Role of air pollution in chronic kidney disease: an update on evidence, mechanisms and mitigation strategies.

Air pollution results from a variable and complex mixture of harmful gases and suspended particles and is the most worrisome of all environmental hazards. It is implicated in several non -communicable diseases and is recognized to be a public health problem. Though the initial exposure to air pollution is through the respiratory system, kidneys are thought to be exposed to higher concentrations owing to their filtration function. Chronic kidney disease is the insidious end result of several disease processes which cumulatively form a large healthcare burden, particularly in low- and middle-income countries. There is a growing body of evidence that air pollution may be a contributing factor that leads to CKD by not only its direct effects, but can also compound the effect of other factors/diseases causing kidney injury. PM2.5 exposure particularly has been implicated, although there is some evidence regarding other air pollutants as well. These pollutants are thought to act on kidneys through several interlinked systemic pathways and mechanisms which individually and collectively damage the nephrons. Long-term exposures seem to gradually diminish renal function and lead to end-stage renal disease. A thorough understanding of the mechanism of kidney injury is the key for formulating and implementing effective strategies for reducing this burden. Maintaining the air quality, promoting education, improving health quality and promotion of targeted nephroprotective measures through effective policy and research support are required in addressing this global public health problem.

Mucormycosis in COVID-19 pandemic: Risk factors and linkages.

Mucormycosis is a serious and potentially fatal fungal infection caused by a type of rare but opportunistic fungal pathogen called mucormycetes. Recently, mucormycosis, also known as black fungus, made severe chaos in India during the second wave (between April and June 2021) of the tragical COVID-19 epidemic by its sudden and devastating surge with up to 50% mortality rate. While the exact cause of its sharp rise suddenly and specifically during the second wave still remains debatable, it has been noted that the people who are diabetic and have recovered from COVID-19 infection are more predisposed to mucormycosis. Nevertheless, the precise reason and mechanism(s) underlying the surge of this deadly infection needs to be investigated to comprehend its pathogenesis and pathological elements and discover rationale preventative/ therapeutic solutions. It is speculated that the indiscriminate use of steroids, antibiotics and zinc as a self-medication practice that increased during the COVID-19 epidemic may have promoted the dysbiosis of gut microbiota thereby inducing immune-suppression and making the risk group highly susceptible to this mycotic disease. In these contexts, this timely article attempts to contemplate and discuss some of the possible factors and potential mechanisms that can help to understand and explain the conundrum of sudden, steep and deadly upsurge of mucormycosis infections during the second wave of COVID-19 epidemic.

Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern.

OBJECTIVE: A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant. MATERIALS AND METHODS: A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities. RESULTS: Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant. DISCUSSION AND CONCLUSION: By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.

Regression Equations of Respiratory Impedance Measured by Forced Oscillation Technique for Indian Children.

OBJECTIVE: To develop regression equations of within and whole-breath respiratory impedance for Indian children aged 5 to 17 y. METHODS: A prospective cross-sectional study was carried out in 5 to 17 y old school children of Bhopal, India. Healthy children were identified by physical examination and by administering questionnaire. The respiratory system resistance (Rrs) and reactance (Xrs) were measured at frequency of 5, 11, and 19 Hz by forced oscillation technique (FOT). The regression equations of within and whole-breath Rrs and Xrs were developed separately for boys and girls by multiple linear regression models. RESULTS: Total 336 children were recruited and data of 320 healthy children (boys - 159), standing height of 146.1 ± 16.6 cm and body mass index of 17.2 ± 2.9 kg/m2 were included in the analysis. The mean respiratory system resistance at 5 Hz (R5) and respiratory system reactance at 5 Hz (X5) of the children, irrespective of gender were 5.46 ± 2.10 cmH2O/L/s and - 1.43 ± 0.85 cmH2O/L/s respectively. Boys of age 16 y and older had significantly smaller Rrs as compared to girls of corresponding age (p < 0.05). The standing height of children had the highest predictive power, followed by age in the regression model. With an increase in standing height, the magnitude of both Rrs and Xrs values of children decrease. The bodyweight of children had a negligible contribution to the regression models. CONCLUSIONS: The regression equations of within- and whole-breath Rrs and Xrs of Indian children aged 5 to 17 y are presented for the first time. The R5 values of Indian children were comparable to children of other ethnicities.

Morbidity profile of child labor at gem polishing units of Jaipur, India.

BACKGROUND: There are millions of working children worldwide. Several causes are suggested for this social evil of which poverty plays a significant role in whether a child will work. OBJECTIVE: To determine the morbidity profile in the working children of gem polishing units of Jaipur, India and assess some of its associated socio-economic factors. METHODS: The present cross-sectional study included 586 gem polishing working children. Using interview, the demographic characteristics, occupational and clinical history of participants were recorded. The reason for taking up the job, income from the job and their desire to attend the school were also asked to assess the social causes of child labor in this region. RESULTS: The mean±SD age of the working children was 11.3±5.3 years. In most of the instances, parents compelled the child to take up the job. Supposed to increase the family income substantially, the child labor activity failed to do so. On the other hand, the children suffered from several occupational health problems like eyestrain, headache, gastrointestinal complaints (eg, abdominal pain, nausea, vomiting, and diarrhea), musculoskeletal symptoms (e.g., back pain, pain in limbs, neck pain, and joint pains) and skin diseases (e.g., scabies, dermatitis). CONCLUSION: It seems that the social factors forcing the children to work in the studied region, result in deterioration of their health and affect their growth.

Occupational health problems of highway restaurant workers of Pune, India.

To meet the ever-increasing demand for new cuisines, the catering industry in India is becoming more prominent day by day. According to a recent estimate, more than two million restaurants are now dominating the present scenario of the Indian catering industry. The health hazards in restaurants vary according to the place that a worker is employed. The hazards among kitchen staff include several different types of accidents such as burns from deep fryers, slipping on grease and cuts from knives, whereas musculoskeletal disorders are more common among waiters and helpers who usually bear load. The present cross-sectional study included 127 workers from 15 restaurants and dhabas situated at Pune-Mumbai high way. Interview technique followed by clinical examination was the tool for data collection. Musculoskeletal symptoms such as low back pain, fatigue, body ache and pain in limbs were present in 18 (14.2%) of the workers. Gastrointestinal complaints such as heartburn, abdomen pain, stomatitis, etc. were reported by 12 (9.4%) subjects, while skin-related symptoms, such as itching and discoloration were reported in 12 (9.4%) subjects. Seventy-three (57.5%) of the subjects were free from any symptoms.

Silica exposure and serum angiotensin converting enzyme activity.

BACKGROUND: Silicosis is known in industrial workers for centuries. Till recently, the mainstay of its diagnosis and progress was clinical examination of the respiratory system, pulmonary function test and chest radiography. Several biomarkers such as serum angiotensin converting enzyme (ACE) activity have been examined to determine the extent of silicosis. OBJECTIVE: To elucidate the effect of age, gender, duration of exposure to silica dust, smoking habit, and pulmonary function status on the serum ACE activity among quartz stone workers without disease. METHODS: A cross-sectional study was carried out on 134 (111 men and 14 women) workers of quartz stone crushing units were studied. Standard diagnostic criteria were used for diagnosing silicosis and tuberculosis. Pulmonary functions of the participants were also assessed. RESULTS: The mean±SD age for participants was 26.1±6.3 years (26.6±6.3 for men and 21.9±4.3 for women). The mean±SD duration of exposure was 1.1±1.9 years. In the present study, only one case of silicosis and eight cases of tuberculosis were found. The mean±SD serum ACE levels for those with and without respiratory disease were 68.44±11.61, and 66.9±14.4 IU/L, respectively (p>0.05). CONCLUSION: We could not observe any association between serum ACE activity and age, gender, duration of exposure, smoking habits and pulmonary function status. However, elevated levels of serum ACE was found in a solitary case of silicosis.

Respiratory morbidities among working children of gem polishing industries, India.

There are millions of working children worldwide. In gem polishing industry, exposure to occupational hazards of dust and chemicals used in polishing of gemstone may result in respiratory symptoms and respiratory disorders. The present study included 586 exposed and 569 comparison group subjects. Data was collected through personal interview, clinical examination, and chest radiography. The respiratory morbidity was diagnosed on the basis of clinical signs and symptoms and chest radiography. The study variables included age, sex, daily working hours, and duration of exposure. The mean age of the child laborers was 11.31 +/- 5.34 years. Prevalence of respiratory morbidity was significantly high in the female child laborers. The other study variables namely age, duration of exposure, and daily working hours were found to be statistically non-significant. The prevalence of respiratory morbidity among child laborers of gem polishing industry in Jaipur was found to be 7%.

Mapping 'Occupational Health' courses in India: A systematic review.

The occupational health scenario is undergoing a paradigm shift in developing countries with rapid industrialization. Inadequate human resource is, however, a concern. The creation of Basic Occupational Health Services will demand a further increase in specialist manpower. The current training capacity of occupational health specialists has been mapped by a systematic review in India. Twenty-one institutes have been identified all across the country. They have an existing capacity for training about 460 specialists. This number is inadequate considering the population of India's working class. A mixture of strategies must be urgently planned for addressing this issue.

Metallic vaginal ring pessary: a rare entity.

Vaginal pessaries still have role in the management of uterovaginal prolapse especially in elderly women, unfit for surgery and as a temporary relief for women waiting for surgery. Forgotten vaginal pessaries may cause serious complications. We here by present a case wtih metallic vaginal ring pessary for 16 years without significant symptoms.

A study on human risk factors in non-fatal road traffic accidents at Nagpur.

A cross sectional study was conducted among 423 victims of road traffic accidents reporting to Indira Gandhi Medical College, Nagpur for treatment during 1999-2000. Data was collected on pre-designed proforma by interview technique. Majority of the victims were male (85.8%) and of 18-37 years (74%); 64.5% of the subjects were consuming alcohol regularly and 5.9% were drug abusers; 43.7% and 10.2% had visual and hearing impairment respectively; 43.5% were not having any driving experience and 74.4% of the victims with two wheelers were not using any helmets at the time of accidents. Findings highlight the need for sustained health education and enforcement of traffic laws.

How does lobeline injected intravenously produce a cough?

In order to examine, whether the lobeline-induced cough is a true reflex or a voluntary effort to get rid of its irritating sensations in the upper respiratory tract, we systematically studied the cough response to lobeline, of subjects who were unable to make conscious discriminations i.e. were either comatose (n=4) or anaesthetized (n=5). 8 microg/kg lobeline injected into the right atrium of one and 29 microg/kg intravenously (i.v.) into another evenly and spontaneously breathing comatose subject produced a cough after 4s and 12s, respectively. Cough was repeatable and showed a dose response relationship i.e., its latency decreasing and its duration/intensity increasing with the dose. In a third subject, capable only of weak spontaneous respiration, a relatively high dose injected into the right atrium (44 microg/kg) generated a pronounced cough-like respiratory movement superimposed on the artificial ventilation and also during the apnoea after disconnecting the pump. No respiratory response was evoked in a fourth subject who had no evidence of brainstem reflexes. In five normals, cough was elicited with a mean dose of 35+/-5 microg/kg i.v. (latency 14+/-2 s; duration 10+/-3 s). After thiopental anaesthesia, injecting 41+/-7 microg/kg produced a cough within 13+/-2 s that lasted for 12+/-2 s. It may be noted that neither the later dose nor the latency or duration of cough that it produced were significantly different from the pre anaesthesia values (P>0.05). These two sets of results show unequivocally that the lobeline-induced cough is evoked reflexly; its magnitude in the conscious state could vary by subjective influences. We discuss the likelihood of its origin from juxtapulmonary capillary receptors.

A risk scoring system for prediction of haemorrhagic stroke.

The present pair-matched case control study was carried out at Government Medical College Hospital, Nagpur, India, a tertiary care hospital with the objective to devise and validate a risk scoring system for prediction of hemorrhagic stroke. The study consisted of 166 hospitalized CT scan proved cases of hemorrhagic stroke (ICD 9, 431-432), and a age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. On conditional multiple logistic regression five risk factors- hypertension (OR = 1.9. 95% Cl = 1.5-2.5). raised scrum total cholesterol (OR = 2.3, 95% Cl = 1.1-4.9). use of anticoagulants and antiplatelet agents (OR = 3.4, 95% Cl =1.1-10.4). past history of transient ischaemic attack (OR = 8.4, 95% Cl = 2.1- 33.6) and alcohol intake (OR = 2.1, 95% Cl = 1.3-3.6) were significant. These factors were ascribed statistical weights (based on regression coefficients) of 6, 8, 12, 21 and 8 respectively. The nonsignificant factors (diabetes mellitus, physical inactivity, obesity, smoking, type A personality, history of claudication, family history of stroke, history of cardiac diseases and oral contraceptive use in females) were not included in the development of scoring system. ROC curve suggested a total score of 21 to be the best cut-off for predicting haemorrhag stroke. At this cut-off the sensitivity, specificity, positive predictivity and Cohen's kappa were 0.74, 0.74, 0.74 and 0.48 respectively. The overall predictive accuracy of this additive risk scoring system (area under ROC curve by Wilcoxon statistic) was 0.79 (95% Cl = 0.73-0.84). Thus to conclude, if substantiated by further validation, this scorincy system can be used to predict haemorrhagic stroke, thereby helping to devise effective risk factor intervention strategy.

Knowledge and practices regarding injury care among stone quartz workers.

The present study designed as cross sectional study was carried out to study the knowledge and practice regarding injury care among stone quartz workers of Chhotaudepur. A total of 137 stone quartz workers were included in the study, which consisted of 54.7% males and 45.3% females. 85.4% of the workers were illiterate and almost all the workers belonged to lower socio-economic strata according to the Modified Kuppuswamy's socio-economic scale. Majority of the subjects (56.2%) responded that they would consult doctor if they get injured while 32.2% responded that they would neglect the wound, as it will heal spontaneously. Thus the present study suggests that the knowledge regarding injury care among stone quartz workers was poor. Even the attitude and practice regarding injury care was also inappropriate.

Environmental risk factors: a study in Kutch region.

The environment risk factors particularly drinking water status and vector breeding status. In the earthquake--affected villages in Kutch region are presented.