Air quality mapping using GIS and economic evaluation of health impact for Mumbai City, India.

UNLABELLED: Mumbai, a highly populated city in India, has been selected for air quality mapping and assessment of health impact using monitored air quality data. Air quality monitoring networks in Mumbai are operated by National Environment Engineering Research Institute (NEERI), Maharashtra Pollution Control Board (MPCB), and Brihanmumbai Municipal Corporation (BMC). A monitoring station represents air quality at a particular location, while we need spatial variation for air quality management. Here, air quality monitored data of NEERI and BMC were spatially interpolated using various inbuilt interpolation techniques of ArcGIS. Inverse distance weighting (IDW), Kriging (spherical and Gaussian), and spline techniques have been applied for spatial interpolation for this study. The interpolated results of air pollutants sulfur dioxide (SO2), nitrogen dioxide (NO2) and suspended particulate matter (SPM) were compared with air quality data of MPCB in the same region. Comparison of results showed good agreement for predicted values using IDW and Kriging with observed data. Subsequently, health impact assessment of a ward was carried out based on total population of the ward and air quality monitored data within the ward. Finally, health cost within a ward was estimated on the basis of exposed population. This study helps to estimate the valuation of health damage due to air pollution. IMPLICATIONS: Operating more air quality monitoring stations for measurement of air quality is highly resource intensive in terms of time and cost. The appropriate spatial interpolation techniques can be used to estimate concentration where air quality monitoring stations are not available. Further, health impact assessment for the population of the city and estimation of economic cost of health damage due to ambient air quality can help to make rational control strategies for environmental management. The total health cost for Mumbai city for the year 2012, with a population of 12.4 million, was estimated as USD8000 million.

Vehicular pollution modeling using the operational street pollution model (OSPM) for Chembur, Mumbai (India).

Megacities in India such as Mumbai and Delhi are among the most polluted places in the world. In the present study, the widely used operational street pollution model (OSPM) is applied for assessing pollutant loads in the street canyons of Chembur, a suburban area just outside Mumbai city. Chembur is both industrialized and highly congested with vehicles. There are six major street canyons in this area, for which modeling has been carried out for NOx and particulate matter (PM). The vehicle emission factors for Indian cities have been developed by Automotive Research Association of India (ARAI) for PM, not specifically for PM10 or PM2.5. The model has been applied for 4 days of winter season and for the whole year to see the difference of effect of meteorology. The urban background concentrations have been obtained from an air quality monitoring station. Results have been compared with measured concentrations from the routine monitoring performed in Mumbai. NOx emissions originate mainly from vehicles which are ground-level sources and are emitting close to where people live. Therefore, those emissions are highly relevant. The modeled NOx concentration compared satisfactorily with observed data. However, this was not the case for PM, most likely because the emission inventory did not contain emission terms due to resuspended particulate matter.

Creating Backup Management Resources for Spine Care during the Coronavirus Disease 2019 Pandemic.

During this unprecedented time of the coronavirus disease 2019 (COVID 19) pandemic, most countries are struggling to optimize their healthcare resources. Although the prevention and treatment of COVID 19 has become the priority for the majority of the population, most medical professionals are facing the challenge of balancing the management of this pandemic and treating patients with other diseases. Healthcare professionals from all specialties are facing this situation and designing guidelines and recommendations that are contributing to the literature that is crucial for disease management at the current time. We share our experience with two ends of the spectra that we currently observe in spine patients. One group of patients included the non-operative cases that presented with back pain. Further, we discuss our experience with operative precautions and digitally assisted discharge.

An Unusual Presentation of Hemophilia A: Pseudotumor of Distal End Radius-Masquerading as Giant Cell Tumor.

Hemophilia is a coagulation defect caused by a functional or absolute deficiency of coagulation factors. Deficiency of factor VIII leads to hemophilia A; deficiency of factor IX causes hemophilia B. Pseudotumor may arise from hemorrhage into the muscle and within the subperiosteal space and can lead to destruction of the adjacent muscle, bone, nerves, and vessels. A 60-year-old man presented with the complaint of pain and swelling in right wrist. The patient consulted the general practitioner who misdiagnosed it as a case of giant cell tumor due to typical X-ray changes. Biopsy was done following which there was prolonged bleeding leading to worsening of clinical condition and the patient presented in our hospital with ulcerated swelling. Routine blood investigations were within normal limit. Prothrombin time was 12.1 seconds and activated partial thromboplastin time (aPTT) was 54.3 seconds. Raised aPTT led to suspicion of hemophilia, and factor VIII and IX levels were investigated. Factor IX level was within normal limit. Factor VIII level was 6.3%. The patient was managed conservatively. Factor VIII level was replaced according to standard protocol (40 IU/kg per dose thrice a week for 10 days). Daily dressing was done using tranexamic acid locally. Lesion healed completely in 6 months.

Immunotherapy for non-responders among patients of spinal tuberculosis.

BACKGROUND: Combined chemo- and immunotherapy are the major advancement in the treatment of tuberculosis. Immunotherapy supposedly increases cure rate while reducing the duration of treatment and tissue damage. Non-responders are those patients of tuberculosis who do not respond to anti-tubercular therapy (ATT) in the desired manner despite the mycobacteria showing sensitivity to the given drugs. The role of immunotherapy in the treatment of this particular subset of patients has been investigated scarcely. METHODS: The present study included a retrospective review of prospectively collected clinico-radiological data of 14 non-responder patients who were taking ATT for spinal tuberculosis for a mean duration of 10.3 months. An immunotherapeutic regime comprising of single intramuscular injection of vitamin D 600,000IU, 3 days course of oral albendazole 200mg daily, salmonella vaccine 0.5ml intramuscular and influenza vaccine 0.5ml intramuscular were added to ATT. The vaccines and the course of oral albendazole were repeated after a month. RESULTS: Before immunotherapy, seven patients were partially dependent while other seven were completely dependent on others for activities of daily living. All except one patient after treatment became independent till last follow-up (p value <0.01). Post immunotherapy, ATT was continued for mean duration of 4.9 months with mean follow-up of 22.4 months. All patients showed good clinical response within 2-6 weeks after the initiation of immunotherapy. CONCLUSIONS: The crux to success of the immunotherapy regime is its potential to restore the existing Th1 Th2 imbalance and to provide substitute to the anergic and dysfunctional immune cells.