Assessment of the relationship between exposure to air pollutants and COVID-19 pandemic in Tehran city, Iran.

The COVID-19 disease caused by the SARS-CoV-2 virus first identified in December 2019 has resulted in millions of deaths so far around the world. Controlling the spread of the disease requires a good understanding of the factors (e.g. air pollutants) that influence virus transmission and the conditions under which it spreads. This study analyzed the relationships between COVID-19 cases and both short-term (6-month) and long-term (60-month) exposures to eight air pollutants (NO, NO2, NOx, CO, SO2, O3, PM2.5 and PM10) in Tehran city, Iran, by integrating geostatistical interpolation models, regression analysis, and an innovated COVID-19 incidence rate calculation (Q-index) that considered the spatial distributions of both population and air pollution. The results show that the higher COVID-19 incidence rate was significantly associated with the exposure to higher concentrations of CO, NO, and NOx during the short-term period; the higher COVID-19 incidence rate was significantly related to the exposure to higher concentrations of PM2.5 during the long-term period; while COVID-19 incidence rate was not significantly associated with the concentrations of O3, SO2, PM10 and NO2 in either period. This study indicates that exposure to air pollutants can effect an increase in the number of infected people by transmitting the virus through the air or by predisposing people to the disease over time. The Q-index calculation method developed in this study can be also used by other studies to calculate more accurate disease rates that consider the spatial distribution of both population and air pollution.

Macroeconomic Development and Dramatic Increase in Stroke Burden in Rural China: A 25-Year Population-Based Study.

Low socioeconomic status is associated with a high stroke risk. However, few studies have quantitatively assessed the relationship between stroke burden and national economic development indicators. We explored the quantitative association between macroeconomic development and stroke burden in rural China. In this population-based, prospective study (1992-2016), we collected data on annual registrations of stroke events and deaths in Tianjin, China. Economic development over the period was represented by gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) of rural residents in China. We assessed the association of first-ever stroke incidence with PPP-aGDP and PCNI. During the 25-year study period, there were 1,185 stroke events and 362,296 person years of surveillance. First-ever stroke incidence increased by an average of 10.7% per 1,000 USD increase in overall PPP-aGDP and by 12.0% per 1,000 Yuan increase in PCNI; respectively, the mean increases were 9.6 and 10.8% in men and 13.0 and 14.4% in women (all, P < 0.001). These same changes in PPP-aGDP and PCNI also resulted in increases in the incidence of ischemic stroke (12.6 and 14.3%, respectively; P < 0.05), and intracerebral hemorrhage (both, 6.2%; P < 0.05). Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0.96-years (P = 0.002) for each 1,000 USD increase in PPP-aGDP and by 1.08-years (P = 0.003) for each 1,000 Yuan increase in PCNI. Macroeconomic development was positively associated with stroke incidence in rural China. Thus, enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings could guide other developing countries with information regarding the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development.

Association of Blood Pressure With Stroke Risk, Stratified by Age and Stroke Type, in a Low-Income Population in China: A 27-Year Prospective Cohort Study.

Association of stroke risk with new blood pressure criterion 2017 is unknown in China. We assessed the association between blood pressure (BP) values and stroke risk in a low-income population in Tianjin, China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were categorized into five strata and strokes were recorded as stroke, ischemic stroke, and hemorrhagic stroke. Stroke risk was analyzed according to blood pressure stratum using Cox regression analysis. Overall, 4,017 residents (age, ≥18 years) were included in this prospective cohort study. Over a 27-year follow-up period (total, 86,515.78 person-years), 638 participants experienced first-ever strokes. The stroke risk was higher among individuals with SBPs ≥140 mmHg or DBPs ≥90 mmHg than among those with SBPs < 130 mmHg or DBPs < 80 mmHg (reference group), after adjusting for covariates. However, hemorrhagic stroke risk increased only in participants with SBPs ≥160 mmHg. The stroke risk increased for individuals < 65-years-old having BP values ≥130/80 mmHg and for individuals ≥65-years-old with BP values ≥160/90 mmHg. To reduce the stroke burden in China, target BP goals must be established for adults, with different targets for the middle-aged and the elderly segments of the population. These results are very important for guiding clinical practice and may be generalized to other developing countries experiencing rapid economic development and where transitions in the spectrum of prevalent diseases have occurred.

Initial Assessment and Implications for Surgery: The Missed Diagnosis of Irreducible Knee Dislocation.

Irreducible knee dislocation is a rare but devastating orthopedic emergency. Limited discussion about its characteristics has been undertaken due to its low incidence. The purpose of this study was to present a series of irreducible dislocated knees and cumulatively reviewed all existing publications in this filed. A retrospective case series study was undertaken in patients with irreducible knee dislocation. Patients' data were carefully collected and presented. Historical cases of irreducible knee dislocation in published papers were reviewed, and their diagnosis, treatment, and prognosis were summarized. Six patients with six irreducible knee dislocations were enrolled with an average age of 51.2 ± 9.7 years. Patterns of injuries were classified into KD-III M (three cases), KD-IV (two cases), and KD-V (one case). Dimple sign was presented in all cases on both physical examination and MRI. All patients received single-stage arthrotomy together with cruciate ligament reconstruction acutely. In cumulative literature review, 34 papers with 45 irreducible knee dislocations were included. KD-III M was the most familiar type of ligamentous injury (75.0%). Dimple sign was recorded in 83.7% occasions and the most frequent two trapped structures were medial retinaculum (31.8%) and MCL (43.1%). Open reduction was conducted in all cases to reduce the knee, and the prognosis of 88.0% cases was considered to be acceptable after different staged surgery. The "dimple" sign is pathognomonic but not necessary for diagnosis of irreducible knee dislocations. The general consensus for treatment is immediate neurovascular status assessment and acute open reduction.

Association between carotid intima-media thickness and fasting blood glucose level: A population-based cross-sectional study among low-income adults in rural China.

AIMS/INTRODUCTION: Carotid intima-media thickness (CIMT) is an established predictor of cardiovascular disease and stroke. We aimed to identify the association between CIMT and blood glucose, as well as the risk factors associated with increased CIMT in a low-income Chinese population. MATERIALS AND METHODS: Stroke-free and cardiovascular disease-free residents aged ≥45 years were recruited. B-mode ultrasonography was carried out to measure CIMT. RESULTS: There were 2,643 participants (71.0%) in the normal group, 549 (14.7%) in the impaired fasting glucose group and 533 (14.3%) in the diabetes mellitus group. The determinants of increased CIMT were older age; male sex; low education; hypertension; smoking; high levels of systolic blood pressure, fasting blood glucose and low-density lipoprotein cholesterol; and low levels of diastolic blood pressure, triglycerides and high-density lipoprotein cholesterol, after adjusting for covariates. Age and hypertension were the common risk factors for increased CIMT in all three groups. Furthermore, male sex, smoking and high low-density lipoprotein cholesterol level were positively associated with the mean CIMT in the normal group; high triglycerides levels were negatively associated with the mean CIMT in the impaired fasting glucose group; and alcohol consumption was an independent risk factor for mean CIMT in the diabetes mellitus group. Hypertension was the greatest risk factor for increased CIMT. CONCLUSIONS: These findings suggest that it is crucial to manage and control traditional risk factors in low-income populations in China in order to decelerate the recent dramatic increase in stroke incidence, and to reduce the burden of stroke.

Increased Stroke Burdens Among the Low-Income Young and Middle Aged in Rural China.

BACKGROUND AND PURPOSE: Although stroke in the young and middle aged accounts for 31% of all strokes in China, the disease burden is unknown. We aimed to determine the secular trends in stroke incidence and the transition of subtypes in rural China over a 24-year period. METHODS: In 1992, 14 920 residents were recruited to participate in the Tianjin Brain Study. Stroke events and all deaths were registered annually. We assessed the trends in incidence of first-ever stroke, including intracerebral hemorrhage and ischemic stroke, among adults aged 35 to 64 years during 1992 to 1999, 2000 to 2007, and 2008 to 2015. The annual proportion of change in stroke incidence was evaluated from 1992 to 2015. RESULTS: The age-standardized incidence of first-ever stroke per 100 000 person-years increased significantly, from 122 in 1992 to 1999, to 215.8 in 2000 to 2007, to 471.8 in 2008 to 2015. The incidence of first-ever stroke increased annually by 11.9% overall (12.4% in men, 9.0% in women, 8.7% for intracerebral hemorrhage, and 10.7% for ischemic stroke; P<0.001). The greatest increases were observed in adults aged 55 to 64 years, with an annual increase of 11.6% for ischemic stroke (10.8% in men and 6.9% in women). However, the proportion of intracerebral hemorrhage has not changed over the past 24 years. CONCLUSIONS: In contrast with that in developed countries, the burden of stroke in China originates primarily from young and middle-aged adults. Thus, control of risk factors in this population is required to reduce the future burden of stroke in China.

Prevalence and Risk Factors of Carotid Plaque Among Middle-aged and Elderly Adults in Rural Tianjin, China.

Carotid plaque (CP) is associated with cardiovascular and cerebrovascular events. However, population-based studies with a large sample are rare in China, particularly those in the low-income population. We aimed to determine the prevalence of CP and the associated risk factors in the rural areas of northern China. Between April 2014 and June 2014, we recruited 3789 residents aged ≥45 years. B-mode ultrasonography was performed to measure the extent of CP. The prevalence of CP was 40.3% overall, 47.1% in men, and 35.4% in women (P < 0.001). The prevalence of CP increased with increasing age (P < 0.001). The participants with CP were more likely to have hypertension, diabetes, high total cholesterol (TC) levels, and high low-density lipoprotein-cholesterol levels and be a current smoker; however, they were less likely to be obese. Multiple logistic regression analysis, adjusted for confounders, indicated that age, male sex, hypertension, diabetes, current smoking, and high LDL-C levels were the independent risk factors for CP. There was a lower risk of CP with alcohol consumption. The findings suggest that managing the conventional risk factors is crucial to reduce the burden of cardiovascular and cerebrovascular diseases in the low-income population in China.