Impact of solid fuel usage on respiratory symptoms among reproductive aged women: a cross-sectional study in Sri Lanka.

BACKGROUND: Worldwide, around 3 billion people rely on solid fuel for their daily energy needs. Household air pollution secondary to solid fuel burning is a major risk factor for respiratory mobility among vulnerable populations. This study aimed to investigate the respiratory symptoms associated with solid fuel usage, the level of kitchen fuel smoke exposure and its association with respiratory symptoms among reproductive-aged women in Sri Lanka, where most households exclusively use firewood as the primary cooking fuel. METHODS: A descriptive cross-sectional study was conducted among 403 reproductive-aged women (15 to 49 years) in the Central Province, Sri Lanka. A structured interviewer-administered questionnaire was used to collect data, and an exposure assessment was done using a breath carbon monoxide monitor. RESULTS: After adjusting for potential confounding factors by the logistic regression models, the odds ratios (OR) of the liquid petroleum gas-only users for at least one respiratory symptom relevant to cough (OR: 0.39; 95% confidence interval [CI]: 0.20-0.78), wheezing (OR: 0.47; 95% [CI]: 0.26-0.87), and dyspnea (OR: 0.44; 95% CI: 0.24-0.84) were significantly lower compared to firewood-only users. The mean of expired air carbon monoxide and estimated carboxyhemoglobin levels of liquid petroleum gas-only users (2.84 ± 2.85 ppm; 1.08 ± 0.46%) were significantly lower than those of firewood-only users (5.27 ± 4.64 ppm; 1.47 ± 0.74%). CONCLUSIONS: The use of firewood increased the risk of respiratory symptoms among reproductive-aged women in Sri Lanka. Health education focused on positive behavioral changes and effective and efficient clean energy policies are recommended to mitigate the risk associated with solid fuel smoke exposure.

Pharmacological treatment of inhalation injury after nuclear or radiological incidents: The Chinese and German approach.

Inhalation injury is often associated with burns and significantly increases morbidity and mortality. The main toxic components of fire smoke are carbon monoxide, hydrogen cyanide, and irritants. In the case of an incident at a nuclear power plant or recycling facility associated with fire, smoke may also contain radioactive material. Medical treatments may vary in different countries, and in this paper, we discuss the similarities and differences in the treatments between China and Germany. Carbon monoxide poisoning is treated by 100% oxygen administration and, if available, hyperbaric oxygenation in China as well as in Germany. In addition, antidotes binding the cyanide ions and relieving the respiratory chain are important. Methemoglobin-forming agents (e.g., nitrites, dimethylaminophenol) or hydroxocobalamin (Vitamin B12) are options. The metabolic elimination of cyanide may be enhanced by sodium thiosulfate. In China, sodium nitrite with sodium thiosulfate is the most common combination. The use of dimethylaminophenol instead of sodium nitrite is typical for Germany, and hydroxocobalamin is considered the antidote of choice if available in cases of cyanide intoxications by fire smoke inhalation as it does not further reduce oxygen transport capacity. Systematic prophylactic use of corticosteroids to prevent toxic pulmonary edema is not recommended in China or Germany. Stable iodine is indicated in the case of radioiodine exposure and must be administered within several hours to be effective. The decorporation of metal radionuclides is possible with Ca (DTPA) or Prussian blue that should be given as soon as possible. These medications are used in both countries, but it seems that Ca (DTPA) is administered at lower dosages in China. Although the details of the treatment of inhalation injury and radionuclide(s) decorporation may vary, the general therapeutic strategy is very similar in China and Germany.

Improving risk assessment approaches for chemicals with both endogenous and exogenous exposures.

To conduct risk assessments of exogenous chemicals for which there are also endogenous exposures, knowledge of the chemistry and biology of both types of exposures needs to be integrated into problem formulation and carried through to risk characterization. This issue is framed in a risk assessment context, highlighting the importance of quantifying increments of dose from all sources of the same or similar chemicals interacting with biological targets; understanding the influence of endogenous chemical concentrations on disease risk; and assessing total dose to targets in evaluating risk from incremental environmental exposures. Examples of recent assessments illustrate the importance of addressing this issue. Evaluations of data on blood or organ concentrations of ammonia, methanol, formaldehyde, acetaldehyde, and three gaseous signaling molecules (hydrogen sulfide, carbon monoxide, and nitric oxide) provide examples where current data are already informing perspectives on relative exposures at the portal of entry and systemically. To facilitate quality risk assessments of exogenous chemicals with endogenous exposures, a series of specific questions are presented that need to be addressed in systematic review to enhance problem formulation, improve the development of holistic conceptual models, and to facilitate the identification of priority data needs for improving risk assessments.

Carbon Monoxide Poisoning in Miami-Dade County Following Hurricane Irma in 2017.

OBJECTIVE: The Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) investigated 106 reported carbon monoxide (CO) exposures over a 9-day timeframe after Hurricane Irma. This report evaluates risk factors for CO poisoning and the importance of heightened surveillance following natural disasters. METHODS: Data on CO poisoning cases from September 9 to 18, 2017 were extracted from Merlin, the Florida Department of Health Surveillance System. Medical records were obtained and follow-up interviews were conducted to collect data on the confirmed CO poisoning cases. Data were analyzed using SAS v9.4. RESULTS: Ninety-one of the 106 people exposed to CO met the case definition for CO poisoning: 64 confirmed, 7 probable, and 20 suspect cases. Eighty-eight percent of the affected individuals were evaluated in emergency departments and 11.7% received hyperbaric oxygen treatment. The most frequently reported symptoms included headache (53.3%), dizziness (50.7%), and nausea (46.7%). Three patients expired due to their exposure to CO. CONCLUSIONS: Post Hurricane Irma, the DOH-Miami-Dade investigated numerous cases for CO exposure. By understanding who is most likely to be impacted by CO and the impact of generators' location on people's health, education efforts can be tailored to the population most at risk and further CO exposures and related mortalities following natural disasters can be reduced. (Disaster Med Public Health Preparedness. 2019;13:94-96).

Normal carboxyhaemoglobin level in carbon monoxide poisoning treated with hyperbaric oxygen therapy.

Throughout the world both intentional and inadvertent exposure to carbon monoxide (CO) remains an important public health issue. While CO poisoning can be lethal, the morbidity is predominantly due to nervous system injury. A previously healthy 22-year-old woman was found unconscious at home by her sister. Her parents were found dead in the house with a recent history of a dysfunctional furnace. She was presumed to have CO poisoning despite an initial carboxyhaemoglobin level of 2.5%. Patient had both clinical and radiological evidence of neurological damage. However, with multiple sessions of hyperbaric oxygen (HBO) therapy she recovered to a near normal functional status. There is no consensus that exists among treating physicians about the role of hyperbaric oxygen in management of neurological injury. The case described here has significant neurological damage related to CO exposure but improved after HBO therapy.

Exposures and cross-shift lung function declines in wildland firefighters.

Respiratory problems are common among wildland firefighters. However, there are few studies directly linking occupational exposures to respiratory effects in this population. Our objective was to characterize wildland fire fighting occupational exposures and assess their associations with cross-shift changes in lung function. We studied 17 members of the Alpine Interagency Hotshot Crew with environmental sampling and pulmonary function testing during a large wildfire. We characterized particles by examining size distribution and mass concentration, and conducting elemental and morphological analyses. We examined associations between cross-shift lung function change and various analytes, including levoglucosan, an indicator of wood smoke from burning biomass. The levoglucosan component of the wildfire aerosol showed a predominantly bimodal size distribution: a coarse particle mode with a mass median aerodynamic diameter about 12 µm and a fine particle mode with a mass median aerodynamic diameter < 0.5 µm. Levoglucosan was found mainly in the respirable fraction and its concentration was higher for fire line construction operations than for mop-up operations. Larger cross-shift declines in forced expiratory volume in one second were associated with exposure to higher concentrations of respirable levoglucosan (p < 0.05). Paired analyses of real-time personal air sampling measurements indicated that higher carbon monoxide (CO) concentrations were correlated with higher particulate concentrations when examined by mean values, but not by individual data points. However, low CO concentrations did not provide reliable assurance of concomitantly low particulate concentrations. We conclude that inhalation of fine smoke particles is associated with acute lung function decline in some wildland firefighters. Based on short-term findings, it appears important to address possible long-term respiratory health issues for wildland firefighters. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resources: a file containing additional information on historical studies of wildland fire exposures, a file containing the daily-exposure-severity questionnaire completed by wildland firefighter participants at the end of each day, and a file containing additional details of the investigation of correlations between carbon monoxide concentrations and other measured exposure factors in the current study.].

Mass balance source apportionment modeling of indoor air pollution exposures during the Ethiopian coffee ceremony.

Mass balance modeling was used to apportion previously measured carbon monoxide and respirable particle exposures of women preparing coffee during Ethiopian coffee ceremonies. The coffee ceremony generates smoke indoors from the use of charcoal and incense. This creates inhalation exposures, particularly for the women preparing the coffee. Understanding the health risks associated with this practice will be improved with knowledge of the relative contribution to combustion byproduct exposures from the different sources. Source fingerprints were developed in the laboratory for carbon monoxide and respirable particle emissions from charcoal and incense. A mass balance model determined that the majority of the carbon monoxide exposures were from charcoal use and that the respirable particle exposures were approximately half from incense and half from charcoal. Efforts to decrease health risks from these exposures must be directed by Ethiopian cultural stakeholders who understand the exposure conditions, the health risks, and the societal context.

El asesino silencioso: intoxicaciones por monóxido de carbon / The silent killer. Carbón monoxide poisoning

Introducción. El monóxido de carbono (CO) es un contaminante de la atmósfera terrestre y tóxico para el ser humano. Las intoxicaciones por CO están infradiagnosticadas. Objetivo. Describir las característica sociodemográficas. Objetivo. Describir las características sociodemográficas y clínicas de los pacientes atendidos por intoxicación por CO (ICO). Metodología. Estudio transversal entre 2006 y 2010 en el servicio de urgencias de un hospital, en menores de 15 años atendidos por ICO. Se incluyeron variables sociodemográficas y clínicas. Se realizó una estadística descriptiva mediante frecuencias y estadístico exacto de Fisher, mediante SPSS 18. Resultados. Se registraron 63 urgencias por ICO. La prevalencia incrementó del 0,14/1.000 en 2006 al 3,07/1.000 en 2010. La mayoría se presentó en varones (34 niños, 53,9%), entre 0-4 años (37, 58,7%), españoles (28, 58,3%). La causa principal de las ICO fue la incorrecta combustión del carbón (14, 30,2%). La sintomatología que predomina es la neurológica, como cefalea (16, 25,4%), destacando los asintomáticos (23, 36,5%). La carboxihemoglobina fue superior al 10% en un 35,6% de las ICO. 36 niños (57,1%) precisaron tratamiento en cámara hiperbárica. Conclusiones. La clínica de las ICO es muy inespecífica, similar a cuadros virales y síntomas neurológicos sin causa aparente y afecta a diversos miembros de una familia, sobre todo en invierno (AU)

Introduction. Carbon monoxide (CO) is a contaminant of the Earth´s atmosphere and toxic to humans. The incidence of CO poisoning (COP) is underdiagnosed. Objectives. To describe the sociodemographic and clinical characteristics of patients treated for CO poisoning (COP). Methodology. Cross-sectional study between 2006 and 2010 in the emergency room of a local hospital in under 15 attended by COP. We included sociodemographic and clinical variables. Descriptive statistics were performed using frequencies and Fisher exact test, using SPSS 18. Results. There were 63 emergency COP, each corresponding to a different child. The increased prevalence of 0,14/1,000 in 2006 to 3,07/1.000 in 2010. Most occurred in males (34, 53,9%), 0-4 years (37, 58,7%), Spanish (28, 58,3%). The main cause of COP was the incorrect burning coal (14, 30,2%). The predominant symptoms are neurological, such as headache (16, 25,4%), highlighting the asymptomatic (23, 36,5%). Carboxyhemoglobin was above 10% in 35,6% of the COP. 36 children (57,1%) required treatment in a hyperbaric chamber. Conclusion. The clinic of the COP is very nonspecific, similar to viral conditions and unexplained neurological symptoms and affects several members of a family, especially in winter (AU)

Exposures to high levels of carbon monoxide from wood-fired temazcal (steam bath) use in highland Guatemala.

The temazcal is a wood-fired steam bath used in the rural highlands of Guatemala for bathing and healing. We measured carbon monoxide (CO) among 288 participants in 72 temazcales. Participants were drawn from communities who participated in the RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects) chimney stove intervention trial. Temazcal CO exposures were extremely high, averaging 431 parts per million (time-weighted average). Compared to kitchen wood-smoke exposures, the temazcal contributes significantly to weekly exposures, despite the fact that the population spends less time in the temazcal than in the kitchen. This report 1) describes temazcal use patterns; 2) reports participants' signs and symptoms during temazcal use; 3) models the distribution of temazcal CO concentrations; 4) assesses reliability of exhaled breath CO as a biomarker of CO exposure; and 5) provides a proportional analysis of CO concentrations from temazcal use, as compared to kitchen concentrations.

Intoxicación por monóxido de carbono: una patología poco valorada en urgencias / Carbon monoxide poisoning: an undervalued event in the emergency department

La intoxicación aguda por monóxido de carbono (CO) es una urgencia médica que, de no tratarse oportunamente, puede dejar considerables secuelas neurológicas o incluso provocar la muerte del paciente. El cuadro clínico depende de la intensidad de la exposición a este gas y varía según el grado de afectación de los distintos órganos involucrados. La administración de oxígeno normobárico (NBO) es el tratamiento utilizado en la mayoría de los servicios de urgencias hasta la resolución de los síntomas y la normalización de los niveles de carboxihemoglobina (COHb), siendo dados de alta los pacientes en la práctica común sin seguimiento posterior. Presentamos el caso de un paciente que acude a urgencias por síncope y nos cuestionamos si la utilización de oxigeno hiperbárico (HBO) frente a (NBO) disminuye las secuelas neurológicas, así como la existencia de indicaciones con evidencia científica para su uso (AU)

Carbon monoxide (CO) poisoning is a medical emergency, which if not treated properly could leave considerable neurological sequelae or even cause the death of the patient. The signs and symptoms depend on the intensity of the exposure to the gas and vary according to the degree to which the different organs are affected. Administration of normobaric oxygen (NBO) is the treatment used in most emergency services. This gas is administered until symptoms are resolved and carboxyhemoglobin (COHb) levels have returned to normal. The patient is then discharged with no subsequent follow-up. We present the case of a patient who came to the emergency department due to syncope. We ask ourselves whether the use of hyperbaric oxygen (HBO) compared to NBO decreases neurological sequelae, and if there is scientific evidence for its use in this indication (AU)

Long-term exposure to close-proximity air pollution and asthma and allergies in urban children.

The aim of this study was to evaluate the impact of urban air pollution, assessed through reliable indicators of exposure, on asthma and allergies in schoolchildren. A validated dispersion model combining data on traffic conditions, topography, meteorology and background pollution was used to relate 3-yrs averaged concentrations of major urban pollutants at the sites of schools to skin prick tests, exercise-induced asthma and reported asthma and allergies in 6,683 children (9-11 yrs) attending 108 schools randomly selected in six French communities. For the 4,907 children who had resided at their current address for the past 3 yrs, asthma (exercise induced, past year and lifetime) was significantly positively associated with benzene, SO(2), particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)), nitrogen oxides (NO(x)) and CO. In the same children, eczema (lifetime and past year) was significantly positively associated with benzene, PM(10), NO(2), NO(x) and CO, lifetime allergic rhinitis with PM(10) and sensitisation to pollens with benzene and PM(10). Among the 2,213 children residing at their current address since birth, the associations persisted for lifetime asthma with benzene (adjusted OR per interquartile range (95% CI) 1.3 (1.0-1.9)) and PM(10 )(1.4 (1.0-2.0)), and for sensitisation to pollens with volatile organic compounds (1.3 (1.0-1.9)) and PM(10) (1.2 (1.0-1.9)). Accurately modelled urban air pollution was associated with some measures of childhood asthma and allergies.

[Screening for carbon monoxide (CO) poisoning by general practitioners in home visits]. / Dépistage des intoxications au monoxyde de carbone (CO) par des médecins généralistes effectuant des visites à domicile.

OBJECTIVE: To evaluate the interest of carbon monoxide (CO) detector used by general practionners visiting patients at home. METHODS: CO detector (cost: 200 euros) was attributed to 300 general practionners visiting at least 20 patients at home per week. Alarm was triggered when ambient CO concentration exceeded 80ppm. Measurement of CO in expired breath was also possible. Activity and alarms were prospectively collected. Circumstances of intoxication were recorded. Evaluation was finally performed. The end-poind was to quantify CO-poisoning detected by the use of the device and the cost of this stratégy. RESULTS: From November 2001 to November 2004, 65 scenes of intoxication with 79 victims were prospectively reported by 12 general practionners. Final evaluation revealed that 23 physicians omitted to declare alarms. Alarm incidence was of 1 for 17.527 visits; with a related cost of approximately 858 euros for 24 months. Ambient carbon monoxide concentration exceeded 200ppm in 25% of cases. Hospital admission was required for 91% of the victims. Hyperbaric oxygen therapy was performed in two cases. General practionners (n=272) considered that CO detector was useful for safety reasons (91%), they wanted to continue the experience, but did not plan to buy such device (59%). DISCUSSION: Use of CO detectors by general practionners visiting patients at home allowed to identify 65 scenes of CO intoxication. In most cases, the cause of the visit did not suggested CO poisoning. The cost of the device seems to limits its large use. CONCLUSION: CO detector is a safety tool for both general prationners and patients. Its large use has to be questioned.

Unintended benefits: leadership skills and behavioral change among Guatemalan fieldworkers employed in a longitudinal household air pollution study.

The RESPIRE and CRECER studies measured the effects of reduced household air pollution (HAP) from wood-fired cookstoves on respiratory health in rural highland Guatemala. This article examines behavior change and leadership skill development in local community members who were hired as fieldworkers to assist with research. Fieldworkers administered household questionnaires, shared functions similar to community health workers, and bridged health resources to communities. A mixed-methods design for data collection (in-depth interviews, focus groups, impact drawings, knowledge questionnaire, and retrospective pre-test) was used. Purposive sampling included 10 fieldworkers and 13 local service providers. Fieldworkers showed an increase in knowledge, positive attitudes, and practices around HAP. They developed new technical, interpersonal, and leadership skills. Fieldworkers played a crucial role in building confianza (trust) with the community, bridging resources, and improving outside researchers' relationships with locals. Recommendations for future researchers include inclusion of additional training courses and adoption of community participatory approaches.

An unusual CO-conspirator in a case of acute coronary syndrome.

Carbon monoxide (CO) poisoning is a common cause of morbidity and mortality that exerts its physiological effects by competition with molecular oxygen. Therefore, tissues that extract a high fraction of oxygen from circulating blood are at high risk for injury due to CO toxicity. While neurological complications of CO poisoning have been well described, cardiac damage secondary to CO poisoning also occurs, but has been less frequently reported. We present the case of a young man with CO poisoning who had elevated cardiac biomarkers, a regional wall motion abnormality, and was found to have obstructive coronary disease. Evidence of myocardial necrosis in the setting of CO toxicity should prompt consideration of an evaluation for coronary artery disease, particularly among those with risk factors.

Is Gulf War Syndrome really a mystery?

Since the end of the 1991 Gulf War about 20,000 United States veterans and similar proportions of troops from other allied contingents have been affected by a variety of symptoms which have collectively become known as 'Gulf War Syndrome'. Similar symptoms have been reported in Iraqi civilians including children. Despite extensive investigations no agreement has been reached on whether there is an underlying cause or causes. In this article, the principal features of the illness are summarised and some of the proposed causes discussed. It is proposed that the common cause is the toxic smoke from incomplete combustion of oil from burning wells, and this hypothesis is related to the known toxicology of two likely combustion products, nitric oxide and carbon monoxide. The effect of this proposal on possible investigations and treatment is considered.

In utero and lactation exposure of rats to 1R4F reference cigarette mainstream smoke: effect on prenatal and postnatal development.

Childhood cognitive and behavioral deficits have been reported in children born to mothers who smoked during pregnancy (Institute of Medicine, 2001). To investigate these potential responses in an animal model, reproductive and neurotoxicity evaluations based on the U.S. FDA guidelines were used to examine the offspring of male and female Sprague-Dawley rats exposed 2 h/day, 7 days/week by nose-only inhalation to whole mainstream smoke total particulate matter (TPM). Concentrations of 150, 300, or 600 mg/m(3) were used (males: 4 weeks prior to and during mating; and females: 2 weeks prior to mating, during mating, and through weaning at postnatal day 21). Sham air controls receiving filtered air and cage controls were also maintained. F(1) rats were weighed, identified by gender, examined for clinical signs of toxicity, and evaluated for neurobehavioral effects through postnatal day 65. Parental exposure was evidenced by smoke concentration-related increases in blood carboxyhemoglobin, nicotine, and cotinine and by characteristic cigarette smoke-related rodent respiratory tract histopathology. Also, nicotine and cotinine were found in F(1) blood through the lactation period. Maternal toxicity occurred at concentrations of 300 and 600 mg TPM/m(3), where total body weight gain during gestation was significantly (p < or = 0.05) decreased compared to sham controls. While smoke concentration-related decreases in F(1) birth weight and growth were evident (600 mg TPM/m(3), significantly different from sham at all time points), no adverse effects on developmental landmarks, including age at vaginal patency or preputial separation, motor activity, acoustic startle response or learning, and memory, were observed in the F(1) generation. This study confirmed that maternal exposure to high levels of mainstream cigarette smoke during gestation and lactation reduces birth weight and retards growth in the rat neonate; however, the developmental and neurobehavioral testing methodologies employed did not appear to be sensitive for an evaluation of neonatal behavioral effects following parental smoke exposure.

Intoxicación por monóxido de carbono en el embarazo / Intoxication by carbon monoxide in the pregnancy

Se presenta un caso clínico de embarazo con intoxicación con monóxido de carbono, sus consecuencias y tratamiento.

Vitamin B6 revisited. Evidence of subclinical deficiencies in various segments of the population and possible consequences thereof.

The importance of vitamin B6 in human nutrition is discussed with special reference to the possibility of undetected long-term subclinical deficiencies in the population at large. It is well known that this vitamin plays a vital role in many physiological processes, such as amino acid metabolism, lipid metabolism and the immune process. In view of the well-documented photo- and thermolability of the different B6 vitamers it stands to reason that serious dangers to health may be associated with undetected, lingering subclinical deficiencies, e.g. induction of and predisposition to various diseases (such as atherosclerosis, multiple sclerosis, degeneration of the myelin sheath of the central nervous system). With the advent of modern analytical techniques it is now imperative that a survey of the vitamin B6 status of a representative sample of the population at large be performed, and that fortification of key food items and/or other means of B6 supplementation be considered pending the outcome of such a survey.