Exhaled Nitric Oxide: A Novel Biomarker of Adverse Respiratory Health Effects in Epidemiological Studies

The sampling of exhaled breath is a noninvasive procedure that can be performed easily in adults, children, and patients with respiratory disease. Several studies have demonstrated increased exhaled nitric oxide in patients with pulmonary disease, including asthma. In addition, exhaled nitric oxide may be an elegant tool for monitoring of environmental health effects of air pollution and the prevalence of atopy in epidemiological surveys. Recent literature about exhaled nitric oxide is presented in this article. Technical, physiological, and behavioral confounding factors of exhaled nitric oxide measurement are outlined.     

Effectiveness of Clean Indoor Air Ordinances in Controlling Environmental Tobacco Smoke in Restaurants

Clean indoor air (CIA) ordinances in Toledo, Ohio, and Bowling Green, Ohio, regulate smoking in restaurants to protect patrons and employees. Yet complete protection is questionable because the ordinances allow for smoking in certain dining sections. Two restaurants were studied in each city, one smoking and one nonsmoking. Levels of contaminants related to environmental tobacco smoke (ETS)—determined by personal and area air monitoring—in the nonsmoking restaurants were comparable to levels in a control environment. However, levels of ETS-related contaminants in the smoking restaurants, including designated nonsmoking sections, were significantly higher than levels in the control environment. ETS-related contamination of the nonsmoking sections in the smoking restaurants is attributable to direct openings between the smoking and nonsmoking sections. Reasonable protection of employees and patrons against ETS-related contaminants requires strict enforcement of CIA ordinances. Full protection is achievable only with 100% smoke-free policies.     

Health Effects of Exposure to High Concentrations of Automotive Emissions

On-site and remote health evaluations were performed on 550 employees of the Triborough Bridge and Tunnel Authority in New York City. Extremely high ambient air pollution was observed. Carbon monoxide averaged 63 ppm over a 30-day period with a maximum hourly concentration of 217 ppm in one facility. Eighty-five percent of the smoking and 47% of the nonsmoking tunnel workers had carboxyhemoglobin saturations in excess of 3%. A high percentage of the group had symptoms suggestive of chronic bronchitis; airway resistance was elevated in one third and almost all bridge and tunnel workers had an increase in closing volume, suggesting small airway disease.     

Measurement of Mercury in Human Hair

Measurements of total and inorganic mercury in human hair were used to trace the history and extent of methyl mercury exposures. Data on the distribution of mercury in hair were converted by a mathematical model into information about the key indices of exposure, including times of onset and termination, peak concentration in hair, and half-time of retention in blood. The model was used for computer simulations of the true distribution of mercury in hair and was validated by analyses of segments of single hairs. Conventional methods of hair sampling and fitting the resulting data to a curve were shown to introduce systematic errors underestimating peak concentrations and overestimating retention times. These errors were minimized by practical modification of the hair sampling procedures and by a new graphic method for deriving the measurements of distribution of the trace element in hair.     

OBITUARIES

A stand model to generate alternative management strategies for a long range planning model has been constructed for intensively-managed radiata pine plantations in Gippsland, Victoria. The model can be used to evaluate different intensities of silviculture as well as to provide estimates of future production.     

Pralidoxime Safety andToxicity In Children

Background. Current the safety of pralidoxime administration via adult autoinjectors for pediatric patients has not been established. Up until 2000, the published literature did not recommend its usage for children less than 12kg or under the age of 10 years old. Since 2000, limited published articles have emerged validating adult autoinjector usage for the pediatric victim, in extreme circumstances. Objective. We sought to determine whether adverse drug reactions (ADR) from pralidoxime administration to children occur. Method. Recurrent PubMed Medline literature search of all years were performed from 2001 to 2004 inclusive. The main search criteria were articles pertaining to U.S. children 16 years or younger who received pralidoxime. In addition, a review of 3 years (1999–2001) of detailed retrospective TESS exposure annual poison center data was obtained from the AAPCC. Results. Eighty-one children met inclusion criteria andreceived pralidoxime for suspected organophosphate poisoning. Two children (2.5%) expired. Three children (3.7%) were identified as having a potential adverse drug reaction; all were mild. Conclusion. The author's recognize this study possesses limitations that require its findings be interpreted with caution. Our data suggest that adverse drug reactions to pralidoxime treatment in children are rare. However, further investigation is needed to more firmly establish the safety of this antidote in children andfor its use in the prehospital environment.     

Safety in the Work Place,Coshh and the Veterinary Nurse

Abstract

In small animal first opinion practice we occasionally see patients of the furless and legless variety. Often portrayed as the ‘stuff of nightmares’ our serpent friends have a bad reputation, and, formost, are not at the top of the list of our favourite animals. Unfortunately, the majority of the reptilian patients that grace our surgeries have fallen foul of poor basic husbandry, which is left for us to discover and fix. This article aims to give a basic guide to hospitalising some of the more common reptile species seen in veterinary practice and addresses the essential questions that need to be asked on admission as taking a detailed history of the husbandry is an essential part of the diagnostic process. .     

Asbestos exposure and tuberculous pleurisy as developmental causes of progressive unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis

BackgroundUnilateral upper-lung field pulmonary fibrosis (upper-PF), which is radiologically consistent with pleuroparenchymal fibroelastosis, develops after thoracic surgery. In most patients with unilateral upper-PF, aberrant intra-/extra thoracic air commonly emerges and an autopsy shows chronic pleuritis, which indicates that pleural involvement is associated with upper-PF development. If so, there may be patients with unilateral upper-PF who have a history of pleural involvement, including tuberculous pleurisy (TP) or asbestos exposure (AE). This study aimed to examine this supposition.MethodsWe examined the radiological reports of all consecutive patients from 2012 to 2018 to investigate whether there were patients having unilateral upper-PF and a history of TP or AE.ResultsEight patients were included in the study. Five patients had a history of TP, and the remaining three had that of AE. All patients were men and had respiratory symptoms, and seven patients presented with restrictive ventilatory impairment. The interval between TP or last AE and upper-PF development was long, with a median of over 20 years. The upper-PF lesion was commonly located in the right lung, and aberrant intrathoracic air was observed in five patients during their clinical course. Additionally, the upper-PF lesion transformed into a cystic lesion in six patients, which resulted in Aspergillus infection in two patients. The prognosis was poor, with a median overall survival of 38 months.ConclusionsUnilateral upper-PF developed even in patients with a history of pleural involvement. Our results indicate that pleural involvement plays an important role in the development of unilateral upper-PF.     

Climate change and cancer: converging policies

Intervening on risk factors for noncommunicable diseases (including cancer) in industrialized countries could achieve a reduction of between 30% and 40% of premature deaths. In the meantime, the need to intervene against the threat of climate change has become obvious. CO₂ emissions must be reduced by 45% by the year 2030 and to zero by 2050 according to recent agreements. We propose an approach in which interventions are designed to prevent diseases and jointly mitigate climate change, the so‐called cobenefits. The present article describes some examples of how climate change mitigation and cancer prevention could go hand in hand: tobacco control, food production, and transportation (air pollution). Many others can be identified. The advantage of the proposed approach is that both long‐term (climate) and short‐term (health) benefits can be accrued with appropriate intersectoral policies.

Abbreviations

GHG

greenhouse gases

IARC

International Agency for Research on Cancer

LMICs

low‐ and middle‐income countries

NCD

noncommunicable disease

PMI

Philip Morris International

SDGs

Sustainable Development Goals

UPF

ultraprocessed food