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1.
Medicine (Baltimore) ; 103(5): e37166, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38306513

RESUMO

RESULTS: After excluding 4 patients with an anesthesia duration of < 2 hours, data from 34 patients (1163 sets of tracheal and esophageal temperatures) were analyzed. Concordance correlation coefficient was 0.78. The overall mean bias (95% limits of agreement) between the tracheal and esophageal temperatures was -0.16°C (-0.65°C to 0.34°C). The percentage of temperature differences within ±â€…0.25°C was 73.5% ± 32.3, with a median of 89.4% [0,100]. The linear mixed-effects model revealed that the estimated intercept was 0.17°C with a 95% confidence interval (CI) of 0.13°C to 0.22°C. The duration of anesthesia and the number of temperature measurements were associated with higher concordance between the tracheal and esophageal temperatures in univariate analysis.


Assuntos
Temperatura Corporal , Umidificadores , Humanos , Temperatura , Temperatura Alta , Esôfago
2.
Sci Rep ; 13(1): 20026, 2023 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-37973969

RESUMO

A humidifier disinfectant (HD) has been prohibited by the government due to its serious effects on the human body. Several studies on the relationship between HD and lung diseases have been performed independently on children and adults. However, there have been no reports on the effects of HD exposure on pregnant women and their foetuses. Therefore, the present study was conducted to investigate the effects of HD exposure on the foetuses of women who encountered HD during pregnancy. A total of 56 cases were recruited from 2017 to 2019 through the Korea Environmental Industry & Technology Institute, and data obtained from the medical records included maternal date of birth, maternal date of death, maternal start and end date of HD exposure, maternal date of symptom onset, neonatal birthday, neonatal birthweight, gestational age, and neonatal survival status within 28 days. All data were retrospectively investigated through medical records. Of the 47 mothers, 20 (42.6%) mothers survived, and 27 (57.4%) mothers died. In the group of survivors, there was a shorter period of total HD use, period of HD use before pregnancy and period of HD use to onset of symptoms. Shorter durations of HD use resulted in higher survival rate of mothers. HD use caused an increase in gestational age surviving foetuses, and foetal mortality increased when clinical symptoms developed before birth.


Assuntos
Desinfetantes , Adulto , Criança , Recém-Nascido , Humanos , Gravidez , Feminino , Desinfetantes/efeitos adversos , Umidificadores , Estudos Retrospectivos , Gestantes , Mães
3.
Epidemiol Health ; 45: e2023095, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37905312

RESUMO

OBJECTIVES: Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS: Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized. RESULTS: Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach. CONCLUSIONS: The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.


Assuntos
Desinfetantes , Umidificadores , Animais , Humanos , Desinfetantes/toxicidade , Exposição por Inalação/efeitos adversos , Causalidade
4.
Int J Occup Med Environ Health ; 36(5): 596-605, 2023 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-37781784

RESUMO

OBJECTIVES: The humidifier disinfectant catastrophe in South Korea was a social disaster caused by toxic chemical substances. The present study aimed to examine the relationships between psychological symptoms and adaptive life functioning in survivors of humidifier disinfectants. This study examined the differential effects of psychological symptoms on life adjustment between survivors of humidifier disinfectant and the general population. MATERIAL AND METHODS: A total of 452 individuals (228 general and 224 survivor groups) participated in this research. This study utilized the Adult Self-Report, one of the most widely used comprehensive mental health scales for measuring both psychological symptoms (e.g., anxiety/depression) and life adjustment functioning (e.g., interpersonal relationship). For the data analysis, multi-group structural equation modeling analysis was conducted using AMOS 21.0 program. RESULTS: The results of this study indicated that attention problems out of 8 psychological symptoms was the only significant factor related to life adjustment in both general and survivor groups. In addition, there was a significant 2-way interaction effect of group status and somatic complaints on life adjustment. CONCLUSIONS: When the somatic complaint symptom was higher, participants in the survivor group were less likely to adjust in life than the general group. Taken together, the somatic complaints of the survivors more strongly influence the life adjustment than the general population. Finally, the authors discuss practical implications for survivors of humidifier disinfectants for designing suitable intervention strategies.Int J Occup Med Environ Health. 2023;36(5):596-605.


Assuntos
Desinfetantes , Umidificadores , Adulto , Humanos , República da Coreia/epidemiologia , Autorrelato , Depressão
5.
BMC Public Health ; 23(1): 1800, 2023 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-37779205

RESUMO

BACKGROUND: Humidifier disinfectants (HDs) were commonly used household chemicals to prevent microbial growth in a humidifier water tank in South Korea. A growing body of evidence has indicated that its airborne exposure can induce severe lung injury. However, there has been low awareness of other health outcomes in HD users. This study aimed to evaluate health conditions appealed by claimants for compensation in relation with an increased exposure to HD. METHODS: From survey data of personal HD exposure assessment of claimants for compensation in Korea, we included a total of 4,179 subjects [cases in each dataset were defined by nine reported health conditions, i.e., pneumonia, asthma, cardiovascular disease, respiratory disease, otorhinolaryngologic disease, brain disease (including cerebrovascular disease), dermatological disease, lung cancer, and all cancers]. HD exposures was considered as the following exposure criteria: exposure duration, exposure proximity, exposure direction, chemical type, cumulative exposure time, indoor air concentration, and cumulative exposure level. Logistic regression models were used to evaluate the associations between HD exposure and health conditions. RESULTS: After adjusting for sociodemographic and health behavioral factors and other chemical exposures (households, environmental, and occupational exposures), an increase in cumulative HD exposure time was significantly associated with risks of all nine diseases (all p-trends < 0.05). An increase in HD exposure duration was associated with asthma, respiratory disease, otorhinolaryngologic disease, dermatological disease, all cancers, and lung cancer (p-trends < 0.05). Indoor HD concentration was associated with only pneumonia (p-trend = 0.015). CONCLUSIONS: Our findings suggest that cumulative exposures to airborne HD might potentially increase the risk of various reported health outcomes.


Assuntos
Asma , Desinfetantes , Neoplasias Pulmonares , Otorrinolaringopatias , Pneumonia , Humanos , Desinfetantes/efeitos adversos , Umidificadores , República da Coreia/epidemiologia , Asma/epidemiologia
6.
BMJ Case Rep ; 16(9)2023 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-37751984

RESUMO

Hypersensitivity pneumonitis is an immune-mediated interstitial lung disease that presents with respiratory symptoms, with or without systemic symptoms, following exposure to an identified or unidentified external factor. It can be caused by extrinsic factors including household items such as ultrasonic humidifiers.We present an intriguing case of a previously healthy 50-year-old man who displayed recurrent episodes of progressive dyspnoea and fever after repeated exposure to his household ultrasonic humidifier. He was treated with corticosteroids, followed by the removal of the humidifier, resulting in total recovery and absence of recurrence of further episodes.The clinical presentation of hypersensitivity pneumonitis can be dramatic, and the differential diagnosis is broad. The correct diagnosis is achieved by combining clinical, radiological and histopathological patterns. The key to finding the aetiology lies in a thorough history, with an important role for household investigations to identify the external factor.


Assuntos
Alveolite Alérgica Extrínseca , Umidificadores , Masculino , Humanos , Pessoa de Meia-Idade , Ultrassom , Alveolite Alérgica Extrínseca/diagnóstico por imagem , Alveolite Alérgica Extrínseca/etiologia , Dispneia/complicações , Febre/complicações
7.
Respir Investig ; 61(5): 660-667, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37541165

RESUMO

BACKGROUND: The ATS/JRS/ALAT Guidelines for the Diagnosis of Hypersensitivity Pneumonitis (GL for HP) were published in 2020. Humidifier lung and summer-type HP are forms of HP, but it is unclear whether they can be diagnosed using GL for HP. This study examined the level of confidence where humidifier lung and summer-type HP can be diagnosed with GL for HP. METHODS: Data from 23 patients with humidifier lung and 20 patients with summer-type HP (mean age, 67.3 and 57.4 years, respectively) diagnosed between October 2012 and January 2022 were retrospectively reviewed. We evaluated high resolution computed tomography (HRCT) patterns, bronchoalveolar lavage fluid (BALF) findings, exposures, and histopathological findings to determine the level of confidence where a diagnosis of HP could be made using the GL for HP. RESULTS: HRCT pattern was classified as typical HP in 5 (22%) and compatible with HP in 18 (78%) patients with humidifier lung and considered as typical HP in 17 (85%) and compatible with HP in 3 (15%) patients with summer-type. The confidence level for diagnosis of HP was definite in 2 (8.7%), moderate in 14 (60.9%), and low in 7 (30.4%) patients with humidifier lung. It was definite in 12 (60%), high in 3 (15%), and moderate in 5 (25%) patients with summer-type HP. CONCLUSIONS: GL for HP showed utility in diagnosing humidifier lung in many patients with a moderate to low confidence. However, there was a definite to high confidence for patients with summer-type HP.


Assuntos
Alveolite Alérgica Extrínseca , Tricosporonose , Humanos , Tricosporonose/patologia , Umidificadores , Estudos Retrospectivos , Alveolite Alérgica Extrínseca/diagnóstico por imagem , Alveolite Alérgica Extrínseca/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia
8.
Arerugi ; 72(3): 295-299, 2023.
Artigo em Japonês | MEDLINE | ID: mdl-37225471

RESUMO

A 58-year-old man presented with dyspnea on exertion and diffuse ground-glass opacities with mosaicism on chest computed tomography in April 201X. A transbronchial lung biopsy revealed organizing pneumonia and lymphocytic infiltration, and steroids were administered. During steroid tapering, the shortness of breath and ground-glass opacities recurred, and a transbronchial lung re-biopsy revealed organizing pneumonia without a granuloma again. Based on the clinical history, imaging features, and amount of humidifier usage, hypersensitivity pneumonitis caused by a humidifier was suspected. The inhalation challenge test was considered positive, and the diagnosis was confirmed. There have been some reports of unidentified granuloma in patients with humidifier lungs. Therefore, this case suggests that humidifier lung should be considered as a possibility even if pathological examination does not reveal granulomas and inflammatory changes such as organizing pneumonia are the only findings.


Assuntos
Alveolite Alérgica Extrínseca , Pneumonia em Organização , Pneumonia , Masculino , Humanos , Pessoa de Meia-Idade , Broncoscopia , Umidificadores , Alveolite Alérgica Extrínseca/diagnóstico , Dispneia , Pulmão/diagnóstico por imagem
9.
Respir Care ; 68(1): 87-91, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35973715

RESUMO

BACKGROUND: Regular care and cleaning of positive airway pressure (PAP) devices are important for maintaining equipment in the home. Illness and hospitalization have occurred from inadequate cleaning and use of tap water in the humidifier. In recent years, ozone and ultraviolent-light disinfection devices have been advertised for cleaning home PAP equipment. Our clinic provides instructions; however, cleaning practices performed in the home are unknown. METHODS: A survey of home cleaning practices for PAP equipment was conducted in a pediatric sleep clinic during 2019-2020. Survey domains were method, cleaning and replacement frequency for each component, type of water used, instruction preferences, and demographics. The primary aim was to identify home PAP cleaning practices and compare with provided instructions. The secondary aim was to determine if respiratory-related symptoms (eg, congestion, runny nose, sneezing, coughing) occurred or increased with PAP use or inadequate cleaning. RESULTS: The survey was completed by 96 respondents. Most reported weekly cleaning of mask (36, 38%), tubing (41, 43%), and humidifier (31, 33%) with soap and water as the primary method for each. The majority used distilled water in the humidifier (74, 77%) and reported respiratory symptoms did not occur with PAP use (64, 67%). Very few indicated a device was used to clean equipment. No associations were found between length of time for PAP use and cleaning practices. There was a moderately low correlation between age and cleaning. Increased age was associated with decreased cleaning frequency (r = 0.20, P = .048). CONCLUSIONS: Care and cleaning practices of home PAP equipment varied from instructions provided in clinic. Most reported at least weekly cleaning of items for which daily cleaning is recommended. Few reported using a device for cleaning or having respiratory symptoms from PAP treatment.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Humanos , Criança , Pressão Positiva Contínua nas Vias Aéreas/métodos , Apneia Obstrutiva do Sono/terapia , Inquéritos e Questionários , Umidificadores
10.
Chemosphere ; 312(Pt 1): 137232, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36379427

RESUMO

Humidifier disinfectant (HD) is a causative agent of atypical lung injury reported in 2011 in South Korea, and various diseases caused by HD after exposure cessation have been reported to date. However, there is limited research on most of the reported diseases in terms of their association with HD exposure, and information on the progression of diseases caused by HD exposure is also limited. Therefore, we investigated the effects of HD inhalation on the body in rats. Rats were exposed to 0.15, 0.50, and 1.60 mg/m3 polyhexamethylene guanidine-phosphate (PHMG-p), which is the major component of HDs and most closely related to HD-associated lung injury. We conducted necropsy four times during the recovery period (0, 4, 12, and 24 weeks) and evaluated general systemic toxicities. There were significant changes in the mortality rate, body weight, and food consumption in the PHMG-p-exposed groups. Hematology revealed changes in hemoglobin level, hematocrit, red blood cell, reticulocyte, and white blood cell counts until 12 weeks of the recovery period. PHMG-p induced a delay in prothrombin time until 12 weeks of the recovery period. The aspartate aminotransferase, alanine aminotransferase, total bilirubin, and triglyceride levels were higher in the PHMG-p-exposed groups than in the control group at week 4 of the recovery period, and these parameters normalized after 12 weeks of the recovery period. Histopathological examination in PHMG-p exposed groups revealed several changes in the lungs, including the presence of alveolar macrophages, chronic inflammation, squamous metaplasia, alveolar emphysema, and pulmonary fibrosis. The severity of these symptoms was maintained or exacerbated till 24 weeks. Overall, PHMG-p inhalation can induce irreversible histological changes in the lungs and cause various types of damage throughout the body, even after exposure ends.


Assuntos
Desinfetantes , Lesão Pulmonar , Ratos , Animais , Exposição por Inalação , Umidificadores , Guanidinas/toxicidade , Desinfetantes/toxicidade , Fosfatos
11.
Sci Total Environ ; 856(Pt 1): 158787, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36116655

RESUMO

The commonly used consumer product of an ultrasonic humidifier (e.g., cool mist humidifier) emits fine particles containing metals from tap water used to fill the humidifier. The objectives are: 1) predict emitted indoor air inhalable metal concentrations produced by an ultrasonic humidifier filled with tap-water containing As, Cd, Cr, Cu, Mn, and Pb in 33 m3 or 72 m3 rooms with varying air exchange rates; 2) calculate daily ingestion and 8-h inhalation average daily dose (ADD) and hazard quotient (HQ) for adults and children (aged 0.25-6 yr); and 3) quantify deposition in respiratory tract via multi-path particle dosimetry (MPPD) model. Mass concentrations of indoor air metals increase proportionally with aqueous metal concentrations in fill water, and are inversely related to ventilation. Inhalation-ADDs are 2 magnitudes lower than ingestion-ADDs, using identical water quality for ingestion and fill-water. However, in the 33 m3, low 0.2/h ventilated room, inhalation-HQs are >1 for children and adults, except for Pb. HQ inhalation risks exceed ingestion risks at drinking water regulated levels for As, Cd, Cr, and Mn. MPPD shows greater dose deposits in lungs of children than adults, and 3 times greater deposited doses in a 33 m3 vs 72 m3 room. Rethinking health effects of drinking water and consumer products to broaden consideration of multiple exposure routes is needed.


Assuntos
Poluição do Ar em Ambientes Fechados , Água Potável , Metais Pesados , Criança , Adulto , Humanos , Poluição do Ar em Ambientes Fechados/análise , Umidificadores , Qualidade da Água , Cádmio , Ultrassom , Chumbo , Medição de Risco , Monitoramento Ambiental , Metais Pesados/análise
12.
Indoor Air ; 32(11): e13129, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36437646

RESUMO

This systematic review investigates the emissions from ultrasonic humidifiers (e.g., cool mist humidifiers) within indoor air environments, namely soluble and insoluble metals and minerals as well as microorganisms and one organic chemical biocide. Relationships between ultrasonic humidifier fill water quality and the emissions in indoor air are studied, and associated potential adverse health outcomes are discussed. Literature from January 1, 1980, to February 1, 2022, was searched from online databases of PubMed, Web of Science, and Scopus to produce 27 articles. The results revealed clear positive proportional relationships of the concentration of microorganisms and soluble metals/minerals between fill water qualities and emitted airborne particles, for both microbial (n = 9) and inorganic (n = 15) constituents. When evaluating emissions and the consequent health outcomes, ventilation rates of specific exposure scenarios affect the concentrations of emitted particles. Thus, well-ventilated rooms may alleviate inhalation risks when the fill water in ultrasonic humidifiers contains microorganisms and soluble metals/minerals. Case reports (n = 3) possibly due to the inhalation of particles from ultrasonic humidifier include hypersensitivity pneumonitis in adults and a 6-month infant; the young infant exhibited nonreversible mild obstructive ventilator defect. In summary, related literature indicated correlation between fill water quality of ultrasonic humidifier and emitted particles in air quality, and inhalation of the emitted particles may cause undesirable health outcomes of impaired respiratory functions in adults and children.


Assuntos
Poluição do Ar em Ambientes Fechados , Umidificadores , Lactente , Criança , Humanos , Ultrassom , Aerossóis , Minerais
13.
J Korean Med Sci ; 37(44): e319, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36377294

RESUMO

BACKGROUND: Humidifier disinfectant-related lung injury (HDLI) is a severe form of toxic inhalational pulmonary parenchymal damage found in residents of South Korea previously exposed to specific guanidine-based compounds present in humidifier disinfectants (HD). HD-associated asthma (HDA), which is similar to irritant-induced asthma, has been recognized in victims with asthma-like symptoms and is probably caused by airway injury. In this study, diffusing capacity of the lung for carbon monoxide (DLCO) in individuals with HDA was compared to that in individuals with pre-existing asthma without HD exposure. METHODS: We retrospectively compared data, including DLCO values, of 70 patients with HDA with that of 79 patients having pre-existing asthma without any known exposure to HD (controls). Multiple linear regression analysis and logistic regression analysis were performed to confirm the association between HD exposure and DLCO after controlling for confounding factors. The correlation between DLCO and several indicators related to HD exposure was evaluated in patients with HDA. RESULT: The mean DLCO was significantly lower in the HDA group than in the control group (81.9% vs. 88.6%; P = 0.021). The mean DLCO of asthma patients with definite HD exposure was significantly lower than that of asthma patients with lesser exposure (P for trend = 0.002). In multivariable regression models, DLCO in the HDA group decreased by 5.8%, and patients with HDA were 2.1-fold more likely to have a lower DLCO than the controls. Pathway analysis showed that exposure to HD directly affected DLCO values and indirectly affected its measurement through a decrease in the forced vital capacity (FVC). Correlation analysis indicated a significant inverse correlation between DLCO% and cumulative HD exposure time. CONCLUSION: DLCO was lower in patients with HDA than in asthma patients without HD exposure, and decreased FVC partially mediated this effect. Therefore, monitoring the DLCO may be useful for early diagnosis of HDA in patients with asthma symptoms and history of HD exposure.


Assuntos
Asma , Desinfetantes , Humanos , Umidificadores , Desinfetantes/efeitos adversos , Estudos Retrospectivos , Estudos de Casos e Controles , Pulmão , Asma/diagnóstico , Asma/etiologia , Monóxido de Carbono/toxicidade
14.
Indoor Air ; 32(10): e13133, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36305059

RESUMO

Ngari Prefecture, Tibet, China, features its ultrahigh altitude above 4200 m, very little annual precipitation and extremely low relative humidity. Residents who have migrated to Tibet from the plains use indoor humidification to reduce the respiratory discomfort caused by prolonged exposure to dry indoor air. In this study, field investigations and analysis of residential indoor environments and humidification methods in Ngari Prefecture revealed that ninety-eight percent of humidifier consumers in the prefecture used low-cost ultrasonic humidifiers filled with indoor tap water. The results revealed that the arsenic (As) concentration of the tap water was 41.6 µg/L, over four times China's standards for drinking water quality (10 µg/L). The source As concentration in the air humidified by the tap water-filled ultrasonic humidifier is (619.8 ± 59.1) (ng/m3 ·air), while no As was detected in the air humidified by the evaporative humidifier. For ultrasonic humidifier with tap water-filled, the inhalation dose of a healthy adult was 45.4 ng/d. The minute ventilation volume of migrated residents who had been in Ngari for less than two years (12.5 ± 4.3 L/min) was greater than those of the long-term residents (10.0 ± 4.5 L/min), which may exacerbate the short-term inhalation exposure risk for migrated residents. To reduce the health risks associated with As exposure, evaporative humidifiers are recommended for households using domestic water. If ultrasonic humidifiers are used, the tap water must be purified with terminal filters.


Assuntos
Poluição do Ar em Ambientes Fechados , Arsênio , Exposição por Inalação , Umidificadores , Umidade
15.
Artigo em Inglês | MEDLINE | ID: mdl-36231196

RESUMO

Around nine million people have been exposed to toxic humidifier disinfectants (HDs) in Korea. HD exposure may lead to HD-associated lung injuries (HDLI). However, many people who have claimed that they experienced HD exposure were not diagnosed with HDLI but still felt discomfort, possibly due to the unknown effects of HD. Therefore, this study examined HD-exposed subjects with normal-appearing lungs, as well as unexposed subjects, in clusters (subgroups) with distinct characteristics, classified by deep-learning-derived computed-tomography (CT)-based tissue pattern latent traits. Among the major clusters, cluster 0 (C0) and cluster 5 (C5) were dominated by HD-exposed and unexposed subjects, respectively. C0 was characterized by features attributable to lung inflammation or fibrosis in contrast with C5. The computational fluid and particle dynamics (CFPD) analysis suggested that the smaller airway sizes observed in the C0 subjects led to greater airway resistance and particle deposition in the airways. Accordingly, women appeared more vulnerable to HD-associated lung abnormalities than men.


Assuntos
Aprendizado Profundo , Desinfetantes , Desinfetantes/toxicidade , Feminino , Humanos , Umidificadores , Pulmão/diagnóstico por imagem , Masculino , República da Coreia , Tomografia Computadorizada por Raios X
16.
J Korean Med Sci ; 37(33): e257, 2022 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-35996934

RESUMO

BACKGROUND: It has been 10 years since the outbreak of lung disease caused by humidifier disinfectants in Korea, but the health effects have not yet been summarized. Therefore, this study aims to systematically examine the health effects of humidifier disinfectants that have been discovered so far. METHODS: All literature with humidifier disinfectants and their representative components as the main words were collected based on the web, including PubMed, Research Information Sharing Service, and government publication reports. A total of 902 studies were searched, of which 196 were selected. They were divided into four groups: published human studies (group 1), published animal and cytotoxicology studies (group 2), technical reports (group 3), and gray literature (group 4). RESULTS: Out of the 196 studies, 97 (49.5%) were published in peer-reviewed journals as original research. Group 1 consisted of 49 articles (50.5%), while group 2 consisted of 48 articles (49.5%). Overall, respiratory diseases such as humidifier disinfectant associated lung injury, interstitial lung disease, and asthma have a clear correlation, but other effects such as liver, heart, thymus, thyroid, fetal growth, metabolic abnormalities, and eyes are observed in toxicological experimental studies, but have not yet been identified in epidemiologic studies. CONCLUSION: The current level of evidence does not completely rule out the effects of humidifier disinfectants on extrapulmonary disease. Based on the toxicological evidence so far, it is required to monitor the population of humidifier disinfectant exposure continuously to see if similar damage occurs.


Assuntos
Desinfetantes , Pneumopatias , Lesão Pulmonar , Animais , Desinfetantes/toxicidade , Humanos , Umidificadores , Lesão Pulmonar/etiologia , República da Coreia/epidemiologia
18.
Respir Care ; 67(9): 1147-1153, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35672136

RESUMO

BACKGROUND: Under-humidification and associated complications may occur with heated humidifiers. Hygrometric performances of heated wire humidifiers are reduced by high ambient and high outlet ventilator temperatures. Currently, there is no reliable monitoring tool to evaluate humidification performances of heated wire humidifiers in the daily practice. We sought to demonstrate the relation between humidity delivered by heated wire humidifiers and different parameters that could be used to monitor humidity of gas delivered to subjects. METHODS: On a bench test, we measured heater plate temperature, inlet chamber temperature, and delivered humidity with MR850 system. Temperature displayed on the humidifier was also recorded. The measurements were performed at different ambient temperatures and five minute ventilation levels (5, 7.5, 10, 12.5, 15 L/min). Inlet chamber temperatures varied from 20-40°C. In each condition, hygrometric measurements with the psychrometric method were performed at steady state. RESULTS: We performed 279 measurements at steady state including all conditions. We found a good correlation between heater plate temperature and absolute humidity delivered (R2 = 0.82). This relationship was hardly affected by ambient temperature, but minute ventilation had more effect. For different minute ventilations, the correlation between heater plate temperature and absolute humidity delivered was very good with coefficient of determination R2 from 0.87-0.98. Heater plate temperature > 62°C was a good predictor of absolute humidity delivered > 30 mg H2O/L (area under the curve = 0.96, sensibility 79%, specificity 94%). No correlation existed between humidity delivered and the outlet chamber temperature (displayed on the humidifier). CONCLUSIONS: In this bench study, we have shown a good correlation between heater plate temperature and humidity delivered with a heated wire humidifier. This means that a "hidden" hygrometer is built into the heated wire humidifier. Heater plate temperature should be used as a surrogate of humidity to improve the humidification monitoring.


Assuntos
Umidificadores , Ventiladores Mecânicos , Temperatura Alta , Humanos , Umidade , Temperatura
19.
J Korean Med Sci ; 37(13): e101, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35380026

RESUMO

The association between lung injury and exposure to humidifier disinfectant (HD) containing a mixture of chloromethylisothiazolinone (CMIT) and methylisothiazolinone (MIT) has been controversial in South Korea. This study conducts a literature review in order to evaluate the likelihood of CMIT/MIT reaching the lower part of the respiratory tract and causing lung injury. A literature review focused on the inhalation risk of HD containing a mixture of CMIT and MIT. The major contents included the physicochemical properties of CMIT and MIT contained in HDs and methodological reviews on substance analysis, toxicity tests and clinical cases. HD products marketed in South Korea have been reported to contain approximately 1-2% CMIT and 0.2-0.6% MIT along with magnesium nitrate (20-25%), magnesium chloride (0.2-1.0%), and water (70-75%). The types of CMIT and MIT dispersed into the air and deposited in the respiratory tract are assumed to be either gaseous substances or nanoparticles mixed with magnesium salts. The result of the literature review including clinical cases of lung injury among CMIT/MIT HD product users, demonstrated that these chemicals likely reach the lower respiratory tract and accordingly cause lung injury. A number of humidifier disinfectant-associated lung injury cases with clinical evidence should be prioritized in risk assessment of HD containing CMIT and MIT, even though there might be insufficient evidence in all related areas, including inhalation exposure assessment studies, animal testing, and epidemiological studies.


Assuntos
Desinfetantes , Lesão Pulmonar , Animais , Desinfetantes/toxicidade , Humanos , Umidificadores , Lesão Pulmonar/etiologia , Medição de Risco , Tiazóis
20.
Sci Rep ; 12(1): 847, 2022 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-35039563

RESUMO

Heat stress affects pig metabolism, health and welfare, resulting in reduced growth and important economic losses. The present experiment aimed to evaluate the effects of two climatic environments [temperate (TEMP) vs. tropical humid (TROP)] on feeding behaviour in growing pigs. The feeding behaviour traits were measured with automated feeders and included: daily feed intake, daily eating time, feeding rate, daily number of meals, feed intake per meal, and feeding time per meal. Pigs came from a backcross population between Large White (LW, heat sensitive) and Creole (CR, heat tolerant) pigs. The same 10 F1 LW × CR boars (sire families [SF]) were mated with related LW sows in each environment. Feeding behaviour was recorded for a total of 1,296 pigs (n = 634 pigs for TEMP and n = 662 pigs for TROP) between 11 and 23 weeks of age. Growth performance and thermoregulatory responses (rectal and skin temperatures) were also measured. Results show that TROP conditions affect feeding behaviour traits: animals had more meals per day but these meals were smaller both in duration and in size, resulting in lower daily feed intake and less time eating per day. Significant SF by environment (GxE) interactions were found for all feeding behaviour traits. When SF were distributed into robust and sensitive groups (previously defined according to performance and thermoregulatory traits), results showed group by environment interactions for all feeding traits, except meal frequency. Moreover, a significant difference in feeding rate between robust and sensitive group was detected in TEMP, suggesting that feeding rate may be a good candidate to evaluate heat tolerance.


Assuntos
Comportamento Animal/fisiologia , Regulação da Temperatura Corporal/fisiologia , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Resposta ao Choque Térmico/fisiologia , Abrigo para Animais , Suínos/crescimento & desenvolvimento , Suínos/fisiologia , Animais , Feminino , Umidificadores , Masculino , Suínos/psicologia , Temperatura
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