Effect of air pollution on diabetes and cardiovascular diseases in São Paulo, Brazil

Type 2 diabetes increases the risk of cardiovascular mortality and these patients, even without previous myocardial infarction, run the risk of fatal coronary heart disease similar to non-diabetic patients surviving myocardial infarction. There is evidence showing that particulate matter air pollution is associated with increases in cardiopulmonary morbidity and mortality. The present study was carried out to evaluate the effect of diabetes mellitus on the association of air pollution with cardiovascular emergency room visits in a tertiary referral hospital in the city of São Paulo. Using a time-series approach, and adopting generalized linear Poisson regression models, we assessed the effect of daily variations in PM10, CO, NO2, SO2, and O3 on the daily number of emergency room visits for cardiovascular diseases in diabetic and non-diabetic patients from 2001 to 2003. A semi-parametric smoother (natural spline) was adopted to control long-term trends, linear term seasonal usage and weather variables. In this period, 45,000 cardiovascular emergency room visits were registered. The observed increase in interquartile range within the 2-day moving average of 8.0 µg/m³ SO2 was associated with 7.0% (95%CI: 4.0-11.0) and 20.0% (95%CI: 5.0-44.0) increases in cardiovascular disease emergency room visits by non-diabetic and diabetic groups, respectively. These data indicate that air pollution causes an increase of cardiovascular emergency room visits, and that diabetic patients are extremely susceptible to the adverse effects of air pollution on their health conditions.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Programa de Pós-graduação em Clínica MédicaUniversidade Católica de Santos Programa de Pós-graduação em Saúde ColetivaUniversidade de São Paulo Laboratório de Poluição Atmosférica ExperimentalUniversidade de São Paulo Faculdade de Medicina Divisão de Pneumologia do Instituto do CoraçãoUniversidade de Santo Amaro Faculdade de Medicina Programa de Pediatria AmbientalUNIFESP, EPM, Programa de Pós-graduação em Clínica MédicaSciEL

The impact of sugar cane-burning emissions on the respiratory system of children and the elderly

We analyzed the influence of emissions front burning sugar cane on the respiratory system during almost I year in the city of Piracicaba in southeast Brazil. From April 1997 through March 1998, samples of inhalable particles were collected, separated into fine and coarse particulate mode, and analyzed for black carbon and tracer elements. At the same time, we examined daily records of children ( 64 years of age) admitted to the hospital because of respiratory diseases. Generalized linear models were adopted with natural cubic splines to control for season and linear terms to control for weather. Analyses were carried out for the entire period, as well as for burning and rionburning periods. Additional models were built using three factors obtained from factor analysis instead of particles or tracer elements. Increases of 10.2 mu g/m(3) in particles <= 2.5 mu m/m(3) aerodynamic diameter (PM2.5) and 42.9 mu g/m(3) in PM10 were associated with increases of 21.4% [95% confidence interval (0), 4.3-38.5] and 31.03% (95% Cl, 1.25-60.21) in child and elderly respiratory hospital admissions, respectively. When we compared periods, the effects during the burning period were much higher than the effects during nonburning period. Elements generated from sugar cane burning (factor 1) were those most associated with both child and elderly respiratory admissions. Our results show the adverse impact of sugar cane burning emissions on the health of the population, reinforcing the need for public efforts to reduce and eventually eliminate this source of air pollution.Univ São Paulo, Sch Med, Environm Epidemiol Study Grp, Lab Expt Air Pollut, BR-05508 São Paulo, BrazilCatholic Univ Santos, Community Hlth Postgrad Program, Santos, BrazilUniv São Paulo, Ctr Nucl Energy Agr, Piracicaba, BrazilUniv São Paulo, Inst Phys, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Dept Internal Med, Pulm Physiopathol & Air Pollut Res Grp, São Paulo, BrazilHarvard Univ, Sch Publ Hlth, Exposure Epidemiol & Risk Program, Dept Environm Hlth, Boston, MA 02115 USAUniv Santo Amaro, Sch Med, Environm Pediat Program, São Paulo, BrazilUniversidade Federal de São Paulo, Sch Med, Dept Internal Med, Pulm Physiopathol & Air Pollut Res Grp, São Paulo, BrazilWeb of Scienc

Indoor NO2 air pollution and lung function of professional cooks

Studies ofcooking- generated NO2 effects are rare in occupational epidemiology. in the present study, we evaluated the lung function of professional cooks exposed to NO2 in hospital kitchens. We performed spirometry in 37 cooks working in four hospital kitchens and estimated the predicted FVC, FEV1 and FEF25-75, based on age, sex, race, weight, and height, according to Knudson standards. NO2 measurements were obtained for 4 consecutive days during 4 different periods at 20-day intervals in each kitchen. Measurements were performed inside and outside the kitchens, simultaneously using Palm diffusion tubes. A time/exposure indicator was defined as representative of the cumulative exposure of each cook. No statistically significant effect of NO2 exposure on FVC was found. Each year of work as a cook corresponded to a decrease in predicted FEV1 of 2.5% (P=0.046) for the group as a whole. When smoking status and asthma were included in the analysis the effect of time/exposure decreased about 10% and lost statistical significance. On predicted FEF25-75, a decrease of 3.5% (P=0.035) was observed for the same group and the inclusion of controllers for smoking status and asthma did not affect the effects of time/exposure on pulmonary function parameter. After a 10-year period of work as cooks the participants of the study may present decreases in both predicted FEV1 and FEF25-75 that can reach 20 and 30%, respectively. the present study showed small but statistically significant adverse effects of gas stove exposure on the lung function of professional cooks.Univ São Paulo, Fac Med, Lab Poluicao Atmosfer Expt, BR-01246903 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Disciplina Clin Med,Grp Fisiopatol Pulmonar & Pol, São Paulo, SP, BrazilABC, Fac Med, Dept Saude Coletividade, Santo Andre, SP, BrazilUniv Catolica Santos, Programa Posgrad Saude Coletiva, Santos, SP, BrazilCtr Univ Araraquara, Lab Fisioterapia Cardioresp, Araraquara, SP, BrazilUniv Estadual Paulista, Inst Quim, Araraquara, SP, BrazilHarvard Univ, Sch Publ Hlth, Dept Environm Hlth, Exposure Epidemiol & Risk Program, Boston, MA 02115 USAUniv Santo Amaro, Fac Med, Programa Pediat Ambiental, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Disciplina Clin Med,Grp Fisiopatol Pulmonar & Pol, São Paulo, SP, BrazilWeb of Scienc

Air pollution and the respiratory system

A poluição atmosférica encontra-se presente nos mais diferentes cenários ao longo dos últimos 250 anos, desde que a Revolução Industrial acelerou o processo de emissão de poluentes que, até então, estava limitado ao uso doméstico de combustíveis vegetais e minerais e às emissões vulcânicas intermitentes. Hoje, aproximadamente 50% da população do planeta vivem em cidades e aglomerados urbanos e estão expostas a níveis progressivamente maiores de poluentes do ar. Este estudo é uma revisão não sistemática sobre os diferentes tipos e fontes de poluentes do ar e os efeitos respiratórios atribuídos à exposição a esses contaminantes. Podem ser creditados aos poluentes particulados e gasosos, emitidos por diferentes fontes, aumentos nos sintomas de doenças, na procura por atendimentos em serviços de emergência e no número de internações e de óbitos. Mais do que descompensar doenças pré-existentes, exposições crônicas têm ajudado a aumentar o número de casos novos de asma, de DPOC e de câncer de pulmão, tanto em áreas urbanas quanto em áreas rurais, fazendo com que os poluentes atmosféricos rivalizem com a fumaça do tabaco pelo papel de principal fator de risco para estas doenças. Na rotina de clínicos e pneumologistas, esperamos contribuir para consolidar a importância da investigação sobre a exposição aos poluentes do ar e o reconhecimento de que esse fator de risco merece ser levado em conta na adoção da melhor terapêutica para o controle das descompensações agudas das doenças respiratórias e para a sua manutenção entre as crises

Novos fármacos e fármacos repropostos para o tratamento da tuberculose multirresistente e extensivamente resistente

Multidrug-resistant and extensively drug-resistant tuberculosis (MDR-TB and XDR-TB, respectively) continue to represent a challenge for clinicians and public health authorities. Unfortunately, although there have been encouraging reports of higher success rates, the overall rate of favorable outcomes of M/XDR-TB treatment is only 54%, or much lower when the spectrum of drug resistance is beyond that of XDR-TB. Treating M/ XDR-TB continues to be a difficult task, because of the high incidence of adverse events, the long duration of treatment, the high cost of the regimens used, and the drain on health care resources. Various trials and studies have recently been undertaken (some already published and others ongoing), all aimed at improving outcomes of M/ XDR-TB treatment by changing the overall approach, shortening treatment duration, and developing a universal regimen. The objective of this review was to summarize what has been achieved to date, as far as new and repurposed drugs are concerned, with a special focus on delamanid, bedaquiline, pretomanid, clofazimine, carbapenems, and linezolid. After more than 40 years of neglect, greater attention has recently been paid to the need for new drugs to fight the “white plague”, and promising results are being reported.A tuberculose multirresistente (TB-MDR, do inglês multidrug-resistant) e a extensivamente resistente (TB-XDR, do inglês extensively drug-resistant) continuam representando um desafio para os clínicos e as autoridades de saúde pública. Infelizmente, embora haja relatos encorajadores de taxas de sucesso maiores, a taxa global de desfechos favoráveis do tratamento da TB-MDR/XDR é de apenas 54%, ou muito menor quando o espectro de resistência aos fármacos vai além do da TB-XDR. O tratamento da TB-MDR/XDR continua sendo uma tarefa difícil, em razão da alta incidência de eventos adversos, do longo tempo de tratamento, do alto culto dos esquemas utilizados e da drenagem dos recursos de saúde. Diversos ensaios e estudos foram realizados recentemente (alguns já publicados e outros em andamento), todos visando a melhorar os desfechos do tratamento da TB-MDR/XDR por meio da alteração da abordagem geral, redução do tempo de tratamento e desenvolvimento de um esquema universal. O objetivo desta revisão foi resumir o que se conseguiu até o momento, no que se refere a novos fármacos e fármacos repropostos, dando foco especial para delamanid, bedaquilina, pretomanida, clofazimina, carbapenêmicos e linezolida. Após mais de 40 anos de negligência, recentemente foi dada mais atenção á necessidade de novos fármacos para se combater a “praga branca”, e resultados promissores estão sendo relatados