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The Indian subcontinent is prone to tropical cyclones that used to originate in the North Indian Ocean. Through this study, an inventory of disease outbreaks for the tropical cyclone-affected regions from 2010 to 2018 has been compiled. This inventory is used to assess the success of recent sanitation intervention, Swachh Bharat Mission, also known as the Clean India Mission.
Meteorological parameters from the Indian satellites were used to demarcate the cyclone-affected area. Disease outbreaks and epidemics during the tropical cyclones were compiled from the Integrated Disease Surveillance Program and other relevant sources. The inventory has been used to track the effect of recent sanitation interventions on disease outbreaks.
Districts in the eastern coast of India are frequently affected due to tropical cyclones that have originated from the North Indian Ocean. Infectious diseases like the acute diarrheal diseases, vector-borne diseases, viral fevers, enteric fevers, and food poisoning have recursively occurred during the cyclonic events and persisted up to 2 weeks from the cyclonic episode. The effectiveness of the Clean India Mission is evident during the recent cyclones, Ockhi, Titli, and Gaja, where a significantly lower number of infectious disease outbreaks were recorded.
The Clean India Mission has exhibited positive results on the public health consequences associated with tropical cyclones.
Approximately 50,000 patients per year present at emergency departments (EDs) because of carbon monoxide (CO) intoxication. The hypothesis of this study was that the half-life of CO and the regression period of complaints could be reduced more rapidly by applying oxygen with the Continuous Positive Airway Pressure (CPAP) modality using a non-invasive mechanical ventilator.
The patients were divided into Group 1 and Group 2 in terms of the treatment method applied. Patients in Group 1 received FiO2 1.0 15 l/minute oxygen at room temperature for at least 30 minutes with a non-rebreather mask. Patients in Group 2 received FiO2 1.0 oxygen at 12 cmH2O pressure with non-invasive mechanical ventilation for at least 30 minutes with an oronasal mask in the CPAP modality.
The median values (interquartile range) of carboxyhemoglobin (COHb) levels at zero and 30 minutes of patients were 19% (8) and 14% (6) in Group 1 and 22% (8) and nine percent (3) in Group 2; a median difference of six percent (2) was detected in Group 1 and of 13% (4) in Group 2 in the first 30 minutes (P <.001). When the symptoms of the patients were examined, the median values of Group 1 and Group 2 at zero minutes were both eight units and at 30 minutes were five and three units, respectively. A decrease of five units was determined in the median of Group 2 in the first 30 minutes, and a decrease of two units in the median of Group 1 (P <.001).
The use of CPAP was determined to more rapidly reduce COHb level as opposed to high-flow oxygen therapy. It is also thought that it may enable earlier discharge by reducing the duration of the emergency follow-up since it provides a faster improvement in the symptoms of the patients.
Carbon monoxide (CO) poisoning is the most common cause of death and injury among all poisonings. Myocardial injury is detected in one-third of CO poisonings. In this Case Report, a previously healthy 41-year-old man was referred for CO poisoning. The initial electrocardiogram (ECG) showed 1mm ST segment elevation in leads DII, DIII, and aVF. As the patient did not describe chest pain and had no cardiac symptoms, ECG was repeated 10 minutes later and it was seen that ST segment elevation disappeared. As the patient had a transient ST segment elevation and elevated high-sensitive Tn-T (HsTn-T), the patient was transferred to the coronary angiography laboratory. The patient’s left coronary system was normal, but a thrombus image narrowing the lumen by approximately 60% was observed in the right coronary artery. Intravenous tirofiban was administered for 48 hours. Control coronary angiography showed continuing thrombus formation and a bare metal stent was successfully implanted. This is the first reported case with transient ST segment elevation associated with acute coronary thrombus caused by CO poisoning. It may be recommended that patients with CO poisoning should be followed-up with a 12-lead ECG monitor or 24-hour ECG Holter monitoring, even if they show no cardiac symptoms and echocardiography shows no wall motion abnormality. Early coronary angiography upon detection of such dynamic ECG changes in these recordings as ST segment elevation can reduce the risk of myocardial infarction (MI) and mortality in these patients.
Oxygen is the main treatment of carbon monoxide (CO) poisoning. In two simultaneous cases, the efficacy of conventional and continuous positive airway pressure (CPAP)-administered oxygen therapy was compared. A 63-year-old man and his 58-year-old wife were brought to the emergency department with complaints of dizziness, headache, and nausea. The man had a history of congestive heart failure and additionally had shortness of breath. Initial carboxyhemoglobin (COHb) values were 26% in the male patient and 24% in his wife. For the female patient, oxygen therapy was performed with a reservoir balloon mask; a CPAP device was used for the male patient. The COHb levels decreased below five percent after approximately two hours in the male patient and at the end of five hours in his wife. In follow-up, symptomatic relief was achieved in both patients and no additional complications were observed. According to our experience, CPAP ventilation can be a new and effective method for oxygen therapy in CO poisoning.
A cluster of Salmonella Paratyphi B variant L(+) tartrate(+) infections with indistinguishable pulsed-field gel electrophoresis patterns was detected in October 2015. Interviews initially identified nut butters, kale, kombucha, chia seeds and nutrition bars as common exposures. Epidemiologic, environmental and traceback investigations were conducted. Thirteen ill people infected with the outbreak strain were identified in 10 states with illness onset during 18 July–22 November 2015. Eight of 10 (80%) ill people reported eating Brand A raw sprouted nut butters. Brand A conducted a voluntary recall. Raw sprouted nut butters are a novel outbreak vehicle, though contaminated raw nuts, nut butters and sprouted seeds have all caused outbreaks previously. Firms producing raw sprouted products, including nut butters, should consider a kill step to reduce the risk of contamination. People at greater risk for foodborne illness may wish to consider avoiding raw products containing raw sprouted ingredients.
A total of 592 people reported gastrointestinal illness following attendance at Street Spice, a food festival held in Newcastle-upon-Tyne, North East England in February/March 2013. Epidemiological, microbiological and environmental investigations were undertaken to identify the source and prevent further cases. Several epidemiological analyses were conducted; a cohort study; a follow-up survey of cases and capture re-capture to estimate the true burden of cases. Indistinguishable isolates of Salmonella Agona phage type 40 were identified in cases and on fresh curry leaves used in one of the accompaniments served at the event. Molecular testing indicated entero-aggregative Escherichia coli and Shigella also contributed to the burden of illness. Analytical studies found strong associations between illness and eating food from a particular stall and with food items including coconut chutney which contained fresh curry leaves. Further investigation of the food supply chain and food preparation techniques identified a lack of clear instruction on the use of fresh uncooked curry leaves in finished dishes and uncertainty about their status as a ready-to-eat product. We describe the investigation of one of the largest outbreaks of food poisoning in England, involving several gastrointestinal pathogens including a strain of Salmonella Agona not previously seen in the UK.
Introduction: Screening for organ and tissue donation is an essential skill for emergency physicians. In 2015, 4564 individuals were on a waiting list for organ transplant and 242 died while waiting. As Canadas donation rates are less than half that of other comparable countries, it is crucial to ensure we are identifying all potential donors. Patients deceased from poisoning are a source that may not be considered for referral as often as those who die from other causes. This study aims to identify if patients dying from poisoning represent an under-referred group and determine what physician characteristics influence referral decisions. Methods: In this cross-sectional unidirectional survey study, physician members of the Canadian Association of Emergency Physicians were invited to participate. Participants were presented with 20 organ donation scenarios that included poisoned and non-poisoned deaths, as well as one ideal scenario for organ or tissue donation used for comparison. Participants were unaware of the objective to explore donation in the context of poisoning deaths. Following the organ donation scenarios, a range of follow-up questions and demographics were included to explore factors influencing the decision to refer or not refer for organ or tissue donation. Results were reported descriptively and associations between physician characteristics and decisions to refer were assessed using odds ratios and 95% confidence intervals. Results: 208/2058 (10.1%) physicians participated. 25% did not refer in scenarios involving a drug overdose (n=71). Specific poisonings commonly triggering the decision to not refer included palliative care medications (n=34, 18%), acetaminophen (n=42, 22%), chemical exposure (n=48, 27%) and organophosphates (n=87, 48%). Factors associated with an increased likelihood to refer potential donors following overdose included previous organ and tissue donation training (OR=2.6), having referred in the past (OR=4.3), available donation support (OR=3.9), greater than 10 years of service (OR=2.1), large urban center (OR=3.8), holding emergency medicine certification (OR=3.6), male gender (OR=2.2, CI), and having indicated a desire to be a donor on government identification (OR=5.8). Conclusion: Scenarios involving drug overdoses were associated with under-referral for organ and tissue donation. As poisoning is not a contraindication for referral, this represents a potential source of donors. By examining characteristics that put clinicians at risk for under-referral of organ or tissue donors, becoming aware of potential biases, improving transplant knowledge bases, and implementing support and training programs for the organ and tissue donation processes, we have the opportunity to improve these rates and reduce morbidity and mortality for Canadians requiring organ or tissue donation.
Introduction: Methanol intoxication is a well-recognized toxicological emergency. While most cases of significant methanol poisoning occur via ingestion, there are reports in the literature of poisoning resulting from the inhalational route. We report a series of methanol intoxications secondary to inhalational abuse of a methanol containing lacquer thinner presenting to an inner city Emergency Department. Methods: A laboratory database was searched for methanol levels > 5 mmol/L. (16mg/dL). from January 1, 2010 to December 31, 2015. A chart review was completed to determine mode of poisoning, clinical presentation, treatment, and disposition. Results: We found 35 patients who made a total of 83 emergency department (ED) visits with a methanol level > 5mmol/L. (16mg/dL). The methanol levels ranged from 5.3-39.6 mmol/L. (16.96 -126.72 mg/dL) . 73% of poisonings were secondary to inhalation of a methanol-containing lacquer thinner. The median age of these patients was 43 years, and 49% were male. The majority of patients (96%) resided in the core area. The most frequent chief complaints were substance abuse/intoxication, gastrointestinal complaints, and chest pain. 18% of patients described visual symptoms. Treatments were fomepizole only (59%), fomepizole plus hemodialysis (26%), and hemodialysis alone (2%). 49% of patients were discharged from the ED, while 28% and 23% were admitted to an intensive care unit (ICU) and an internal medicine ward respectively. There were no cases of blindness. We describe a cohort of patients who developed methanol poisoning from inhalation of a methanol containing lacquer thinner that required treatment with fomepizole and hemodialysis. While almost 1/3 of these patients were admitted to ICU, 49% were discharged from the emergency department after a course of fomepizole. The etiology of this outbreak was found to be a change in the formulation of the lacquer thinner, substituting a higher concentration of methanol for toluene. The manufacturer and a number of local retail outlets were contacted. This resulted in the product being taken off the shelves by the retail outlets, and eventually, a change in the product formulation by the manufacturer, with a resultant decrease in the methanol content. After these actions, we have not seen any additional presentations of inhalational methanol intoxication. Conclusion: We report the largest case series to date of patients who presented with methanol intoxication, requiring fomepizole and/or hemodialysis, secondary to inhalation of a methanol containing lacquer thinner. Physician advocacy regarding the etiology of this outbreak resulted in collaboration with retail outlets and subsequent action by the manufacturer. This ended the outbreak.
Background: Carbon monoxide (CO) poisoning is the leading cause of accidental poisoning worldwide. This study undertook a meta-analysis to examine differences in neuropsychological functioning in patients with CO poisoning as compared to healthy controls, and examined the longer-term neuropsychological effects of CO poisoning. Methods: Studies performed between the years 1995 and 2016 were identified through a search of the electronic databases Medline and PsycInfo. Data from the papers identified were pooled to determine standard mean differences using a random-effects model. Results: Ten studies were included in the analysis, with healthy controls performing significantly better than CO poisoned participants on the domains of divided attention, immediate memory, and processing speed. No statistically significant differences were found for sustained attention, recent memory, working memory, visuospatial/constructional ability, and expressive language. Performance by participants with CO poisoning for the domains of sustained attention, recent memory, visuospatial/constructional abilities, and working memory significantly improved over time after initial exposure, demonstrating recovery of these functions over time. No statistically significant differences were evident for divided attention or expressive language. Conclusions: This evidence indicates that healthy controls perform better than do individuals with CO poisoning on a range of neuropsychological domains; however, it also indicates that performance in some domains does improve over time. (JINS, 2018, 24, 405–415)
The objective of this study was to assess the adverse health symptoms experienced by adult subjects who were exposed to benzene after a flaring disaster at the BP refinery in Texas City, Texas.
A total of 2162 adults aged 18 years or older and exposed to benzene were included. Using the patients’ medical charts, we collected and analyzed data on health complaints as well as the patients’ serum levels of beta-2-microglobulin and urinary excretion of phenol.
A total of 11,368 health symptom complaints were reported in 2162 adults exposed to benzene. Neurological symptoms occurred most frequently (174%), followed upper respiratory symptoms (115%), cough (31%), painful joints (30%), cardiac symptoms (28%), dermatological symptoms (28%), gastrointestinal symptoms (27%), diarrhea (25%), vision symptoms (21%), and nausea/vomiting (19%). Logistic regression analysis indicated that urinary symptoms (R2=0.65) and painful joints (R2=0.44) were positively associated with increasing age in benzene-exposed subjects.
Adult subjects exposed to benzene experience a range of adverse health symptoms and an altered profile of urinary phenol, thus indicating they are at high risk of developing serious future health complications. (Disaster Med Public Health Preparedness. 2018;12:232–240)
Carbon monoxide poisoning may cause myocardial toxicity and cardiac autonomic dysfunction, which may contribute to the development of life-threatening arrhythmias. We investigated the potential association between acute carbon monoxide exposure and cardiac autonomic function measured by heart rate variability.
The present study included 40 children aged 1–17 years who were admitted to the Pediatric Intensive Care Unit with acute carbon monoxide poisoning and 40 healthy age- and sex-matched controls. Carboxyhaemoglobin and cardiac enzymes were measured at admission. Electrocardiography was performed on admission and discharge, and 24-hour Holter electrocardiography was digitally recorded. Heart rate variability was analysed at both time points – 24-hour recordings – and frequency domains – from the first 5 minutes of intensive care unit admission.
Time domain and frequency indices such as high-frequency spectral power and low-frequency spectral power were similar between patient and control groups (p>0.05). The ratio of low-frequency spectral power to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group (p<0.001) and was negatively correlated with carboxyhaemoglobin levels (r=−0.351, p<0.05). The mean heart rate, QT dispersion, corrected QT dispersion, and P dispersion values were higher in the carbon monoxide poisoning group (p<0.05) on admission. The QT dispersion and corrected QT dispersion remained longer in the carbon monoxide poisoning group compared with controls on discharge (p<0.05).
The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.
Lead poisoning is a stealthy threat to human physiological systems as chronic exposure can remain asymptomatic for long periods of time before symptoms manifest. We presently review the biophysical mechanisms of lead poisoning that contribute to male infertility. Environmental and occupational exposure of lead may adversely affect the hypothalamic−pituitary−testicular axis, impairing the induction of spermatogenesis. Dysfunction at the reproductive axis, namely testosterone suppression, is most susceptible and irreversible during pubertal development. Lead poisoning also appears to directly impair the process of spermatogenesis itself as well as sperm function. Spermatogenesis issues may manifest as low sperm count and stem from reproductive axis dysfunction or testicular degeneration. Generation of excessive reactive oxygen species due to lead-associated oxidative stress can potentially affect sperm viability, motility, DNA fragmentation, membrane lipid peroxidation, capacitation, hyperactivation, acrosome reaction, and chemotaxis for sperm-oocyte fusion, all of which can contribute to deter fertilization. Reproductive toxicity has been tested through cross-sectional analysis studies in humans as well as in vivo and in vitro studies in animals.
Vultures in Africa are being poisoned deliberately by poachers to prevent the birds alerting authorities to the poachers’ illegal activities, or for harvesting and sale of body parts for use in witchcraft. Hundreds of vultures can be killed at a single poisoned elephant Loxodonta africana carcass, and although field staff trained in poison response activities can limit the damage, mortalities remain numerous. We used the population viability analysis programme VORTEX to simulate seven 100-year-long scenarios investigating various rates of poisoning mortalities and the remedial effects of poison response activities on a population of Critically Endangered white-backed vultures Gyps africanus breeding in Kruger National Park, South Africa. In six scenarios the population declined (λ < 1); in three scenarios the population remained extant over the 100-year simulations but declined by 60–90% from a starting size of 2,400 individuals. In two scenarios one poisoned elephant carcass left untreated and causing the greatest number of vulture deaths was modelled as a catastrophic event with a 50% probability of annual occurrence, which resulted in a 100% probability of population extinction, with a mean time to extinction of 55–62 years. Effective poison response activities were modelled as a 70% reduction of mortality at each poisoned elephant carcass and resulted in population persistence after 100 years but with a c. 90% reduction in size (final n = 205). We highlight that although poison response activities will not prevent poisoning from occurring, they form an essential part of wider conservation actions designed to prevent local extinctions of vultures or other vulnerable species.
This paper examines the racial ecology of lead exposure as a form of environmental inequity, one with both historical and contemporary significance. Drawing on comprehensive data from over one million blood tests administered to Chicago children from 1995-2013 and matched to over 2300 geographic block groups, we address two major questions: (1) What is the nature of the relationship between neighborhood-level racial composition and variability in children’s elevated lead prevalence levels? And (2) what is the nature of the relationship between neighborhood-level racial composition and rates of change in children’s prevalence levels over time within neighborhoods? We further assess an array of structural explanations for observed racial disparities, including socioeconomic status, type and age of housing, proximity to freeways and smelting plants, and systematic observations of housing decay and neighborhood disorder. Overall, our theoretical framework posits lead toxicity as a major environmental pathway through which racial segregation has contributed to the legacy of Black disadvantage in the United States. Our findings support this hypothesis and show alarming racial disparities in toxic exposure, even after accounting for possible structural explanations. At the same time, however, our longitudinal results show the power of public health policies to reduce racial inequities.
MnOx–CeO2/t-ZrO2 catalyst was prepared by impregnation of nanotetragonal zirconia. The NO conversion of 5 wt% MnOx–CeO2/t-ZrO2 catalyst was 68.1% at 100 °C while that of 30 wt% MnOx–CeO2/t-ZrO2 catalyst was 97.4%. The x-ray diffraction, Brunner–Emmet–Teller measurements (BET), and H2-TPR showed surface properties of the prepared catalysts were good for selective catalytic reduction reactions. X-ray photoelectron spectroscopy analysis indicated that Mn4+ and Ce4+ oxidation states were predominant on the surface of the catalyst and so was lattice oxygen which was conducive to Lewis acid sites. NH3-TPD test results demonstrated that Lewis acid sites are predominant on the surface of catalyst. The presence of SO2 reduced the catalyst activity. The realized conversion dramatically decreased to 47% from nearly 100% after 8 h. Characterization of fresh and spent catalysts indicated the deterioration of active component and deposition of NH4HSO4 or (NH4)2SO4 contribute to SO2 poisoning.
Following Hurricane Superstorm Sandy, the New Jersey Department of Health (NJDOH) developed indicators to enhance syndromic surveillance for extreme weather events in EpiCenter, an online system that collects and analyzes real-time chief complaint emergency department (ED) data and classifies each visit by indicator or syndrome.
These severe weather indicators were finalized by using 2 steps: (1) key word inclusion by review of chief complaints from cases where diagnostic codes met selection criteria and (2) key word exclusion by evaluating cases with key words of interest that lacked selected diagnostic codes.
Graphs compared 1-month, 3-month, and 1-year periods of 8 Hurricane Sandy-related severe weather event indicators against the same period in the following year. Spikes in overall ED visits were observed immediately after the hurricane for carbon monoxide (CO) poisoning, the 3 disrupted outpatient medical care indicators, asthma, and methadone-related substance use. Zip code level scan statistics indicated clusters of CO poisoning and increased medicine refill needs during the 2 weeks after Hurricane Sandy. CO poisoning clusters were identified in areas with power outages of 4 days or longer.
This endeavor gave the NJDOH a clearer picture of the effects of Hurricane Sandy and yielded valuable state preparation information to monitor the effects of future severe weather events. (Disaster Med Public Health Preparedness. 2016;10:463–471)