Housing and respiratory health: Exposures, health effects and interventions

Housing quality and affordability are well established as social determinants of health through direct and indirect mechanisms. Respiratory illnesses related to housing are nearly all the result of housing disrepair that allows intrusion into the home of environmental agents that are directly or indirectly associated with disease. Structural deficiencies such as leaks, cracks in the foundation or holes in the home's exterior can facilitate the presence of mould, which is causally linked to the development of asthma and is associated with exacerbation of asthma symptoms in children and adults. Indoor cleanliness can also contribute to the presence of mice and cockroaches. Proper ventilation can improve air quality, reducing exposure to PM, VOCs and infectious respiratory agents. Disparities in exposure to the housing conditions associated with respiratory disease are readily apparent across socioeconomic lines. Low-income families are less likely to be able to afford the costs of maintaining a home, which prevents them from making repairs that could improve respiratory health.Copyright © ERS 2023.

Future challenges and their impact on respiratory health and lung cancer

Air pollution, climate and population health are closely related in terms of their impacts on respiratory health and lung cancer. Air pollutants contribute to the exacerbation of chronic respiratory problems such as COPD and asthma. Air pollutants are also toxic and carcinogenic, initiating and promoting lung cancer development. Climate change in relation to environmental pollution affects the geographical distribution of food supply and diseases such as pneumonia in adults and children. The threat of air pollution, and hence global warming and climate changes, and their effects on population and respiratory health, is an imminent threat to the world and deserves immediate and sustainable combating strategies and efforts. The goals are to increase public awareness and engagement in action, with alignment of international collaboration and policy, and with steering towards further research. Now is the prime time for international collaborative efforts on planning and actions to fight air pollution and climate change before it is too late.Copyright © ERS 2021.

Frequency and Risk Factors for COVID-19 Infection among Healthcare Workers in a Large-Scale University Teaching Hospital: A Case Control Study

Objective: This study aims to find out the frequency and risk factors responsible for COVID-19 infection among healthcare workers in a large-scale university teaching hospital. Methods: This case-control study was conducted on 185 healthcare workers sampled from the database of 1309 participants maintained at Dr. Ruth K. M. Pfau Civil Hospital, Karachi. Both the cases and controls were derived from the hospital's database of COVID-19 Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and COVID-19 antibody tests were performed on the said population. The participants included were physicians working in the hospital. They were grouped into cases and controls based on the positive diagnostic tests. We administered a simple structured questionnaire over the telephone and face to face for the interview. Statistical analyses were performed on IBM SPSS version 25. Results: The mean age of the cases was significantly different than controls [cases (32.7±9.9) vs controls (38.8±10.6), [p-value=0.002]. More cases 29/37 (78.3%) were working at a single setting compared to controls 54/148 (36.5%) (p-value<0.001). The use of Personal Protective Equipment (PPE), exposure to COVID-19 patients and experiencing symptoms also had statistical significance with the odds of infection (p-value<0.05). Conclusion: This study concludes that younger age, exposure to a known COVID-19 patient and longer duration of exposure among the hospital physicians is associated with positive COVID-19 results. Therefore, it is imperative that adequate measures be undertaken to limit the exposure to COVID-19 patients in this age group. [ FROM AUTHOR] Copyright of Annals of Abbasi Shaheed Hospital & Karachi Medical & Dental College is the property of Knowledge Bylanes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Environmental Exposure: Effect on Maternal Morbidity and Mortality and Neonatal Health.

Environmental factors are important causes that impair global pregnancy outcomes and are, importantly, responsible for maternal morbidity and mortality. However, apart from the direct reasons for maternal deaths, mainly obstetric and neonatal complications, such factors are ignored or given less importance. The recent surge in research on the impact of various environmental factors on pregnancy outcomes suggests the need for immediate attention to such factors and device-specific policies to counter the situation. Moreover, the recent coronavirus disease of 2019 (COVID-19) pandemic, global warming, and climate change showed a lack of preparedness to counter the impact of such events on maternal survival and safe and successful pregnancy outcomes. In the present review, we have emphasized the specific factors responsible for increased maternal and neonatal deaths and their association with specific environmental factors. Increased attention on maternal healthcare, preparedness to counter sudden environmental challenges and improvement of the conventional requirement for better maternal healthcare access and nutrition at a global level may improve the scenario.

Effect of restorative experience in reducing the risk perception of COVID-19 infection: Korean male campers' well-being and willingness to pay a premium for camping

During the Coronavirus disease 2019 (COVID-19) pandemic, South Korean men exhibited greater affective risk perceptions than women, displaying anxiety and fear of COVID-19 infection as well as emotional distress. Such negative psychological states can be reduced through exposure to natural environments. Natural settings often provide restorative environments promoting individual mental health, psychological stability, and well-being. Therefore, this study aims to examine the roles of restorativeness as perceived by men in mitigating the affective risk perception of COVID-19, improving well-being, and increasing the willingness to pay a premium to camp in the context of nature-based camping. An online survey was conducted with South Korean men who experienced camping during the COVID-19 pandemic. A total of 208 responses were used for data analysis. The results of structural equation modeling indicated significant relationships between affective risk perception and perceived restorativeness, perceived restorativeness and well-being, and well-being and willingness-to-pay-a-premium. The mediating effect of well-being was also significant. The findings of a multi-group analysis indicated a significant moderating effect of having children on the relationship between perceived restorativeness and well-being, but not on the relationship between well-being and willingness-to-pay-a-premium. The results of this study provide enhanced insight into restorative experiences in nature as a coping mechanism for increased affective risks as perceived by men during the pandemic. In particular, this study examined the psychological benefits of a natural environment in the context of camping and empirically identified the role of camping in promoting a feeling of restorativeness and inducing men's well-being perception by easing negative emotions. This study also provides practitioners with an understanding of changes in men's perceptions and emotional and behavioral responses through positive restorative experiences.Copyright © 2023 The Author(s). Published by MRE Press.

SARS-CoV-2 infection alters the breast milk glycomic profile

Breast milk is generally accepted as the perfect source of nutrition for the health and development of infants. It also assists in infant innate and adaptive immunity through many proteins that are decorated with glycans. Examples of these glycoproteins include IgA, IgG, and innate immune lectins. Maternal diet and environmental exposure such as pathogens and pollutants affect human milk composition including its glycoprofile. Despite altered glycosylation can have a consequence on the nursing infant's health and immunity, the current knowledge is still emerging in this area of study. COVID-19 has gained attention in recent years by causing severe morbidity and mortality. Similar to other infectious diseases such as influenza, our lab recently revealed alterations in glycome of plasma and different tissue samples of COVID-19 infected patients. Inspired by these findings, we are interested in disclosing the effect of SARS-CoV-2 on glycosylation of breast milk proteins. Toward this, we performed a large-scale systematic study using our high-throughput lectin microarray analysis technology. We analyzed 132 control samples (breast milk collected pre- COVID) and breast milk from 78 COVID-19 infected mothers. Our data showed there is a 4-fold increase in -2,3 sialic acid on glycoproteins that is associated with SARS-CoV-2 infection in lactating mothers. Lectin pulldown experiments further testified to these findings. Given the significance of -2,3 sialic acid glycan signature in infectious diseases, our finding could provide valuable insight into therapeutic development.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Persistent allergic respiratory symptoms induced by food allergy: Report of two cases

Case report Dust is a known mixture and carrier of multiple allergens and an epidemiologic study demonstrated the presence of peanut proteins in school cafeterias and classrooms, suggesting that schools may play an important role in exposure to environmental food allergens. While inhalation of food allergens is a known trigger of IgE-mediate acute respiratory reaction as rhinitis and wheezing, little is known about persistent allergic asthma and/or rhinitis induced by chronic inhalation of food allergens. Here we report two cases of teenagers with nuts allergy presenting with persistent respiratory symptoms when exposed to closed and dusty environments. The first case concerns a 12-year-old boy allergic to walnut and hazelnut (specific IgE > 100 and 81.70 kU/l, respectively). For some years he has had a persistent mild asthma, frequent nasal occlusion and rhinorrhea, without any allergic sensitization to aeroallergens. Symptoms occurred exclusively during school period when he required maintenance therapy with inhaled and nasal steroids. He was asymptomatic and did not need any treatment during summer. During the lockdown period due to Covid-19 pandemic, he did not attend school for several months and he was able to discontinue inhaled corticosteroid therapy without recurrence of asthma and rhinitis symptoms. Asthma recurred after he returned to school, but with only mild intermittent symptoms, probably thanks to the use of masks and the frequent airing of the classrooms. On a single occasion he experienced nasal occlusion and rhinorrhea after that a parent had eaten hazelnut cream in the same room where he was. The second case deals with a 17-year-old boy with a history of several food allergies (milk, egg, wheat, banana, nuts, hazelnuts) and mild persistent asthma in absence of sensitization to aeroallergens. He successfully underwent oral desensitization for milk, egg and wheat in previous years. Asthma symptoms improved over the years together with progressive development of oral tolerance to food allergens for which oral immunotherapy had been done. On the other hand, he referred persistence of allergic rhinitis especially during the school year and his symptoms got worse in classroom. Exhaled nitric oxide was quite increased with evidence of eosinophils in nasal smears. In-vitro and in-vivo tests only detected food allergens sensitizations, in particolar to walnuts and hazelnuts (specific IgE were 61.00 and 55.50 kU/l respectively). These two clinical cases suggest that food allergens might be causative agents of allergic persistent asthma and/or rhinitis as aeroallergens do.

The prevalence of SARS-CoV-2 infection in an academic department of anaesthesiology

Background: Anaesthetists are frontline workers who perform aerosol-generating procedures (AGPs) in enclosed environments, which exposes them to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and increases their risk of contracting SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19). This study describes the prevalence of SARS-CoV-2 infection in the academic department of anaesthesiology of the University of the Witwatersrand prior to vaccination. Method(s): A cross-sectional, contextual, descriptive research design, using an anonymous electronic questionnaire, was followed in the study. Consecutive and convenience sampling methods were used. A p-value of < 0.05 was considered statistically significant. Result(s): A total of 147 participants met the inclusion criteria. There were 90 (61.22%) females and 57 (38.78%) males. The mean age was 35.26 years for the 36 participants who tested positive (26.47%) for SARS-CoV-2. Hospital admission was required by 2.78% of participants with COVID-19. Male participants had a higher prevalence of having SARS-CoV-2 infection (p = 0.045). There were no statistically significant associations between SARS-CoV-2 infection and pregnancy (p = 0.09), asthma (p = 0.11), autoimmune disease (p = 0.77), obesity (p = 0.9), diabetes (p = 0.96), hypertension (p = 0.9) and smoking (p = 0.69). Commonly reported COVID-19-like symptoms included fatigue (68.33%), headaches (61.67%) and myalgia (58.33%). Of the participants with a positive SARS-CoV-2 test, 38.46% had reported travelling within 14 days of testing positive (p < 0.001). Community exposure to a person with SARS-CoV-2 was associated with participants contracting SARS-CoV-2 infection (p = 0.001). Conclusion(s): AGPs are not a significant risk factor for anaesthetists in the context of work or community transmission of the virus. There was a statistically significant predisposition for contracting SARS-CoV-2 infection among males, participants who travelled and participants who had community exposure to a SARS-CoV-2 infected person.

Efficacy of medical face masks on birch-induced asthma in ALYATEC EEC

Background: Patients with rhinitis to pollen can exhibit asthma. To control the spread of SARS-CoV-2, the use of face masks has become widespread worldwide. There is no clinical evidence that medical masks are efficient in birch pollen-induced asthma. Objective(s): To study the efficacy of medical face masks in reducing asthma in patients allergic to birch in ALYATEC Environmental Exposure Chamber (EEC). Method(s): 24 GINA 1 birch-related asthma patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC EEC. All patients had positive skin prick tests and specific IgE to birch at screening. Baseline exposures lasted 1 hour to assess asthma responses (20% drop in Forced Expiratory Volume in 1 second (FEV1). Patients with asthma were randomized into 2 groups: with and without a KOLMI face mask (OP-Air), for a 6-hour exposure to birch allergen. Result(s): At baseline, asthma occurred within 30 minutes. In group without mask, the median time for drop in FEV1 was 37 minutes, and 67 min in the group with mask (p=0.219). There was a threshold difference of time for onset of asthma between the 2 groups. At 1 hour-exposure, patients with masks still present in the EEC was twice as much as the group without masks. Asthma questionnaire was not statistically significant in both groups, but was highly correlated with the drop in FEV1 at 30 min exposure. The Kaplan Meyer graph showed that survival probability in EEC was higher for the group with masks than without masks. Borg's scale for dyspnea suggest a difference between the 2 groups starting at 2 hour-exposure. Conclusion(s): This pilot study showed a tendency of face masks to increase the time to develop asthma. Some patients reported mask effectiveness during pollen season.

Comparison of oxidative stress response of in vitro retinal cells exposed to blue light from emissive versus reflective displays

During COVID-19, there was increased use of handheld displays in educational settings. There is growing concern that eye health may be affected by prolonged exposure to the light-emitting diodes used as frontlights or backlights in handheld displays. The potential impact of light exposure from tablet-sized devices with different display technologies and various spectral outputs was assessed in an in vitro model using human retinal epithelial (ARPE-19) cells. Cellular response was quantified by measuring reactive oxidative species (ROS) and by analyzing mitochondrial morphology. Control experiments established a baseline ROS response to hazardous blue light exposure and also that red light resulted in no detectable ROS response. Under identical conditions, ROS response increased with time for all devices. However, different device spectra caused ROS to accumulate at different rates. When operating the devices in the same mode (day or night), cells accumulated ROS two to three times more slowly on exposure to frontlit electronic paper displays compared to backlit liquid crystal displays. With increasing ROS accumulation, mitochondrial morphology shifted from elongate interconnected features typically observed under normal conditions to rounded disconnected features associated with oxidative stress response. © 2023 E Ink Corporation. Journal of the Society for Information Display published by Wiley Periodicals LLC on behalf of Society for Information Display.

Impact of lockdowns on paediatric asthma hospital presentations over three waves of COVID-19 pandemic

The impact of COVID-19 pandemic on paediatric asthma, the most common chronic condition of childhood, in Australia remains unknown. In a multicentre study, we examined the impact of COVID-19 on paediatric asthma in New South Wales Australia. Method(s): Time series analysis was performed to determine trends in asthma hospital presentations in children aged 2-17 years in pre-pandemic (Jan 2015-Dec 2019) and COVID-19 pandemic years (Jan 2020-August 2021) using emergency department and hospital admission datasets from two large tertiary paediatric hospitals. Result(s): In the pre-pandemic years there were in total 492,863 hospital presentations in children aged 2-17 years, of these 13,160 (2.67%) were due to asthma and in pandemic years there were 163,521 hospital presentations of which 3,364 (2.05%) were due to asthma. We observed a significant decrease in asthma hospital presentations during lockdown periods of COVID-19 pandemic including April (68.85%), May (69.46%) and December (49.00%) of 2020 and August 2021 (66.59%) compared to pre-pandemic predictions. The reduction in asthma hospital presentation in April-May of 2020 and August 2021 was observed across all the age-groups excluding children aged 2-5 years. Conclusion(s): While this decline may be associated with reduced exposure to outdoor environmental factors from restricted movement due to lockdowns, such an approach is not feasible or sustainable in the absence of an infectious disease outbreak. Therefore further research to determine the positive factors associated with this observed pattern will help develop strategies to build a resilient health system.

Proximity to livestock farms and COVID-19 in the Netherlands, 2020-2021.

OBJECTIVES: In the Netherlands, during the first phase of the COVID-19 epidemic, the hotspot of COVID-19 overlapped with the country's main livestock area, while in subsequent phases this distinct spatial pattern disappeared. Previous studies show that living near livestock farms influence human respiratory health and immunological responses. This study aimed to explore whether proximity to livestock was associated with SARS-CoV-2 infection. METHODS: The study population was the population of the Netherlands excluding the very strongly urbanised areas and border areas, on January 1, 2019 (12, 628, 244 individuals). The cases are the individuals reported with a laboratory-confirmed positive SARS-CoV-2 test with onset before January 1, 2022 (2, 223, 692 individuals). For each individual, we calculated distance to nearest livestock farm (cattle, goat, sheep, pig, poultry, horse, rabbit, mink). The associations between residential (6-digit postal-code) distance to the nearest livestock farm and individuals' SARS-CoV-2 status was studied with multilevel logistic regression models. Models were adjusted for individuals' age categories, the social status of the postal code area, particulate matter (PM10)- and nitrogen dioxide (NO2)-concentrations. We analysed data for the entire period and population as well as separately for eight time periods (Jan-Mar, Apr-Jun, Jul-Sep and Oct-Dec in 2020 and 2021), four geographic areas of the Netherlands (north, east, west and south), and for five age categories (0-14, 15-24, 25-44, 45-64 and > 65 years). RESULTS: Over the period 2020-2021, individuals' SARS-CoV-2 status was associated with living closer to livestock farms. This association increased from an Odds Ratio (OR) of 1.01 (95% Confidence Interval [CI] 1.01-1.02) for patients living at a distance of 751-1000 m to a farm to an OR of 1.04 (95% CI 1.04-1.04), 1.07 (95% CI 1.06-1.07) and 1.11 (95% CI 1.10-1.12) for patients living in the more proximate 501-750 m, 251-500m and 0-250 m zones around farms, all relative to patients living further than 1000 m around farms. This association was observed in three out of four quarters of the year in both 2020 and 2021, and in all studied geographic areas and age groups. CONCLUSIONS: In this exploratory study with individual SARS-CoV-2 notification data and high-resolution spatial data associations were found between living near livestock farms and individuals' SARS-CoV-2 status in the Netherlands. Verification of the results in other countries is warranted, as well as investigations into possible underlying exposures and mechanisms.

Ambient fine particulate matter exposures and oxidative protein damage in early pregnant women

The association between oxidative protein damage in early pregnant women and ambient fine particulate matter (PM2.5) is unknown. We estimated the effect of PM2.5 exposures within seven days before blood collection on serum 3-nitrotyrosine (3-NT) and advanced oxidation protein products (AOPP) in 100 women with normal early pregnancy (NEP) and 100 women with clinically recognized early pregnancy loss (CREPL). Temporally-adjusted land use regression model was applied for estimation of maternal daily PM2.5 exposure. Daily nitrogen dioxide (NO2) exposure of each participant was estimated using city-level concentrations of NO2. Single-day lag effect of PM2.5 was analyzed using multivariable linear regression model. Net cumulative effect and distributed lag effect of PM2.5 and NO2 within seven days were analyzed using distributed lag non-linear model. In all 200 subjects, the serum 3-NT were significantly increased with the single-day lag effects (4.72%–8.04% increased at lag 0–2), distributed lag effects (2.32%–3.49% increased at lag 0–2), and cumulative effect within seven days (16.91% increased). The single-day lag effects (7.41%–10.48% increased at lag 0–1), distributed lag effects (3.42%–5.52% increased at lag 0–2), and cumulative effect within seven days (24.51% increased) of PM2.5 significantly increased serum 3-NT in CREPL group but not in NEP group. The distributed lag effects (2.62%–4.54% increased at lag 0–2) and cumulative effect within seven days (20.25% increased) of PM2.5 significantly increased serum AOPP in early pregnant women before the coronavirus disease (COVID-19) pandemic but not after that, similarly to the effects of NO2 exposures. In conclusion, PM2.5 exposures were associated with oxidative stress to protein in pregnant women in the first trimester, especially in CREPL women. Analysis of NO2 exposures suggested that combustion PM2.5 was the crucial PM2.5 component. Wearing masks may be potentially preventive in PM2.5 exposure and its related oxidative protein damage. © 2022 Elsevier Ltd

Satellite-based estimates of daily NO2 exposure in urban agglomerations of China and application to spatio-temporal characteristics of hotspots

The analysis of the daily spatial patterns of near-surface Nitrogen dioxide (NO2) concentrations can assist decision makers mitigate this common air pollutant in urban areas. However, comparative analysis of NO2 estimates in different urban agglomerations of China is limited. In this study, a new linear mixed effect model (LME) with multi-source spatiotemporal data is proposed to estimate daily NO2 concentrations at high accuracy based on the land-use regression (LUR) model and Ozone Monitoring Instrument (OMI) and TROPOspheric Monitoring Instrument (TROPOMI) products. In addition, three models for NO2 concentration estimation were evaluated and compared in four Chinese urban agglomerations from 2018 to 2020, including the COVID-19 closed management period. Each model included a unique combination of methods and satellite NO2 products: ModelⅠ: LUR model with OMI products;Model Ⅱ: LUR model with TropOMI products;Model Ⅱ: LME model with TropOMI products. The results show that the LME model outperformed the LUR model in all four urban agglomerations as the average RMSE decreased by 16.09% due to the consideration of atmospheric dispersion random effects, and using TropOMI instead of OMI products can improve the accuracy. Based on our NO2 estimations, pollution hotspots were identified, and pollution anomalies during the COVID-19 period were explored for two periods;the lockdown and revenge pollution periods. The largest NO2 pollution difference between the hotspot and non-hotspot areas occurred in the second period, especially in the heavy industrial urban agglomerations. © 2022 Elsevier Ltd

Efficacy of medical face masks on birch-induced asthma in ALYATEC EEC

Rationale: To control the spread of SARS-CoV-2, the use of face masks has become widespread worldwide. There is no clinical evidence that medical masks are efficient in pollen-induced asthma. We studied the efficacy of medical face masks in reducing asthma in patients allergic to birch in ALYATEC Environmental Exposure Chamber (EEC). Methods: 24 GINA 1 birch-related asthma patients were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC EEC. All patients had positive skin prick tests and specific IgE to birch at screening. Baseline exposures lasted 1 hour to assess asthma responses (20% drop in Forced Expiratory Volume in 1 second (FEV1), then randomized into 2 groups: with and without a KOLMI® face masks (OP-Air), for a 6-hour birch allergen exposure. Results: At baseline, asthma occurred within 30 minutes. In the group without masks, the median time for drop in FEV1 was 37 minutes, and 67 min in the group with mask (p=0.219). There was a threshold difference of time for onset of asthma between the 2 groups. At 1 hour-exposure, patients with masks still present in the EEC was twice as much as the group without masks. Asthma questionnaire score was highly correlated with the drop in FEV1 at 30 min exposure. The Kaplan Meyer graph showed that survival probability in EEC was higher for the group with masks than without masks. Conclusions: This pilot study showed a tendency of face masks to increase the time to develop asthma. Some patients reported mask effectiveness during pollen season.

Autoimmune syndrome induced by adjuvants (asia) in a 71-year- old filipino female after an inactivated virus vaccine: A case report

Background: Autoimmune Syndrome Induced by Adjuvants, or ASIA, suggests certain environmental exposures, including vaccination can cause hyperstimulation of the innate and adaptive immune system leading to production of autoantibodies in a genetically predisposed individual. A diagnosis of exclusion, proposed diagnostic criteria suggested ASIA if specified major and minor criteria are fulfilled. Suspicion for ASIA was raised in our patient due to identified exposure accompanied by typical manifestations not explained by another cause. Case: A 71-year- old Filipino female with controlled hypertension and diabetes, came in due to progressive right eye pain, supraorbital headache, ptosis and limitation of extra-ocular movements for 3 weeks. No blurring of vision, color vision changes, or visual field cuts. She didn't have other systemic features but received 2 doses of inactivated COVID-19 vaccine 1 month (1st) and 1 day (2nd) prior to the symptom onset. The left eye was unremarkable. ESR was elevated (109) with normal CRP. ANA was 1:80 with a speckled pattern. The complements were normal and lupus confirmatory panel was negative. CSF studies showed slightly elevated protein and glucose with no pleiocytosis, IgG level was normal with negative oligoclonal panel and cultures. EMG-NCV showed acute partial incomplete bilateral facial neuropathy. Cranial MRI/MRA showed chronic lacunar infarct in the right corona radiata. The MRI of the orbits showed right optic nerve enhancement with hyperintense nerve sheath compatible with optic neuritis. She underwent pulse IV steroid therapy (Methylprednisolone 1 g) for 3 days and was maintained on oral steroid 1 mg/kg/day. There was minimal improvement of symptoms for which she received intravenous immunoglobulin for 5 days. Her symptoms gradually improved upon discharge. Conclusion(s): Identification of the possible autoimmunity from adjuvants is not to discourage vaccination but rather raise awareness of the need for further studies to screen who might be at risk and to prepare or even develop alternatives, such as vaccines with a different type of adjuvant.

Does atmospheric dimethyldiselenide play a role in reducing COVID-19 mortality?

Environmental selenium (Se) distribution in the US is uneven, yet US residents appear to have a relatively narrow range of serum Se concentrations, according to the NHANES III survey data; this is probably due to the modern food-distribution system. In the US, Se concentration in alfalfa leaves has been used as a proxy for regional Se exposure (low, medium or high, corresponding to ≤ 0.05, 0.06-0.10 and ≥ 0.11 ppm respectively). Se in plants, soil, water, and bacteria can be transformed into volatile dimethyldiselenide, which can be inhaled and excreted via the lung. Hence, pulmonary Se exposure may be different in states with different atmospheric Se levels. We found a significantly higher death rate from COVID-19 in low-Se states than in medium-Se or high-Se states, though the case densities of these states were not significantly different. Because inhaled dimethyldiselenide is a potent inducer of nuclear-factor erythroid 2 p45-related factor 2 (Nrf2), exposure to higher atmospheric dimethyldiselenide may increase Nrf2-dependent antioxidant defences, reducing the activation of NFκB by SARS-CoV-2 in the lung, thereby decreasing cytokine activation and COVID-19 severity. Atmospheric dimethyldiselenide may thereby play a role in COVID-19 mortality, although the extent of its involvement is unclear. Synopsis Loss of pulmonary dimethydiselenide via exhalation may help explain a significantly higher death rate from COVID-19 in states with low environmental (atmospheric) Se concentrations.

Prevalence of, and Factors Associated with Asthma among Teenager Students in Erbil City

Background: Asthma is a common chronic disease among teenager students, and has led to a significant morbidities and disabilities. Few comprehensive studies have estimated the prevalence of asthma in Erbil city. Objective(s): To find out the prevalence of asthma in 12 to 19-year-old teenager students in Erbil city and to identify the factors that are associated with prevalence of asthma. Method(s): A cross-sectional study was carried out on 2000, 12 to 19-year-old students in Erbil city, during the academic year 2021-2022. The questionnaire was developed by the researcher. The data were analyzed by SPSS, version 25, software. A pvalue of <= 0.05 was considered, statistically significant. Result(s): The prevalence of physician-diagnosed asthma was 7.0%. Significant association (p < 0.001) was detected between the prevalence of asthma and the following factors: using gaseous heating system, using kerosene heating system, insecticides spray use, presence of dampens on the wall, household pets, smoking, having plants at house and spending some time at the house or public garden, while there was no significant association between the prevalence of asthma and the following factors: allowing household pets in bed (p 0.895), using home generator (p = 0.160), presence of a factory (p = 0.139) or generator ( p = 0.474) near the house, exposure to irritant substances during work after the school hours (p = 0.150). Conclusion(s): The prevalence of asthma in Erbil city, Iraqi Kurdistan Region was 7.0 %. The rate of asthma and asthma related symptoms is highly effected by many of risk factors like heating system inside the house and house related factors such as presence of dampens, molds, household pets, presence of plants and flowers in the house and smoking among 12 to 19-year-old teenager. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Atraumatic radial and ulnar artery thrombotic occlusion resulting in critical limb ischemia triggered by black mold infestation

Background: Atraumatic upper extremity arterial thrombosis is uncommon. We present a case of radial and ulnar artery thrombosis with critical limb ischemia, with symptoms resolving after remediation of a black mold home infestation. This case highlights the importance of identifying potential environmental exposures in uncommon clinical presentations. Case presentation: Chart review of all visits in two hospital systems. Informed consent was obtained from the patient. Result(s): A 51-year-old male noted pain and paresthesia of the left hand. Critical ischemia was found with mid-forearm occlusion of the radial and ulnar arteries;surgical care included no distal target for bypass and digital ray amputation. Workup did not reveal autoimmunity, thrombophilia, or source of embolism. Symptoms were recurrent with ongoing ischemia and tissue loss. Further evaluation identified a home water leak. Professional remediation of black mold coincided with resolution of pain, discoloration, and ulceration without return of symptoms at follow up of 22 months. Conclusion(s): Immune-mediated mechanisms can lead to clinical thrombotic events. Vascular occlusion related to COVID-19 has stimulated interest in thrombotic pathways not routinely emphasized. We postulate neutrophil extracellular traps (NETs), triggered by chronic exposure to mold, contributed to persistent digital ischemia. NETs are fibrous extensions of extracellular strings of DNA, antimicrobial peptides, and chromatin that bind pathogenic microbes and provide scaffolding for thrombi, triggering vascular occlusion. This is a novel case of upper extremity arterial occlusion leading to amputation associated with exposure to black mold. Thrombosis may be related to NETs formation and symptoms did not resolve until the environmental mediator was eradicated. Environmental exposure should be considered in otherwise healthy patients who present with atraumatic critical digital ischemia without thrombophilia, autoimmunity, illicit drug use, or vasculitis.

National Trends in Pediatric Critical Asthma Severity during the Covid-19 Pandemic

INTRODUCTION: Asthma exacerbations in children have historically been attributed to a combination of viral infection, environmental exposures, and individual patient attributes. The COVID-19 pandemic has provided a unique opportunity to evaluate variations in asthma severity during a time of changing viral exposure patterns and patient behaviors. This study describes the trends in pediatric critical asthma severity during the COVID-19 pandemic. METHOD(S): We performed a retrospective analysis of the Virtual Pediatric Systems (VPS) database. Inclusion criteria were: patients admitted to a pediatric intensive care unit in the United States from 2014-2021 with a discharge diagnosis of "asthma with acute exacerbation" or "asthma with status asthmaticus." Asthma severity was determined by the maximum level of respiratory support required during the admission, from lowest to highest: 1-Heated high flow nasal cannula;2-Non-invasive positive pressure;3-Endotracheal intubation;4-Inhaled anesthetics or ECMO. Patients were divided into Pre-COVID, Pandemic Era 2020, and 2021 groups based on the date of admission, with the start of the COVID-19 pandemic defined as April 1, 2020. Subgroup analysis was performed based on race/ethnic group. RESULT(S): A total of 51,746 patients were identified in the VPS database that met the stated criteria. The average number of admissions per month was 713 and 206 in the Pre-COVID and Pandemic groups, respectively. Patients categorized as "Severe" (severity levels 3 & 4) represented 3.8% and 4.7% of admissions, respectively (p< 0.05). Patients categorized as "Moderate" (severity level 2) represented 16.9% and 21.7% of admissions, respectively (p< 0.05). Asthma mortality rates were found to be 0.3% and 0.7%, respectively (p< 0.05). Subgroup analysis by race/ ethnic group found that asthma severity by race/ethnicity was unchanged from the pre-COVID baseline. CONCLUSION(S): During the COVID-19 pandemic, the number of critical asthma admissions decreased while the average severity and mortality rate in those patients increased. Further study is needed to determine whether these findings are due to delayed presentation to healthcare, changes in viral exposure patterns, or other factors.