Air pollutants such as NO2 and PM2.5 have consistently been linked to mortality, but only few previous studies have addressed associations with long-term exposure to black carbon (BC) and ozone (O3).
...We investigated the association between PM2.5, PM10, BC, NO2, and O3 and mortality in a Danish cohort of 49,564 individuals who were followed up from enrollment in 1993–1997 through 2015. Residential address history from 1979 onwards was combined with air pollution exposure obtained by the state-of-the-art, validated, THOR/AirGIS air pollution modelling system, and information on residential traffic noise exposure, lifestyle and socio-demography.
We observed higher risks of all-cause as well as cardiovascular disease (CVD) mortality with higher long-term exposure to PM2.5, PM10, BC, and NO2. For PM2.5 and CVD mortality, a hazard ratio (HR) of 1.29 (95% CI: 1.13–1.47) per 5 μg/m3 was observed, and correspondingly HRs of 1.16 (95% CI: 1.05–1.27) and 1.11 (95% CI: 1.04–1.17) were observed for BC (per 1 μg/m3) and NO2 (per 10 μg/m3), respectively. Adjustment for noise gave slightly lower estimates for the air pollutants and CVD mortality. Inverse relationships were observed for O3. None of the investigated air pollutants were related to risk of respiratory mortality. Stratified analyses suggested that the elevated risks of CVD and all-cause mortality in relation to long-term PM, NO2 and BC exposure were restricted to males.
This study supports a role of PM, BC, and NO2 in all-cause and CVD mortality independent of road traffic noise exposure.
•Higher exposure to PM2.5, PM10, NO2 and black carbon was associated with mortality.•Associations of air pollutants and CVD mortality were independent of noise exposure.•O3 exposure was not associated with increased mortality risk.
•Primary carbonaceous particle and SOA exposure was associated with mortality.•Primary carbonaceous particle and SIA exposure was associated with CVD mortality.•Sea salt exposure was not associated ...with increased mortality risk.
Studies on health effects of long-term exposure to specific PM2.5 constituents are few. Previous studies have reported an association between black carbon (BC) exposure and cardiovascular diseases (CVD) and a few studies have found an association between sulfate exposure and mortality. These studies, however, relied mainly on exposure data from centrally located air-monitoring stations, which is a crude approximation of personal exposure.
We focused on specific chemical constituents of PM2.5, i.e. elemental and primary organic carbonaceous particles (BC/OC), sea salt, secondary inorganic aerosols (SIA, i.e. NO3–, NH4+, and SO42-), and secondary organic aerosols (SOA), in relation to all-cause, CVD and respiratory disease mortality.
We followed a Danish cohort of 49,564 individuals from enrollment in 1993–1997 through 2015. We combined residential address history from 1979 onwards with mean annual air pollution concentrations obtained by the AirGIS air pollution modelling system, lifestyle information from baseline questionnaires and socio-demography obtained by register linkage.
During 895,897 person-years of follow-up, 10,193 deaths from all causes occurred – of which 2319 were CVD-related and 870 were related to respiratory disease. The 15-year time-weighted average concentrations of PM2.5, BC/OC, sea salt, SIA and SOA were 13.8, 2.8, 3.4, 4.9, and 0.3 µg/m3, respectively. For all-cause mortality, a higher risk was observed with higher exposure to PM2.5, BC/OC and SOA with adjusted hazard ratios of 1.03 (95% confidence intervals: 1.01, 1.05), 1.06 (1.03, 1.09), and 1.08 (1.03, 1.13) per interquartile range, respectively. The associations for BC/OC and SOA remained after adjustment for PM2.5 in two-pollutant models. For CVD mortality, we observed elevated risks with higher exposure to PM2.5, BC/OC and SIA. The results showed no clear relationship between sea salt and mortality.
In this study, we observed a relationship between long-term exposure to PM2.5, BC/OC, and SOA and all-cause mortality and between PM2.5, BC/OC, and SIA and CVD mortality.
•Air pollution, traffic noise and lack of green space have been associated with diabetes in analyses mainly focusing on one or two environmental factors at a time.•We aimed to investigate if air ...pollution, road traffic noise and green space are independent risk factors of type 2 diabetes.•In a multi-pollutant analysis, ultrafine particles, NO2, noise at both most and least exposed façade and two proxies of lack of green space were all associated with higher risk of type 2 diabetes.•The cumulative risk estimate of the multi-pollutant analysis was much higher than the risk estimate of any single pollutant.
Air pollution, road traffic noise and lack of greenness coexist in urban environments and have all been associated with type 2 diabetes. We aimed to investigate how these co-exposures were associated with type 2 diabetes in a multi-exposure perspective.
We estimated 5-year residential mean exposure to fine particles (PM2.5), ultrafine particles (UFP), elemental carbon (EC), nitrogen dioxide (NO2) and road traffic noise at the most (LdenMax) and least (LdenMin) exposed facade for all persons aged > 50 years living in Denmark in 2005 to 2017. For each air pollutant, we estimated total concentrations and traffic contributions. Based on land use maps, we estimated proportion of green and non-green space within 150 and 1000 m of all residences. In total, 1.9 million persons were included and 128,358 developed type 2 diabetes during follow-up. We performed analyses using Cox proportional hazards models, with adjustment for individual and neighborhood-level sociodemographic co-variates.
In single-pollutant models, all air pollutants, noise and lack of green space were associated with higher risk of diabetes. In two-, three- and four-pollutant analyses of the air pollutants, only UFP and NO2 remained associated with higher diabetes risk in all models. LdenMax, LdenMin and the two proxies of green space remained associated with diabetes in two-pollutant models of, respectively, noise and green space. In a multi-pollutant analysis, we found hazard ratios (95 % confidence intervals) per interquartile range of 1.021 (1.005; 1.038) for UFP, 1.012 (0.996; 1.028) for NO2, 1.022 (1.012; 1.033) for LdenMin, 1.013 (1.004; 1.022) for LdenMax, and 1.038 (1.031; 1.044) and 1.018 (1.010; 1.025) for lack of green space within, respectively, 150 m and 1000 m, and a cumulative risk index of 1.131 (1.113; 1.149).
Air pollution, road traffic noise and lack of green space were independently associated with higher risk of type 2 diabetes.
Functional characterization of metagenomic DNA often involves expressing heterologous DNA in genetically tractable microorganisms such as
Escherichia coli
. Functional expression of heterologous ...genes can suffer from limitations due to the lack of recognition of foreign promoters or presence of intrinsic terminators on foreign DNA between a vector-based promoter and the transcription start site. Anti-terminator proteins are a possible solution to overcome this limitation. When bacteriophage lambda infects
E. coli
, it relies on the host transcription machinery to transcribe and express phage DNA. Lambda anti-terminator protein Q (λQ) regulates the expression of late-genes of phage lambda.
E. coli
RNA polymerase recognizes the P
R
' promoter on the lambda genome and forms a complex with λQ, to overcome the terminator t
R
'. Here we show the use of λQ to efficiently transcribe a capsular polysaccharide cluster,
cps3
, from
Lactobacillus plantarum
containing intrinsic terminators in
Escherichia coli
. In addition, we expand the use of anti-terminator λQ in
Pseudomonas putida
. The results show ~ fivefold higher expression of a fluorescent reporter located ~ 12.5kbp downstream from the promoter, when the transcription is driven by P
R
' promoter in presence of λQ compared to a lac promoter. These results suggest that λQ could be used in metabolic engineering to enhance expression of heterologous DNA.
•Air pollution during pregnancy associated with telomere length (TL) in newborns.•Second trimester air pollution positively associated with umbilical cord blood TL.•Third trimester air pollution ...inversely associated with umbilical cord blood TL.•Air pollution at home and work show similar association with umbilical cord blood TL.•No association between air pollution and TL in placenta or maternal blood.
Telomere length (TL) is a biomarker of biological aging that may be affected by prenatal exposure to air pollution. The aim of this study was to assess the association between prenatal exposure to air pollution and TL in maternal blood cells (leukocytes), placenta and umbilical cord blood cells, sampled immediately after birth in 296 Danish mother-child pairs from a birth cohort. Exposure data was obtained using the high-resolution and spatial–temporal air pollution modeling system DEHM-UBM-AirGIS for PM2.5, PM10, SO2, NH4+, black carbon (BC), organic carbon (OC), CO, O3, NO2, and NOx at residential and occupational addresses of the participating women for the full duration of the pregnancy. The association between prenatal exposure to air pollutants and TL was investigated using distributed lag models. There were significant and positive associations between TL in umbilical cord blood cells and prenatal exposure to BC, OC, NO2, NOx, CO, and O3 during the second trimester. TL in umbilical cord blood was significantly and inversely associated with prenatal exposure to PM2.5, BC, OC, SO2, NH4+, CO and NO2 during the third trimester. There were similar inverse associations between TL from umbilical cord blood cells and air pollution exposure at the residential and occupational addresses. There were weaker or no associations between air pollution exposure and TL in placenta tissue and maternal blood cells. In conclusion, both the second and third trimesters of pregnancy are shown to be sensitive windows of exposure to air pollution affecting fetal TL.
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•Mixed-effect model predictions showed hyperlocal variation of air pollution in urban settings.•First time that UFP map has been created with measurements on all street ...segments.•Hotspot and ratio analyses revealed differences in spatial variation between BC, NO2 and UFP.•May helps policymakers by zooming into the areas of interest and adapt urban topography.•May helps epidemiologists to differentiate between the health effects of pollutants.
Hyperlocal air quality maps are becoming increasingly common, as they provide useful insights into the spatial variation and sources of air pollutants. In this study, we produced several high-resolution concentration maps to assess the spatial differences of three traffic-related pollutants, Nitrogen dioxide (NO2), Black Carbon (BC) and Ultrafine Particles (UFP), in Amsterdam, the Netherlands, and Copenhagen, Denmark. All maps were based on a mixed-effect model approach by using state-of-the-art mobile measurements conducted by Google Street View (GSV) cars, during October 2018 – March 2020, and Land-use Regression (LUR) models based on several land-use and traffic predictor variables.
We then explored the concentration ratio between the different normalised pollutants to understand possible contributing sources to the observed hyperlocal variations. The maps developed in this work reflect, (i) expected elevated pollution concentrations along busy roads, and (ii) similar concentration patterns on specific road types, e.g., motorways, for both cities. In the ratio maps, we observed a clear pattern of elevated concentrations of UFP near the airport in both cities, compared to BC and NO2.
This is the first study to produce hyperlocal maps for BC and UFP using high-quality mobile measurements. These maps are important for policymakers and health-effect studies, trying to disentangle individual effects of key air pollutants of interest (e.g., UFP).
Endoscopic retrograde cholangiopancreatography is an advanced investigation both diagnostically and therapeutically. It does need expertise and simultaneously a complete setup with the appropriate ...equipment, staff and radiological backup.1 The choice of the patients has to be spot on as the procedure does come up with complications like any other one including post-ERCP pancreatitis that can be bothersome to treat and challenging even for experienced gastroenterologists.2 The hospital stay is much longer sometimes with patients needing more scrutiny by the attending physician as resultant cholangitis is very troublesome and agonising for the patient needing antibiotics. 2The rising fever and increase in inflammatory markers take days to settle. . So prevention is better than cure in a sense that misery of both the patient and doctor can be avoided.
It’s a common observation that most young gastroenterologists are more inclined towards learning ERCP.3 This is very encouraging keeping in mind there is a deficiency of skills, especially in peripheries. The problem is that eagerness to learn such advanced procedures has kept them out of the loop and rather deviated them from the basics of gastroenterology and hepatology because they tend to forget the theoretical knowledge and core concepts which are inevitably essential prerequisites for an emerging expert.2 Most ERCPS is done after a detailed workup and as a follow-up the investigation after magnetic resonance pancreatography, (MRCP) which is a non-invasive investigation for finding the cause of deranged liver function and dilated common bile duct on ultrasound abdomen for gallstones.4 Its better not to rely on a single US abdomen report if the clinical picture is different. It’s more appropriate to repeat it and go for an ERCP if the situation demands .This all comes with experience after seeing so many patients presenting with different forms and manifestations.
The biggest dilemma is that most of the specialists do ERCPs directly without doing non-invasive investigations and that is when the clinical judgement of a physician is compromised and there is an increased risk of complications such as pancreatitis and perforation. The overall risk of PEP risk is 9.7% which can rise to over 14.7% in high-risk patients especially those with sphincter of Oddi dysfunction and a previous history of pancreatitis.5 It’s a better and safer approach to weigh the benefits vs. complications. Merely complications and giving reasons aren’t enough. One needs to own them as well by managing on time and counselling the patients why did they happen in the first place as there is element of colossal trust between the patient and attending physician that need to be kept
As gastroenterologists we struggle with simple interpretation of deranged liver function tests rarely making wrong diagnosis by going for fancy investigations acquired from the books. There is lack of thought and wisdom at same time resulting in wastage of time and resources. The thing which arouses our curiosity is therapeutics and interventional endoscopies all the time. That shouldn’t be the aim all the time though necessary for progression of our careers. There are so many other aspects of gastroenterology that we need to focus. EASL guidelines of management of hepatitis B and C are published quite frequently. 6Every year there is an update on other diseases as well such as Barret Esophagus and Gastroesophageal Reflux Disease.7 There are innovative articles reflecting the latest trends in gastroenterology published all the time. One needs to focus on reading them and acquire the basics of subject before advancing and applying them in real clinical scenarios. These scenarios are quite tricky when it comes to diagnosis and same is the case in post graduate exams with trainees failing them quite frequently .There has to be more emphasis on ward rounds and learning from scenarios in case based discussions. Simulation is a powerful learning method in medical education that can be used in clinical settings.8Similarly one has to observe the procedures,assist,perform under supervision and then doing them independently once your mentor is confident enough about the skills acquired over the period of time.
There are many areas of our subject on which we need to focus ranging from acute hepatitis to hepatocellular carcinoma.9 What we need to realise is that ERCP and EUS are advanced aspects of gastroenterology but that isn’t the end of the journey or the road. The eyes can’t see what the mind doesn’t know. There needs to be greater emphasis on the basics of gastroenterology enabling us to diagnose the patients promptly and refer the right ones for endoscopy, colonoscopy, endoscopic ultrasound, fibro scan, liver biopsy and even ERCP.10
Learning skills in a state of art of facility is must but one has to have a solid theoretical knowledge and application of it into appropriate clinical situation requiring sound clinical reasoning, critical thinking and problem solving skill.11 There are no shortcuts to experience and no stop to learning as well. It’s worth learning in a good setup with compassionate seniors and letting the time teach you the best. Hard work is the key to success and learning can’t be overnight. One has to be devoted to a cause as that is always rewarded and people working strenuously and continuous are winners eventually .The important thing is patience which most of us lack. All excellent clinicians were not made in a single day. They too went through the process of learning just like us .Some of us learn faster than others which shouldn’t matter as slow and steady wins the race. No book or can teach you practical skills and vice versa. The skills have to be learnt properly as today you are a trainee and in future a fully fledged supervisor training so many residents. There is always a ray of hope and lightening at the end of the tunnel. As long as there is a desire and eagerness to learn from others, it will bear fruits of learning in the long run. It’s wiser not to get disappointed on a single mistake in any procedure including ERCP as long you learn from that by analysing it carefully with an intention and a strong will not to repeat in future.
Introduction and aim Medication errors (MEs) pose a severe threat in the medical field. Since such errors are preventable, it is paramount for all healthcare workers to be educated on the matter. ...This study aimed to assess medical interns' attitudes and knowledge of medication safety and errors. We also aimed to validate current university programs to educate students about medication safety and errors. Methods A cross-sectional study that utilized a self-administered online questionnaire comprised 31 questions. The questionnaire was distributed via social media networks, such as WhatsApp, Twitter, email, Instagram, and Snapchat among 100 medical, pharmacy, and nursing interns in Saudi Arabia. The study population included both Saudi and non-Saudi interns. Results The majority of participants, comprising 92% (n=92), indicated that they were familiar with the definition of medication errors (ME). Additionally, 85% (n=85) expressed their willingness to report instances of MEs when medications were not prescribed but required. Moreover, 90% (n=90) of the surveyed individuals expressed their willingness to report MEs in situations where patients did not receive medications as prescribed. In cases where patients experienced harm and required treatment due to an ME, 91% (n=91) of respondents committed to reporting such incidents. A total of 52 (52%) respondents stated that they would report MEs regardless of whether they reached/harmed the patient. A good ME knowledge level was observed in 48% of respondents. A higher likelihood of good ME knowledge was significantly associated with safety reporting system (SRS) awareness and reporting MEs regardless of whether they reached/harmed the patient (p<0.05). College, awareness/attitude, or other demographic factors were not significantly related to ME knowledge (p>0.05). Conclusion This study showed that although interns in the healthcare field do have some knowledge about MEs, there is still a significant need to improve their knowledge. This can be achieved through various ways, one of which is by implementing this topic into the university curricula.
To verify the analytical performance of cobas® HBV PCR and cobas® HCV PCR assays with Abbott m2000 RealTime System as the reference method.
De-identified residual, archived patient specimens, and ...College of American Pathologists (CAP) proficiency testing samples were used. Analytical parameters verified were accuracy, precision, limit of detection (LOD), linear range, and cross-contamination. Experiments were designed in accordance with Clinical Laboratories Standards Institute (CLSI) guidelines and CAP standards. Analysis of accuracy was done through regression plots and Bland Altman analyses. Precision was analyzed through coefficient of variation and ANOVA; LOD through probit analysis; and linear range through polynomial fit analysis.
The regression plots for accuracy showed a slope nearing 1, with a y-intercept close to zero, while Bland Altman analyses also showed no systematic evidence of bias, though concordance of results was not perfect near the lower limit of quantification. Coefficients of variation were all below 15%, while ANOVA returned p-values above 0.99, indicating no statistically significant imprecision. The LOD verified were an order of magnitude higher than the manufacturer reported ones for both assays, while the linear range verified was more limited. Within the verified range, polynomial fit analysis showed line to be the best fit for the data.
cobas® HBV PCR and cobas® HCV PCR assays showed acceptable accuracy, acceptable precision, as well as no evidence of cross-contamination. The LOD verified were higher, and linear ranges more limited than those reported by the manufacturer. Verifications of these may be limited by availability of appropriate testing specimens.
•No systematic bias was found between Roche cobas® 6800 against Abbott m2000 for HBV and HCV PCR.•Imprecision of cobas® HBV and cobas® HCV PCR was within acceptable limits.•Manufacturer-reported LOD remained unverified, perhaps limited by testing material types.•Linearity of cobas® HBV and cobas® HCV PCR was verified for a more limited range.
Fatty liver is nothing new when it comes to gastroenterology practice. In fact it is the most common finding on routine ultrasound scans while performing it for any other clinical indication. We do ...see a large number of patients having deranged liver function tests undergoing assessment by experienced physicians. Extensive workup is not futile and can add to the satisfaction of the doctor and patient concerned but sometimes it’s exhaustive. There has been a considerable advancement in management of NAFLD; it still remains physician’s worst nightmare especially when there is transformation to full blown cirrhosis and its devastating complications.
Obesity, diabetes and hypertriglyceridemia are found inevitably with NAFLD forming metabolic syndrome do add fuel to the fire as far as treating such patients are concerned . They are integral parts of metabolic syndrome which itself can lead to disastrous complications. One of the most vital segments of NAFLD management is weight loss which doesn’t have to be vigorous rather a more steadfast approach with patience is needed. Convincing an obese patient for losing weight is a daunting task as his metabolic demands are entirely different from a normal weight or a thin lean individual.
Distinction between Alcoholic Liver Disease and NALFD is not merely based on interpretation of liver function tests. The ALT and AST ratio does help but isn’t definitive. Many physicians do advise abstinence from alcohol as main treatment modality for alcoholic liver disease yet it becomes conspicuously difficult to manage them once the history of alcohol use is for decades. When nothing works, liver biopsy is a last resort showing classical pathological changes for both the diseases. That too requires experienced pathologist and sometime a second examination of the slide is needed as well.
There is a need for multi-disciplinary approach for management NALFLD. There needs to be a close collaboration between hepatologist, dieticians and endocrinologists especially in case of metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) has quite high prevalence of about 25% in western countries. Patients at the greatest risk are those with obesity and type 2 diabetes mellitus. In 2019 the American Diabetes Association guidelines called, for the first time, for clinicians to screen for steato hepatitis and fibrosis all patients with type 2 diabetes and liver steatosis or abnormal plasma amino transferees. Merely screening isn’t enough. Rather more robust approach is required with target oriented results.
The choice of treatment and sound clinical judgement will matter a lot. Weight loss in combination with antidiabetic drugs Iike pioglitazone have been found to reverse fibrosis and slow down the progression of disease. The role of vitamin E is also of paramount importance. The biggest dilemma is that patient with NALFD are symptomatic in the beginning with no clues whatsoever. Early diagnosis and treatment are the keys. It’s also mandatory for general physicians to refer the patients to gastroenterologists. NALFLD has raised a colossal uproar in the world over the last few years. Burnout NASH is another culprit that has raised alarms in the gastroenterology world. Being the 2nd most common cause of liver transplantation is a serious enough reason for all the medics in general and hepatologists to act vigilant and not be complacent about it.
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