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The present investigation deals with the health risk assessment due to the heavy metals (Cd, Cr, Cu, Co, Mn, Pb, Ni, and Zn) in groundwater in the industrial township of Virudhunagar district. Twenty groundwater samples were collected, and the measured concentration of the heavy metals follows the order Pb > Ni > Zn > Co > Cr > Cd > Cu > Mn. The metal pollution indices (heavy metal evaluation index, Heavy metal pollution index, degree of contamination) were calculated using the measured heavy metal concentrations. The samples collected nearer to the industrial zone have elevated concentrations of Pb, Cd, and Ni. The carcinogenic and noncarcinogenic risks were calculated based on the measured heavy metals concentration and average daily intake of water. The calculated carcinogenic risk values (5.66 × 10−3–1.56 × 10−2) (Pb, Cd, and Ni) exceed the acceptable limit of 10−6–10−4. The noncarcinogenic risk exceeds the acceptable limit of one for the heavy metals Pb and Cr. The higher carcinogenic and noncarcinogenic risk values reveal that the study area has health risks due to Pb, Cd, Ni, and Cr metals. Furthermore, factor analysis and cluster analysis showed that the industrial impact and wastage dumpsites are the prime sources for heavy metal contamination in groundwater of the study area.

The present investigation has been carried out in the Ottapidaram taluk to evaluate the suitability of groundwater for drinking purposes and to assess the non-carcinogenic health risks. Twenty groundwater samples were collected, and the major physicochemical parameters were measured along with the heavy metals lead (Pb 2+ ) and chromium (Cr 2+ ). The analyzed anions and cations follow the average dominance order, Cl −  > PO 4 3−  > SO 4 2−  > NO 3 −  > F − , and Mg 2+  > Ca 2+  > Na +  > K + , respectively. From the water quality index to know the 45% of the water samples are unsuitable for drinking purposes. The statistical analysis of the data infers that major geochemical process of the region is leaching of salts by contaminated water, followed by industrial pollution and geogenic sources. The spatial representation of the different parameters reveals that the western part of the study area is predominated by geogenic sources and the eastern part is contaminated by industrial effluents. The non-carcinogenic risks of F − , NO 3 − , Cr 2+ , and Pb 2+ were assessed. The findings show 40% of the samples exceeds the chromium hazard quotient, and 50% exceed the lead hazard quotient value of 1 recommended by the US Environmental Protection Agency (USEPA). The present investigation shows that Cr 2+ and Pb 2+ highly pollute the groundwater due to the industrial impacts. The present study suggests that the groundwater from this taluk is worse, and people from this taluk have health risks due to groundwater drinking.

An elderly man with a history of a prior inferior wall myocardial infarction underwent ablation for an atypical right atrial flutter. Electroanatomic mapping revealed diffuse scarring on the anterior, anterolateral, and posterior right atrium, presumably due to atrial infarction from the prior inferior wall myocardial infarction, forcing the activation wavefront through an area of slow conduction across the lower end of the crista terminalis, leading to lower loop reentry in a counterclockwise fashion around the inferior vena cava and a 12‐lead ECG showing positive flutter waves in the inferior leads reflecting septal activation in a cranio‐caudal direction.

Falsely detected atrial tachycardia episode in a patient with CRT-P due to FFRW oversensing resulting in ventricular sensed response triggered BiV pacing and auto adjusting sensitivity phenomenon.Falsely detected atrial tachycardia episode in a patient with CRT-P due to FFRW oversensing resulting in ventricular sensed response triggered BiV pacing and auto adjusting sensitivity phenomenon.

OBJECTIVESignificant involvement of the cardiovascular system is known in multisystem inflammatory syndrome in children (MIS-C). This study aimed to examine the recovery of affected cardiovascular parameters over a medium-term follow-up.METHODSA cohort of 69 children was studied prospectively. Assessments of left ventricular (LV) function and coronary artery abnormalities (CAA) were conducted at admission, 1.5 months, and 3 months. Coronavirus Disease 2019 (COVID-19) antibody titers were assessed at these three time points. Echocardiographic and antibody parameters (rising/decreasing) were analyzed for correlation. Outcomes were assessed using logistic regression.RESULTSAt admission, among the 78.2% of patients who were tested, 88.9% tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). A quarter of the patients had pericardial effusion, and half had valvulitis. Decreased ejection fraction, global circumferential strain (GCS), and global longitudinal strain (GLS) were seen in 54.4%, 68.6%, and 35.8% of patients, respectively. CAAs were observed in 27.78% of patients. Systolic dysfunction was significantly associated with older age. During follow-up, severe LV dysfunction normalized within 6-7 weeks, while mild to moderate dysfunction reached normalcy by two weeks. Both GCS and GLS reached normalcy within a median of two weeks. Diastolic parameters recovered by six weeks. Most small and moderate coronary aneurysms resolved, but a giant aneurysm in an infant remained large even after 15 months. Trends in antibodies and ejection fraction (EF) at three months were significantly correlated. Admission EF, GLS (at 6 weeks) and deceleration time (at 3 months) were significantly associated with intensive care unit (ICU) admission. The median segmental strain of the cohort remained low in certain segments at three months.CONCLUSIONSmaller CAAs resolve, whereas giant CAAs persist. EF and GLS are important predictors of Pediatric Intensive Care Unit (PICU) stay. The residual impairment of median segmental strain and persistent diastolic dysfunction at three months indicate the need for long-term follow-up.

Objective: Significant involvement of the cardiovascular system is known in multisystem inflammatory syndrome in children (MIS-C). This study aimed to examine the recovery of affected cardiovascular parameters over a medium-term follow-up. Methods: A cohort of 69 children was studied prospectively. Assessments of left ventricular (LV) function and coronary artery abnormalities (CAA) were conducted at admission, 1.5 months, and 3 months. Coronavirus Disease 2019 (COVID-19) antibody titers were assessed at these three time points. Echocardiographic and antibody parameters (rising/decreasing) were analyzed for correlation. Outcomes were assessed using logistic regression. Results: At admission, among the 78.2% of patients who were tested, 88.9% tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). A quarter of the patients had pericardial effusion, and half had valvulitis. Decreased ejection fraction, global circumferential strain (GCS), and global longitudinal strain (GLS) were seen in 54.4%, 68.6%, and 35.8% of patients, respectively. CAAs were observed in 27.78% of patients. Systolic dysfunction was significantly associated with older age. During follow-up, severe LV dysfunction normalized within 6-7 weeks, while mild to moderate dysfunction reached normalcy by two weeks. Both GCS and GLS reached normalcy within a median of two weeks. Diastolic parameters recovered by six weeks. Most small and moderate coronary aneurysms resolved, but a giant aneurysm in an infant remained large even after 15 months. Trends in antibodies and ejection fraction (EF) at three months were significantly correlated. Admission EF, GLS (at 6 weeks) and deceleration time (at 3 months) were significantly associated with intensive care unit (ICU) admission. The median segmental strain of the cohort remained low in certain segments at three months. Conclusion: Smaller CAAs resolve, whereas giant CAAs persist. EF and GLS are important predictors of Pediatric Intensive Care Unit (PICU) stay. The residual impairment of median segmental strain and persistent diastolic dysfunction at three months indicate the need for long-term follow-up. Keywords: Strain imaging, coronary artery abnormality, COVID-19, ventricular systolic function, diastolic function, MIS-C Amac: Cocuklarda multisistem inflamatuar sendromda kardiyovaskuler sistemin onemli bir yer aldigi bilinmektedir. Bu calisma, orta vadede etkilenen kardiyovaskuler parametrelerin iyilesmesini incelemeyi amaclamistir. Yontem: Bu calismada 69 cocuk hastadan olusan bir kohort prospektif olarak incelendi. Sol ventrikul (LV) fonksiyonu ve koroner arter anormallikleri (KAA) degerlendirmeleri basvuru, 1,5 ay ve 3 ayda yapildi. Korona virus hastaligi 2019 (COVID-19) antikor titreleri bu uc zaman noktasinda degerlendirilmistir. Ekokardiyografik ve antikor parametreleri (artan/azalan) korelasyon acisindan analiz edilmistir. Sonuclar lojistik regresyon kullanilarak degerlendirilmistir. Bulgular: Basvuru sirasinda hastalarin %78,2'si test edildi ve %88,9'unda Siddetli Akut Solunum Sendromu Korona virus 2 (SARS-CoV-2) pozitif cikmistir. Hastalarin dortte birinde perikardiyal efuzyon ve yarisinda valvulit vardi. Hastalarin sirasiyla %54,4'unde, %68,6'sinda ve %35,8'inde ejeksiyon fraksiyonunda, global cevresel strainde (GCS) ve global uzunlamasina strainde (GLS) azalma gorulmustur. Hastalarin %27,78'inde KAA gozlenmistir. Sistolik disfonksiyon ileri yas ile anlamli derecede iliskiliydi. Takip sirasinda, ciddi LV disfonksiyonu 6-7 hafta icinde normale donerken, hafif ila orta dereceli disfonksiyon iki hafta icinde normale ulasti. Hem GKS hem de GLS medyan iki hafta icinde normale ulasti. Diyastolik parametreler alti hafta icinde duzelmistir. Kucuk ve orta dereceli koroner anevrizmalarin cogu duzelmistir, ancak bir bebekte gorulen dev anevrizma 15 ay sonra bile buyuk kalmistir. Antikorlardaki egilim ile uc aylik ejeksiyon fraksiyonu (EF) arasinda anlamli bir korelasyon vardi. Basvuru EF'si, GLS (6. haftada) ve yavaslama suresi (3. ayda) yogun bakim unitesine yatis ile anlamli derecede iliskiliydi. Kohortun medyan segmental gerilimi uc ayda belirli segmentlerde dusuk kalmistir. Sonuc: Kucuk KAA'lar duzelirken, dev KAA'lar devam etmektedir. EF ve GLS, pediatrik yogun bakim unitesinde kalis suresinin onemli belirleyicileridir. Uc ayda medyan segmental strainde reziduel bozulma ve kalici diyastolik disfonksiyon uzun sureli takip ihtiyacini gostermektedir. Anahtar Kelimeler: Strain goruntuleme, koroner arter anormalligi, COVID-19, ventrikuler sistolik fonksiyon, diyastolik fonksiyon, MIS-C