Effects of exposure to fine particulate matter in elderly hospitalizations due to respiratory diseases in the South of the Brazilian Amazon

Exposure to air pollution is an important cause of hospital admissions due to respiratory diseases. Nevertheless, few studies use pollutant concentration data estimated by mathematical models. A time-series ecological study was developed, using data from hospitalizations due to respiratory diseases in people over 60 years of age, residents of Cuiabá, Brazil, during 2012, obtained from the Brazilian Ministry of Health. The independent variables were the concentrations of fine particulate matter (PM2.5) and carbon monoxide (CO) estimated by mathematical modeling, minimum temperature, and relative humidity (obtained from the Brazilian Meteorological Agency), and the number of forest fires. The generalized linear regression model of Poisson was used, with lags of 0 to 7 days. The coefficients obtained were transformed into relative risk of hospitalization, with respective 95% confidence intervals; alpha=5% was adopted. In that year, 591 hospitalizations were evaluated, with a daily average of 1.61 (SD=1.49), the PM2.5 average concentration was 15.7 µg/m3, and the CO average concentration was 144.2 ppb. Significant associations between exposure to these contaminants and hospitalizations in lags 3 and 4 in 2012 were observed. There was a hospitalization risk increase of 31.8%, with an increase of 3.5 µg/m3 of PM2.5 concentrations and an increase of 188 in the total number of hospitalizations, with an expense of more than ≈US$ 96,000 for the Brazilian Public Health System. This study provided information on the cost of air pollution to the health system and the feasibility of using a mathematical model to estimate environmental concentration of air pollutants.

Estrés oxidativo, función pulmonar y exposición a contaminantes atmosféricos en escolares mexicanos con y sin asma / Oxidative stress, lung function and exposure to air pollutants in Mexican schoolchildren with and without asthma

Resumen: Objetivo: Evaluar la asociación entre la exposición a contaminantes atmosféricos y marcadores de estrés oxidativo, por un lado, y la función pulmonar, por el otro, en escolares, con y sin asma, de las ciudades de Salamanca y León, en Guanajuato, México. Material y métodos: Se realizaron determinaciones de marcadores de estrés oxidativo y pruebas de función pulmonar en 314 escolares, y se obtuvo información sobre contaminantes atmosféricos (ozono, dióxido de azufre, monóxido de carbono y partículas menores de 2.5 µm y menores de 10 µm) de las estaciones de monitoreo correspondientes. Para evaluar la asociación se corrieron modelos de regresión lineal múltiple. Resultados: Con un día de retraso a la exposición a partículas menores de 10 µm (PM10), se observó un incremento de 0.09 pmol en los dienos conjugados entre niños asmáticos de Salamanca (p<0.05). La exposición a ozono durante el mismo día incrementó la concentración de lipo-hidroperóxidos en 4.38 nmol entre asmáticos de Salamanca, así como en 2.31 nmol por la exposición a PM10 para dos días de retraso (p<0.05). La capacidad vital forzada disminuyó 138 y 203 ml en niños sin asma, respectivamente, por la exposición a monóxido de carbono (p<0.05). Conclusiones: La exposición a contaminantes atmosféricos incrementa el estrés oxidativo y disminuye la función pulmonar en escolares con y sin asma.

Abstract: Objective. To assess the association between the air pollutants exposure on markers of oxidative stress and lung function in schoolchildren with and without asthma from Salamanca and Leon Guanajuato, Mexico. Materials and methods: We realized determinations of oxidative stress biomarkers and lung function tests in 314 schoolchildren. Information of air pollutants (O3, SO2, CO, PM2.5 and PM10) were obtained from monitoring stations and multiple linear regression models were run to assess the association. Results: An increase of 0.09 pmol in conjugated dienes was observed by exposure to PM10 lag 1 in asthmatics from Salamanca (p<0.05). The exposure to O3 during the same day increased the concentration of Lipohydroperoxides in 4.38 nmol in asthmatics of Salamanca, as well as in 2.31 nmol by exposure to PM10 lag 2 (p<0.05). The forced vital capacity decreased by 138 and 203 ml in children without asthma, respectively, due to exposure to carbon monoxide (p<0.05). Conclusions: Exposure to air pollutants increase oxidative stress and decreased lung function in schoolchildren, with and without asthma.

Salud ambiental, vigilancia y monitoreo de la calidad de aire: Contaminante atmosférico: Monóxido de carbono / Environmental health and air quality monitoring: Air pollutant: Carbon monoxide

El monóxido de carbono es un gas tóxico, inodoro e incoloro que se forma por la combustión incompleta de hidrocarburos como gas o kerosene. Las fuentes pueden ser estufas, calefones, braseros, calderas y hornos en malas condiciones de mantenimiento, así como los escapes de automóviles. Las viviendas o escuelas cercanas a calles de alto tránsito pueden estar también expuestas. Es importante señalar que es además uno de los componentes del humo del tabaco. La exposición al monóxido de carbono en el interior de los hogares produce una intoxicación de características graves e incluso con altos niveles de mortalidad. Respecto de la exposición en el aire exterior, las concentraciones más altas normalmente se miden cerca de las vías de transito principales, dado que los vehículos son la principal fuente de CO. se presentan una serie de gráficos que permiten observar los valores de monóxido de carbono registrados en la Ciudad de Buenos Aires. Dichos registros son obtenidos en las tres estaciones de Monitoreo de Calidad del Aire que posee la Ciudad (Estación La Boca, Parque Centenario y Córdoba), las cuales registran las concentraciones de éste contaminante en forma continua (24 horas diarias, los 365 días del año) mediante métodos homologados internacionalmente. (AU)

Situación epidemiológica de intoxicación por monóxido de carbono (CO) / Epidemiological situation of carbon monoxide intoxication (CO)

El monóxido de carbono es un gas tóxico, incoloro, inodoro e insípido que se produce durante la quema de combustible. Las intoxicaciones por monóxido de carbono (CO) constituyen causa de enfermedad y muerte. Además del evento agudo, los cuadros de intoxicación graves pueden dejar secuelas cognitivas. La exposición crónica también es importante dado que puede producir sintomatología neurológica y cognitiva. Se presentan diferentes análisis de la serie histórica que va desde 2005 a la Semana Epidemiológica 38 de 2016, de las intoxicaciones por Monóxido de Carbono asistidas en la Ciudad de Buenos Aires. Los datos para la construcción de indicadores del presente informe provienen del registro de casos individuales de intoxicación por CO, en el módulo C2 de Vigilancia Clínica del Sistema Nacional de Vigilancia de la Salud (SNVS)

Air pollutants and hospitalization due to pneumonia among children. An ecological time series study / Poluentes atmosféricos e internações por pneumonia em crianças. Estudo ecológico de série temporal

ABSTRACT CONTEXT AND OBJECTIVE: Exposure to air pollutants is one of the factors responsible for hospitalizations due to pneumonia among children. This has considerable financial cost, along with social cost. A study to identify the role of this exposure in relation to hospital admissions due to pneumonia among children up to 10 years of age was conducted. DESIGN AND SETTING: Ecological time series study using data from São José dos Campos, Brazil. METHODS: Daily data on hospitalizations due to pneumonia and on the pollutants CO, O3, PM10 and SO2, temperature and humidity in São José dos Campos, in 2012, were analyzed. A generalized additive model of Poisson's regression was used. Relative risks for hospitalizations due to pneumonia, according to lags of 0-5 days, were estimated. The population-attributable fraction, number of avoidable hospitalizations and cost savings from avoidable hospitalizations were calculated. RESULTS: There were 539 admissions. Exposure to CO and O3 was seen to be associated with hospitalizations, with risks of 1.10 and 1.15 on the third day after exposure to increased CO concentration of 200 ppb and ozone concentration of 20 µg/m3. Exposure to the pollutants of particulate matter and sulfur dioxide were not shown to be associated with hospitalizations. Decreases in CO and ozone concentrations could lead to 49 fewer hospitalizations and cost reductions of R$ 39,000.00. CONCLUSION: Exposure to certain air pollutants produces harmful effects on children's health, even in a medium-sized city. Public policies to reduce emissions of these pollutants need to be implemented.

RESUMO CONTEXTO E OBJETIVOS: A exposição a poluentes do ar é um dos fatores responsáveis pelas internações por pneumonias em crianças. Esse desfecho tem custo financeiro considerável, além do custo social. Estudo para identificar o papel dessa exposição nas internações em crianças com até 10 anos de idade foi desenvolvido. TIPO DE ESTUDO E LOCAL: Estudo ecológico de séries temporais com dados de São José dos Campos, Brasil. MÉTODOS: Dados diários de internações por pneumonia, dos poluentes CO, O3, PM10, SO2 além de temperatura e umidade de São José dos Campos, em 2012, foram analisados. Utilizou-se modelo aditivo generalizado da regressão de Poisson e foram estimados os riscos relativos para internações por pneumonia segundo defasagens de 0 a 5 dias. Foram calculadas a fração atribuível populacional, as internações evitáveis e a economia nos custos das internações evitáveis. RESULTADOS: Foram 539 internações. Exposição ao CO e O3 se mostraram associadas às internações, com riscos de 1,10 e 1,15 no terceiro dia após a exposição decorrentes de aumento nas concentrações do CO em 200 ppb e nas concentrações de ozônio em 20 µg/m3. Exposições aos poluentes material particulado e dióxido de enxofre não se mostraram associados às internações. Diminuição nas concentrações de CO e O3 poderiam reduzir em 49 internações e de R$ 39 mil nos custos. CONCLUSÃO: Mesmo em uma cidade de médio porte, exposição a determinados poluentes do ar causa efeito danoso à saúde da criança, sendo necessária a implantação de políticas públicas para redução da emissão desses poluentes.

Perfil epidemiológico, sinais e sintomas respiratórios de indivíduos que inalaram fumaça tóxica no incêndio da boate Kiss, Santa Maria, RS, Brasil / Epidemiological profile, respiratory signs and symptoms of individuals who inhaled toxic smoke in Kiss nightclub fire, Santa Maria, RS, Brazil

Introdução: O incêndio ocorrido na Boate Kiss, na cidade de Santa Maria-RS, em 27 de janeiro de 2013, vitimou fatalmente 242 sujeitos asfixiados pela inalação de fumaça tóxica, deixando, aproximadamente, outros mil feridos. Objetivo: Analisar os sinais e sintomas respiratórios, em médio prazo, apresentados pelas pessoas que inalaram fumaça tóxica no incêndio. Métodos: Realizou-se este estudo transversal no ambulatório do Centro Integrado de Atenção às Vítimas de Acidentes, localizado no Hospital Universitário de Santa Maria, na cidade de Santa Maria-RS. Resultados: A amostra foi composta por 589 indivíduos (27,8±10,2 anos) que possuíam ou estavam cursando ensino superior. Os sinais e sintomas respiratórios mais prevalentes foram tosse produtiva, fadiga e opressão torácica. Conclusões: A persistência de sinais e sintomas respiratórios, após oito meses do episódio, representa um impacto à saúde das pessoas que inalaram a fumaça tóxica, havendo a necessidade de um monitoramento minucioso nos próximos anos.

Introduction: The fire occurred at Kiss nightclub in the city of Santa Maria-RS, on January 27, 2013, fatally killed 242 people, asphyxiated by inhalation of toxic smoke and approximately another one thousand were injured. Objective: To evaluate respiratory signs and symptoms in the medium term, shown by individuals who inhaled of toxic smoke in fire. Methods: Cross-sectional study was conducted in the clinic of the Integrated Center for Attention to Victims, located at the Hospital Universitário de Santa Maria, in Santa Maria-RS. Results: The sample consisted of 589 subjects (27.8 ± 10.2 years) who had or were attending higher education. The most common signs and respiratory symptoms were productive cough, fatigue and chest tightness. Conclusions: The persistence of signs and respiratory symptoms, after eight months of the episode, is an impact on the health of individuals who inhaled of toxic smoke. Thus, there is the need for careful monitoring in the coming years.

Integridade respiratória é prejudicada em tabagistas passivos adultos expostos em ambiente domiciliar / Respiratory integrity is impaired in adults passive smokers exposed in household environment

Objetivo: Analisar a integridade respiratória de adultos tabagistas passivos expostos em ambiente domiciliar. Métodos: Avaliaram-se 56 voluntários, divididos em grupo de tabagistas passivos (GTP; n=29), composto por familiares de tabagistas, e grupo controle (GC; n=27). Foi realizada avaliação inicial que constava de dados pessoais, antropométricos, pressão arterial (PA), frequência cardíaca, saturação periférica de oxigênio, frequência respiratória. Em seguida, foi aplicado um questionário de afecções respiratórias, mensurado o nível de monóxido de carbono no ar exalado e realizada espirometria. Resultados: Valores de PA mais elevados no GTP foram observados. O GTP apresentou menores valores espirométricos nos índices volume expiratório forçado no primeiro segundo (p<0,0342) e capacidade vital forçada (p<0,0291). Com relação à intensidade dos sintomas, pôde-se observar diferença significativa no sintoma relacionado à coceira no nariz, no qual o GTP relatou maior intensidade (p<0,002). Maior intensidade também foi relatada no GTP no sintoma de respirar com mais dificuldade em lugares que tenham muita poeira ou quando o clima muda (p<0,0001). Conclusão: Tabagistas passivos apresentam prejuízo em sua integridade respiratória caracterizado por maior intensidade de sintomas respiratórios e alterações de função pulmonar.

Objective: To analyze the respiratory integrity of adult passive smokers exposed in home environment. Methods: A total of 56 volunteers, divided into passive smokers group (GPS; n = 29) composed of family members of smokers and a control group (CG; n = 27) with no history of exposure. Initial evaluation was performed which consisted of personal data, anthropometric, blood pressure (BP), heart rate, peripheral oxygen saturation, respiratory rate. Then a questionnaire was administered to respiratory diseases, measured the carbon monoxide level in exhaled air and spirometry was performed. Results: Higher BP values were observed in the GPS. The GPS showed lower spirometric values in forced expiratory volume in one second (p <0.0342) and forced vital capacity (p <0.0291). Regarding the intensity of the symptoms we observed significant difference in the symptom related to itchy nose, in which the GPS reported higher intensity (p <0.002). Higher intensity was also reported in the GPS symptom in breathing more difficult in places that have a lot of dust or when the weather changes symptom (p <0.0001). Conclusion: Passive smokers presented impairment in their respiratory health characterized by a greater intensity of respiratory symptoms and alterations in lung function.

Avaliação da concentração de monóxido de carbono em estudantes universitários da área da saúde / Evaluation of the carbon monoxide concentration in university students of health area

Objetivo - Avaliar o nível de monóxido de carbono exalado em estudantes universitários da área da saúde fumantes, não fumantes, fumantes passivos e ex-fumantes. Método - Participaram do estudo estudantes universitários da área da saúde, maiores de 18 anos, de ambos os sexos, fumantes, não fumantes, fumantes passivos e ex-fumantes. Foram excluídos do estudo estudantes em processo de cessação de tabagismo. Foram coletadas medidas de monóxido de carbono no ar exalado (COex) e nível de dependência de tabagismo através do teste de Fagerstrõm. Resultados - Foram estudados 100 universitários, sendo 65% não fumantes, 11% fumantes, 16% fumantes passivos e 8% ex-fumantes.Houve predomínio do sexo feminino para os estudantes não fumantes (55,48%) e para os fumantes passivos (68,75%). Os fumantes apresentaram grau de dependência do tabagismo de leve a moderada. A média de COex em não fumantes foi de 8,4±7,6 ppm, nos fumantes foi de 32,1±20,1 ppm, nos fumantes passivos de 14,6±8,3 ppm e nos ex-fumantes de 14,4±6,6 ppm. Os cursos que tiveram menos fumantes foram Fisioterapia (9,09%) e Enfermagem (9,09%) e o curso com mais fumante foi o de Medicina (36,36%). Conclusão - Há um percentual considerável de indivíduos fumantes entre os cursos da área da saúde e os níveis de monóxido de carbono no ar exalado destes estudantes fumantes, ex-fumantes, fumantes passivos e não fumantes foram altos.

Objective - To evaluate the level of exhaled carbon monoxide in university students in the health area smokers, nonsmokers, passive smokers and former smokers. Method - Participants were college students in the health area, over 18 years, of both sexes, smokers, nonsmokers, passive smokers and former smokers. The study excluded students in the process of smoking cessation. We collected measurements of carbon monoxide in exhaled air and level of dependence on smoking by the Fagerstrõm test. Results - There were 100 students, 65% nonsmokers,11% smokers, passive smokers 16% and 8% former smokers. There were more female students to nonsmokers (55.48%) and passive smokers (68.75%). Smokers had the degree of tobacco dependence treatment of mild to moderate. The mean expired CO in nonsmokers was 8.4 ±7.6 ppm, in smokers was 32.1 ± 20.1 ppm, in passive smokers, and 14.6 ± 8.3 ppm and in former smokers, 14.4 ± 6.6 ppm. The courses had fewer smokers were physiotherapy (9.09%) and nurses (9.09%) and the course was more smoking medicine (36.36%). Conclusion - There is a considerable percentage of smokers among the courses in the area of health and levels of carbon monoxide in exhaled air of student smokers, former smokers, passive smokers and nonsmokers were high.

Effect of air pollution on onset of acute coronary syndrome in susceptible subgroups

While long-term exposure to air pollutants is associated with an increase in heart diseases and mortality, little information is available about the short-term effects of air pollution. This case-crossover study assessed the relationship of particulate matter [PM[10]] and carbon monoxide [CO] levels with hospital admission for acute coronary syndrome in Tehran, Islamic Republic of Iran. We interviewed 250 patients with a first episode of acute coronary syndrome and obtained data from hospital records and Tehran Air Quality Control Company. The risk of acute coronary syndrome was significantly associated with elevated concentrations of CO the day before the event [OR 1.18; 95% CI: 1.03-1.34] but not significantly with PM[10] [OR 1.00; 95% CI: 0.99-1.02]. Stratification by age, sex, diabetes, hypertension and smoking status did not affect the results, but women were more susceptible than men to CO levels [OR for women/men 1.68; 95% CI: 1.25-2.26]

Air pollution and low birth weight: a historical cohort study from Tehran

This historical cohort study was designed to clarify the association between air pollution and low birth weight [LBW] amongst women referred to Tehran hospitals in 2007. In total, 225 eligible pregnant women who lived within 5 km of an air pollution monitoring station during their pregnancy were selected for the study. Data were collected via interview and hospital records. Exposure to each pollutant was estimated for each woman individually throughout her pregnancy and for each trimester. Exposures were modelled as categorical variables using inter-quartile ranges in a logistic regression model. The results showed a significant association between exposure to CO and LBW [OR = 2.08, 95% CI: 1.70-4.60], particularly during the second trimester [OR = 3.96, CI: 1.83-12.5. We conclude that exposure to air pollution during pregnancy may be associated with LBW

Efectos proinflamatorios de la contaminación atmosférica / Proinflammatory effects of air pollution in Santiago de Chile

Intermittent exposure of rats to Santiago's traffic pollution is associated to a decrease in growth after more than 100 days (range: 101-111) and to histological lung damage after 90 and particularly after 180 days. Our aim was to assess whether a 90 days exposure of rats to air from a Santiago's heavy traffic avenue, is able to induce a systemic proinflammatory reaction. Thirty-days-old Sprague-Dawley rats (n = 7) were directly exposed to air from a heavy traffic avenue (8 h, 5 days a week, from April 27 to July 29, 2009). Controls (n = 7) breathed animal room air. Rats were weighed twice a week and after completing 90 days of observation, lungs were subjected to histopathology and C reactive protein, viscosity and F2-isoprostane in plasma and microhematocrit were determined in blood samples. Exposure to PM10, PM2.5, ozone, NO2 and CO were estimated from registrations of 4 Santiago's monitoring stations. Plasmatic C reactive protein and viscosity and microhematocrit were significantly increased after 90 days of exposure as compared to controls (p < 0.05). No significant changes were observed in F2-isoprostane, nor in lung histopathology, nor in body weight curve versus time in exposed as compared to control series. Hourly mean value of PM25 in the 8 h of exposure was high: 38.9 ug/m³. It is concluded that 90 days of intermittent exposure of rats to Santiago's air pollution would promote a systemic inflammatory reaction. This response to air pollution might precede the decrease in body growth and the histological lung damage reported previously by our laboratory in the same species after intermittent Santiago's urban air pollution exposure.

La exposición intermitente de ratas centinela a la contaminación del tráfico vehicular de Santiago se ha asociado a disminución del crecimiento corporal después de cien días de exposición (rango: 101-111) y a daño histopatológico del pulmón a los 90 días y más, especialmente a los 180 días de exposición. Nuestro objetivo fue evaluar si la exposición al aire de una avenida con elevado tráfico vehicular durante 90 días era capaz de inducir en la rata una respuesta inflamatoria sistémica. Ratas Sprague-Dawley de 30 días de edad (n = 7) fueron directamente expuestas a respirar el aire de una avenida con elevado flujo vehicular (8 h, 5 días por semana, desde el 27 de abril hasta el 29 de julio de 2009). Las ratas control (n = 7) respiraron aire del bioterio. Las ratas se pesaron dos veces por semana y después de completar 90 días de observación, los pulmones se destinaron a estudio histopatológico. Se realizó microhematocrito y se determinó proteína C reactiva, viscosidad y F2-isoprostano plasmáticos en muestras de sangre. La exposición a PM10, PM2,5, ozono, NO2 y CO se calculó de los registros de cuatro estaciones de monitoreo de Santiago. Después de 90 días de exposición se observó un aumento significativo (p < 0,05) de la proteína C reactiva y de la viscosidad plasmática y también del microhematocrito, en relación a la serie control. No se observaron cambios significativos en F2-isoprostano plasmático, ni en la histopatología pulmonar, ni en la curva de peso corporal versus tiempo al comparar la serie expuesta con la serie control. El promedio horario de PM2,5 en las 8 horas de exposición fue alto: 38,9 ug/m³. Concluimos que 90 días de exposición intermitente a la contaminación aérea de Santiago en el modelo experimental promueve una reacción inflamatoria sistémica. Esta respuesta a la contaminación aérea podría preceder a la disminución del crecimiento corporal y al daño histológico pulmonar encontrado en otro de nuestros estudios en esta misma especie después...

Efeitos auditivos em operadores de empilhadeira / Auditory effects in forklift operators

OBJETIVO: Conhecer os efeitos, para a audição, da exposição combinada ao monóxido de carbono e ao ruído em um grupo de operadores de empilhadeira. MÉTODOS: Realizou-se audiometria convencional em grupo controle exposto apenas ao ruído (Grupo 1) e um grupo de funcionários expostos ao monóxido de carbono e ao ruído (Grupo 2). RESULTADOS: Observou-se um caso sugestivo de perda auditiva induzida por ruído para o grupo exposto somente ao ruído (Group 1), e cinco casos para o grupo exposto ao monóxido de carbono e ruído (Group 2). A ocorrência de mudança significativa de limiar também foi maior no Grupo 2. Observaram-se diferenças nos limiares auditivos da orelha esquerda nas frequências de 1 kHz e 8 kHz no Grupo 2, comparativamente ao Grupo 1. CONCLUSÃO: Os resultados demonstraram efeitos auditivos significativos causados pela exposição combinada ao monóxido de carbono e ao ruído em operadores de empilhadeira, em comparação ao grupo exposto somente ao ruído. Conclui-se que é imprescindível a realização dos monitoramentos ambiental, biológico e auditivo nos operadores de empilhadeira, independentemente do nível de ruído ao qual se encontram expostos.

PURPOSE: To get to know the effects of the combined exposure to carbon monoxide and noise on hearing, in a group of forklift operators. METHODS: A pure tone audiometry was carried out in a control group exposed only to noise (Group 1), and a group of employees exposed to both carbon monoxide and noise (Group 2). RESULTS: A single case of noise-induced hearing loss was observed in the group exposed to noise (Group 1), and five cases were observed in the group exposed to both carbon monoxide and noise (Group 2). The occurrence of significant threshold change was also higher in Group 2. There was a difference between the auditory thresholds in 1 and 8 kHz of the left ear in Group 2, when compared to Group 1. CONCLUSION: Results showed significant auditory effects caused by the combined exposure of forklift operators to carbon monoxide and noise, when compared to the group exposed only to noise. Thus, environmental, biological, and auditory monitoring of forklift operators is indispensable, regardless the level of noise to which they are exposed.

Quemadura de vía aérea / Airway burn

La mayoría de las muertes tempranas por accidentes con fuego son provocadas por la inhalación de gases más que por las lesiones causadas por llamas, debido principalmente al compromiso ventilatorio que esto produce. Por lo anterior debe existir un alto grado de sospecha de compromiso de vía aérea en aquellos pacientes que presenten quemaduras faciales, en espacios cerrados, vibrisas chamuscadas, compromiso respiratorio progresivo, esputo carbonáceo o que se encuentren en estado de inconciencia. Sin embargo, la presencia de estos hallazgos no es patognomónica de daño en el árbol bronquial ni su ausencia lo descarta. El principal método de diagnóstico es la fibrobroncoscopía, que permite observar directamente las lesiones y además lavar y remover restos que puedan encontrarse en la vía aérea, pero lamentablemente no se encuentra disponible en todos los servicios de urgencia.

Most of the early deaths from accidents with are fire mainly caused by compromise of the ventilation due to gas inhalation rather thand by injuries caused by flames. Therefore there must be a high degree of suspicion of air compromise for patients presenting facial burns indoors, burnt hair of the nasal cavity, progressive respiratory compromise, carbonaceous sputum or unconsciousness. However, neither is the presence of these findings pathognomonic of damage to the bronchial tree nor does their discharge it. The main method is the fibrobroncoscopy diagnosis, which allows direct observation of the injuries and also the washing and removal of debris that can be found in the airways. Unfortunately, this is method is not available in all amergency services.

Prevención de accidentes por inhalación de monóxido de carbono en edificios: una intervención comunitaria / Accidents prevention for inhalation of carbon monoxide in buildings. a community intervention

A partir de 2002 se implementó en la comuna de Providencia un proyecto de Prevención de Accidentes por Inhalación de Monóxido de Carbono en Edificios. Objetivos: Minimizar los riesgos de accidentes por inhalación de CO para los habitantes de su territorio; junto con informar y sensibilizar a la comunidad sobre la combustión segura de gas domiciliario, su normativa y la facilitación de las soluciones a los problemas detectados. Metodología: El proyecto se centró en la solución de problemas derivados de las deficiencias en la combustión de gas en edificios, a través de la capacitación de actores relevantes y coordinación entre organismos técnicos y proveedores de soluciones técnicas y financieras, para ayudar a las comunidades a satisfacer las regulaciones de seguridad para sus instalaciones de gas, de modo que pudieran obtener el sello verde, que otorga la Superintendencia de Electricidad y Combustibles (SEC). Resultados: La totalidad de las comunidades que se integraron al proyecto desde 2002 hasta 2008 sumaron 519 con 751 personas capacitadas, que contaron con apoyo en los aspectos técnicos y legales para lograr mejoras en sus sistemas de combustión hasta el logro del sello verde, color que caracteriza edificaciones con una combustión y ventilación seguras. Hasta el año 2008, el 46 por ciento de las comunidades integradas al proyecto habían obtenido sello verde, mientras un 13,2 por ciento regularizó la situación de inspecciones atrasadas o sin inspección. El 7,5 por ciento inició las reparaciones necesarias para ser reevaluado por la SEC. Por lo tanto 342 comunidades con 27.184 departamentos y 62.523 habitantes, que representan el 66,5 por ciento del total de residentes de edificios de la comuna; obtuvieron avances importantes en sus niveles de salud ambiental y seguridad en la combustión de gases al interior de los edificios.

A project of prevention and control of accidents by inhalation of carbon monoxide in buildings of the district of Providencia, Chile, was implemented since 2002 in order to minimize the risks for the inhabitants together with reporting and sensitizing to the community about the topics of combustion of domiciliary gas and their regulations and to help to find solutions to the detected problems. Methodology: The project focused on the solution of problems derived from building´s gas combustion systems deficiencies, by capacitation of relevant actors and acting as a clearing house by means of coordination between technical organisms and suppliers and financers of solutions, in order to help the communities to fulfil the safety regulations for their gas facilities so they could opt to obtain the green stamp that is given by the Superintendence of Electricity and Fuels(SEC). Outcomes: The number of communities that joined the project from 2002 until 2008 were 519, with more than 750 enabled persons. They received support about technical and legal aspects to achieve the green stamp that in Chile is given to buildings with safe ventilation and combustion systems. The project benefits spread to all the residents of the buildings subject to the intervention because until 2008, 46 percent of the communities that were integrated to the project had obtained the green stamp and 13,2 percent the situation of delayed inspections or absence of inspection had been regularized, with the SEC. In addition a 7,5 percent of communities started the improvements of their systems to be reassessed by the national authority (SEC). Therefore, 342 communities with 27.184 apartments and 62523 inhabitants who represented 66,5 percent of building residents of the district, obtained important advances in their levels of environmental health and safety in indoor gas combustion.

Environmental health effects of brick kilns in Kathmandu valley.

INTRODUCTION: Brick kilns operating in Kathmandu valley are known to be a leading cause of air pollution. The main objective of this study was to assess the effect of brick kilns on environment and human health. This study has been done at Duwakot VDC in Bhaktapur. METHODS: This study was conducted during brick kilns operating and not operating periods. Different methods were used for data collection, such as household environmental health survey, school health examination, and air quality measurement for total suspend particles, particulate matter of size less than 10 microns, Sulphur Dioxide, Oxides of Nitrogen, and Carbon Monoxide. RESULTS: A total of 330 individuals were interviewed during household environmental survey and majority of them expressed about smoke related respiratory discomfort at home and surrounding. Out of 141 school children who underwent thorough physical health examination, 79 students were from Ganesh Public School (located near to brick kilns) and 62 were from Nabin English School (far away from brick kilns). Statistically significant high odds ratios for respiratory problems like tonsillitis (4.17 95% CI 2.05, 8.45) and acute pharyngitis (4.08 95% CI 2.01, 8.33) were observed among the students from Ganesh Public School. Average value of particulate matter of size less than 10 microns and total suspend particles for the pre operation time was 0.029 mg/m3 and 0.033 mg/m3 respectively whereas, it reached 0.050 mg/m3 and 0.056 mg/m3 respectively during the brick kiln operation time. CONCLUSION: The concentration of various air pollutants was higher during the operation of brick kilns at Duwakot. Similarly, the health status of the school children attending the school close to the vicinity of the brick kilns was worse compared to the students attending the school away from the brick kilns.

Chemical and physical hazards in different small workshops activities

Workers in informal small-scale industries [SSI] in developing countries involved in welding, spray painting, woodwork, and metalwork are exposed to various hazards with consequent risk to health. The present study was to assess occupational exposures to chemical and physical hazards among workers in small workshops. Three different industrial activities were selected for this study. These activities are: car repairing, welding, and wood processing. Inside the selected workshops, different physical hazards as noise, heat stress, illumination, and dust as well as air pollutants of carbon monoxide [CO] nitrogen dioxide, [NO2] sulphur dioxide [SO2], and benzene were measured at the same two periods of the day [morning and evening] using calibrated devices. Analyzed data revealed high significant increase in the selected areas in the levels of noise, thermal stress, illumination and dust during morning and evening exposure between as compared to the control area in the selected areas respectively. Only for NO2, levels of the other gases pollutants inside all exposed workshops are higher than those inside the control workshops. In conclusion, the workers at the studied industries were exposed to potential occupational hazards. These findings should be considered as s a preventive measures for monitoring and application of control strategies in such workplace environment

Safety practice and occupational exposure to physical and chemical hazards in pesticides and fertilizers packing industry

In pesticides and fertilizer formulation and packaging processes, workers may be exposed to toluene, benzene, xylene, carbon monoxide emissions as well as noise and reduced illumination during milling, mixing, loading, packaging and storage operations. Occupational hazards are associated with exposure to mixtures containing high proportions of active ingredients, and exposure to carriers/fillers and additives. The present study was designed to assess occupational exposure to chemicals, physical, hazards and safety practice in the pesticides and fertilizers packing industry. It was conducted in pesticide and fertilizer packing industry. Occupational exposure to organic solvents as toluene, benzene, xylene and carbon Monoxide as well as noise and illumination levels were carried out using calibrated instruments. Safety practice was done using safety questionnaire. Analyzed data revealed high significance increase levels of toluene, benzene, xylene, and carbon Monoxide as well as in the levels of noise and illumination in fertilizers and pesticides packing departments in comparison with administrative area. Nevertheless, the conditions of many of the safety practice are not satisfactory while the others are satisfactory and adequate, It was concluded that there are great needs for improvement, including identifying and controlling the hazards. providing information, training, monitoring and also legislative requirements that need to be met

Repercussões clínicas da exposição à poluição atmosférica / Clinical repercussions of exposure to atmospheric pollution

A poluição atmosférica é um assunto exaustivamente discutido mundialmente. As repercussões clínicas decorrentes das exposições aos principais poluentes atmosféricos são apresentadas resumidamente. Os padrões de qualidade do ar para esses agentes, segundo a Agência de Proteção Ambiental Americana, estão descritos em relação aos seus valores primários e tempo médio. Os efeitos respiratórios conseqüentes à queima de combustíveis fósseis e de biomassa são apresentados de forma sucinta visando, essencialmente, a alertar os profissionais da saúde para o aumento da morbidade relacionada com a poluição ambiental.

Atmospheric pollution is a topic of extensive discussion the world over. The clinical repercussions of exposure to the principal atmospheric pollutants are summarized herein. According to the American Environmental Protection Agency, air quality standards for these agents are set based on their primary and half-life values. The respiratory effects of the burning of fossil fuels and biomass are succinctly presented, with a special focus on alerting health care professionals of the increased morbidity related to environmental pollution.

Contaminación por monóxido de carbono: un problema de salud ambiental / Carbon monoxide contamination: an environmental health problem

El monóxido de carbono es considerado uno de los mayores contaminantes de la atmósfera terrestre. Sus principales fuentes productoras responsables de aproximadamente 80 por ciento de las emisiones, son los vehículos automotores que utilizan como combustible gasolina o diesel y los procesos industriales que utilizan compuestos del carbono. Esta sustancia es bien conocida por su toxicidad para el ser humano. Sus efectos tóxicos agudos incluida la muerte han sido estudiados ampliamente; sin embargo, sus potenciales efectos adversos a largo plazo son poco conocidos. En los últimos años, los estudios de investigación experimentales en animales y epidemiológicos en humanos han evidenciado relación entre población expuesta en forma crónica a niveles medios y bajos de monóxido de carbono en aire respirable y la aparición de efectos adversos en la salud humana especialmente en órganos de alto consumo de oxígeno como cerebro y corazón. Se han documentado efectos nocivos cardiovasculares y neuropsicológicos en presencia de concentraciones de monóxido de carbono en aire inferiores a 25 partes por millón y a niveles de carboxihemoglobina en sangre inferiores a 10 por ciento. Las alteraciones cardiovasculares que se han descrito son hipertensión arterial, aparición de arritmias y signos electrocardiográficos de isquemia. Déficit en memoria, atención, concentración y alteraciones del movimiento tipo parkinsonismo, son los cambios neuropsicológicos con mayor frecuencia asociados a exposición crónica a bajos niveles de monóxido de carbono y carboxihemoglobina.

Carbon monoxide is considered to be a major factor contaminating earths atmosphere. The main sources producing this contamination are cars using gasoline or diesel fuel and industrial processes using carbon compounds; these two are responsible for 80 percent of carbon monoxide being emitted to the atmosphere. This substance has a well-known toxic effect on human beings and its acute poisonous effects (including death) have been widely studied; however, its long-term chronic effects are still not known. During the last few years, experimental research on animals and studies of human epidemiology have established the relationship between chronic exposure to low and middle levels of carbon monoxide in breathable air and adverse effects on human health, especially on organs consuming large amounts of oxygen such as the heart and brain. Harmful cardiovascular and neuropsychological effects have been documented in carbon monoxide concentration in air of less than 25 ppm and in carboxyhaemoglobin levels in blood of less than 10 percent. The main cardiac damage described to date has been high blood pressure, cardiac arrhythm and electrocardiograph signs of ischemia. Lack of memory, attention, concentration and Parkinson-type altered movement are the neuropsychological changes most frequently associated with chronic exposure to low levels of carbon monoxide and carboxyhaemoglobin.