Use of unclean cooking fuels and visual impairment of older adults in India: A nationally representative population-based study.

Despite widespread use of unclean cooking fuels (UCF) in India, evidence from nationally representative data on its association with visual impairment was lacking. We used a population-based nationwide survey of adults aged 45 years and older that included reported UCF and measured visual impairment. We estimated that 44.8% (95% CI: 42.6, 47.1) of older adults in India lived in households that used UCF. Age- and sex-adjusted prevalence of visual impairment was estimated to be 33.0% (95% CI: 31.0, 34.9) in the older population that did not use UCF and 9.0 percentage points (pp) (95% CI: 8.9, 9.1) higher among those who did. Among those who used UCF, age- and sex-adjusted prevalence of low distance vision was 4.3 pp (95% CI: 4.2, 4.4) higher, prevalence of low near vision was 8.0 pp (95% CI: 7.9, 8.1) higher, and prevalence of blindness was 1.0 pp (95% CI: 0.9, 1.0) higher. After controlling for a rich array of sociodemographic characteristics and state fixed effects, we estimated that use of UCF was associated with higher prevalence of visual impairment by 3.2 pp (95% CI: 1.4, 5.0), low distance vision by 1.8 pp (95% CI: 0.7, 2.9), and low near vision by 3.2 pp (95% CI: 1.3, 5.0). Doubly robust estimates of these differences were slightly larger. Blindness was not significantly partially associated with use of UCF (95% CI: -0.4, 0.6). We did not find support for the hypotheses that the visual impairment risk associated with use of UCF was even larger for females and in households without a separate kitchen or ventilation. The older population of India is highly reliant on UCF that is very strongly associated with visual impairment. Impaired vision should not be overlooked among the harms associated with UCF.

[Celebrations with consequences: fever, dyspnea and chest pain]. / Feierlichkeiten mit Folgen: Fieber, Dyspnoe und Thoraxschmerz.

HISTORY: We report on a 35-year-old male patient who presented to the emergency department a day after celebrations. The night before, the alcoholized patient tried to spit fire with an oily fuel paste. A fever, dyspnea and chest pain were present. FINDINGS AND DIAGNOSIS: The patient is febrile, but in reduced general conditions. In laboratory chemistry shows elevated inflammatory parameters. Due to the conventional radiology findings we completed the diagnostic with a CT-scan, which shows confirmed streaky opacities, especially in the middle lobe. DIAGNOSIS: Based on the very suggestive history and diagnostic findings, a fire eater's lung was diagnosed. THERAPY AND COURSE: Under treatmen with CoAmoxicillin, oxygen, inhalation with Ipratropiumbromid/Salbutamol and symptomatic treatment, we could reach a clinical improvement and discharged within three days. CONCLUSION: Aspiration of oily fuel paste led to lipoid pneumonia. Few such cases have been described so far, but the medical history, symptoms and radiological imaging are very characteristic. Antibiotic therapy is not primarily necessary, however, depending on the clinical condition may help to prevent bacterial superinfection. The administration of systemic steroids is controversial in this situation.

DNA damage and inflammatory response in workers exposed to fuels and paints.

Workers exposed to fuels and paints may present alterations in several parameters. Thus, we assessed potential biomarkers, with the aim of detecting early changes in gasoline station attendants and painters. Blood samples were collected for the analysis of inflammatory and DNA damage markers, besides biochemical, haematological and oxidative stress parameters. Biochemical and haematological parameters, which are assessed with routine exams, showed few changes. However, these findings could mask the workers' real health status. Besides, markers of oxidative damage were not modified. Levels of inflammatory parameters (cytokines and nitric oxide levels) and the DNA damage marker 8-hydroxydeoxyguanosine were significantly changed in the workers. Our results suggest that inflammatory and DNA damage parameters can be potential biomarkers for the biological monitoring of workers exposed to fuels and paints and may contribute to the development of occupational protection standards.

Surgical Evaluation of Flame Burn Injuries in Syrian Civilians.

The aim of the current study was to evaluate the severity and location of flame burns and the mortality rate of civilians affected by these in the Syrian Civil War and to present the surgical treatment outcomes of the injured civilians to be able to provide recommendations. This was a prospective hospital-based observational cohort study involving 573 patients with data collected from 2011 to 2018. All of these patients were Syrian civilians, and their flame burn injuries were related to the Syrian conflict. All burns were divided into four subgroups according to TBSA and compared. The groups of TBSA were compared as 0 to 25% (n = 97), 25 to 50% (n = 257), 50 to 75% (n = 135), and >75% (n = 84) (P = .413). Almost all had a second (n = 331; 57.7%) and third (n = 189; 32.9%) degree deep burns. The median burn size was 47% TBSA in the patients. The burn mechanism was mostly the flame type of burn (n = 467; 81.5%) as a result of fuel oil explosions, followed by bomb-related burns (n = 106; 18.5%) (P < .001). Mortality was seen in 223 (39%) due to the high surface area and reaching hospital too late at 1 to 8 days (P = .187). The findings of this study indicate that war-related flame burns result in an extremely high mortality rate and time is lost, which could protect against life-threatening outcomes.

Characterization of PM2.5-bound polycyclic aromatic hydrocarbons and their derivatives (nitro-and oxy-PAHs) emissions from two ship engines under different operating conditions.

Emissions from ship exhaust have been recognized as an important source of air pollution in coastal areas. To investigate the impacts of engine type, fuel and operating conditions on polycyclic aromatic compounds (PACs) emissions, particle matter (PM2.5) samples emitted from an inland-river bulk freighter (BF) using marine diesel oil (MDO) and an ocean-going passenger vessel (PV) using heavy fuel oil (HFO) were collected under five operation conditions (preheating, leaving, cruising, entering and berthing). The concentrations of 17 polycyclic aromatic hydrocarbons (PAHs), 12 nitro-PAHs (NPAHs) and 4 oxygenated-PAHs species were determined. The concentrations of ΣPAHs, ΣNPAHs and ΣOPAHs measured on the BF and PV exhausts ranged from 1.95 to 417 µg/m3, 86.5 to 6.89 × 103 ng/m3 and 2.00-102 µg/m3, respectively. Both ships showed a high proportion of four-ring PAHs, while the BF had more three-ring PAHs (34.00-70.38%) and the PV had more five-ring PAHs (30.02-35.95%). The calculation of indicatory PACs are able to increase the precision of source appointment. The emission factors (EFs) of PACs under maneuvering (including preheating, leaving, entering and berthing) was much higher than those under cruising, which might be due to the engine load, fuel consumption, and secondary reactions. Compared with HFO, combustion with MDO decreased the power-based ΣPAH EFs by 82-99%, power-based ΣNPAH EFs by 86-98%, and power-based ΣOPAHs EFs by 50-82%. These data highlight the importance of quantifying and monitoring ship emissions in close proximity to port area, and are useful for enhancing the relevant databases and improving the accuracy of ship emission inventories.

Chronic bronchitis and airflow obstruction is associated with household cooking fuel use among never-smoking women: a community-based cross-sectional study in Odisha, India.

BACKGROUND: The use of solid biomass as cooking fuel could be a potential risk factor for chronic bronchitis (CB) and airflow obstruction (AFO) among never-smoking women. The disease burden in India among women is generally underestimated due to limited population-based epidemiological investigations. The aim of the study was to determine the prevalence of CB and AFO among never-smoking women, and its association with household cooking fuel use. METHODS: We conducted a community-based cross-sectional study with a representative study sample (N = 1120) in Odisha, India during 2013-14. Study participants, never-smoking women aged 18-49 years, were recruited randomly from the population census. Trained community health volunteers administered a validated questionnaire that aligned with the standards of the Burden of Obstructive Lung Disease (BOLD) initiative and conducted spirometry. Prevalence estimates of CB (defined as "cough with productive of sputum for at least 3 months of the year for at least 2 years") and AFO (pre-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 0.7) was estimated. Indoor PM2.5 exposure data were collected from a subset of 130 of the total 1120 homes in the study settings. Multivariable regression models were used to estimate the associated risk factors. RESULTS: Prevalence of CB and AFO were 7.3 and 22.4% respectively among the study participants. Of the study participants, 31% used exclusive liquefied petroleum gas, 18% used mixed fuel and 51% exclusively used solid biomass fuel for household cooking. In adjusted analysis, both CB (odds ratio 1·96, 95% CI: 1.06-3.64; p = 0·031) and AFO (OR 5.55, 95% CI: 3.51-8.78; p < 0·001) were found to be associated with cooking with solid biomass fuel. Interquartile range increases in PM2.5 was associated with significantly lower FEV1/FVC ratio. CONCLUSIONS: The study highlights that the estimates of population burden of CB and AFO are much higher than shown in previous epidemiological studies, and that cooking fuel type and time spent on cooking were associated with increased chronic bronchitis as well as decreased lung function as measured by FEV1/FCV ratios. To most accurately understand the current burden of disease and most effectively prevent an escalation in the future disease burden, further epidemiological investigations are warranted.

Household Fuel Use and Cardiovascular Disease Mortality: Golestan Cohort Study.

BACKGROUND: Household air pollution is the third largest risk factor for global disease burden, but direct links with cardiovascular disease mortality are limited. This study aimed to evaluate the relationship between household fuel use and cardiovascular disease mortality. METHODS AND RESULTS: The Golestan Cohort Study in northeastern Iran enrolled 50 045 individuals 40 to 75 years of age between 2004 and 2008 and collected data on lifetime household fuel use and other baseline exposures. Participants were followed up through 2012 with a 99% successful follow-up rate. Cox proportional hazards models were fitted to calculate hazard ratios for associations between pehen (local dung), wood, kerosene/diesel, or natural gas burning for cooking and heating and all-cause and cause-specific mortality, with adjustment for lifetime exposure to each of these fuels and potential confounders. A total of 3073 participants (6%) died during follow-up; 78% of these deaths were attributable to noncommunicable diseases, including cardiovascular, oncological, and respiratory illnesses. Adjusted 10-year hazard ratios from kerosene/diesel burning were 1.06 (95% confidence interval, 1.02-1.10) and 1.11 (95% confidence interval, 1.06-1.17) for all-cause and cardiovascular mortality, respectively. Subtype-specific analyses revealed a significant increase in ischemic heart disease (10-year hazard ratio, 1.14; 95% confidence interval, 1.06-1.21) and a trend toward cerebrovascular accident (10-year hazard ratio, 1.08; 95% confidence interval, 0.99-1.17) mortality. Stratification by sex revealed a potential signal for increased risk for all-cause and cardiovascular disease mortality among women compared with men, with similar risk for ischemic heart disease mortality. CONCLUSIONS: Household exposure to high-pollution fuels was associated with increased risk for all-cause and cardiovascular disease mortality. Replicating these results worldwide would support efforts to reduce such exposures.

Mortality from neurodegenerative diseases in a cohort of US flight attendants.

BACKGROUND: Concern exists about the potential chronic neurological effects among aircrew of exposure to chemical contaminants from engine oil in aircraft cabin air. We evaluated mortality from neurodegenerative diseases among 11,311 former US flight attendants. METHODS: Vital status was ascertained through 2007, and life table analyses were conducted to obtain standardized mortality ratios (SMRs). RESULTS: Amyotrophic lateral sclerosis (ALS) mortality was over twice as high in the cohort as in the US general population, based on nine observed ALS deaths. There was no clear pattern in risk when SMRs for ALS were stratified by exposure duration. Mortality from other neurodegenerative diseases was not elevated. CONCLUSIONS: Our findings are limited due to small numbers of observed deaths and reliance on mortality data, but suggest that flight attendants may have an increased risk of ALS. Additional research is needed. Am. J. Ind. Med. 59:532-537, 2016. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Vehicle refuelling, use of domestic wood heaters and the risk of childhood brain tumours: Results from an Australian case-control study.

BACKGROUND: The aetiology of childhood brain tumours (CBT) is largely unknown. Damage to germ cells after parental exposure to airborne carcinogens, such as volatile organic compounds and polycyclic aromatic hydrocarbons is one plausible pathway. This analysis aimed to investigate whether parental refuelling of vehicles or the use of domestic wood heaters in key time periods relating to the child's birth was associated with an increased risk of CBT. PROCEDURE: Cases <15 years of age were recruited through 10 paediatric oncology centres around Australia; controls were recruited through nationwide random-digit dialling, frequency matched to cases on age, sex and State of residence. Exposure to refuelling and wood heaters was ascertained through questionnaires from both parents. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression, adjusting for relevant covariates. RESULTS: Data were available for 306 case and 950 control families. Paternal refuelling ≥4 times/month was associated with an increased risk of CBT (OR 1.59, 95% CI: 1.11, 2.29), and a dose-dependent trend was observed (P = 0.004). No association was seen for maternal refuelling. Use of closed, but not open, wood heaters before (OR 1.51, 95% CI: 1.05, 2.15) and after (OR 1.44, 95% CI: 1.03, 2.01) the child's birth was associated with increased risk of CBT, but dose-response relationships were weak or absent. CONCLUSIONS: Paternal refuelling of vehicles ≥4 times/month and the use of closed wood heaters before the child's birth may increase the risk of CBT. Replication in larger studies is needed. Pediatr Blood Cancer 2015;62:229-234. © 2014 Wiley Periodicals, Inc.

Household cooking with solid fuels contributes to ambient PM2.5 air pollution and the burden of disease.

BACKGROUND: Approximately 2.8 billion people cook with solid fuels. Research has focused on the health impacts of indoor exposure to fine particulate pollution. Here, for the 2010 Global Burden of Disease project (GBD 2010), we evaluated the impact of household cooking with solid fuels on regional population-weighted ambient PM2.5 (particulate matter ≤ 2.5 µm) pollution (APM2.5). OBJECTIVES: We estimated the proportion and concentrations of APM2.5 attributable to household cooking with solid fuels (PM2.5-cook) for the years 1990, 2005, and 2010 in 170 countries, and associated ill health. METHODS: We used an energy supply-driven emissions model (GAINS; Greenhouse Gas and Air Pollution Interactions and Synergies) and source-receptor model (TM5-FASST) to estimate the proportion of APM2.5 produced by households and the proportion of household PM2.5 emissions from cooking with solid fuels. We estimated health effects using GBD 2010 data on ill health from APM2.5 exposure. RESULTS: In 2010, household cooking with solid fuels accounted for 12% of APM2.5 globally, varying from 0% of APM2.5 in five higher-income regions to 37% (2.8 µg/m3 of 6.9 µg/m3 total) in southern sub-Saharan Africa. PM2.5-cook constituted > 10% of APM2.5 in seven regions housing 4.4 billion people. South Asia showed the highest regional concentration of APM2.5 from household cooking (8.6 µg/m3). On the basis of GBD 2010, we estimate that exposure to APM2.5 from cooking with solid fuels caused the loss of 370,000 lives and 9.9 million disability-adjusted life years globally in 2010. CONCLUSIONS: PM2.5 emissions from household cooking constitute an important portion of APM2.5 concentrations in many places, including India and China. Efforts to improve ambient air quality will be hindered if household cooking conditions are not addressed.

FEV1 inversely correlates with metalloproteinases 1, 7, 9 and CRP in COPD by biomass smoke exposure.

BACKGROUND: Matrix metalloproteinases (MMPs) and C-reactive protein (CRP) are involved in chronic obstructive pulmonary disease (COPD) pathogenesis. The aim of the present work was to determine plasma concentrations of MMPs and CRP in COPD associated to biomass combustion exposure (BE) and tobacco smoking (TS). METHODS: Pulmonary function tests, plasma levels of MMP-1, MMP-7, MMP-9, MMP-9/TIMP-1 and CRP were measured in COPD associated to BE (n = 40) and TS (n =40) patients, and healthy non-smoking (NS) healthy women (controls, n = 40). RESULTS: Plasma levels of MMP-1, MMP-7, MMP-9, and MMP-9/TIMP-1 and CRP were higher in BE and TS than in the NS healthy women (p <0.01). An inverse correlation between MMP-1, MMP-7, MMP-9, MMP-9/TIMP-1 and CRP plasma concentrations and FEV1 was observed. CONCLUSIONS: Increase of MMPs and CRP plasma concentrations in BE suggests a systemic inflammatory phenomenon similar to that observed in COPD associated to tobacco smoking, which may also play a role in COPD pathogenesis.

Impact of dispersed fuel oil on cardiac mitochondrial function in polar cod Boreogadus saida.

In this study, impact of dispersed oil on cardiac mitochondrial function was assessed in a key species of Arctic marine ecosystem, the polar cod Boreogadus saida. Mature polar cod were exposed during 48 h to dispersed oil (mechanically and chemically) and dispersants alone. The increase observed in ethoxyresorufin-O-deethylase activity and polycyclic aromatic hydrocarbon metabolites in bile indicated no difference in contamination level between fish exposed to chemical or mechanical dispersion of oil. Oil induced alterations of O2 consumption of permeabilised cardiac fibres showing inhibitions of complexes I and IV of the respiratory chain. Oil did not induce any modification of mitochondrial proton leak. Dispersants did not induce alteration of mitochondrial activity and did not increase oil toxicity. These data suggest that oil exposure may limit the fitness of polar cod and consequently could lead to major disruption in the energy flow of polar ecosystem.

Evaluation of burn injuries related to liquefied petroleum gas.

Liquefied petroleum gas (LPG) is a fuel that is widely used for domestic, agricultural, and industrial purposes. LPG is also commonly used in restaurants, industries, and cars; however, the home continues to be the main site for accidents. In Turkey, the increased usage of LPG as a cooking or heating fuel has resulted in many burn injuries from LPG mishaps. Between January 2000 and June 2011, 56 LPG-burned patients were compared with 112 flame-burned patients. There were no significant differences with respect to the mean age, sex, hospitalization time, and mortality in both groups. In the LPG-caused burn cases, 41 burns (73.2%) occurred at home, seven (12.5) were work-related mishaps, and eight (14.3) were associated with car accidents. The majority of the LPG burns (82%, 46 patients) resulted from a gas leak, and 18% of them were related to the failure to close LPG tubes in the patients' kitchens (10 patients). Burns to the face and neck (82 vs 67%, P = .039) and upper (62 vs 23%, P = .000) and lower (70 vs 45%, P = .002) extremities were significantly higher in LPG-caused burn cases than flame-burned cases. General awareness regarding the risk of LPG and first aid for burns appears to be lacking. The LPG delivery system should be standardized throughout countries that widely use LPG.

Successful skin homografting from an identical twin in a severely burned patient.

Flame burns are a serious condition and usually have high morbidity and mortality because they affect large areas of the body surface as well as the lungs. In these patients, it is especially difficult to find healthy skin for grafting if they have more than 70% third-degree burns. Repeated autografting or synthetic wound care materials are the only treatment options to cover burned areas. Partial-thickness skin grafting from the patient's identical twin sibling may be an alternative treatment option, if possible. Here, we report a patient with severe flame injury treated with skin from his identical twin. The patient had third-degree burns covering 70% of his body surface. Initial treatment consisted of fluid and electrolyte replacement, daily wound care, and surgical debridements, as well as nutritional support. After initial treatment, we performed a successful skin grafting from his identical twin. Skin grafting between identical twins might be an alternate method for severely burned patients.

WHO indoor air quality guidelines: household fuel combustion

Almost 3 billion people, in low- and middle-income countries mostly, still rely on solid fuels (wood, animal dung, charcoal, crop wastes and coal) burned in inefficient and highly polluting stoves for cooking and heating. In 2012 alone, no fewer than 4.3 million children and adults died prematurely from illnesses caused by such household air pollution, according to estimates by the World Health Organization. Together with widespread use of kerosene stoves, heaters and lamps, these practices also result in many serious injuries and deaths from scalds, burns and poisoning. These new indoor air quality guidelines for household fuel combustion aim to help public health policy-makers, as well as specialists working on energy, environmental and other issues understand best approaches to reducing household air pollution -- the greatest environmental health risk in the world today. Recommendations, general to specific. The recommendations include general considerations for policy, a set of four specific recommendations, and a best-practice recommendation addressing linked health and climate impacts. Among the general considerations, or overarching advice, is that policies should promote community-wide action, and that the safety of new fuels and technologies must be assessed rather than assumed.

Chromosomal bands affected by acute oil exposure and DNA repair errors.

BACKGROUND: In a previous study, we showed that individuals who had participated in oil clean-up tasks after the wreckage of the Prestige presented an increase of structural chromosomal alterations two years after the acute exposure had occurred. Other studies have also reported the presence of DNA damage during acute oil exposure, but little is known about the long term persistence of chromosomal alterations, which can be considered as a marker of cancer risk. OBJECTIVES: We analyzed whether the breakpoints involved in chromosomal damage can help to assess the risk of cancer as well as to investigate their possible association with DNA repair efficiency. METHODS: Cytogenetic analyses were carried out on the same individuals of our previous study and DNA repair errors were assessed in cultures with aphidicolin. RESULTS: Three chromosomal bands, 2q21, 3q27 and 5q31, were most affected by acute oil exposure. The dysfunction in DNA repair mechanisms, expressed as chromosomal damage, was significantly higher in exposed-oil participants than in those not exposed (p= 0.016). CONCLUSION: The present study shows that breaks in 2q21, 3q27 and 5q31 chromosomal bands, which are commonly involved in hematological cancer, could be considered useful genotoxic oil biomarkers. Moreover, breakages in these bands could induce chromosomal instability, which can explain the increased risk of cancer (leukemia and lymphomas) reported in chronically benzene-exposed individuals. In addition, it has been determined that the individuals who participated in clean-up of the oil spill presented an alteration of their DNA repair mechanisms two years after exposure.

Occupational exposure to chlorinated and petroleum solvents and mycosis fungoides.

OBJECTIVE: To evaluate the potential association between occupational exposure to chlorinated and petroleum solvents and mycosis fungoides (MF). METHODS: A questionnaire on lifetime job history was administered to 100 patients diagnosed with MF and 2846 controls. Odds ratios (ORs) were calculated as the measure of the association between exposure to each specific solvent and MF. RESULTS: In the total sample and in men, cases and controls did not differ in relation to exposure to any of the solvents studied. In women, an association with MF was seen for the highest level of estimated exposure to perchloroethylene (OR = 11.38; 95% confidence interval: 1.04 to 124.85) and for exposure less than the median to kerosene/fuel/gasoil (OR = 8.53; 95% confidence interval: 1.11 to 65.62). CONCLUSIONS: These results do not provide conclusive evidence that exposure to solvents may increase risk of MF because they were not found in men.

Considerable hazards produced by heavy fuel oil in operating thermal power plant in Assiut, Egypt.

Heavy fuel oil and ash samples were collected from the Assiut thermal power plant in Egypt and subjected to gamma spectrometry analysis for natural radioactivity contents. Considerable results were observed where the ash contains nearly 1,000 times natural radionuclides more than raw oil. The results were confirmed by measuring the samples via using different devices in different institutions. All ash samples had radium equivalent activities and external hazard index values more than 370 Bq/kg and unity respectively. The mean absorbed dose rate was10,650 nGy/h which is nearly 190 times higher than the global average value of 55 nGy/h. The corresponding annual external effective dose is estimated to be 13 mSv/year, which is nearly 30 times higher than that in areas of natural background radiation (0.46 mSv/year).