Short-term effects of air pollutants on outpatient volume of respiratory diseases in Guiyang / 环境与职业医学

Background Affected by concentration, composition, and population tolerance of air pollutants, the relationship between air pollutants and population health has regional differences. There is still a research gap in Guiyang. Objective To explore the short-term effects of air pollutant concentrations in low-pollution areas on the outpatient volume of respiratory diseases. Methods Spearman correlation analysis was used to evaluate the correlation between air pollutants, meteorological factors, and respiratory outpatient volume from January 1, 2013 to December 31, 2020 in Guiyang City. A single pollutant distribution lag nonlinear model and a multi-pollutant interaction model were established based on Poisson distribution. A three-dimensional diagram was drawn to display the relationship between air pollutants and respiratory outpatient volume. Quantitative analysis was conducted on the attribution risk and lag effect of air pollutant concentration on outpatient volume of respiratory diseases in Guiyang City. Results The results of the single pollutant model showed that fine particulate matter (PM2.5), nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide (SO2) elevated the outpatient volume of respiratory diseases. The maximum relative risk (RR) and 95%CI values of PM2.5, NO2,CO, and SO2 appeared on Day 2, 0, 5, and 6, respectively, which were 1.019 (1.015, 1.023), 1.146 (1.122, 1.171), 1.129 (1.116, 1.143), and 1.046(1.040, 1.052), respectively. For every quartile concentration increment of PM2.5, NO2, CO, or SO2, the outpatient volume of respiratory diseases increased by 0.943% (0.111%, 1.782%), 4.050% (3.573%, 4.529%), 0.595% (0.317%, 0.874%), or 0.667% (0.235%, 1.100%), respectively. The maximum RR (95%CI) of O3 was 1.015 (1.007, 1.023) and appeared on Day 0. The results of multi-pollutant model showed that PM2.5, NO2, CO, SO2, and O3 all elevated the outpatient volume of respiratory diseases. The maximum RR values of PM2.5, NO2, CO, SO2 and O3 appeared on Day 14, 0, 5, 7 and 0, respectively, which were 1.027 (1.021, 1.034), 1.213 (1.179, 1.248), 1.059 (1.043, 1.074), 1.016 (1.005, 1.026), and 1.024 (1.015, 1.033), respectively. Compared with the single pollutant model, the RR values of PM2.5, NO2, and O3 on the outpatient volume of respiratory diseases in the multi-pollutant model showed an upward trend, while the RR values of CO and SO2 in the multi-pollutant model showed a downward trend. Conclusion The impact of low concentrations of PM2.5, NO2, CO, and SO2 on human health cannot be ignored.

Aspectos por considerar en autopsias por intoxicación aguda con monóxido de carbono, el asesino silente. A propósito de dos casos / Aspects to consider in autopsies for acute carbon monoxide poisoning, the silent killer. About two cases

El monóxido de carbono (CO) es un gas que se produce durante la combustión incompleta de diferentes materiales orgánicos. Una vez que se inhala, se absorbe hacia la sangre, ejerciendo su efecto a nivel sistémico. Se une fuertemente a la hemoglobina, y forma la carboxihemoglobina lo que provoca una disminución del transporte de oxígeno a los tejidos y dependiendo de su concentración puede ser mortal. Los hallazgos comúnmente encontrados en la autopsia son color rojo cereza en la piel y órganos, así como edema pulmonar, entre otros. El diagnóstico de intoxicación por CO se basa en la medición post mortem de carboxihemoglobina en sangre, por lo que se deben tomar muestras para cuantificar estos niveles. Con respecto al manejo en estos casos, se presenta dos casos correspondientes a la autopsia médica legal en las que se estableció como causa de muerte la intoxicación por monóxido de carbono.

Carbon monoxide (CO) is a gas that is produced during the incomplete combustion of different organic materials. Once inhaled, it is absorbed into the blood, exerting its effect at the systemic level. It strongly binds to hemoglobin, and forms carboxyhemoglobin, which causes a decrease in oxygen transport to the tissues and, depending on its concentration, can be fatal. The findings commonly found in the autopsy are cherry red color in the skin and organs, as well as pulmonary edema, among others. The diagnosis of CO poisoning is based on the postmortem measurement of carboxyhemoglobin in the blood, so samples must be taken to quantify these levels. Regarding the handling of these cases, two cases corresponding to the legal medical autopsy are presented in which carbon monoxide poisoning was established as the cause of death.

El rol del laboratorio en los hallazgos de intoxicación y exposición a monóxido de carbono / The role of the laboratory in findings of carbon monoxide poisoning and exposure

El monóxido de carbono es un gas altamente tóxico que se origina principalmente por la combustión incompleta de combustibles fósiles. La intoxicación presenta síntomas inespecíficos que solapan otras patologías y por lo tanto es indispensable la confirmación mediante la medición de la carboxihemoglobina en sangre. El laboratorio incorporó la determinación en el informe del estado ácido base a partir de octubre del 2018, debido a que previamente el médico debía solicitarla frente a la sospecha de una intoxicación. El objetivo del trabajo fue evaluar si esta medida implementada por el laboratorio contribuyó a mejorar el diagnóstico de intoxicación por CO, analizar las características de los pacientes con COHb mayor o igual a 5% y definir un valor de reporte inmediato para la COHb. El 46% de los casos con COHb mayor o igual a 5% no se relacionaban con una intoxicación y/o exposición a CO. De los casos de intoxicación se encontró que el 77% fueron diagnosticados a partir de la sospecha médica y un 23% por hallazgo del laboratorio. Se concluyó que es de mucha utilidad el rol del laboratorio en detectar aquellos casos que no fueron evidentes clínicamente. Existen ciertas patologías como las oncológicas o la enfermedad de Wilson donde se vieron valores elevados de COHb sin presentar intoxicación y se definió finalmente, como valor de reporte inmediato 7% para la COHb. (AU)

Carbon monoxide is a highly toxic gas that originates mainly from incomplete combustion of fossil fuels. Intoxication causes nonspecific symptoms that overlap with other conditions and, therefore, confirmation by measuring blood carboxyhemoglobin is essential. The laboratory incorporated the measurement in the acid-base status report as of October 2018, as it was previously required to be requested by the physician in case of suspected intoxication. The aim of this study was to evaluate whether this measure implemented by the laboratory contributed to the improvement of the diagnosis of CO intoxication, to analyze the characteristics of patients with COHb greater than or equal to 5% and to define an immediate reporting value for COHb. Overall, 46% of the cases with COHb greater than or equal to 5% were not related to CO poisoning and/or exposure. Of the cases of intoxication, 77% were diagnosed based on medical suspicion and 23% on laboratory findings. It was concluded that the laboratory has a useful role in detecting cases that were not clinically evident. There are certain diseases including different types of cancer or Wilson's disease where elevated COHb values were seen without intoxication and finally, 7% for COHb was defined as the immediate reporting value (AU)

Carbon Monoxide Poisoning from Heavy Cigarette Smoking Presenting as Delusion in a Patient with a History of Chronic Schizophrenia (Methamphetamine Induced)

We describe a case of carbon monoxide poisoning in a 54-year-old male from heavy cigarette smoking presenting as delusions. The patient has a history of methamphetamine-induced schizophrenia now in remission for 2 years, and not on any psychotropics and is drug-free.

Intoxicación por monóxido de carbono: estudio observacional de pacientes que acudieron a Urgencias durante 2020 / Carbon monoxide poisoning: an observational study of patients admitted to Emergency Department during 2020

El objetivo fue describir las intoxicaciones monóxido de carbono. Se diseñó un corte transversal que incluyó una muestra consecutiva de mediciones de carboxihemoglobina (COHb), realizadas Enero y Diciembre 2020 en la Central de Emergencias del Hospital Italiano de Buenos Aires. Se utilizaron bases secundarias y revisión manual de historias clínicas para recolección de varia-bles de interés. Durante el período de estudio hubo 20 pacientes confirmados, con media de 50 años (DE 20), 55% sexo masculino, 20% tabaquistas, y una única embarazada. El 70% correspondieron al trimestre Junio-Julio-Agosto. La fuente de intoxicación más frecuente se debió a accidentes domésticos (calefón, estufa, brasero, hornalla, salamandra) que representaron el 50% de los casos, 30% por incendios, y el 20% restante explicado por tabaco o factor desconocido. Los estudios de laboratorio más solicitados fueron: 95% recuento de glóbulos blancos, 85% glucemia, 70% CPK, y 55% troponina. Los hallazgos relevantes fueron COHb con mediana de 7.15%, CPK con mediana de 89 U/mL, y troponina con mediana de 8.5 pg/mL. La totalidad se realizó electrocardiograma: 15% presentaron arritmia como hallazgo patológico, y ninguno isquemia. En cuanto la presentación clínica: 30% presentó cefalea, 15% síncope, 15% coma, 10% mareos y 10% convulsiones. Sólo 25% tuvieron tomografía y 15% resonancia de cerebro, sin hallazgos críticos. Sin embargo, 15% fueron derivados para trata-miento con cámara hiperbárica. La mayoría ocurrieron en invierno y explicados por accidentes domésticos. Será necesario un fortalecimiento del rol preventivo que apunte al control de la instalación y el buen funcionamiento de artefactos, como mantener los ambientes bien ventilados (AU)

The objective was to describe carbon monoxide poisoning. A cross sectional was designed, which included a consecutive sample of carboxyhemoglobin (COHb) measurements, carried from January to December 2020 at the Emergency Department of tHospital Italiano de Buenos Aires. Secondary databases and manual review of medical records were used to collect variables of interest. During the study period there were 20 confirmed patients, with a mean age of 50 (SD 20), mostly male (55%), 20% smokers, and only one pregnant woman, 70% corresponded to June-July-August. The most frequent source of poisoning was explained to domestic accidents (water heater, stove, brazier, stove, salamander) which represented 50% of cases, 30% due to fires, and the remaining 20% by tobacco or unknown factor. The most laboratory studies were: 95% white blood cell count, 85% glycemia, 70% CPK, and 55% troponin. Meanwhile, relevant findings were carboxyhemoglobin with a median of 7.15%, CPK with a median of 89 U/mL, and troponin with a median of 8.5 pg/mL. All underwent an electrocardiogram: 15% presented arrhythmia as a pathological finding, and none ischemia. Regarding the clinical presentation: 30% presented headache, 15% syncope, 15% coma, 10% dizziness and 10% seizures. Only 25% had brain tomography and 15% MRI, without pathological findings. However, 15% were referred for treatment with a hyperbaric chamber. Most of the cases occurred in winter and explained by domestic accidents. It will be necessary to strengthen the preventive role that aims to control the installation and the proper functioning of devices, such as keeping rooms well ventilated (AU)

Efficacy of mouse nerve growth factor combined with edaravone in the treatment of carbon monoxide poisoning and its influence on oxygen free radical-related indicators / 中国医师进修杂志

Objective:To investigate the therapeutic effect of the combination of mouse nerve growth factor and edaravone in the treatment of carbon monoxide poisoning and its effect on patients′ cognitive function, lactic acid clearance rate, and related indicators of oxygen free radicals.Methods:A selection of 158 patients with carbon monoxide poisoning in the Huxi Hospital Affilliated Jining Medical College from May 2017 to June 2020 were divided into study group (80 cases) and control group (78 cases) according to the treatment plan. Both groups were given conventional treatment. On this basis, the control group was given edaravone, and the study group was given mouse nerve growth factor combined with edaravone, both of which were treated for 2 weeks. The clinical efficacy of the two groups was compared with those before treatment and 1 week and 2 weeks after treatment. Neurological impairment score (NIHSS), disease severity score (APACHE Ⅱ), cognitive function score (MMSE), serum inflammatory factors [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)], oxygen free radical related indicators [lipid peroxide (LPO), superoxide dismutase (SOD), gluten Glutathione peroxidase (GSH-PX), malondialdehyde (MDA)] levels, blood lactic acid levels before treatment and lactic acid clearance rates after 12 h, 24 h, 72 h treatment, and statistics of adverse reactions and 30-day mortality.Results:The total effective rate of the study group was higher than that of the control group after 2 weeks of treatment [95.00% (76/80) vs. 78.21% (61/78)] ( P<0.05); NIHSS and APACHEⅡ scores of the study group after 1 week and 2 weeks of treatment Lower than the control group: (6.08 ± 1.15) points vs. (8.94 ± 1.71) points, (4.58 ± 0.74) points vs. (6.32 ± 0.93) points and (6.79 ± 1.03) points vs. (8.02 ± 1.47) points, (5.94 ± 1.47) points vs. (7.25 ± 0.94) points, the MMSE score was higher than that of the control group: (22.09 ± 4.35) points vs. (19.34 ± 5.32) points, (26.05 ± 2.37) points vs. (22.47 ± 4.64) points ( P<0.05) After 1 and 2 weeks of treatment, the serum TNF-α, IL-6, CRP, LPO and MDA levels in the study group were lower than those in the control group: (22.62 ± 4.12) ng/L vs. (29.43 ± 4.68) ng/L and (18.21 ± 2.09) ng/L vs. (24.37 ± 3.16) ng/L, (39.67 ± 4.35) ng/L vs. (52.14 ± 5.48) ng/L and (34.83 ± 3.75) ng/L vs. (41.07 ± 4.09) ng/L, (12.63 ± 1.85) mg/L vs. (17.02 ± 2.47) mg/L and (8.27 ± 1.16) mg/L vs. (11.05 ± 1.62) mg/L, (11.06 ± 1.28) μmol/L vs. (15.97 ± 1.85) μmol/L and (8.24 ± 1.12) μmol/L vs. (12.97 ± 1.40) μmol/L, (7.15 ± 1.16) μmol/L vs. (9.02 ± 1.47) μmol/L and (6.12 ± 0.96) μmol/L vs. (7.84 ± 1.25) μmol/L, the levels of SOD and GSH-PX were higher than those in the control group ( P<0.05); the lactate clearance rate in the study group was higher than that in the control group after 12, 24 and 72 h of treatment: (18.49 ± 3.63)% vs. (14.62 ± 2.95)%, (23.19 ± 4.20)% vs. (17.42 ± 3.57)%, (29.86 ± 6.37)% vs. (25.38 ± 5.21)% ( P<0.05); the incidence of adverse reactions in the study group during treatment Compared with the control group, there was no significant difference ( P>0.05); there was no significant difference in the 30-day mortality between the study group and the control group ( P>0.05). Conclusions:The combination of mouse nerve growth factor and edaravone in the treatment of carbon monoxide poisoning can reduce the severity of disease and neurological deficits, improve cognitive function and lactate clearance rate, reduce inflammation and oxidative stress, improve efficacy, and have good safety.

Correlation analysis of apparent diffusion coefficient combined with C-reactive protein on delayed encephalopathy caused by carbon monoxide poisoning / 中华急诊医学杂志

Objective:To investigate the Correlation between ADC combined with serum C-reactive protein (CRP) and delayed encephalopathy after carbon monoxide poisoning (DEACMP), It provides scientific basis for early prediction of DEACMP.Methods:According to the design principle of case-control study, the data of acute carbon monoxide poisoning (ACOP) patients admitted to Shandong Provincial Hospital from December 2017 to December 2021 were retrospectively selected. Among them, patients with DEACMP were selected as the case group, without DEACMP were used as the control group. Univariate and multivariate analyses were performed on the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of ADC combined with CRP as a combined predictor for disease.Results:A total of 89 patients with ACOP were included, including 33 patients with DEACMP and 56 patients without DEACMP. There were no significant differences in gender, age, smoking, drinking, and underlying diseases (hypertension, coronary heart disease) between groups ( P>0.05). Logistic regression analysis showed that white blood cell count (WBC) ( OR=1.64, 95% CI: 1.19-2.26, P=0.003), CRP ( OR=1.22, 95% CI: 1.03-1.45, P=0.019) and ADC value of central semiovale white matter ( OR=0.99, 95% CI: 0.98-1.00, P=0.010) were associated with DEACMP in patients with ACOP. The ROC curve results showed that the area under the ROC of ADC combined with CRP in the center of semiovale was 0.765 (95% CI: 0.656-0.845), the specificity was 87.9%, the sensitivity was 23.2%, and the cut-off value was 3.5°. Conclusions:WBC, CRP and ADC value of central semiovale are independent factors for DEACMP. ADC value of central semiovale combined with CRP has more clinical value in the early diagnosis of DEACMP. For ACOP patients with DEACMP triggering factors, the diagnosis and treatment awareness of early screening of brain magnetic resonance imaging should be strengthened to avoid DEACMP.

Protective effect and mechanism of hyperbaric oxygen on delayed encephalopathy after carbon monoxide poisoning via the mitochondrial pathway in mice / 中华急诊医学杂志

Objective:To explore the protective effect and underlying mechanism of hyperbaric oxygen (HBO) on delayed encephalopathy after carbon monoxide poisoning (DEACMP) in mice.Methods:Totally 225 adult male Kunming mice were selected to establish CO poisoning model via intraperitoneal injection carbon monoxide (CO), and were randomly divided into the air control group, CO poisoning group, and HBO group. Each group was further divided into five time points group, that was 1, 3, 7, 14 and 21 d. The mice in the air control group were injected intraperitoneally with the same amount of air, and the HBO group received HBO treatment at the same time every day. DEACMP mice model was screened by behaviors using the open field test, new object recognition test and nesting test, and the content of myelin basic protein (MBP) were assayed. The mouse brain tissue and mitochondrial were prepared and malonialdehyde (MDA) and adenosine triphosphate (ATP) content were measured with ultraviolet spectrophotometer. MBP content in brain tissue and cytochrome C (CytC) content in the mitochondrial were measured by ELISA. The mitochondria membrane potential (MMP) was measured by flow cytometry.Results:Compared with the air control group, the content of carboxyhemoglobin (COHB) in blood increased significantly and the content of MBP in brain tissue decreased significantly in CO poisoning mice. CO poisoning mice showed motor ability and cognitive dysfunction. Compared with the air control group, the contents of MMP, CytC and ATP were significantly decreased ( P<0.01) in the CO poisoning group; while the MDA content was significantly increased ( P<0.01). Compared with the CO poisoning group, mice behaviors were improved significantly ( P<0.05), the content of MBP, MMP, CytC and ATP were increased ( P<0.05), while the MDA content decreased significantly ( P<0.01) in the HBO group. Conclusions:The abnormal mitochondrial function might be closely related to the occurrence and development of DEACMP, and HBO therapy plays an effective role in preventing and treating the DEACMP mice model via the mitochondrial pathway.

Research progress on head imaging features of carbon monoxide poisoning and delayed encephalopathy / 中华劳动卫生职业病杂志

Acute carbon monoxide poisoning and its delayed encephalopathy have obvious damage to the central nervous system. There are different neuroimaging changes in different stages of the disease, and they are relatively specific. This article reviews the clinical research progress on the imaging changes of carbon monoxide poisoning and delayed encephalopathy, including computed tomography (CT) , conventional magnetic resonance imaging (MRI) , diffusion weighted imaging (DWI) , diffusion tensor imaging (DTI) , diffusion kurtosis imaging (DKI) , magnetic resonance spectroscopy (MRS) and other imaging changes reflecting the function and metabolic state of the brain tissue.

Effect of transcranial direct current stimulation on neurological injury markers and prognosis in patients with acute and severe carbon monoxide poisoning / 中华劳动卫生职业病杂志

Objective: To observe the effects of transcranial direct current stimulation (tDCS) on nerve injury markers and prognosis in patients with acute severe carbon monoxide poisoning (ASCOP) . Methods: In May 2021, 103 ASCOP patients were treated in the emergency department of Harrison International Peace Hospital of Hebei Medical University from November 2020 to January 2021. The patients were divided into two groups according to whether they received tDCS treatment. The control group (50 cases) were given oxygen therapy (hyperbaric oxygen and oxygen inhalation) , reducing cranial pressure, improving brain circulation and cell metabolism, removing oxygen free radicals and symptomatic support, and the observation group (53 cases) was treated with 2 weeks of tDCS intensive treatment on the basis of conventional treatment. All patients underwent at least 24 h bispectral index (BIS) monitoring, BIS value was recorded at the hour and the 24 h mean value was calculated. Neuron-specific enolase (NSE) and serum S100B calcium-binding protein (S100B) were detected after admission, 3 d, 7 d and discharge. Follow-up for 60 days, the incidence and time of onset of delayed encephalopathy (DEACMP) with acute carbon monoxide poisoning in the two groups were recorded. Results: The NSE and S100B proteins of ASCOP patients were significantly increased at admission, but there was no significant difference between the two groups (P=0.711, 0.326) . The NSE and S100B proteins were further increased at 3 and 7 days after admission. The increase in the observation group was slower than that in the control group, and the difference was statistically significant (P(3 d)=0.045, 0.032, P(7 d)=0.021, 0.000) ; After 14 days, it gradually decreased, but the observation group decreased rapidly compared with the control group, with a statistically significant difference (P=0.009, 0.025) . The 60 day follow-up results showed that the incidence of DEACMP in the observation group was 18.87% (10/53) , compared with 38.00% (19/50) in the control group (P=0.048) ; The time of DEACMP in the observation group[ (16.79±5.28) d] was later than that in the control group[ (22.30±5.42) d], and the difference was statistically significant (P=0.013) . Conclusion: The early administration of tDCS in ASCOP patients can prevent the production of NSE and S100B proteins, which are markers of nerve damage. and can improve the incidence and time of DEACMP.

Correlation between chest computed tomography findings and pulmonary function test results in the post-recovery phase of COVID-19

ABSTRACT Objective The radiological and functional lung sequelae in COVID-19 survivors remain unclear. We compared the chest computed tomography findings of COVID-19 patients with normal and abnormal pulmonary function test results in the post-recovery phase. Methods The data of consecutive patients who underwent pulmonary function tests and chest computed tomography within 14 days after recovery from COVID-19 at two medical centers between May and October 2020 were collected retrospectively. Two thoracic radiologists who were blinded to the clinical information and pulmonary function test results classified the patients according to the computed tomography features, evidence of fibrotic-like changes, and semi-quantitative quantification of the extent of pulmonary abnormalities. The clinical characteristics and computed tomography findings of patients with normal pulmonary function test results were compared with those of patients with abnormal results. Results A total of 101 COVID-19 survivors, comprising 48 ambulatory and 53 hospitalized patients, were included at a median of 95 days from initial symptom onset. Computed tomography revealed fibrotic-like changes in 10.9% of patients. A reduction in the diffusion capacity of carbon monoxide was the most common lung function abnormality (19.8%). Abnormal diffusion capacity of carbon monoxide was associated with the presence and extension of lung opacities on chest computed tomography scans and fibrotic pulmonary abnormalities. The sensitivity, specificity, and accuracy of reduced diffusion capacity of carbon monoxide for detecting fibrotic-like pulmonary changes on chest computed tomography scans were 72.7%, 87.8%, and 86.1%, respectively. Conclusion Our study suggests that the presence of an abnormal diffusion capacity of carbon monoxide in the post-recovery phase of COVID-19 is associated with a greater risk of long-term parenchymal lung disease, as evidenced by the presence of fibrotic-like changes on chest computed tomography scans, such as traction bronchiectasis and architectural distortion.

The bactericidal mechanisms of carbon monoxide and the feasibility of carbon monoxide-releasing molecules as anti-infective drugs / 药学学报

The bactericidal mechanism of carbon monoxide (CO) and the feasibility of CO-releasing molecules as anti-infective drugs were summarized by consulting scientific literature, combined with our own research work. Anaerobic bacteria are usually tolerant to high concentration of CO, and some can even grow with CO as sole carbon or energy source, but most pathogenic bacteria are sensitive to CO. In view of the difficulty of gaseous CO in controlling the applying dose and the action site, CO release molecules were synthesized. CO release molecules not only have higher bactericidal activities against common pathogenic bacteria than gaseous CO, but also have the ability to kill antibiotics-resistant bacteria and destroy their biofilms. CO mainly binds with heme-Fe2+ in cells, interrupting the electron transfer of respiration chains, which would result in the generation of reactive oxygen species. CO can also disturb intracellular ion balance, which further triggers free radical reactions. Due to its diverse acting targets, uneasy to induce drug resistance, and synergistic effect with other antibiotics, CO is expected to be the next generation of anti-infection drugs.

Risk factors for the prognosis of rheumatoid arthritis-associated interstitial lung disease: a multicenter retrospective clinical study / 中华风湿病学杂志

Objective:To explore the impact of clinical features, serological indicators, and pulmonary function test (PFT) on the prognosis of rheumatoid arthritis-associated interstitial lung disease (RA-ILD).Methods:Clinical data of RA-ILD patients who were diagnosed by HRCT and were followed up in Changhai Hospital or Yancheng First People's Hospital from 2011 to 2021 were collected Respiratory functional impairment of the patients was evaluated according to the changes of HRCT score and PFT, and the patients were divided into progressive group and stable group. COX survival analysis and ROC curve were used to determine the factors related to the progression of RA-ILD.Results:Finally 98 RA-ILD patients were included. The mean age of ILD onset was (62.9±12.1) years old, the median course of RA was 7.0 (1.0, 15.3)years, and the median follow-up time was 36.5 months (14.0, 79.5). There were 49 cases in the progressive group, and the clinical characteristics and laboratory tests of the two groups were compared. The results showed that: progressive time [(23(8.5,43.0)months vs 63(32.5,90.9) months, Z=-4.55, P=0.001)], HRCT score [(115(109,135) vs 111(105,116), Z=-2.70, P=0.007)], forced vital capacity(FVC) predicted [(70.1±15.7)% vs (80.8±19.7)%, t=2.12, P=0.039)], diffusing capacity of the lungs for CO(DLCO) predicted [(57.5±16.3)% vs (83.4±18.8)%, t=4.87, P=0.001)], male [(44.9% vs 18.4%, χ2=7.97, P=0.005)], UIP pattern [(36(73.5%) vs 9(18.4%), χ2=29.96, P<0.001)], RF>200 U/ml[(21(65.6%) vs 18(41.9%), χ2=4.15, P=0.042)], anti-CCP>75 U/ml [(42(91.3%) vs 35(71.4%), χ2=6.10, P=0.013], all had significantly different between the two groups. In multivariate analyses, UIP[ HR(95% CI)=3.25(1.62,6.50), P<0.001], anti-CCP antibody >75 U/ ml[ HR(95% CI)=3.85 (1.20,12.33), P=0.023] and smoking [ HR (95% CI): 5.74(1.10, 30.13), P=0.039] were significantly correlated with the progression of pulmonary fibrosis in RA-ILD patients. PFT was performed in only 44 patients with RA-ILD. The univariate analyses and ROC curve suggested that DLCO predicted [ HR (95% CI)=1.04 (1.02,1.06), P<0.001] was a significant risk factor for the progression of RA-ILD, and the area under curve (AUC) of DLCO was 0.845 [95% CI=(0.729,0.961)]. Conclusion:UIP pattern, high titer of anti-CCP antibody, smoking, and reduced DLCO predicted % may be potential predictors for poor prognosis of RA-ILD patients.

Quemadura por inhalación de humo e intoxicación por monóxido de carbono en paciente pediátrico

Introducción: El monóxido de carbono es uno de los mayores contaminantes de la atmósfera terrestre, su toxicidad es bien conocida por el ser humano. Las fuentes productoras responsables de aproximadamente 80 % de las emisiones de monóxido de carbono son los vehículos automotores que utilizan como combustible gasolina o diesel, los procesos industriales que utilizan compuestos del carbono y el fuego dentro de los hogares. Sus efectos tóxicos agudos incluida la muerte se han estudiados ampliamente, no así sus potenciales efectos adversos a largo plazo. Objetivo: Describir el comportamiento de la intoxicación aguda por monóxido de carbono en paciente pediátrico, su diagnóstico y tratamiento. Presentación del caso: paciente de 11 años de edad que sufre intoxicación aguda por monóxido de carbono. Ingresa en el Hospital Universitario procedente del primer nivel de atención médica como urgencia vital. Se estabiliza e identifican las alteraciones multisistémicas producidas por lesiones asociadas con la inhalación de humo y gases tóxicos en espacios cerrados. Se determina su correcto tratamiento. Conclusiones: La forma más pertinente de disminuir la morbilidad y la mortalidad en pacientes como el que se presenta, se basa en dos pilares: la correcta identificación y el acertado manejo para cada intoxicación. La aplicación de estos dos aspectos puede lograr un factor protector. Hay subregistro de la ocurrencia de los casos de intoxicación por monóxido de carbono que no son atendidos en los servicios de salud y de los que producen la muerte inmediata, por lo que es importante su diagnóstico y tratamiento oportuno.

Introduction: Carbon monoxide is one of the largest pollutants in the Earth's atmosphere, its toxicity is well known to humans. The producing sources responsible for approximately 80% of carbon monoxide emissions are motor vehicles that use gasoline or diesel as fuel, industrial processes that use carbon compounds and fire inside homes. Its acute toxic effects including death have been studied extensively, but its potential long-term adverse effects have not been studied. Objective: To describe the behavior of acute carbon monoxide poisoning in pediatric patients, their diagnosis and treatment. Case presentation: 11-year-old patient suffering from acute carbon monoxide poisoning. He is admitted to the University Hospital from the first level of medical care as a vital emergency. Multisystem alterations caused by lesions associated with the inhalation of smoke and toxic gases in enclosed spaces are stabilized and identified. Its correct treatment is determined. Conclusions: The most pertinent way to reduce morbidity and mortality in patients such as the one presented is based on two pillars: correct identification and correct management for each poisoning. The application of these two aspects can achieve a protective factor. There is underreporting of the occurrence of cases of carbon monoxide poisoning that are not treated in health services and those that cause immediate death, so their detection, diagnosis and timely treatment is important.

Conducta tabáquica en estudiantes universitarios en Tunja (Boyacá)

Objetivo: Determinar el grado dependencia al tabaquismo y la motivación a la cesación del consumo de tabaco en estudiantes fumadores de una institución universitaria en la ciudad de Tunja (Boyacá). Materiales y métodos: Estudio transversal analítico con fase correlacional, con muestreo probabilístico por conglomerados. La identificación de la conducta tabáquica se realizó a través de los instrumentos de Fagerström y Richmond, en relación con la medición de los niveles de concentración de monóxido de carbono a través de cooximetría de pulso. Resultados: En los 79 estudiantes se observó una edad promedio de 21 años, siendo en la mayoría del sexo masculino (86%), con un consumo de cigarrillo en promedio de 4.2 años. Se pudo establecer que el 82.3% [IC : 73.4 - 91.1] de los estudiantes fumaron menos de 10 cigarrillos al día, con un grado leve correspondiente al 89 % [IC : 81.0-94.9], quienes se caracterizaron por fumar 5 o menos paquetes de cigarrillos al año. De igual manera el 82 % [IC : 73.4 - 89.9] de los fumadores se clasificaron como moderados y el 94 % [IC : 87.3 - 98.7] de ellos son poco dependientes a la nicotina. De igual forma, se estableció que solo el 32.91 % [IC : 24.1 - 43.0] presentó alto grado de motivación para dejar de fumar. En relación con el nivel de porcentaje de saturación de monóxido de carbono, en promedio fue de 6 % (DE 2.2), existiendo relación directamente proporcional con el grado y la clasificación del fumador determinada a través del método de Wilcoxon (P=0.00). Conclusión: Se identificó que la mayoría de los participantes presenta moderada motivación para la cesación del consumo; por lo tanto, es necesario incentivar el inicio de programas de deshabituación tabáquica que impacten la calidad de vida en adultos jóvenes, así mismo, en la reducción de la morbi/mortalidad por enfermedades respiratorias crónicas a futuro.

Objective: To determine the degree of dependence on smoking and the motivation to stop smoking in students of a university institution in the city of Tunja (Boyacá). Materials and methods: Analytical cross-sectional study with a correlational phase, with probabilistic cluster sampling. The identification of smoking behavior was carried out using the Fagerström and Richmond instruments, in relation to the measurement of carbon monoxide concentration levels through pulse co-oximetry. Results: An average age of 21 years was observed in the 79 students, with the majority being male (86%), with an average cigarette consumption of 4.2 years. It was established that 82.3% [95% CI: 73.4 - 91.1] of the students smoked less than 10 cigarettes a day, with a slight degree corresponding to 89% [95% CI: 81.0-94.9] who were characterized by smoking 5 or less cigarette packs per year. Similarly, 82% [95% CI: 73.4 - 89.9] of smokers were classified as moderate and 94% [95% CI: 87.3 - 98.7] of them were little dependent on nicotine. Similarly, it was established that only 32.91% [95% CI: 24.1 - 43.0] presented a high degree of motivation to quit smoking. In relation to the level of percentage of carbon monoxide saturation, on average it was 6% (SD 2.2), with a directly proportional relationship with the degree and classification of the smoker determined through the Wilcoxon method (P = 0.00). Conclusion: Most of the participants were found to present moderate motivation to stop smoking, therefore, it is necessary to encourage the start of smoking cessation programs that impact the quality of life in young adults, as well as reducing morbidity/mortality from chronic respiratory diseases in the future.

Epidemiological Study of Deaths due to Carbon Monoxide Poisoning Referred to Forensic Medicine in Mazandaran, Iran.

Carbon monoxide (CO) poisoning is the leading cause of death as a result of poisoning. Objective: This study aimed to investigate the epidemiology and prevalence of CO poisoning in Mazandaran province from 2016 to 2018. Methods: This is a descriptive-analytical and retrospective study on the information obtained from the files of the deceased individuals who died because of CO poisoning in the forensic medicine department of Mazandaran province during the years 2016 to 2018. Results: In this study, 83 deaths due to CO poisoning were recorded. 32.5% of these people were over 50 years old, 81.9% of them were men, and 61.4% of them were married. The level of education in 92.8% of them was reported to be less than a bachelor's degree and the bedroom (66.3%) was the main place of poisoning. 56.6% of these poisonings were due to city gas poisoning and 56.6% of deaths were reported as groups death. The bruises color was rosette in 53% of the deaths. The Carboxyhemoglobin levels in most of them were +2 (63.9%) and most deaths occurred in January (19.3%). The age group, source of CO, place of poisoning, carboxyhemoglobin level, education level, and the month of poisoning was significantly different among these three years. Conclusion: CO poisoning is still a substantial public health issue. City gas is defined as the main source of CO poisoning. Low educational level was related to CO deaths. Raising the awareness of the people can reduce the number of Co poisoning cases in the Mazandaran.

EXHAUST EMISSION ANALYSIS OF CI ENGINE USING VARIOUS BLENDS OF PPO-DIESEL

Plastic pyrolysis oil blended with diesel was tested in a single cylinder diesel engine in an experimental study. Waste plastic is used to make plastic pyrolysis oil. Various blends of PPO-DIESEL are tested for engine exhaust emission at various loads in this study. Nitrogen oxide (NOx), carbon monoxide (CO), carbon dioxide (CO2), and hydro carbon (HC) are all measured in engine exhaust emissions. According to the results, D80PPO20 blend is best compared to other fuels for NOx, CO in all blends has no difference at full load, D60PPO40 blend is best compared to other fuels for CO2, and D80PPO20 blend is best compared to other fuels for HC. PPO-DIESEL blends can be used without modification in CI engines.

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Epidemiological characteristics and influencing factor of non-occupational carbon monoxide poisoning during 2007—2018 in Shanghai / 环境与职业医学

Background Non-occupational carbon monoxide (CO) poisoning is a public health problem that seriously affect people’s health and lives. Objective To describe the prevalence of non-occupational CO poisoning during 2007—2018 in Shanghai, analyze its epidemiological characteristics and potential influencing factors, and explore effective prevention and control measures. Methods Daily reported non-occupational CO poisoning cases and meteorological factors from 2007 to 2018 were collected in Shanghai, epidemiological characteristics were analyzed by descriptive epidemiology methods, and a distributed lag nonlinear model was used to assess the association between temperature and non-occupational CO poisoning. Results A total of 2264 non-occupational CO poisoning events and 3866 cases from 2007 to 2018 were reported in Shanghai, including 59 death cases. More than half of the poisoning cases were female (56.3%), and young adults accounted for more cases than any other age group (54.8%). The poisoning events mainly occurred in winter (from December to next February); however, cases reported in summer increased in recent years. The peak period of the events was from 20:00 to 24:00. Households (85.2%) and restaurants (8.0%) were the common places of non-occupational CO poisoning events, and the main cause was improper use of gas water heater (36.9%). A nonlinear curve was found between daily average temperature of current day and the occurrence of non-occupational CO poisoning. Temperature was negatively associated with the risk of non-occupational CO poisoning when the temperature was lower than 9.6 ℃, while a positive association was found during 9.7-26.0 ℃. Conclusion Winter is a high season for non-occupational CO poisoning in Shanghai, rising cases reported in summer is also worthy of attention. Supervision should be strengthened to ban sales of unqualified gas water heaters, and health education on CO poisoning prevention and control should be conducted through multiple channels, in order to reduce the incidence of CO poisoning.

Determination of concentrations of indoor air pollutants emitted from briquette combustion / Монголын Анагаах Ухаан

Introduction@#This field assessment was performed to ensure the effective implementation of Order No. A/142 of the Deputy Prime Minister of Mongolia dated 30^th December 2021 and Order No. A/01 of the Head of the National Committee for Reducing Environmental Pollution dated 3^rd January 2022 and to monitor the level of indoor air pollutants emitted from traditional stoves and standard stoves. @*Purpose@#To determine the level of indoor air pollutants emitted from briquette combustion and to develop recommendations by comparing various types of stoves and dwellings. @*Materials and Methods@#Through analytical cross-sectional designs, three households from Songinokhairkhan district and one household from Chingeltei district were selected to participate in this assessment as they use briquettes for heating, vary in their dwelling types (ger (traditional Mongolian tent), house) and their stove types (traditional, standard), stay home during the day and chose to participate in the assessment. 24-hour continuous measurements were conducted for each dwelling and before taking measurements, we calibrated and adjusted the air suction velocity of the measuring instrument at the Central Metrology Laboratory. The monitor was placed at a distance of 0.5m from the stove and a height of 0.5-1.0m from the floor. The results were then compared with the Mongolian National Standard “General air quality and technical requirements MNS4585:2016” and WHO Guidelines for Indoor Air Quality 2021. Statistical analysis was performed using SPSS 24.0 software, mean, ANOVA test, and if the p-value is less than 0.05, our results are statistically significant.@*Results@#The concentration level of SO₂ in houses with “Dul” stoves was within the level specified in the Mongolian standard MNS4585: 2016 and WHO Guidelines for Indoor Air Quality 2021, while 24-hour SO₂ concentration in gers and houses with traditional stoves was 1.3-2.92 times higher than the standards. The 24-hour average concentration of nitrogen dioxide in houses with traditional stoves was 1.73 times higher than the Mongolian air quality standard MNS4585: 2016. There were statistically significant differences in the emission levels of SO₂ and NO₂ depending on dwelling and stove types (df=4, f=4.04, p=0.008 and df=4, f=17.17, p=0.001, respectively.). The 8-hour average (10,000 μg/m3) CO concentration was statistically significant for various types of dwellings and stoves (df=4, f=45.17, p=0.001), whereas there was a statistically significant difference in CO concentrations in gers with traditional stoves and gers with standard stoves in terms of morning, afternoon, and evening hours (df=3, f=33.17, p=0.001). @*Conclusion@#Indoor air pollutants in the households except for houses with “Dul” stoves have been determined to exceed the air quality standards set by the Mongolian air quality standards and WHO Guidelines for Indoor Air Quality 2021.