Specific Exposure Research Articles

Prenatal metal exposures and childhood gut microbial signatures are associated with depression score in late childhood

BackgroundChildhood depression is a major public health issue worldwide. Previous studies have linked both prenatal metal exposures and the gut microbiome to depression in children. However, few, if any, have studied their interacting effect in specific subgroups of children. ObjectivesUsing an interpretable machine-learning method, this study investigates whether children with specific combinations of prenatal metals and childhood microbial signatures (cliques or groups of metals and microbes) were more likely to have higher depression scores at 9–11 years of age. MethodsWe leveraged data from a well-characterized pediatric longitudinal birth cohort in Mexico City and its microbiome substudy (n = 112). Eleven metal exposures were measured in maternal whole blood samples in the second and third trimesters of pregnancy. The gut microbial abundances were measured at 9–11-year-olds using shotgun metagenomic sequencing. Depression symptoms were assessed using the Child Depression Index (CDI) t-scores at 9–11 years of age. We used Microbial and Chemical Exposure Analysis (MiCxA), which combines interpretable machine-learning into a regression framework to identify and estimate joint associations of metal-microbial cliques in specific subgroups. Analyses were adjusted for relevant covariates. ResultsWe identified a subgroup of children (11.6 % of the sample) characterized by a four-component metal-microbial clique that had a significantly high depression score (15.4 % higher than the rest) in late childhood. This metal-microbial clique consisted of high Zinc in the second trimester, low Cobalt in the third trimester, a high abundance of Bacteroides fragilis, a high abundance of Faecalibacterium prausnitzii. All combinations of cliques (two-, three-, and four-components) were significantly associated with increased log-transformed t-scored CDI (β = 0.14, 95%CI = [0.05,0.23], P < 0.01 for the four-component clique). SignificanceThis study offers a new approach to chemical-microbial analysis and a novel demonstration that children with specific gut microbiome cliques and metal exposures during pregnancy may have a higher likelihood of elevated depression scores.

Exposure to Imidacloprid under variable conditions disturbs the muscle fatty acid profile of a fresh water non target fish: Labeo rohita

Economy of Pakistan is heavily dependent upon agriculture and extensive use of pesticide is quiet common to enhance the crop yield. Imidacloprid is among the first choice pesticides in Pakistan and it has been reported that through run off along with water it ends up in water bodies affecting non target aquatic fauna. Through the present investigation, we are reporting the effects of Imidacloprid on the fatty acids composition of a non-target, commercially important carp: Labeo rohita. Fish were exposed to sub lethal concentration of Imidacloprid (120 mgL1) for 2, 4 and 8 days (short term) as well as for 16, 32 and 64 days (long term experimental conditions). Pesticide untreated controls were also maintained for each treatment. Following the specific Imidacloprid exposure, fatty acid composition (%) was determined in the muscle of all experimental groups by using gas chromatography. Fish exposed to Imidacloprid for 8 days had reduced Palmitic acid (p = 0.02) and elevated muscle Arachidic acid (p < 0.001) than control group. Labeo rohita exposed to the pesticide for 32 days had elevated muscle Oleic (p = 0.02) and Linoleic acid (p = 0.02) while fish exposed to Imidacloprid to 64 days had reduced muscle Palmitic (p = 0.04) and Oleic acid (p = 0.03). In conclusion, we are reporting that the exposure to sub lethal concentration of Imidacloprid disturb the muscle fatty acid composition of Labeo rohita that may affect its food quality. The effects were more pronounced under long term experimental conditions and were probably due to potentiating lipid peroxidation and disturbed fish metabolism upon Imidacloprid exposure.

An investigation of 3M Cordova, IL production worker's per- and polyfluoroalkyl substances biomonitoring results and mortality experience

Per- and polyfluoroalkyl substances (PFAS) are a wide-ranging group of chemicals that have been used in a variety of polymer and surfactant applications. While 3M Cordova, Illinois was not one of 3M's primary manufacturing facilities for the legacy long-chain PFAS (PFOS, PFOA, PFHxS), it has been a major manufacturing site for short-chain PFAS (compounds that are or may degrade to PFBS or PFBA). The purpose of this research focused on: 1) an analysis of biomonitoring data of employees and retirees, and 2) an analysis of the cohort mortality of workers from 1970 to 2018. Employees had higher PFBS and PFBA serum concentrations than the retirees, while retirees had higher concentrations for PFOS, PFOA, and PFHxS. Compared to the 2017–2018 NHANES data, employees’ PFOS and PFHxS concentrations in 2022 were two-fold higher, with PFOA levels comparable. These NHANES data did not include serum PFBS or PFBA. Cross-sectional trends of PFOS and PFOA levels from 1997 to 2022 showed PFOS declined from 151 ng/mL to 10.4 ng/mL. Similarly, PFOA decreased from 100 ng/mL to 1.5 ng/mL. A longitudinal analysis of 48 participants with measurements in both 2006 and 2022 showed concentrations decreased by 74% for PFOS and 90% for PFOA. In the mortality study, 1707 employees who worked 1 day or longer were followed for an average of 25.6 years and had 143 (8%) deaths. There were no significantly elevated risks for any specific cause of death, regardless of latency period (0 or 15 years). While no specific PFAS exposures were examined, worker mortality experience (1970–2018) was analyzed by major departments representing primary work areas. Employees and retirees at the Cordova facility continue to have elevated PFOS and PFHxS serum concentrations compared to the general population, however, their legacy PFAS concentrations have declined over time, consistent with the estimated serum elimination half-lives of these PFAS in humans assuming nominal ambient exposures. For PFBS and PFBA, the results indicated no long-term accumulation in the blood likely due to their short serum elimination half-lives. After nearly 50 years of follow-up, this Cordova workforce showed no increased risk of mortality from cancer or any other specific cause of death.

Probiotics in Infancy and Childhood for Food Allergy Prevention and Treatment.

Food allergy represents a failure of oral tolerance mechanisms to dietary antigens. Over the past few years, food allergies have become a growing public health problem worldwide. Gut microbiota is believed to have a significant impact on oral tolerance to food antigens and in initiation and maintenance of food allergies. Therefore, probiotics have also been proposed in this field as a possible strategy for modulating both the gut microbiota and the immune system. In recent years, results from preclinical and clinical studies suggest a promising role for probiotics in food allergy prevention and treatment. However, future studies are needed to better understand the mechanisms of action of probiotics in food allergies and to design comparable study protocols using specific probiotic strains, defined doses and exposure times, and longer follow-up periods.

Microwave Treatment of Three Different Types of Sewage Sludge Based on Their Solar Drying Exposure Time: Effect on Microorganisms, Water Content and Agronomic Aspects

This study aimed to treat sewage sludge through microwave irradiation at a laboratory scale. The objective was to investigate the effect of microwave irradiation on microorganisms, water content, organic matter, and agronomic nutrients present in sewage sludge. Three types of sewage sludges obtained from a full-scale wastewater treatment plant were considered: Sludge A (raw sludge), Sludge B (subjected to 15 days of solar exposure, achieving 48% dryness), and Sludge C (exposed to solar conditions and left open to the air for 23 months, reaching 94% dryness). These diverse sludges were exposed to microwave irradiation at various power levels (analysed variables: ε (Watts/g), θ (°C), T (min)). The specific exposure powers and temperature levels for the water reduction analysis were: 555, 955, 1355, and 1500 Watts/g and 55, 75, 95, and 105 °C, respectively. On the other hand, microbiological and agronomic nutrient analyses were conducted at 75 °C–1355 W and 95 °C–1355 W. After microwave exposure experiments, the results demonstrated the high effectiveness of microwave technology in eradicating indicator microorganisms of faecal contamination and reducing sludge volume while not affecting trace elements of significant agricultural value. The reduction in Escherichia Coli revealed that 4 min of irradiation was necessary to completely eliminate it to 0 ulog, indicating a 100% reduction, in Sludge A. In Sludges B and C, an additional 1 min was needed under conditions of 75 °C and 1355 W for a mass of 50 g. Moreover, Sludge A (46.27 × 105 or 4.80 ulog of dry matter), Sludge B (1.29 × 106 or 6.11 ulog of dry matter), and Sludge C (8.77 × 104 or 4.94 ulog of dry matter) were heavily contaminated with faecal coliforms. It took 6 min to reduce faecal coliforms to below the detection threshold.

Longitudinal gut microbiota composition of South African and Nigerian infants in relation to tetanus vaccine responses.

Infants who are exposed to HIV but uninfected (iHEU) have higher risk of infectious morbidity than infants who are HIV-unexposed and uninfected (iHUU), possibly due to altered immunity. As infant gut microbiota may influence immune development, we evaluated the effects of HIV exposure on infant gut microbiota and its association with tetanus toxoid vaccine responses. We evaluated the gut microbiota of 82 South African (61 iHEU and 21 iHUU) and 196 Nigerian (141 iHEU and 55 iHUU) infants at <1 and 15 weeks of life by 16S rRNA gene sequencing. Anti-tetanus antibodies were measured by enzyme-linked immunosorbent assay at matched time points. Gut microbiota in the 278 included infants and its succession were more strongly influenced by geographical location and age than by HIV exposure. Microbiota of Nigerian infants, who were exclusively breastfed, drastically changed over 15 weeks, becoming dominated by Bifidobacterium longum subspecies infantis. This change was not observed among South African infants, even when limiting the analysis to exclusively breastfed infants. The Least Absolute Shrinkage and Selection Operator regression suggested that HIV exposure and gut microbiota were independently associated with tetanus titers at week 15, and that high passively transferred antibody levels, as seen in the Nigerian cohort, may mitigate these effects. In conclusion, in two African cohorts, HIV exposure minimally altered the infant gut microbiota compared to age and setting, but both specific gut microbes and HIV exposure independently predicted humoral tetanus vaccine responses.IMPORTANCEGut microbiota plays an essential role in immune system development. Since infants HIV-exposed and uninfected (iHEU) are more vulnerable to infectious diseases than unexposed infants, we explored the impact of HIV exposure on gut microbiota and its association with vaccine responses. This study was conducted in two African countries with rapidly increasing numbers of iHEU. Infant HIV exposure did not substantially affect gut microbial succession, but geographic location had a strong effect. However, both the relative abundance of specific gut microbes and HIV exposure were independently associated with tetanus titers, which were also influenced by baseline tetanus titers (maternal transfer). Our findings provide insight into the effect of HIV exposure, passive maternal antibody, and gut microbiota on infant humoral vaccine responses.

Risk of bladder, kidney and prostate cancer from occupational exposure to welding fumes: a systematic review and meta-analysis.

Our aimed to conduct a meta-analysis of cohort studies on risk of genitourinary (GU) cancers in workers exposed to welding fumes (WF). We performed a systematic review of studies published on Pubmed, Scopus and Embase following PRISMA criteria. Two researchers selected cohort studies on WF exposure. From 2582 articles, 7 non-overlapping studies were included. Quality of studies was scored according to CASP. We run a random effects meta-analysis to calculate the relative risk (RR) and 95% confidence intervals (CI) of GU cancer, overall and stratified by cancer, country, and quality score. We included seven studies reporting results on GU cancers, including prostate, bladder and kidney cancer (PC, BC, and KC). The RR was 1.19 (95% CI = 1.07-1.32, 16 risk estimates) for GU cancer; 1.13 (95% CI = 0.90-1.42, 4 risk estimates) for PC; 1.26 (95% CI = 0.98-1.60, 7 risk estimates) for BC and 1.28 (95% CI = 1.12-1.47, 5 risk estimates) for KC. Heterogeneity was present in all meta-analyses (p < 0.001). The increased risk was more pronounced in North American than in European studies (respectively, OR = 1.35, 95% CI = 1.18-1.55; OR = 1.13, 95% CI = 1.01-1.27 p heterogeneity = 0.03). There was no heterogeneity according to quality score (p = 0.4). Data were insufficient to investigate associations by industry or welding type. Publication bias for each cancer was excluded. This meta-analysis suggests increased risk of KC and BC, but not of PC, in workers exposed to WF. Confounding by other occupational and non-occupational risk factors could not be excluded. Data were not adequate to address the risk of specific exposure circumstances.

Pesticides, cancer, and oxidative stress: an application of machine learning to NHANES data

BackgroundThe large-scale application of pyrethroids and organophosphorus pesticides has great benefits for pest control. However, the increase of cancer incidence rate in recent years has also caused public concern about the health risks of pesticides. Hence, we utilized data from the National Health and Nutrition Examination Survey (NHANES) to assess the association and risk between pesticide exposure and several cancers, along with the comprehensive impact of oxidative stress. In this study, six cancers and six common pesticides were included to analyze their correlation and risk. And the levels of eight oxidative stress marks and two inflammatory markers were used for stratified analysis. Multiple logistic regression analysis was applied to estimate the odds ratio and 95% confidence intervals. Machine learning prediction models were established to evaluate the importance of different exposure factors.ResultsAccording to the data analyzed, each pesticide increased the risk of three to four out of six cancers on average. Iron, aspartate aminotransferase (AST), and gamma glutamyl transferase levels positively correlated with cancer risk in most cases of pesticide exposure. Except for demographic factors, factors such as AST, iron, and 3-phenoxybenzoic acid showed high contributions to the random forest model, which was consistent with our expectations. The receiver operating characteristic curve showed that the prediction model had sufficient accuracy (74.2%).ConclusionOur results indicated that specific pesticide exposure increased the risk of cancer, which may be mediated by various oxidative stress mechanisms. Additionally, some biochemical indicators have the potential to be screened for cancer prevention.

NEUROLOGICAL CONSEQUENCES OF ABUSIVE USE OF ANABOLIC-ANDROGENIC STEROIDS

The abuse of anabolic-androgenic steroids (AASs) is associated with high morbidity and mortality rates. The highest incidence of this malpractice documented in males (prevalence rate about 6.4%), a third of which develop adverse reactions. Accordingly, the objective was to review published studies about the neurological complications triggered by the indiscriminate use of AASs, with focus on the pathogenesis of lesions in the nervous system (NS). As a result it was observed that at NS, these stimulants actuate through a complex signaling systems that include the neuroendocrine alteration of the hypothalamic-pituitary-gonadal axis, modification of neurotransmitters and their receptors, as well as the induction of neuronal death by apoptosis in several pathways. These organic neurological alterations can lead to a clinical symptomatology with neurological, mood and sleep disorders. Consequently, varying adverse effects were observed analogous to the class of AAS utilized, how it was administered and time of use. Even though to date, only a few classes were submitted for scientific analyses, on dosages, mode of administration and specific exposure times. Furthermore, the illegal use and production of these drugs does not propitiate their appropriate application, quality control and purity. It was concluded that the abuse of AAS has inimically severe and complex effects, including serious neurotoxic issues.

Exploring the Nexus between Estrogenic Exposures from Food and Environment and Breast Cancer Risk

Estrogen, a powerful hormone, is intricately linked to breast cancer susceptibility. This review navigates the intricate web of connections between dietary and environmental estrogen exposures and the development of breast cancer. We meticulously explore diverse sources, ranging from natural plant-derived estrogens like soy isoflavones to pervasive environmental contaminants such as bisphenol A, scrutinizing their potential impact on cancer risk. Our inquiry delves into the intricate molecular mechanisms through which these exposures interact with estrogen receptors, igniting downstream signaling pathways that fuel breast cell proliferation and survival. While conventional risk assessment tools provide valuable insights, we also shed light on modifiable lifestyle factors individuals can embrace to potentially mitigate their risk, advocating for the maintenance of a healthy weight and regular physical activity. Yet, amidst the scientific inquiry, we acknowledge the ongoing debates and limitations, particularly concerning the robustness of associations between specific exposures and cancer risk. Ultimately, we champion the dissemination of evidence-based knowledge, empowering individuals to make informed decisions about their dietary choices, lifestyle modifications, and potential interventions, thereby fostering a future where individuals possess the agency to proactively manage their breast cancer risk profile.

Environmental and Occupational Triggers of Dry Eye Symptoms in the Ahsa Region of Saudi Arabia: A Cross-Sectional Study.

This cross-sectional study aimed to investigate the associations between environmental and occupational factors and the prevalence of dry eye symptoms among participants from the Ahsa region of Saudi Arabia. Participants from urban, rural, and suburban areas seeking medical care at primary health centers were recruited through systematic random sampling. Data on demographics, exposures, and ocular health were captured using a structured questionnaire. Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI), Impact of Dry Eye on Everyday Life (IDEEL), and Symptom Assessment in Dry Eye (SANDE) questionnaires. Logistic regression analysis examined the relationships between environmental/occupational factors and the prevalence of dry eye symptoms. Key exposures included particulate matter (PM) (60%), low humidity (55%), wind/dust (50%), prolonged computer use (65%), and chemical irritants (45%). These factors were significantly associated with an increased prevalence of dry eye symptoms, with the following odds ratios (ORs): PM (1.85, 95% CI: 1.35-2.52), low humidity (1.45, 95% CI: 1.05-2.00), wind and dust (1.60, 95% CI: 1.20-2.14), prolonged computer use (2.10, 95% CI: 1.55-2.85), and chemical irritants (1.75, 95% CI: 1.30-2.35). All associations were statistically significant (p < 0.05). The use of protective equipment was associated with reduced odds of dry eye symptoms (OR 0.60, 95% CI: 0.42-0.85, p = 0.03). This study identifies significant associations between specific environmental and occupational exposures and the prevalence of dry eye symptoms. Reducing modifiable exposures through policy, workplace enhancements, and clinical preventative strategies is essential to mitigate the burden of dry eye symptoms related to modern lifestyles and technology.

Thermal energy storage materials designed from recycled Tetra Pak waste and paraffin waxes with enhanced photothermal conversion efficiencies

The phase change material (PCM)-integrated solar water heaters have great potential to save energy by utilizing renewable resources and to extend working hours even after sunsets. The PCM composites fabricated with recycled waste products lead to the circular economy which would contribute significantly to the sustainable development goals. In this work, Tetra Pak waste (TP) was used to prepare a form-stable PCM composite by mixing with paraffin wax (PW) and expanded graphite (EG) to integrate with solar water heaters. Two different PWs with melting points of 44 (RT44) and 64 (RT64) were used in the lower and higher temperature ranges of domestic water heating applications, respectively. The prepared composites exhibited enhanced thermal conductivity (1.1–1.15 W/m.°C), heat storage capacity (98.5–105.6 J/g), and photothermal conversion efficiency (85% and 55% for composites with RT44 and RT64, respectively). The numerical analysis conducted on a validated model helped to estimate the optimum composite thickness for specific solar exposure time. The fabricated PCM composite promoted the recycling of TP waste into useful products and was efficient in maintaining a higher nocturnal water temperature in the solar water heater.

Comprehensive survey on the use of plastic additives in toy products used in Japan.

Plastic additives have adverse effects on human health. Children frequently use toys that contain various substances found in paints, plasticizers, and other materials, which heighten the risk of specific chemical exposure. Infants are particularly prone to chemical exposure through the "mouthing" behavior because of the possibility of placing toys in their mouths. Thus, this vulnerability should be considered during risk assessments of chemical exposure. This study performed a comprehensive analysis of the chemical components in various 84 plastic toys including "designated toys" (toys that may be harmful to infant health if in contact with their mouths: Article 78 of the Enforcement Regulations of the Food Sanitation Law by the Minister of Health, Labor and Welfare) such as dolls, balls, blocks, bathing toys, toy vehicles, pacifiers, and household items, purchased in the Japanese market by nontargeted and targeted analysis. Plasticizers, flame retardants, and fragrances were the main compounds in almost all the toy products. The results showed that plastic products made in China tended to contain high levels of phthalate esters. In particular, hazardous plasticizers, such as diisodecyl, di-n-octyl, and diisononyl phthalates were detected above the regulatory limit (0.1%) in used products manufactured before regulations were passed in Japan. Furthermore, we detected alternative plasticizers, such as acetyl tributyl citrate (ATBC; 52%), diisononyl adipate (DINA; 50%), and di(2-ethylhexyl) terephthalate (DEHT; 40%). ATBC was detected at high concentrations in numerous toy products. Thus, infants with free access to indoor plastic toys might be exposed to these chemicals. This study observed that the chemical profiles of toy products were dependent on the year of manufacture. Furthermore, the detection of currently regulated plasticizers in secondhand products manufactured before regulations were enforced, along with the increasing trend of using alternative substances to regulated phthalate esters in products, suggests the potential exposure of infants to these plasticizers through the use of toys. Therefore, regular fact-finding surveys should continue to be conducted for the risk assessment and safety management of domestic toy products.

Label-free optical detection of calcium ion influx in cell-derived nanovesicles using a conical Au/PDMS biosensor.

Ion channels, which are key to physiological regulation and drug discovery, control ion flux across membranes, and their dysregulation leads to various diseases. Ca2+ monitoring is crucial for cellular signaling when performing Ca-based assays in ion channel research; these assays are widely utilized in both academic and pharmaceutical contexts for drug screening and pharmacological profiling. However, existing detection methods are limited by slow detection speeds, low throughput, complex processes, and low analyte viability. In this study, we developed a label-free optical biosensing method using a conical Au/polydimethylsiloxane platform tailored to detect Ca2+ influx in A549-originated nanovesicles facilitated by the transient receptor potential ankyrin 1 (TRPA1) channel. Nanovesicles expressing cellular signaling components mimic TRPA1 signal transduction in cell membranes and improve analyte viability. The conical Au/polydimethylsiloxane sensor converted Ca2+ influx events induced by specific agonist exposure into noticeable changes in relative transmittance under visible light. The optical transmittance change accompanying Ca2+ influx resulted in an enhanced sensing response, high accuracy and reliability, and rapid detection (∼5 s) without immobilization or ligand treatments. In the underlying sensing mechanism, morphological variations in nanovesicles, which depend on Ca2+ influx, induce a considerable light scattering change at an interface between the nanovesicle and Au, revealed by optical simulation. This study provides a foundation for developing biosensors based on light-matter interactions. These sensors are simple and cost-effective with superior performance and diverse functionality.

Predicting antibiotic resistance in Enterobacterales to support optimal empiric treatment of urinary tract infections in outpatient veterans.

Bacterial resistance is known to diminish the effectiveness of antibiotics for treatment of urinary tract infections. Review of recent healthcare and antibiotic exposures, as well as prior culture results is recommended to aid in selection of empirical treatment. However, the optimal approach for assessing these data is unclear. We utilized data from the Veterans Health Administration to evaluate relationships between culture and treatment history and the subsequent probability of antibiotic-resistant bacteria identified in urine cultures to further guide clinicians in understanding these risk factors. Using the XGBoost algorithm, a retrospective cohort of outpatients with urine culture results and antibiotic prescriptions from 2017 to 2022 was used to develop models for predicting antibiotic resistance for three classes of antibiotics: cephalosporins, fluoroquinolones, and trimethoprim/sulfamethoxazole (TMP/SMX) obtained from urine cultures. Model performance was assessed using Area Under the Receiver Operating Characteristic curve (AUC) and Precision-Recall AUC (PRAUC). There were 392,647 prior urine cultures identified in 214,656 patients. A history of bacterial resistance to the specific treatment was the most important predictor of subsequent resistance for positive cultures, followed by a history of specific antibiotic exposure. The models performed better than previously established risk factors alone, especially for fluoroquinolone resistance, with an AUC of .84 and PRAUC of .70. Notably, the models' performance improved markedly (AUC = .90, PRAUC = .87) when applied to cultures from patients with a known history of resistance to any of the antibiotic classes. These predictive models demonstrate potential in guiding antibiotic prescription and improving infection management.

Functional longevity of exposed geosynthetics

The time at which a geosynthetic’s performance falls below established functional thresholds is known as the geosynthetic’s functional longevity. As opposed to “durability” which commonly refers to an individual exposure environment such as UV exposure or a specific chemical exposure preceded and followed by an index test to quantify physical changes, functional longevity is the result of the synergistic effects of one or more exposure environments happening simultaneously or sequentially preceded and followed by a performance test. Therefore, functional longevity is characterized by a “suite” of durability tests and an accompanying performance test. Exposed geosynthetics, such as rolled erosion control products (RECPs) and engineered turf are the most common candidates for functional longevity characterization. In each case, exposures can include ultraviolet radiation, biodegradation, and damaging mechanical forces. These exposures inevitably degrade the geosynthetic over time. Yet, the important question is, when do the synergistic effects of the simultaneous or sequential exposures degrade the geosynthetic to the point where its performance falls below established thresholds? This question can only be answered by putting the candidate product through a relevant series of durability and performance tests. This paper describes a series of durability and performance tests being used to characterize the functional longevity of RECPs.

Prevalence of vitamin B12 deficiency in patients treated with metformin

Background/Aim: Metformin has been associated with vitamin B 12 (cobalamin) deficiency, pushing scientific societies such as the American Diabetes Association and the European Association for the Study of Diabetes to emphasise the need for screening B 12 levels, without specific metformin doses or exposure durations triggering this screening. Robust data regarding the prevalence of B 12 deficiency in metformin-treated patients in Portugal are currently lacking. Aim of this study was to identify the prevalence of B 12 deficiency in a sample of diabetic patients taking metformin. Secondary objectives were determining the minimum dose and minimum and median time exposure time leading to this deficiency and identifying the average duration of metformin use in the patients with this deficiency. Methods: Descriptive and cross-sectional observational study was performed on a sample of 79 users from a population of 714 diabetic patients on metformin. Inclusion criteria comprised individuals aged 18 or older, receiving metformin for at least 1 month and voluntarily participating in the study. Exclusion criteria included a history of gastrectomy or B 12 supplementation. Results: A prevalence of 25.3 % of vitamin B 12 deficiency was identified in the study sample. Minimum doses of 500 mg of metformin per day and a minimum exposure period of 1 year were associated with B 12 deficiency. An average exposure time of 5.33 years was identified. Conclusion: These results align with the prevalence described in the few international studies and should alert physicians to potential clinical manifestations of this deficiency, such as anaemia and neurological symptoms like neuropathy.

Demographic and socioeconomic predictors of religious/spiritual beliefs and behaviours in a prospective cohort study (ALSPAC) in Southwest England: Results from the offspring generation.

We explored associations between possible demographic and socioeconomic causes of religious/spiritual beliefs and behaviours (RSBB) in the offspring generation of the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined approximately 4,450 offspring aged 28 years with RSBB data from a prospective birth cohort study (ALSPAC) in Southwest England. Three RSBB outcome measures were assessed: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other) and religious attendance (frequency of attendance at a place of worship). We explored age- and sex-adjusted associations between 35 demographic and socioeconomic exposures and each of the three RSBB outcomes using multinomial regression. Exposure-sex interactions were also examined. Some sociodemographic factors were associated with RSBB in this cohort; for instance, being female and from an ethnicity other than White were associated with increased religiosity across all domains. For many other exposures, however, associations were frequently null or inconsistent, often depending on the specific exposure and outcome combination. As an example, higher educational attainment was associated with higher rates of religious attendance, but not with religious belief or affiliation; in contrast, higher income was associated with lower levels of religiosity. No consistent interactions between sex and the exposures on RSBB were found. Effect sizes were also rather weak, with most pseudo- R 2 values below 0.5% and a maximum of 1.2%. The results highlight that several demographic and socioeconomic factors are associated with RSBB in this cohort. However, the number of these associations, and their magnitude, is smaller than comparable results from the parental generation of these offspring, suggesting that patterns of sociodemographic factors associated with RSBB differ between these generations. In addition to describing these associations, this paper will help inform future studies using these data, particularly regarding the choice of potential sociodemographic confounders.

Water for human consumption in Zagreb city as a possible source of some contaminants

In the Zagreb city area extensive monitoring of water for human consumption has been carried out for years, which includes several dozen different chemical, biological and physical parameters. Given the daily water intake in our bodies, the possibility of ingesting certain contaminants via water has a significant role. This especially applies to nitrates, which are in the second place of importance, since it has been found that the water is their source. In this paper, we present results of the presence for the following contaminants: aluminum, cadmium, chlorate and chlorite, nitrate and mercury in water that can be consumed via water in the city of Zagreb for the period 2016-2020. The results indicate stable average annual values of monitored contaminants, except for aluminum and chlorates, for which it was found that the values of annual averages differ several times. However, even in cases of higher values, their contribution to water intake does not pose a risk to the health of consumers, nor it significantly contribute to their overall intake. Still, given the assumption that this is a specific exposure, to which the consumer is tied to the place of residence, it is important to constantly monitor trends, so that each exposure is kept to a minimum.

Extensile Exposures in Revision and Complex Primary Total Knee Arthroplasty: A Review of Anatomy, Biomechanics, and Techniques.

Developing adequate exposure when performing a revision total knee arthroplasty is critical to an efficient and safe intraoperative course. Proper planning and knowledge of the relevant anatomy are important when dissecting scar tissue associated with previous trauma or surgery and navigating bone loss. We present a review of the different total knee arthroplasty extensile exposure techniques that have been described in the literature. Specific exposures discussed include the femoral peel, banana peel, medial epicondylar osteotomy, quadriceps snip, tibial tubercle osteotomy, wandering resident, and the V-Y quadricepsplasty with patella turndown. Furthermore, we review the histological healing potential, biomechanical principles that drive post-operative expectations, post-operative rehabilitation protocols, and reported functional outcomes of each technique.