Development of Ahmedabad's Air Information and Response (AIR) Plan to Protect Public Health.

Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology’s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad’s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country’s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.

Pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumorrhachis as complications of common flu.

BACKGROUND: Spontaneous pneumomediastinum is an uncommon benign condition that is occasionally associated with subcutaneous emphysema and occasionally with pneumothorax, but is rarely associated with pneumorrhachis (air within the spinal epidural space). CASE REPORT: We describe the case of a 20-year-old man and discuss a classification system of pneumorrhachis and its pathoanatomy, clinical and radiological presentation and management based on a detailed review of the previous literature. The pathophysiology is multifocal and diagnosis is state-of-the-art, as free intra-spinal air collection and coexistence of it both should be differentiated. Computed tomography with reconstruction of imaging is the method of choice for investigation. Symptoms associated with pneumorrhachis are due to its cause and origin and rarely due to pneumorrhachis, itself. Neurological symptoms and signs due to pressure effect are rarely found, but were present in our case. The management requires a multidisciplinary regimen and has to be individualized. The case was successfully managed conservatively, except for intercostal drainage for symptomatic pneumothorax. The patient stayed at rest and his symptoms improved within a few days. Seven days later the intraspinal air and pneumomediastinum were spontaneously resolved on follow-up chest computed tomography. In spontaneous pneumomediastinum, pneumorrhachis is self-limiting and benign. CONCLUSIONS: The same management is advised in spontaneous pneumomediastinum with or without pneumorrhachis in non-complicated, asymptomatic cases.