women suspected or confirmed with COVID-19 infection. Methods: A literature review of published articles was carried out using keywords of corona virus (and its root derivatives), pregnancy, vertical transmission and childbirth in Medline, Cochrane, CINAHL and Web of Sciences. Clinical articles including case-control, case reports, case series and reviews published between 2019 and 2020, in English language were included. Editorials and Letter to Editors were not included. Two independent authors reviewed title and abstract and another set of two independent authors screened full text. A total of 22 articles were shortlisted for addition into the final manuscript. Results: A total of 403 pregnancies were considered in the study with most of the patients in the third trimester of pregnancy. There was no maternal mortality reported in the literature, however 1.49% fetal mortality has been reported. Conclusion: Extensive care should be taken to determine the timing and mode of delivery, preparation of a safe-to-deliver labor room and the choice of anesthesia with detailed newborn observation.</p

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially