#International Journal of Pulmonary and Respiratory Sciences

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Happy Easter

[cambridgepublishers]

Journal of Heart Lung and Circulation Case Reports

Journal of Heart, Lung and Circulation Case Reports published Case Reports in Heart Journal, Case Reports in Lungs Journal, Case Reports in Circulation Journal etc. Images in Heart Lung and Circulation Case Reports is an International peer reviewed journal dealing with cardiovascular science, cardiac surgery, clinical cardiology, pulmonary circulation, pneumonia and various lung diseases.

Journal of Heart, Lung and Circulation Case Reports aims to publish both clinical and medical materials on all aspects of Cardiac diseases, Pulmonary circulation and Medicine. Heart Journal, Lung and Circulation Case Reports publishing all types of write ups like Clinical and Medical Case Reports, Short Communications, Commentary, Images, Video articles, Technical Evaluations and Thesis etc.

Heart Failure Case Reports Journal

Heart failure or congestive heart failure occurs when the heart is unable to pump sufficient blood to meet the body's needs. Signs and symptoms commonly include shortness of breath, excessive tiredness, and leg swelling.

Valvular Heart Disease Case Reports Journal

Refers to dysfunction of the valves in two forms- either regurgitation, where a dysfunctional valve lets blood flow in the wrong direction or stenosis, when a valve is narrow.

Pulmonary Circulation Case Reports Journal

It is the portion of the circulatory system which carries deoxygenated blood away from the right ventricle of the heart, to the lungs, and returns oxygenated blood to the left atrium and ventricle of the heart.

Hypertrophic Cardiomyopathy Case Reports Journal

It is a disease in which a portion of the myocardium (heart muscle) is enlarged without any obvious cause, creating functional impairment of the heart.

Chronic Obstructive Pulmonary Disease

COPD is a type of obstructive lung disease characterised by long-term poor airflow.

Symptoms-shortness of breath and cough with sputum production.

Echocardiogram Case Reports Journal

Cardiac Echo or Echocardiogram is a Sonogram of Heart - uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.

Coronary Artery Disease (CAD) Case Reports Journal

CAD or Ischemic Heart Journal Disease (IHD) is a group of diseases which includes stable angina, sudden cardiac death, unstable angina and myocardial infarction.

Electrocardiogram Case Reports Journal

Electrocardiogram is a process of recording the activity of a heart for a period of time by placing the electrodes on the skin, these electrodes detect the variations occurring in the heart muscles. This is performed commonly by cardiology test.

Pneumonia Case Reports Journal

Pneumonia is an inflammatory condition of the lung, primarily affecting the alveoli. Symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing.

Heart Transplantation Case Reports Journal

Cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed.

Asthma Case Reports Journal

Asthma is a long-term inflammatory disease of the airways of the lungs.

It is characterised by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.

Pulmonary Fibrosis Case Reports Journal

It is a respiratory disease in which scars are formed in the lung tissues, leading to thickening of the walls and causing reduced oxygen supply in the blood.

Respiration Case Reports Journal

Respiration is defined as the movement of oxygen from the outside environment to the cells within tissues, and the transport of carbon dioxide in the opposite direction.

Cystic Fibrosis Case Reports Journal

Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections.

Manuscript Submission

Authors may submit their manuscripts through the journal's online submission portal: https://www.literaturepublishers.org/submit.html

For more information on Cambridge Publishers - Journal of Heart Case Reports visit our site:- https://www.cardiologycasereportsjournal.org/journal/Journal-of-Heart-Lung-and-Circulation-Case-Reports.html

https://www.cardiologycasereportsjournal.org/journal/Journal-of-Heart-Lung-and-Circulation-Case-Reports.html

[ourhaileydavies]

Sequential Delivery of Growth Factors from Hydrolytically Degradable Silica-Based Nanoparticles for Cartilage Tissue Engineering-Juniper publishers

Abstract

Articular cartilage shows a very limited self-healing capability due to it's a vascular structure. It has been reported that sequential supplementation of various growth factors such as bone morphogenic protein 7 (BMP-7), transforming growth factor-beta 1 (TGF-01) and insulin-like growth factor-I (IGF-I) play critical roles in reconstruction of articular cartilage tissue. The objective of this work is to design a drug delivery system which facilitates the controlled sequential delivery growth factors to maximize the extent of chondrogenic differentiation of mesenchymal stem cells and consequently reconstruction of damaged cartilage tissue. Surface-modified silica nanoaprticles (SNs) with short segments of lactide (L) and glycolide (G) units were used for grafting and timed-release of growth factors. It was shown that by changing the length of L and G units, the release rate of grafted bovine serum albumin (BSA) on the surface of SNs can be controlled. Nanoparticles with bigger G units showed faster release rate of BSA compared with shorter G units. Additionally, the presence of short LG segments did not significantly change the size distribution of SNs.

Introduction

Articular cartilage can resist a significant amount of mechanical stress and provide a lubricating surface for the gliding joints and a load-bearing matrix attached to the underlying bone [1] . However, due to its avascular nature and low metabolism, it has a very limited self-repair capability upon suffering a trauma [2] . The disease control and prevention center reported that nearly 27 million Americans suffer from joint pain and stiffness, loss of function and disability [3]. While various strategies such as transplantation of autogenous or allogenous chondrocytes, or the use of mesenchymal stem cells (MSCs) are currently used for cartilage treatment, these strategies always suffer from inherent risks of an immune reaction, lack of suitable donor site, and more importantly they rarely restore the full function to the joint [4,5].

It has been demonstrated that different types of growth factors such as bone morphogenic protein 7 (BMP-7), transforming growth factor-beta 1 (TGF-β1) and insulin-like growth factor-I (IGF-I) play critical roles in tissue engineering of articular cartilage to induce chondrogenic differentiation of Mesenchymal Stem Cells (MSCs) [6-8]. However, the bioavailability and bioactivity of these growth factors are both time and concentration dependent [4,9,10]. Several studies have shown that the sequential supplementation of growth these factors is critical to prevent dedifferentiation of cells by first promoting proliferation with one specific growth factor, and then differentiation and expression of a desired phenotype with another [9,10]. A critical barrier to progress in this way is the lack of suitable delivery systems which work for precise controlled and orchestrated time-dependent delivery of multiple growth factors, although many studies have been conducted to control the delivery of growth factors for different tissue engineering applications. Accordingly, the main challenge of this work is to engineer a programmable delivery system to control the release rate of BMP-7, TGF-β1 and IGF-I growth factors and consequently maximize the chondrogenic differentiation of MSCs.

To address this challenge, the idea is to engineer a silica based nanoparticle system containing short segments of biodegradable polymers such as polylactic acid and polyglycolic acid to control the release rate of grated proteins (Figure 1). We have chosen MSNs given their demonstrated biocompatibility, osteogenic potential[11] , and efficacy as drug delivery vehicles for sustained release of antibiotics [12] and anti-cancer drugs [13]. We envision that due to the hydrophilic nature of silica nanoparticles, bioactivity of the grafted proteins will be significantly enhanced over solid hydrophobic micro/nanoparticles such as poly lactic-co- glycolic acid (PLGA) which are currently used for drug delivery applications. Accordingly, we assume that the protein release rate can be tuned by type or length of the degradable segments. The novelty of this project is to design a low-cost hydrolytically degradable nanocarrier system which facilitates a programmable sequential delivery of multiple growth factors with a controlled timed-release to enhance chondrogenic differentiation of MSCs for cartilage tissue engineering applications.

Materials and Methods

Materials: Lactide (L) and glycolide (G) monomers with >99.5% purity (Ortec, Easley, SC) were dried under vacuum at 40°C for at least 12h before use. N, N/-disuccinimidyl carbonate (DSC) and bovine serum albumin (BSA) were received from Novabiochem (EMD Biosciences, San Diego, CA) and Jackson Immuno Research (West Grove, PA), respectively. Hydrophilic silica nanoparticles (SN) was kindly donated by Evonik Corporation (New Jersy). All other reagents were purchased from Sigma Aldrich (St. Louis, MO).

Methods: To activate the silanol groups of SNs were activated by adding 1.5x10-4 mol triethyl amine (TEA) to 250mg of SN containing 3x10-4 mol SiOH groups in 70ml toluene as the solvent. In the next step, 6x10-4 mol of isopropyl alcohol was added to the mixture to continue the reaction for 2h at 50 °C. Then, the desired amount of L was added to the mixture along with 1ml tin (II) 2-ethylhexanoate as the reaction catalyst and the reaction was run for 6h. The lactide chain-extended silica was used as an initiator for chain extension with G monomer with a predetermined L to G ratio. The reaction was allowed to proceed for 6h at 50°C and the product was precipitated in ice-cold hexane to remove the unreacted monomers. In separate reactions, the mole ratio of L and G was changed from 100% (L100) to 75% (L75/G25) and 50% (L50/G50) while the total amount of L and G was kept fixed at 3x10-3 mol. The synthesized copolymer on SNs surface was functionalized with succinimide groups by reacting hydroxyl end-groups of the copolymer with DSC as we described previously [14]. The product was purified by dialysis against DI water and lyophilized.

To attach BSA on the surface of modified SNs, 10mg SNs was suspended in 0.5mL PBS by sonication for 1 min. Next, 0.5mL of the protein in PBS (20mg/mL for BSA) was added to the SNs suspension. The amine group of the protein was allowed to react with succinimide end-groups of LG in the surface of SNs under ambient conditions for 12h as we previously described (Figure 1) [15]. The protein grafted SNs were freeze-dried to obtain a free-flowing powder. To determine grafting efficiency, the protein grafted SNs were resuspended in PBS and centrifuged at 18,000 rcf for 10min and the supernatant was analyzed for total protein content with the ninhydrin reagent as we described previously [16]. Grafting efficiency was determined by dividing the amount of attached protein (total - free protein) by the initial amount in the grafting reaction.

Size distribution of the SNs was measured by dynamic light scattering with a Submicron Particle Sizer (Model 370, NICOMP, Santa Barbara, CA) as described previously [16,17]. For measurement of release kinetic, 1mg protein grafted SNs were incubated in 1mL PBS at 37°C as we previously described [15]. At each time point, the suspension was centrifuged at 18350 rcf for 10min, the supernatant was removed, the SNs were resuspended in 1mL fresh PBS and incubated until the next time point. The amount of BSA in the supernatant was measured with the ninhydrin reagent as described [16,18].

Results and Discussion

The calculated grafting efficiency of BSA to SNs based on the procedure explained in the method section was 52±9%. The effect of L and G segments on average diameter and size distribution of nanoparticles are shown in (Figure 2a). It can be observed the addition of short L and G parts in SNs does not significantly change the average diameter of particles. The particle sizes are between 120±12 and 165±15 for SN and SN- L100, respectively. Figure 2b reveals the effect of the length of L and G segments on release rate of BSA from nanoparticles. The results demonstrated that by increasing the length of lactide the release rate of BSA will decrease significantly. The cumulative release percentage of BSA is 51±5, 65±8 and 91±4 for L50/ G50, L75/G25 and L100, respectively, after 24 days. The average release rate of BSA from L50/G50, L75/G2 5 and L100 is 3.2, 2.4 and 2.1 wt%, respectively, during the first 24 days.

It has been reported that the release kinetic of BSA grafted to the PLG copolymer follows the degradation rate of the copolymer [19]. Additionally, it has been previously shown that the degradation kinetic of LG based micelles depends on the proximity of water molecules to L and G ester groups [20,21], which is dependent on hydrophobicity of the degradable units [19]. Therefore, the fraction of less hydrophobic G in LG segments has a profound effect on LG unit degradation and consequently the release rate of protein. As a result, by increasing the fraction of G, which is less hydrophobic than L, from 0 to 50%, the the average release rate of BSA increased from 2.1 wt% to 3.2 wt%.

Conclusion

It was shown that by surface modification of silica nanoparticles with short segments of lactide and glylcolide, the controlled release of growth factors can be achieved. Based on the release profile of BSA from surface modified silica nanopartilces, by increasing the ratio of glycolide segment from 0% to 50% with respect to lactide segment, the average release rate of BSA will increase from 2.1 wt% to 3.2 wt% per day. Some of the potential challenges of using nanoparticulate systems for drug delivery applications are the stability of the nanoparticles in aqueous environment, bioactivity of growth factors and controlling release mechanism of growth factors from nanoparticles. Therefore, further studies need to be done on the properties of surface modified nanoparticles as well as controlled release of target growth factors like of BMP-7, TGF-^1 and IGF-Iand their effect on chondrogenic differentiation of MSCs.

To know more about Open Access Journal of Head Neck & Spine Surgery please click on:

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[militant-holy-knight]

We have been paying dearly for China's lies.

"This is one of the worst cover-ups in human history, and now the world is facing a global pandemic," said Rep. Michael T. McCaul, the ranking Republican member of the House Foreign Affairs Committee, before the US intelligence community concluded, in a classified report to the White House, that China has concealed the origin and extent of the catastrophic global coronavirus outbreak.

The Chinese Communist Party's "failure has unleashed a global contagion killing thousands", wrote Cardinal Charles Maung Bo, president of the Federation of Asian Bishops' Conferences, on April 1. "As we survey the damage done to lives around the world, we must ask who is responsible?"

"... there is one government that has primary responsibility for what it has done and what it has failed to do, and that is the CCP [Chinese Communist Party] regime in Beijing. Let me be clear — it is the CCP that has been responsible, not the people of China... Lies and propaganda have put millions of lives around the world in danger... In recent years, we have seen an intense crackdown on freedom of expression in China. Lawyers, bloggers, dissidents and civil society activists have been rounded up and have disappeared."

One more person has just disappeared: Ai Fen, a Chinese physician who was head of the emergency department at Wuhan Central Hospital, had worked with the late Dr. Li Wenliang. Ai, who claimed that her bosses silenced her early warnings about coronavirus, appears to have vanished. Her whereabouts, according to 60 Minutes Australia, are unknown. The journalists who saw what happened inside Wuhan have also disappeared. Caixin Global reported that the laboratories which sequenced the coronavirus in December were ordered by Chinese officials to hand over or destroy the samples and not release their findings. "If I had known what was to happen, I would not have cared about the reprimand, I would have fucking talked about it to whoever, where ever I could", Ai Fen said in an interview in March. Those were her last recorded words.

There is no record at all, however, about how this pandemic began. Wet market? A cave full of bats? Pangolins? Or a bio-weapons laboratory? No foreign doctors, journalists, analysts or international observers are present in Wuhan. Why, if the virus came out of a wet market or a cave, did China suppress inquiries to such an extent? Why, in December, did Beijing order Chinese scientists to destroy proof about the virus? Why did Chinese officials claim that US soldiers brought the virus to Wuhan? Why should it be scandalous that a US President calls a virus that began in China a "Chinese virus"?

Who announced on January 11 that Wuhan's wet market was the origin of this epidemic? The Chinese regime. It was later discovered that the first known case of coronavirus traced back to November 17, 2019.

The same Chinese regime later claimed that this coronavirus "may not have originated in China". What respected scientist or institution can now trust anything that comes out of China?

Many leading scientists have dismissed the claim that the Covid-19 virus was an engineered pathogen. This conclusion was seemingly based on the fact that Wuhan has two major virus research labs: the Wuhan Center for Disease Control and Prevention, which is apparently less than a mile from the market, and the Wuhan Institute of Virology, a biosafety level 4 (BSL-4) laboratory, handling the world's most deadly pathogens, located just seven miles from the market. The story was immediately and emphatically trashed as a "conspiracy theory".

Those scientists claim that the virus likely originated among wildlife before spreading to humans, possibly through a food market in Wuhan. They say that, through genetic sequencing, they have identified the culprit for Covid-19 as a bat coronavirus. End of story? Science, thankfully, begins by asking questions and then seeking answers.

Bats were not, it seems, sold at Wuhan's wet market. The Lancet noted in a January study that the first Covid-19 case in Wuhan had no connection to the market. The Lancet's paper, written by Chinese researchers from several institutions, detailed that 13 of the 41 first cases had no link to the market. "That's a big number, 13, with no link," commented Daniel Lucey, an infectious disease specialist at Georgetown University. So how did the epidemic start?

"Now it seems clear that [the] seafood market is not the only origin of the virus, but to be honest we still do not know where the virus came from now", notes Bin Cao, pulmonary specialist at Capital Medical University, and the corresponding author of the Lancet article.

US Secretary of State Mike Pompeo has said that China's Communist Party is withholding information about the coronavirus.

If we do not know, it is necessary be open to all possibilities.

"Less than 300 yards from the seafood market is the Wuhan branch of the Chinese Center for Disease Control and Prevention" wrote David Ignatius of the Washington Post.

"Researchers from that facility and the nearby Wuhan Institute of Virology have posted articles about collecting bat coronaviruses from around China, for study to prevent future illness. Did one of those samples leak, or was hazardous waste deposited in a place where it could spread?".

"Collecting viruses" presumably does not exclude the possibility of a "leaked virus". Worse, if China is not able to protect its laboratories, it needs to be held accountable and made to pay for the devastating global damage.

"Experts know the new coronavirus is not a bioweapon. They disagree on whether it could have leaked from a research lab", stated The Bulletin of the Atomic Scientists. Professor Richard Ebright of Rutgers University's Waksman Institute of Microbiology, and a major biosecurity expert, agreed with the Nature Medicine authors' argument that the coronavirus was not manipulated by humans. But Ebright does think it possible that the Covid-19 started as an accidental leak from a laboratory, such as one of the two in Wuhan, which are known to have been studying bat viruses:

"Virus collection or animal infection with a virus having the transmission characteristics of the outbreak virus would pose substantial risk of infection of a lab worker, and from the lab worker, the public."

Ebright has also claimed that bat coronaviruses are studied in Wuhan at Biosafety Level 2, "which provides only minimal protection" compared with the top BSL-4.

"We don't know what happened, but there are a lot of reasons to believe that this indeed was a release of some sort", China expert Gordon Chang said to Die Weltwoche.

"No one has been able to study it. How can you say it's not a release from a lab if you can't go to the lab? Indeed, we have seen Beijing do its best to prevent virologists and epidemiologists from actually going to Wuhan. The World Health Organization team went to Wuhan for like half a day with only part of the team."

That is another major problem. The potential major investigator of the Wuhan coronavirus pandemic's origin, the World Health Organization (WHO), is now accused of being "China's coronavirus' accomplice". As late as January 14, the WHO quoted Chinese health officials claiming there had been no human transmissions of the coronavirus within the country yet.

China poses a biosecurity risks for the entire planet. One year before the first coronavirus case was identified in Wuhan, US Customs and Border Protection agents at Detroit Metro Airport stopped a Chinese biologist with three vials labeled "Antibodies" in his luggage. According to an unclassified FBI tactical intelligence report obtained by Yahoo News:

"Inspection of the writing on the vials and the stated recipient led inspection personnel to believe the materials contained within the vials may be viable Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) materials."

Why is China trafficking in dangerous viruses in the first place?

According to Yanzhong Huang, a senior fellow for Global Health at the Council on Foreign Relations:

"A safety breach at a Chinese Center for Disease Control and Prevention lab is believed to have caused four suspected SARS cases, including one death, in Beijing in 2004. A similar accident caused 65 lab workers of Lanzhou Veterinary Research Institute to be infected with brucellosis in December 2019. In January 2020, a renowned Chinese scientist, Li Ning, was sentenced to 12 years in prison for selling experimental animals to local markets".

In February, Botao Xiao and Lei Xiao, from Guangzhou's South China University of Technology, wrote in a research paper:

"In addition to origins of natural recombination and intermediate host the killer coronavirus probably originated from a laboratory in Wuhan. Safety level [sic] may need to be reinforced in high risk biohazardous laboratories".

Xiao later told the Wall Street Journal that he had withdrawn the paper because it "was not supported by direct proofs".

Chinese laboratory mistakes have happened before. By 2010, researchers published as fact: "The most famous case of a released laboratory strain is the re-emergent H1N1 influenza-A virus which was first observed in China in May of 1977 and in Russia shortly thereafter". The virus may have escaped from a lab attempting to prepare a vaccine in response to the U.S. swine flu pandemic alert.

In 1999 the most senior defector in the US from the Soviet biological warfare program, Ken Alibek, revealed that Soviet officials concluded that China had suffered a serious accident at one of its secret biological plants, causing two major epidemics of fever that had swept China in the late 1980s. "Our analysts", Alibek stated in his book, Biohazard, "concluded that they were caused by an accident in a lab where Chinese scientists were weaponizing viral diseases".

In 2004, the World Health Organization disclosed that the latest outbreak of "severe acute respiratory syndrome" (SARS) in China involved two researchers who were working with the virus in a Beijing research lab. The WHO denounced Chinese breaches of safety procedures, and director of the Center for Disease Control and Prevention, Li Liming, resigned. Science magazine also stated that "for the third time in less than a year, an outbreak of SARS seems to have originated from a failure in laboratory containment".

Moreover, three years ago, when China opened the laboratory in Wuhan, Tim Trevan, a Maryland biosafety specialist, told Nature that he worried about the safety of the building because "structures where everyone feels free to speak up and openness of information are important." Free speech and open information: exactly what Chinese regime fought against in December and January.

A Chinese video about a key researcher in Wuhan, Tian Junhua, which was released a few weeks before the outbreak in Wuhan, shows Chinese researchers handling bats that contained viruses. In the video (produced by China Science Communication, run by the China Association for Science and Technology), Tian says:

"I am not a doctor, but I work to cure and save people... I am not a soldier, but I work to safeguard an invisible national defense line".

Tian is also reported as having said:

"I can feel the fear: the fear of infections and the fear of getting lost. Because of the fear, I take every step extremely cautiously. The more scared I feel, the more care I take in executing every detail. Because the process of you finding the viruses is also when you can be exposed to them the easiest. I do hope these virus samples will only be preserved for scientific research and will never be used in real life".

For a month, the Chinese Communist Party, instead of fighting the contagion, did everything possible to censor all information about the Covid-19 outbreak. After President Xi Jinping declared "a people's war" on the epidemic on January 20, Chinese security services pursued 5,111 cases of "fabricating and deliberately disseminating false and harmful information". The Chinese Human Rights Defenders documented several types of punishment, including detention, disappearance, fines, interrogations, forced confessions and "educational reprimand".

After that, China lied about the real number of deaths. There are photographs of long lines of stacked urns greeting family members of the dead at funeral homes in Wuhan. Outside one funeral home, trucks shipped in 2,500 urns. According to Chinese official figures, 2,548 people in Wuhan have died of the Covid-19. According to an analysis by Radio Free Asia, seven funeral homes in Wuhan were each handing out 500 funeral urns containing remains for 12 days, from March 23 to the traditional tomb-sweeping festival of April 5, a time that would indicate up to 42,000 urns, or ten times higher than the official figure.

In February, it was reported that Wuhan crematoriums were working around the clock to cope with the massive influx of infected bodies. Wuhan's officials are apparently pushing relatives of the victims to bury the dead "quickly and quietly".

"Natural virus" does not exclude its fallout from a laboratory where pathogens are collected and studied. The Nature Medicine authors "leave us where we were before: with a basis to rule out [a coronavirus from] a lab construct, but no basis to rule out a lab accident", Professor Ebright commented.

"Debate may rage over which center it is, but at this point it seems undeniable that a center has been directly involved with research on viruses, although not necessarily on the creation of a virus" wrote Father Renzo Milanese, a longtime Catholic missionary in Hong Kong.

"In other words, the virus passed from a research center in Wuhan early on. More importantly there is also no question that the authorities were aware of the dangerousness of the virus, that they did not inform anyone and that they tried to keep the facts hidden".

US Senator Josh Hawley has introduced a resolution calling for an international investigation into China's handling of the spread of the virus. According to Hawley:

"The Chinese Communist Party was aware of the reality of the virus as early as December but ordered laboratories to destroy samples and forced doctors to keep silent. It is time for an international investigation into the role their cover-up played in the spread of this devastating pandemic".

Admitting a fault, as the Japanese did after the Fukushima nuclear accident in 2011, might be one way for a country to be accepted again by the international community. Censoring, denying and covering up, as China is doing, will not.

"China claims that the deadly virus did not escape from its biolab," said a China specialist with the Population Research Institute, Steven W. Mosher. "Fine. Prove it by releasing the research records of the Wuhan lab".

[drneetujainpulmo]

Best Pulmonologist in South Delhi: 2022

As the Covid is spreading across the globe we need Doctors who are best in their field and one organ which Covid hits the most is lungs. You need a pulmonologist who will help you in tough times and not only help you fight Covid but help you in all the respiratory diseases. Dr. Neetu is best pulmonologist in South Delhi. She is an emerging doctor with a talent and skills. She specializes in Critical Care and pulmonary diseases and her patient’s testimonials are the proof that she is the best pulmonologist in South Delhi.

Best Pulmonologist in South Delhi| Know your doctor!!

Dr. Neetu Jain is an accomplished academician and a practicing general surgeon who has a passion for teaching, caring and research. She believes that healthcare should be accessible to everyone, and she uses her experience to make this dream a reality. Dr.Jain’s qualifications include MS (General Surgery) from the University of Delhi, MBBS from Maulana Azad Medical College, New Delhi and MCh (Gastroenterology & Hepatobiliary surgery) from the University of London. She also holds diplomas in Laparoscopic Surgery and Colorectal Surgery from the National Board of Examination, Washington DC USA and from The Royal College of Surgeons in Ireland respectively, adding to her experience that has helped her in successfully treating over 5000 cases with an experience span of 20 years in the field of General surgery & Gastroenterology.

Her dedication to the field of medicine as well as her passion for academics led her to be a Senior Resident at All India Institute of Medical Sciences (AIIMS) and eventually served there for more than 7 years. With her publication record in national and international journals, and more than 30 participations in conferences, she continues to be proud member of Indian Association of Gastroenetrology (IAGE).

Why you should choose her?

And the reason that we are rooting for her is that we have researched a lot and finally came to this conclusion that she is the best pulmonologist in South Delhi because of her dedication, patients satisfaction, success rate and many more.

You should contact her immediately if you feel any pulmonary restlessness.

Address: New Delhi-17

Phone No: 91-8287429854

Mail id: neetusms@yahoo.com

[lupinepublishers-ojnbd]

Lupine Publishers| Neurological, Neuropsychiatric and Psychiatric Symptoms During COVID- 19 Infection and After Recovery: A Systematic Review of Observational Studies

Lupine Publishers| Journal of Neurology and Brain Disorders

Abstract

Background: The SARS-CoV-2 virus causes a wide spectrum of disease severity. Initial manifestations include fever, dry cough, and constitutional symptoms, which may progress to respiratory disease. There may also be neurological and psychiatric manifestations, involving both the central and peripheral nervous system.

Methods: We performed a literature search of the databases PubMed, EMBASE, The Cochrane Library and Web of Science for observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. This was followed by a narrative synthesis to summarise the data and discuss neuropsychiatric associations, symptom severity, management, and recovery.

Findings: The most frequently reported neurological symptoms were ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. Statistically significant relationships were noted between Asian ethnicity and peripheral neuropathy (p=0·0001) and neuro-syndromic symptoms (p=0·001). ITU admission was found to have a statistically significant relationship with male sex (p=0·024). Depression and anxiety were also identified both during and after infection. The most frequent treatments used were intravenous immunoglobulins, followed by antibiotics, antivirals, and hydroxychloroquine; with mean treatment duration of 6 days.

Interpretation: Various neuropsychiatric symptoms have been associated with COVID-19 infection. More studies are required to further our knowledge in the management of neurological and psychiatric symptoms during and after COVID-19 infection

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) is a novel virus, initially discovered in the city of Wuhan, China [1]. SARS-CoV-2 causes coronavirus disease (COVID-19), which has led to an ongoing global pandemic. Despite belonging to the coronavirus family, which usually cause self- limiting upper respiratory tract infections, SARS-CoV-2 is often more virulent than most coronaviruses and may lead to severe respiratory disease [2].

The mechanism of action for SARS-CoV-2 may relate to a specific tropism for respiratory tract mucosal cells through the attachment of viral surface proteins to angiotensin-converting enzyme (ACE) 2 receptors [3]. After infection, the virus causes a wide spectrum of disease severity, with most patients suffering a mild self-limiting disease. Initial manifestations include fever, dry cough and constitutional symptoms (headache, fatigue, myalgia, arthralgia), progressing to respiratory disease of mild to moderate severity [2,4]. Other disease manifestations include gastrointestinal symptoms (nausea, vomiting, diarrhoea), sore throat, skin rashes, anosmia, ageusia, and chest pain [5]. In patients with underlying comorbidities or advanced age, the infection may be complicated with acute respiratory distress syndrome (ARDS), acute renal failure, sepsis, multi-organ failure and death [6,7]. As the pandemic of COVID-19 persists, the knowledge of the clinical disease spectrum is still unfolding. Medical literature of COVID-19 infected patients reveals a variety of extra-pulmonary organ involvement [8]. Among these, COVID-19 has been associated with several neurological and psychiatric effects, involving both the central and peripheral nervous system [9].

Methods

This systematic review follows the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) statement [10] and was registered in the PROSPERO International Prospective Register of Systematic Reviews (number CRD42020203770 at www.crd.york.ac.uk/PROSPERO).

Search Strategy

The literature search was performed in August 2020 using the databases PubMed, EMBASE, The Cochrane Library and Web of Science, from their respective inception dates. The following search terms were used:

(Neuro* OR Nervous OR Psychiatry* OR Mental) AND (COVID OR Corona*)

The search strategies incorporated both medical subject headings (MeSH) and free-text terms, which were adapted according to the database searched. Grey literature was also searched. Reference lists of the identified papers and reviews were hand-searched. Publication languages included English and Greek. There were no publication period restrictions.

Inclusion and Exclusion Criteria

Included studies were observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. The included participants were COVID-19 patients of any ethnic origin, sex/gender, age, country, and were either actively infected from COVID-19 at the time of the study or had recovered. We did not include studies examining psychiatric effects on the general population as an indirect result of the pandemic.

Main Outcomes

The main outcomes included neurological, psychiatric, and neuropsychiatric effects of COVID-19, either based on clinical diagnosis or relevant diagnostic questionnaires. Information about recovery and treatment was reported when available.

Screening

Titles were screened for inclusion, followed by screening of abstracts, and then content. One author (SS) screened the papers, and any disagreements were resolved by discussion with the review’s primary author (MS) and the other authors.

Data Extraction

The Cochrane good practice data extraction form was used for data extraction. Data extraction from reviews involved the NICE extraction form, and the data were extracted in an electronic format.

Risk of Bias/Quality Assessment

The quality and risk of bias were assessed by the Mixed Methods tool for Appraisal (MMAT). The guidance from the Centre for Reviews and Dissemination was used for the appraisal of review papers. Discrepancies were resolved by discussion within the authors’ team.

Strategy for Data Synthesis

We performed a narrative synthesis review of original studies and reviews reporting neurological, psychiatric, and neuropsychiatric effects in COVID-19 patients.

We summarised the data and discussed:

a) Neuropsychiatric associations

b) Symptom severity

c) Management and

d) Recovery

Information from the various identified studies was analysed, summarised, and compared.

Results

Following our literature search, we identified a total of 7,460 papers. After removing the duplicated and irrelevant papers, 328 full text articles remained to be assessed for eligibility using the inclusion and exclusion criteria. Of these, 313 studies were included in the final narrative synthesis: specifically, 307 studies for neurological symptoms and 7 studies for psychiatric symptoms, as shown in Figure 1. A total of 15 full text papers were excluded as they were either not relevant (n=4) or unrelated to COVID-19 infection (n=11).

Figure 1: PRISMA flowchart of selected studies.

Neurological Symptoms

A total of 307 studies for neurological symptoms were included in the narrative synthesis, as mentioned above, of which 202 were case reports, 53 case series, 2 retrospective studies, 21 cohort studies, 15 systematic reviews, 8 cross-sectional studies, 3 casecontrol studies, and 3 retrospective case series. A summary of the studies included in the systematic review is shown in Table 1, and a complete list of the studies is provided in Supplementary Material 1. The mean age of the patients included was 55·11 (±17.91) years. Most of the patients in our cohort were males (61%) and the majority of the participants were Asians (57%).

Table 1: Summary of studies included in the systematic review for neurological symptoms.

Clinical Presentation

A total of 107 studies (42·7%), involving 26,758 patients, included a full account of neurological symptoms experienced by the participants following COVID-19 infection. Table 2 presents the frequency of symptoms and their resolution. The most reported symptoms were ageusia (n=390), hyposmia/anosmia (n=480), dizziness (n=230), headache (n=860), and loss of consciousness (n=310).

Table 2: Frequency and recovery rates of different COVID-19 neurological presentations.

Moreover, a significant number of patients experienced severe neurological manifestations, such as seizures (n=260), acute cerebrovascular events (n=500), cerebellar syndromes (n=70), peripheral neuropathies (n=90), meningitis/encephalitis (n=380), encephalopathies (n=380), neurological syndromes such as Guillain-Barre syndrome (n=320), and spinal cord syndromes (n=30).

A statistically significant relationship was noted between ethnicity and peripheral neuropathy (p=0·0001) as well as between ethnicity and neuro-syndromic symptoms (p=0·001), with Asian patients being more likely to experience these symptoms. Both sexes were statistically as likely to present with symptoms of ageusia (p=0·0001), dizziness (p=0·033), gastrointestinal symptoms (p=0·0001), and anorexia (p=0·0001). However, flu-like symptoms were statistically more prevalent in females (p=0·008), whereas hyposmia (p=0·037) and haemoptysis (p=0·0001) was more frequent in males.

Following recovery from COVID-19 infection, a large proportion of patients demonstrated a complete resolution of their symptoms. Specifically, patients presenting with loss of consciousness and ageusia reported the highest resolution rates (93% and 92% respectively), while the patients that experienced spinal cord syndromes had the lowest resolution rates of their symptoms (33%).

Treatments

The most frequent treatments used in the studies analysed were intravenous immunoglobulins (IVIG) (20·17%), followed by antibiotics such as azithromycin (19·29%), antivirals (14·91%), and hydroxychloroquine (10·52%). However, a combination of therapies was required for treatment in some patients. Figure 2 illustrates the different types of drugs that the COVID-19 patients received during their admission and how the drug therapy is markedly heterogeneous among this group of patients.

Figure 2: Drug type administered to COVID-19 patients.

The most common route of drug administration was intravenous (65%), although oral drug administration and intramuscular injections were also utilised. Patients received treatment for a mean duration of 6 (±4) days.

Prognosis

Patients admitted to an Intensive Therapy Unit (ITU) were reported in 126 studies. Figure 3 shows the different types of management that patients received when admitted to ITU and illustrates that the most common cause of ITU admission was the need for respiratory support with intubation and mechanical ventilation (84% of the cases).

Figure 3: Types of ITU management received by patients.

ITU admission was found to have a statistically significant relationship with males (p=0·024), but not age. Interestingly, there was a statistically significant relationship with ITU admission and symptoms of hyposmia/anosmia (p=0·0001), headache (p=0·035), acute CVA (p=0·0001), seizure (p=0·001), meningitis (p=0·034), and encephalopathies (p=0·0001).

Psychiatric Symptoms

We identified seven studies reporting psychiatric effects, of which five were cross-sectional studies, one was a retrospective cohort study, and one was a case report. Details of the six studies are reported in Table 3. The studies involved 299,000 patients in total, of which 44% were male and 56% were female. Half of the studies were reported in China. Three studies involved 171 patients in hospital settings while having active COVID-19 infection, three studies involved 498 patients at home after recovery, and one study involved 62,354 patients covering both inpatients during infection and those at home after recovery. All studies identified depression and anxiety as being relevant to COVID-19 infection, both during and after infection. Additionally, one study reported suicidality during infection, two studies reported post-traumatic stress disorder after infection, one study suggested obsessivecompulsive disorder after infection, one study suggested insomnia after infection, one study suggested a higher incidence of psychosis, and two studies suggested a higher incidence of dementia diagnosis as being relevant to having been diagnosed with COVID-19.

Table 3: Studies reporting psychiatric effects related to COVID-19 infection.

Discussion

The literature published on the neurological symptoms observed in patients with COVID-19 is vast. Through our review, we aimed to summarise all available literature, as well as include more recent studies that older reviews may not have included. Our review specifically served to identify and examine the frequency and severity of these symptoms through combining this existing literature. In total, 307 neurological studies covering 60,097 patients, were included in this systematic review, which has shown that COVID-19 is associated with a large variety of neurological symptoms. The most frequently reported symptoms included ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. These symptoms are not specific to SARSCoV- 2 infection and are of low severity, however they may suggest neurotropism. They also associate with high resolution rates (all >80%). The most common severe neurological complication of COVID-19 was acute cerebrovascular events. This result is in keeping with other systematic reviews [18,19].

Direct neurological damage including ischemic strokes, meningitis/encephalitis, or Guillain-Barre syndrome are relatively common extra-pulmonary neurological presentations according to our review. These results should be the springboard for further research efforts aiming to distinguish whether these neurological entities are a consequence of direct brain injury/infection or an interaction with other vascular comorbidities of patients suffering severe/critical COVID-19 disease.

A significant proportion of COVID-19 patients were asymptomatic due to the course of SARS-CoV-2 infection. In addition, patients may not present with respiratory symptoms or fever but still have initial neurological manifestations. Thus, when patients present with neurological symptoms, despite the absence of respiratory symptoms, clinicians should maintain a high level of clinical suspicion for the possibility of underlying COVID-19 asymptomatic infection.

The resolution rates of neurological symptoms also varied. Patients presenting with loss of consciousness and ageusia reported the highest resolution rates (93% and 92% respectively), with ageusia resolution rates being 100% in one study [20]. On the other hand, patients who experienced spinal cord syndromes, such as acute myelitis, had the lowest resolution rates of their symptoms (33%). This finding is supported by the established poor overall outcomes associated with acute myelitis, with only approximately one-third of patients experiencing a favourable outcome [21].

A statistically significant relationship was noted between Asian ethnicity and peripheral neuropathy. The relationship between ethnicity and peripheral neuropathy in the context of COVID-19 has yet to be explored. However, peripheral neuropathy as a complication of diabetes has been found to be more prevalent among Caucasian patients [22] and less common in those with Indo- Asian and African- Caribbean origins [23]. Moreover, a statistically significant relationship was noted between Asian ethnicity and neuro-syndromic symptoms. Nonetheless, it is important to note that both of these relationships may have been influenced by the fact that the majority of the participants in the studies included were Asian and that a number of papers did not disclose the ethnicity of their participants.

Additionally, flu-like symptoms were statistically more prevalent in females, possibly because males have been found to have a higher risk of severe illness with COVID-19 [24]. Hyposmia and haemoptysis were statistically more prevalent in males. This is in contrast to several previous studies that found hyposmia to be more common in females with COVID-19 infection [25-28]. However, our patient cohort was predominantly male (62%), which may have contributed to the differing results. Regarding haemoptysis, it is a very uncommon presentation that was only present in 10 patients.

ITU admission was found to have a statistically significant relationship with male sex, but not with age. A meta-analysis of patients with COVID-19 also demonstrated a relationship between sex and ITU admission, with male patients having almost three times the probability of requiring ITU admission compared to females [29]. Surprisingly, our study did not determine any relationship between age and ITU admission. In contrast, another meta-analysis found that patients greater than 70 years old have a higher risk of needing intensive care [30]. Furthermore, there was a statistically significant relationship between ITU admission and the symptoms of hyposmia/anosmia, headache, acute CVA, seizure, meningitis, and encephalopathies.

Treatment varied, with several different therapies and drug routes being used depending on the neurological manifestation and severity of the presentation. The most frequent treatments used were intravenous immunoglobulins (IVIG), followed by antibiotics such as azithromycin, antivirals, and hydroxychloroquine, with patients receiving treatment for a mean duration of 6 days. A systematic review assessing treatment strategies for COVID-19 similarly found antivirals, antimalarials, and antibiotics to be the mainstay of treatment [31]. The frequency of IVIG can be attributed to its use in treating many different neurological conditions, most notably Guillain-Barre Syndrome, which was the fourth most common neurological complication reported in this review. Finally, it is important to consider that the COVID-19 pandemic is rapidly evolving and that treatment options are continually being trialled and developed.

Even though we established an abundance of studies for neurological symptoms, there appears to be a lack of studies regarding the psychiatric effects during and after COVID-19 infection. Nonetheless, all the studies we were able to identify reporting psychiatric effects have found depression and anxiety to be relevant, both during and after infection with COVID-19. In severe cases, there may even be a risk of patients attempting suicide. Compared to people who had flu or other respiratory tract infections, COVID-19 survivors were more likely to receive a diagnosis of anxiety of depression over the same period [17]. It was found that involving psychiatric care for these patients was effective in reducing their symptoms of anxiety and depression. Without proper psychiatric intervention, there is a risk that these psychiatric symptoms could increase the risk of suicidal ideation. Overall, it is recommended that psychiatric and/or psychological support should be available in hospitals to patients admitted to medical wards due to COVID-19, as well as in the community following recovery. This process may involve both the use of pharmacological and/or psychological interventions. Given the fact that COVID-19 survivors were at higher risk of receiving a diagnosis of dementia at 6-months follow-up, access to memory clinics should also be available to this group of patients. More studies examining the short-term and long-term psychiatric effects during and after COVID-19 infection are required in the future to obtain a better understanding of the symptoms, as well as to develop effective management strategies.

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[sciencespies]

Air pollution may affect severity and hospitalization in COVID-19 patients

https://sciencespies.com/environment/air-pollution-may-affect-severity-and-hospitalization-in-covid-19-patients/

Air pollution may affect severity and hospitalization in COVID-19 patients

Patients who have preexisting respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD) and live in areas with high levels of air pollution have a greater chance of hospitalization if they contract COVID-19, says a University of Cincinnati researcher.

Angelico Mendy, MD, PhD, assistant professor of environmental and public health sciences, at the UC College of Medicine, looked at the health outcomes and backgrounds of 1,128 COVID-19 patients at UC Health, the UC-affiliated health care system in Greater Cincinnati.

Mendy led a team of researchers in an individual-level study which used a statistical model to evaluate the association between long-term exposure to particulate matter less or equal to 2.5 micrometers — it refers to a mixture of tiny particles and droplets in the air that are two-and-one half microns or less in width — and hospitalizations for COVID-19. Medical records allowed researchers to use patients’ zip codes for estimating their particulate exposure over a 10-year period.

“Particulate matter is very small, small enough to be inhaled deep into the lungs, they cross into the blood and also affect other organ systems,” says Mendy. “Air pollution as a result of emissions from automobiles, factories or other sources is a generator of particulate matter.”

“Our study didn’t find any correlation between severity of COVID-19 and particulate matter in general, but we found something for people who had asthma and COPD,” says Mendy. “People who have preexisting asthma and COPD, when they are exposed to higher levels of particulate matter, they are more likely to have severe COVID-19, severe enough to be hospitalized.”

Researchers found that a one-unit increase in particulate matter 2.5 was associated with a 60% higher chance of hospitalization for COVID-19 patients with pre-existing respiratory disease. For patients without respiratory disease, no association was observed.

The study’s findings were published online in the scholarly journal Respiratory Medicine.

It is the first study to look at an association between air pollution, COVID-19 and individual patients, says Mendy. A study co-author, Xiao Wu, PhD, in the Department of Biostatistics at Harvard University, led a study last year looking at air pollution and COVID-19 mortality in the United States.

“This study may have policy implications such as reducing particulate exposure,” says Mendy. “Many people want to have more clean energy and reduced emissions into the atmosphere.”

Mendy says the findings of his pilot study are preliminary and he hopes to use it to generate support for a larger more comprehensive study of patients. The UC Health patients in the study were diagnosed with COVID-19 between March 13, 2020 and July 5, 2020. The dataset was stripped of all Health Insurance Portability and Accountability Act (HIPAA) identifiers. The median age for patients was 46 and 96.6% were residents of Ohio with the remaining 3.4% coming from Kentucky, Indiana, New York, South Carolina, West Virginia and Iowa.

Other study co-authors from UC include Jason Keller, a researcher in the Department of Bioinformatics; Cecily Fassler, PhD, postdoctoral fellow in the Department of Environmental and Public Health Sciences; Senu Apewokin, MD, an assistant professor in the Department of Internal Medicine; Tesfaye Mersha, an associate professor pediatrics; and Changchun Xie, PhD, and Susan Pinney, PhD, both professors in the Department of Environmental and Public Health Sciences.

Funding for the study included various grants from the National Institutes of Health supporting researchers.

Story Source:

Materials provided by University of Cincinnati. Original written by Cedric Ricks. Note: Content may be edited for style and length.

#Environment

[biogenericpublishers]

Pulmonary Embolism as an Acute Presentation of Covid-19; A Rare Complication not to be Missed by Abdul Rafi Mohammed* in Open Access Journal of Biogeneric Science and Research

Abstract

Coronavirus disease 2019 (COVID-19) has caused an unprecedented global public health challenge since the first reported case at the end of December 2019. It can range from asymptomatic infections to multiorgan failure and death. We report a case of 53-yearold gentleman who presented with dyspnea alone with no other systemic symptoms and was diagnosed to have COVID-19 related Pulmonary Embolism. He was started on anticoagulation and has made an uneventful recovery. Our report is unusual as very few cases have been reported in literature with similar diagnosis of COVID- related Pulmonary Embolism at first presentation. Physicians need to be aware of this serious condition especially when dealing with COVID-19 positive patients, which can be potentially life threatening if not diagnosed on time.

Keywords: COVID-19; dyspnea; Pneumonitis; Pulmonary Embolism; anticoagulation

Introduction

World Health Organization declared COVID-19 outbreak as a Public Health Emergency of International Concern on 30th January 2020, and later this was declared as a global pandemic. It has subsequently caused a havoc affecting many countries resulting in significant morbidity and mortality. The world economy has had a major impact due to this novel coronavirus infection so far and there are no signs yet of this virus declining. The infection mainly affects the airways epithelium and patients present with respiratory symptoms and fever. However, it’s not unusual for a wide variety of signs and symptoms involving other organ systems too.

Case Presentation

A 53-year-old male gentleman presented to a designated COVID health Centre with symptoms of acute breathlessness. He had a history of contact with COVID positive patient three days ago. He had no past medial history of note and was not taking any regular mediations. There was no family history of any significance and he was an Engineer by profession. On examination, he had temperature 36.9 C, Respiratory rate 26 per minute, oxygen saturations on air 81 %, Blood pressure 129/90 mm Hg and heart rate 96 beats per minute. He was immediately put-on high flow oxygen and saturations gradually improved to 95 % in emergency room of the primary health care center. He had nasopharyngeal and oropharyngeal swabs for COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) whilst still at the COVID center and transferred to secondary care emergency services.

On arrival at the hospital, he was maintaining saturations at 95 percent via a non-rebreather mask with Oxygen flow rate of 15 liters per minute. Rest of his vital parameters were normal. Chest X-ray revealed infiltrates in both lower zones highly suggestive of COVID Pneumonitis. An Emergency CT Pulmonary angiogram was done four hours after admission which showed filling defects in the right lower lobe pulmonary artery divisions suggestive of pulmonary embolism (PE) and bilateral diffuse coalescent ground glass opacities in both upper and lower lobes (Figure 1). RT-PCR was reported positive for COVID-19 the following day.

He was started on the local COVID-19 pneumonia treatment protocol. Therapeutic dose of low molecular weight Heparin was also initiated the same day following diagnosis of PE. His oxygen requirement decreased gradually over next few days and was maintaining normal saturations on room air. He was started on Rivaroxaban on sixth day of hospital admission and was discharged five days later. He is being monitored in COVID-19 recovery clinic and remains well so far six months since his initial diagnosis.

Discussion

COVID-19 predominantly causes lung parenchymal inflammation, but it is not unusual to see pulmonary vascular pathology such as pulmonary embolism (PE). In this reported case, patient presented with dyspnoea alone which can be the only symptom of PE in otherwise healthy but at-risk individuals. PE is a serious condition and reportedly contributes to 5-10% of in hospital deaths [1]. The incidence of PE has been reported to be around 2.6–8.9% of COVID-19 hospitalized patients and up to one-third in patients admitted to intensive care unit (ICU) despite prophylactic anticoagulation [2]. Clinicians should be aware of this potential complication as a recent metaanalysis highlighted that PE is significantly under-diagnosed in COVID-19 [3].

COVID-19 associated coagulopathy is increasingly being recognised and the mechanisms include complément induced systemic hyper inflammatory state (cytokine storm) leading to lung injury as seen in severe COVID-19 cases, lymphocyte exhaustion and immune paresis. Further imbalance of homeostatic interactions between complement and coagulation pathways results in net procoagulant state causing microthrombi in blood vessels [4]. In a large multi-centre study, PE in COVID-19 was found to be primarily due to Pulmonary Intravascular Coagulopathy, unlike the thromboembolic mechanisms associated with non-COVID-19 related PE. As in our case, elevated CRP and male gender were also found to be independent risk factors [5].

Thrombolysis is indicated if there is persistenthemodynamic compromise but can be risky. Refractory hypoxia alone is not an indication for thrombolysis and should be medically managed with anticoagulation [6]. Hence our patient did not receive thrombolysis despite significant hypoxia and was only managed with anticoagulation. Therapeutic anticoagulation is the cornerstone of managing PE. Selecting an appropriate medication and dosage depends on underlying comorbidities such as hepatic or renal dysfunction, thrombocytopenia, and gastrointestinal function [7]. D-dimer values may have a potential to guide anticoagulation therapy and evaluate prognosis in these patients [8].

Long term management of COVID related PE is same as PE due to other causes, which is oral anticoagulants for a term dictated by the severity of PE and associated prothrombotic risk factors [7]. Inferior vena cava filter is considered in recurrent PE despite optimal anticoagulation, if patients have absolute contraindications to anticoagulation or in those who have had anticoagulation related complications [9].

Conclusion

The pathogenicity of COVID-19 associated coagulopathy and related complications is still being extensively researched. COVID-19 related PE even though rare, has to be kept in mind by medical practitioners when dealing with suspected COVID-19 patients with dyspnea, as it can be fatal if not recognized early

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[annieboltonworld]

Juniper Publishers- Open Access Journal of Environmental Sciences & Natural Resources

Evaluation of Air Pollutant Levels in Dire-Dawa City, Ethiopia

Authored by Knife Mesfin

Abstract

Our planet earth is enclosed by a blanket of gaseous mixtures that can cause a harmful effect on life when present in excess of the natural abundance limit. These gaseous substances in the air we breathe, depending on their properties, magnitude and composition could benefit and/or risk the health of humans, animals and aquatic organisms. The existences of unwanted gases in the air we breathe are referred as air pollution, which implies the presence of harmful substances in the ambient air and have an outdoor and indoor sources. Air pollution has a wide array of negative health effects which are believed to be associated with air pollution exposure, among of which are respiratory diseases, cardiovascular diseases, adverse pregnancy outcomes, poor visibility, reproductive and neurological disorders. Air pollution is one of the most dangerous environmental problems, causing many adverse health effects and responsible for the death of many people each year worldwide. The objective of this study was to evaluate the levels of air [CO2, NO2, SO2, CO, VOC] pollutants around the sampling spots (commercial, residential, mixed and industrial) of the City and initiate the city administration to take mitigation measures on time.

The methodology used to collect and measure the selected air pollutants was site selection on field visit and use of Aeroquip series 500 that is employed for quick and short-time measuring of air pollutant levels. The results of the study showed that the levels of nitrogen dioxide (0.0446 ppm), carbon dioxide (459 ppm) and volatile organic compounds (514 ppm) was high in commercial and mixed spots respectively. In residential and industrial spots the values of NO2 and CO2 were close to each other with some differences for volatile organic compounds. But carbon monoxide (CO) and sulphur dioxide (SO2) were below the measuring capacity of the sensor and no value was obtained. Thus improper land use, low awareness, and inadequate enforcement of laws are considered as the main contributors for ambient air pollution in the city.

Keywords: Pollutant; Air Pollution; Standard Limit; Effects; Exposure; Values

Abbreviations: CO: Carbon Monoxide; SO2: Sulphur dioxide; COPD: Chronic Obstructive Pulmonary Disease; NOX: Nitrogen Oxides; CO2: Carbon dioxide; VOC: Volatile Organic Compounds; AAQS: Ambient Air Quality Standard; WHO: World Health Organization

Introduction

Air pollution is one of the most dangerous environmental problems that affect people’s health in a variety of ways [1]. Long term exposure to high levels of air pollution results in cardiovascular, respiratory, reproductive and neurological health problems and cause to the death of many people worldwide, particularly children [2,3]. The emission of gaseous pollutants into the atmosphere degrades the quality of ambient air resulting in haze, poor visibility and damages of culturally valuable materials such as statues and monuments and this degradation in the quality of the air we breathe is described as pollution, meaning the presence of harmful gases in the atmosphere in excess of their natural limit [4]. Air pollutants come from natural and anthropogenic sources and affect the composition of air and eventually cause harm to human health, ecosystems, agricultural crops and the built environment. Air pollution can be understood as a deviation from the unpolluted composition of air under the circumstances of no human intervention.

Air pollution is a widespread health problem associated with respiratory symptoms and can contribute to the development of chronic obstructive pulmonary disease (COPD) with enhanced susceptibility in children, older adults and people with heart and lung diseases [5,6]. Air pollution negatively affects human and ecosystem safety, depending on the exposure dose and time and it is caused by stationary and mobile sources from multiple sectors of human activity such as industry, residential sector, transport, agriculture and can manifest itself via the presence of sulphur dioxide(SO2), nitrogen oxides (NOX) and volatile organic compounds [7,8]. The fast growing trend in infrastructure, industries and transportation network in populous cities are potential contributors for air pollution and their negative impact on public health and environment is a serious issue that cannot be underestimated. Dire-Dawa is one of the fast growing cities in Ethiopia. It is a center for several industries and markets, a place for an International Airport and railway line [9] and the community nearby can be highly susceptible to the hazardous impacts of atmospheric air pollution generated by both natural and anthropogenic activities.

Material and Method

Site Description

This survey study was conducted in Dire Dawa city, which is located in the eastern part of the country, at the foot of Dengego mountain between 9027' and 9049'N Latitude and 41038' and 42019'E Longitude. The city is bordered by Oromia and Somali National Regional States and is located 515 kilometers east of Addis Ababa, situated in the Awash River Basin. The area of the city is 133,043 hectare. The city is a preferred strategic location for both agricultural and industrial activities. It serves as the main gate way for the country's trade line and is one of the largest and modern cities of Ethiopia. The city is divided into commercial, industrial, mixed and industrial zones but not fully implemented as planned. The industrial zone is not well developed and factories are not available as expected. The city experiences a warm and dry climate with low level of precipitation. The mean annual temperature is 25.9°C and the average maximum temperature 32.8°C. The region has two rain seasons; a small rain season and a more pronounced rain season that extends from August to September. The average annual rainfall that the region gets from these two seasons is about 583 mm. Air sample for the survey study was collected from each of the 18 sampling spots (commercial, industrial, mixed, residential) selected by field observation. The survey study was conducted in the first week of June, 2017 G.C (Figure 1).

Data Collection

The sites for data collection were first identified by inspecting the zones by field visit observation.18 ambient air sampling spots from the four separate zones were selected based on their vicinity to the public and the types of activities done around the sampling spots/sites. Aeuroqual series 500, a portable air quality sensor, was used to measure the levels of ambient air pollutants in parts per million (ppm) (Table 1). Evaluation of the values of nitrogen dioxide (NO2), carbon dioxide (CO2) and volatile organic compounds (VOC) was the prior interest of the researcher but gases such as sulphur dioxide (SO2) and carbon monoxide (Co) were included in the valuation. Prior to taking air samples for measurement, the sensor was warmed up to burn off contaminants that could be present in the device.

By first switching on the monitor, the sensor was made to warm for 3 minutes. The reading was then flashed for the next 7 minutes to make sure that the sensor is still in the warm state. Air sample was taken twice a day, in the morning and afternoon, for three minutes each and the two results average was recorded as the final values of the pollutant gases (NO2, CO2, VOC).The measurement was conducted at different days of the week and may lead to discrepancies in the final results of nitrogen dioxide (NO2), carbon dioxide (CO2) and volatile organic compounds (VOC) in the ambient air.

Result and Discussion

Nitrogen dioxide (NO2) level in the ambient air

Nitrogen dioxide (NO2) was one of the ambient air pollutants surveyed in the study areas. Its level was measured at industrial, commercial, mixed and residential spots in the city. Commercial and Industrial spots showed a higher values of nitrogen dioxide (NO2) compared to the values recorded for mixed and residential spots. Commercial and industrial spots indicate nitrogen dioxide (NO2) values of 0.044611 ppm and 0.0435 ppm respectively. The level of nitrogen dioxide (NO2) in mixed and residential spots was found to be 0.0435 and0.042167 ppm. In all cases the recoded values of nitrogen dioxide was less than the hourly average of ambient air quality standard (AAQS) that is 0.106 ppm. The result of the survey also indicated that the difference in the values of nitrogen dioxide (NO2) among industrial, commercial, mixed and residential spots was statically insignificant. Though it was difficult to obtain an ambient air quality standard (AAQS) for a three minute measured value of nitrogen dioxide (NO2), the present value could soon reach or exceed the annual average (0.021 ppm) level set in the ambient air quality standard (AAQS).

As shown in Figure 2, Mariam and Garage sefer have the highest nitrogen dioxide (0.056 ppm) level while Aftesa has the lowest (0.035ppm) level. Measurement of nitrogen dioxide from the collected air sample was carried out twice, in the morning and afternoon and the difference in nitrogen dioxide value was insignificant (p>0.05) in all air sampling spots. Natural sources such as, bacterial and volcanic action, and lightning are considered not to have significant influences on the measured values of nitrogen dioxide as they may be equally distributed in all the study sites of the city. But the high value of nitrogen dioxide in Mariam and Garage sefer (Figure 2) might be contributed to the use of fossil fuels at household levels and vehicle service stations which can use several fuel byproducts and solvents for energy, lubrication, greasing and washing reasons.

Carbon dioxide Level

The method used to determine carbon dioxide (CO2) level in the sampling spots was similar to that of nitrogen dioxide. The effect of carbon dioxide (CO2) as ambient air pollutant is not its impact on human health but in causing climate change. Carbon dioxide concentration at Ashewa and number 1 spot was the highest (493.5 ppm) and Afetesa and Ganda Grada the lowest (407.83 ppm). Measurement of ambient air pollutants (No2, Co2, V0C) indicated a significant difference in the four selected sampling spots of the city (p<0.05). Similar to nitrogen dioxide (NO2), commercial spots have the highest reading value of carbon dioxide (459 ppm) and the remaining sampling spots have closer ppm values with industrial 425 ppm, mixed 435 ppm and residential 426 ppm values respectively (Figure 3).

Volatile Organic Compounds (VOC)

Volatile Organic Compounds (VOCs) are organic compounds with a boiling point of below 260 degree Celsius. They are easily released into the ambient air from various sources and cause air pollution. Hence, many organic compounds fall into this category according to the world health organization (WHO) definition. The value obtained for volatile organic compounds in Mariam and garage sefer was high (728 ppm) compared to carbon dioxide (CO2) and nitrogen dioxide (NO2) and this significant difference is accounted for the daily activates in the garages which release volatile substances used daily for vehicle greasing, lubricating and cleansing reasons. The lowest value was recorded at kera and sebategna (300 ppm). To judge whether these areas are polluted or not by volatile organic compounds was difficult due to lack of a set standard but can give a general idea about the status of volatile organic compounds (VOC) in the area. Statically the VOC values between commercial, residential and mixed spots did not show a significant difference except for industrial which read 429 ppm. Commercial, mixed and residential areas have VOC values of 480, 514 and 506 ppm respectively with the mixed areas showing a relatively higher value (514ppm). Air pollutants such as carbon monoxide and sulphur dioxide were included in the survey but non-of them have recorded a value by the measuring sensor used to measure carbon dioxide (CO2) and nitrogen dioxide (NO2) (Figures 4 & 5).

Conclusion and Recommendations

Ambient air levels of nitrogen dioxide (NO2), carbon dioxide (CO2) and volatile organic compounds (VOCs) was measured at each of the commercial, industrial, mixed and residential sampling spots and the results recorded accordingly. The results showed that the magnitudes of nitrogen dioxide (0.0446 ppm) and carbon dioxide (459 ppm) was higher at commercial spots followed by a relatively similar to each other results at residential (0.0422 ppm and 426 ppm), mixed (0.0435 ppm and 435 ppm) and industrial (0.0435 ppm and 425 ppm) spots but the results of volatile organic compounds at commercial, industrial and residential(480 ppm,429 ppm, 506 ppm)sampling spots respectively showed high values (mixed 514 ppm) relative to the results obtained for nitrogen dioxide (NO2) and carbon dioxide(CO2) at same sampling spots. However, commercial spot at Ashewa and number 1 area recorded 493.5 ppm value for carbon dioxide which is higher than the average value at all four measuring spots. Similarly, commercial spot at Mariam and Garage Sefer areas had higher magnitudes of both nitrogen dioxide (0.056 ppm) and volatile organic compounds (728 ppm) respectively.

Sulphur dioxide and carbon dioxide level measurement was also conducted at each of the sampling spots at similar conditions but each did not read a value because of either their low level in the ambient air or the sensor failed to measure them. The relatively high values of nitrogen dioxide and carbon dioxide at commercial spots may be attributed to many factors such as the presence of institutions that frequently used fossil fuel products for power and transportation, natural resources activity dependent people (such as agriculture) and the number of people in the area community having limited access to electric power but dependent on wood and municipal solid garbage for energy sources. Similarly, the magnitude of volatile organic compounds in the mixed spot is also high, 514 ppm. The reason for this can be accounted for the various activities performed around the area of mixed spot. Mixed area by definition consists of industries, commerce and residents of different living standards. Thus, the higher value of volatile organic compound in this particular case may be due to the cumulative effects of the various activities and inputs used at industrial, commercial and household levels. In general, the values obtained for each pollutant gas was based on a three minute sampling average and are lower than the one hour and annual average results set by world health organization (WHO) and ambient air quality standard (AAQS).

However, the higher readings for nitrogen dioxide, carbon dioxide and volatile organic compounds at Ashewa and Number 1 and Mariam and garage Sefer can provide a clear insight on the future pollution status of the city. Rapid urbanization and congested traffic including train and air transport in the city would continually add harmful pollutants into the atmosphere changing the current situation. The low awareness of the people and the leadership together with increasing ambient air pollution could risk public health and the environment. Hence, further detailed research using modern methods of ambient air sample analysis and training through awareness and initiating the leadership to take all possible measures is crucial to alleviate the likely dangers associated with urban air pollution.

For more articles in Open Access Journal of Environmental Sciences & Natural Resources please click on: https://juniperpublishers.com/ijesnr/index.php

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What we know and don’t know about wildfire smoke’s health risks

Acrid smoke continues to pollute skies in the western United States. On some recent days, the air quality in Portland, Seattle, San Francisco and Los Angeles has been so hazardous, it’s ranked among the worst in the world. 

It’s hard to predict when the smoke will fully clear. And with some parts of the West  having faced a week or more of extremely polluted air, the unusual, sustained nature of the assault is increasing worries about people’s health.

There’s plenty of evidence that air pollution — a broad category that includes soot, smog, and other pollutants from sources such as traffic, industry and fires — can harm health. The list of medical ailments associated with exposure to dirty air includes respiratory diseases, cardiovascular disease and diabetes (SN: 9/19/17).

Most of what’s known about the hazards of wildfire smoke has to do with particulate matter, the tiny bits of solids and liquids in polluted air. Wildfires are especially good at producing particles in a size range that can be dangerous to health. It isn’t clear yet if what fuels wildfire smoke — be it vegetation, a mix of trees and structures, or other human-made sources — affects the toxicity of particulate matter.

A growing body of evidence points to a range of risks to health during or soon after wildfires, such as increased trips to the emergency room for chronic lung conditions. But there are many more questions than answers about the long-term risks for people struggling to cope with day upon day of polluted air, and facing longer and fiercer fire seasons each year due to climate change (SN: 8/27/20).

Science News spoke with scientists about what’s in the air, the health risks and what more we need to learn.

What’s in wildfire smoke?

Wildfire smoke is a complex mixture of gases and particles that is similar to cigarette smoke but without the nicotine, says physician John Balmes of the University of California, San Francisco, who studies the effects of air pollution on health. “It has the same kind of mixture of nasty small particles and irritant gases.”

The precise chemical makeup of the smoke varies by fire. It depends on “the type of fuel burned — including structures, intensity of the fire, atmospheric mixing, and distance or age of smoke,” says Tania Busch Isaksen, who studies public health effects of wildfire smoke at the University of Washington in Seattle.

“Generally speaking, it’s a mixture of carbon dioxide, carbon monoxide, nitrogen oxides, particle matter — fine to coarse — hydrocarbons and other organic compounds,” she says. “Fine particulate matter, PM2.5, is what we are primarily concerned about when we consider impacts on health” (SN: 7/30/20).

Those particles are 2.5 micrometers across or smaller, or about one-thirtieth the width of a human hair (SN: 8/22/18). Common in air pollution produced not only by wildfires, but also by power plants and cars, these particles are so tiny that they can be inhaled deeply into the lungs. There, they can trigger inflammation and possibly seep into the bloodstream.

Can you see how much PM2.5 is in the air?

No. These particles are so tiny and difficult to see that “even if the air seems clear, PM2.5 could be at levels that are dangerous,” says Perry Hystad, an environmental epidemiologist at Oregon State University in Corvallis. In the United States, the most reliable gauge of PM2.5 is the Air Quality Index, or AQI, which is based on data from air quality monitoring stations that measure the concentrations of pollutants in the air.

The U.S. Environmental Protection Agency developed the index to grade levels of common air pollutants, such as ozone, PM2.5  and carbon monoxide. On a scale from 0 to 500, higher numbers indicate dirtier air. The EPA assigns AQI scores to different types of pollution based on studies of each contaminant’s health effects.

The EPA considers scores up to 100 — indicating an average 35.4 micrograms of particulate matter per cubic meter of air over 24 hours  — generally safe. Scores from 101 to 200 may pose particular risk to people in sensitive groups, such as children and those with heart or lung diseases. Those people are advised to limit or avoid prolonged or vigorous outdoor activity. Above 200, everyone should cut down on physical activity outside. At scores 300 or above, with at least 250.4 micrograms of PM2.5 per cubic meter of air, everyone should avoid going outside.

Smoke blanketing the western United States has created hazardous, and at times off-the-chart, levels of pollution in many places. For instance, on the morning of September 17, areas of Oregon near Portland showed PM2.5 AQI levels up to around a hazardous 380. In regions of central California northeast of Fresno, AQI levels reached a staggering 780.

“Especially under conditions that we’re experiencing here in the western United States, it would be wise to check the AQI on a daily basis,” says Kent Pinkerton, a biologist at University of California, Davis.

Savage smoke

Satellite images reveal the shroud of smoke generated by wildfires raging in the West and wafting eastward across the United States (left). A color-coded image of the small particles and chemicals produced by the wildfires (right) indicates that some areas are cloaked in heavier pollution (red) than others.

NOAA/NASA/Worldview

What happens when people breathe in wildfire smoke?

“Wildfires, through the combustion process, create lots and lots of particles” in the size range of PM2.5, says Colleen Reid, an environmental epidemiologist and health geographer at the University of Colorado Boulder. A breath of these microscopic particles can send them all the way to the alveoli, the tiny sacs where the lungs and the blood swap oxygen and carbon dioxide.

Research in lab dishes has found that the particles can lead to inflammation and oxidative stress, in which reactive molecules that contain oxygen build up and can damage cells. The smallest pollution particles may make their way into the bloodstream, possibly causing harm to the cardiovascular system.

The research linking PM2.5 with health generally does not consider what types of materials are burning, so “at this point we are concerned about all PM2.5 regardless of source,” says Anthony Wexler, who studies particulate pollutants at the University of California, Davis. “But the source is likely important.”

Historically, wildfires have burned mostly plant matter. But many of the recent devastating fires in the western U.S., such as the Camp Fire that destroyed the town of Paradise, Calif., in 2018, have devoured human-made structures (SN: 11/15/18). “Houses have paint and solvents and plastics and all this other terrible stuff going up in smoke, too, which may be increasing the toxicity of the material that’s being emitted,” says Wexler. He is currently preparing an experiment to compare the toxicity of the smoke from burnt household materials with that from woody materials.

The impact of extended exposures to wildfire smoke also needs more research. Wildfires put a lot of pollution into the air, more than what’s generally produced from industrial and traffic sources, Reid says. But it’s often for a short period of time. “What’s going on right now in Oregon and Washington and California, where they’ve had essentially a week of very unhealthy levels of air pollution, is less common,” she says.

Recent fires in the western United States have consumed not only trees but many buildings like this one, in Butte County, Calif., which went up in flames on September 9. Some researchers are concerned that plastics and other materials in homes may make smoke more toxic.Noah Berger/Associated Press

What are the immediate health risks from wildfire smoke?

Breathing in smoky air can irritate the respiratory tract, leading to coughing, sore throats and itchy, watery eyes. The foul air can also cause headaches and fatigue.

Hospital visits for lung care go up during wildfires compared to periods without them, according to studies of emergency department traffic. For instance, an increase in PM2.5 exposure related to wildfires in northern California in 2008 was associated with an increase in risk for emergency department visits and hospitalizations for asthma, Reid and colleagues reported in Environmental Research in 2016. The 2012 wildfires in Colorado were linked to a rise in emergency department visits for asthma and chronic obstructive pulmonary disease, according to a 2016 study in Environmental Health. There’s some evidence of increased trips to the hospital for cardiovascular health problems during wildfires as well.

Medical visits for kids go up during wildfires too. During the 2017 Lilac Fire in San Diego county, visits for respiratory problems to a children’s hospital rose due to increased exposure to PM2.5, according to a 2020 study in the Annals of the American Thoracic Society.

Children, especially the very young and those with diseases like asthma, can be more vulnerable to health effects from wildfires. “They breathe more air per minute compared to adults” to meet their physiological needs, says Marissa Hauptman, a pediatrician at Boston Children’s Hospital. That can add up to more exposure. And developing lungs “are more susceptible to injury,” she says. 

A developing fetus may also be at risk from exposure to PM2.5. In a 2012 study in Environmental Health Perspectives, Reid and colleagues reported a slight decrease in birth weight for infants from pregnancies that occurred during the 2003 wildfires in Southern California. Mothers exposed to smoke from Colorado wildfires during the second trimester were more likely to give birth prematurely, according to a 2019 study in the International Journal of Environmental Research and Public Health. Infants born early or smaller than usual can face developmental delays.

What’s known about long-term health risks from wildfire smoke?

Not much. But a few studies provide some initial clues.

One examined how wildfires that scorched large areas of Indonesia in 1997 impacted health 10 years later. This population-wide study found that males and the elderly were worse off in 2007 for health measures such as lung function, the researchers reported in Economics & Human Biology in 2017.

In the United States, the wildfire smoke that plagued the Seeley Lake community in Montana in 2017 has parallels to the prolonged, hazardous exposures happening now in the West. The wildfires produced extremely high levels of PM2.5 from July 31 to September 18 that year; the daily average was 221 micrograms per cubic meter of air. Christopher Migliaccio, a respiratory immunology researcher at the University of Montana in Missoula, and his colleagues screened adults in the community right after the last day of increased smoke and two more times in each of the following two years.

Compared with members of a Montana community that hadn’t been exposed to the same levels of smoke, the participants from the Seeley Lake area had poorer lung function one and two years out, Migliaccio and his colleagues reported in Toxics in August. “I thought people might be worse right after,” he says, “but it’s a little bit of a delayed response.”

Migliaccio and colleagues had planned to screen the participants again this year, but COVID-19 got in the way. Eventually they hope to see whether, in participants that still have worse lung function, the condition is treatable or if it’s “the new normal.”

Can a mask protect you from wildfire smoke?

It depends on the type of mask. “Cloth masks, which are effective at preventing transmission of SARS-CoV-2 [the virus that causes COVID-19] … don’t do anything to protect the wearer from exposure to wildfire smoke,” Balmes says (SN: 6/26/20). Surgical masks provide some protection. But “an N95 is the best protection.” N95 masks are designed to filter out at least 95 percent of airborne particles.

But N95 masks are in short supply, and those masks have not been certified for use by children as they don’t fit properly. So the best protection is to avoid exposure. “People should stay indoors as much as possible with the windows closed,” Balmes says.

How can people keep indoor air clean?

“If they have central ventilation, they should turn that to recirculation,” Balmes says. That can reduce the amount of smoke that enters the home. People can also use a High Efficiency Particulate Air, or HEPA purifier to smoke-proof a single room. And those who cannot afford a HEPA cleaner can put together a makeshift purifier using a MERV-13 furnace filter and a box fan, Balmes says. “They’re not as good as the proper devices, but they do provide some protection.”

People hunkered down indoors can also keep the air clear by not burning gas stoves or candles, or even vacuuming — which can stir up particles inside the home.

But some people don’t have a home to escape to. King County in Washington announced on September 11 the opening of a clean air shelter for people experiencing homelessness.

How else might wildfires be harming health?

The toll that the wildfires have on mental health could also be significant. The past month in the Pacific Northwest has brought images reminiscent of a science fiction novel: hazy, deep orange skies that sometimes completely obscured the sun, turning day to night.

Extreme wildfires, with the potential for long periods of time in which the air is a danger, can upend people’s lives and add to stress levels. One of the few respites to the COVID-19 pandemic — going out for a breath of fresh air — has been shut off for millions of people. And there are many that have no choice but to work or live outdoors, exposed to hazardous air. “There could be a psychological impact of that,” says Reid. “That needs to be explored.”

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Covid-19 Era Post Viral Vagal Neuropathy Presenting as Persistent Shortness of Breath with Normal Pulmonary Imaging

Opinion

All that is shortness of breath is not pulmonary. We have identified a cohort of 18 outpatients in a general otolaryngology practice in New York City who presented with persistent shortness of breath (SOB) despite normal pulmonary imaging. All patients had cough, fever and SOB between March 15 - May 15, 2020 during the height of the COVID-19 pandemic in New York City, with the SOB persisting for 4 - 12 weeks at the time of their presentation. 3/12 were positive for COVID-19 IgG antibodies, one of whom also tested positive with a nasal swab polymerase chain reaction (PCR) assay. Due to limited access, only 12 patients were able to obtain an antibody test and only 7 were able to get the PCR test. Of the 4 patients who had spirometry as part of their pulmonary investigation, the flow volume loop showed flattening of the inspiratory curve in all 4.

History revealed that the SOB was generally not waking these patients up at night nor was it affecting their exercise tolerance. Indeed, they often reported feeling breathing difficulties after their activity. Talking, shouting, singing, and odors typically brought on the SOB.

On physical exam of the larynx with awake video transnasal flexible laryngoscopy, all patients demonstrated that their vocal folds were not moving in normal synch with their breathing, that is, they were closing more than 50% of their glottic airway during quiet respiration when they should be opening. This abnormal vocal fold adduction could also be elicited by having the patient say the 5-word sentence “we see three green trees” and observing the vocal folds slowly closing afterwards for as long as 9 seconds. We believe that the persistent vocal fold adduction gave the patients their SOB. The flattening of the inspiratory curve on spirometry corroborated the laryngeal exam findings. This is different than laryngospasm where the vocal folds suddenly slam shut for prolonged periods of time and gives a different symptom profile.

This vocal fold dysfunction, or paradoxical vocal fold movement disorder [1], is a vagal neuropathy, often occurring after a viral illness. One of the reasons it has traditionally been difficult to make the diagnosis of post viral vagal neuropathy is that most people are unable to recall that they had a viral illness, especially if the inciting event happened years ago. In the time of coronavirus, patients seem to be paying much more attention to when they began to feel ill.

Our cohort was treated successfully with a combination of physical therapy - respiratory retraining - and diet modification techniques. The handful of foods and beverages less than pH4 (Table 1) tend to aggravate the breathing issues so we recommended that they be avoided.

We feel that in a time of understandably great emphasis on serial CT scans of the chest to evaluate patients with persistent shortness of breath, offering this other, emerging diagnostic possibility to account for such symptoms may be helpful to the clinician. In patients with persistent SOB, with or without cough, where the pulmonary imaging is unremarkable whether or not they tested positive for, or have antibodies to, Covid-19, but certainly with positive testing, one should consider both a spirometry and an otolaryngology evaluation. This symptom complex may be due to a virus-related cranial neuropathy which can be readily identified with office laryngoscopic evaluation and then treated, with restoration of premorbid functionality.

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Publish Your Surgery case reports journal at best platform

The Journal of Clinical Images and Case Reports (CICRJ) is the official journal of the Surgical Society. CICRJ provides an international journal of surgery case reports, which includes surgeons, experts, research analysts who work in the research field and share their research work with the scientific community. CICRJ is a peer-reviewed, open access access general surgery case report that aims to publish scholarly articles describing clinical assessments, diagnostic studies, and methods known as diagnosis, treatment, and prevention.

 The international journal of surgery case reports will consider any original cases in the field of respiratory therapy, dermatology, kidney, endocrine, diabetes& Metabolism, Anesthesiology, Gastroenterology, Emergency Medicine & Critical Care, Internal Medicine, Forensic and Legal Medicine, Nephrology, Infectious Disease, Orthopedics & Rheumatology, Infertility, Pathology-Anatomic & Clinical, Palliative Care, Pulmonary Disease, Physiotherapy, Preventive Medicine, Radiation Oncology, Allergy & Immunology, Sleep Disorders Studies, Diabetology, Dentistry and Oral Medicine, Family Medicine & Public Health, ENT Case reports, Hematology, Geriatric Medicine, Neurology, Neonatology, Nutrition and Dietetics, Nuclear Medicine, Ophthalmology, Cancer & Tumor Study, Neurological Surgery, Pain Management, Obstetrics and Gynecology, Pediatrics, Otolaryngology, Psychiatry, Pharmacology and Therapeutics, Andrology & Sexual Health, Physical Medicine & Rehabilitation, Vascular Medicine, Radiology, Bone & Stem Cell, Chemotherapy.

  The purpose behind the Journal of Surgical Case Reports is to promote medical surgeons and researchers, an educational forum whose personal experience and novel therapies can be disseminated to better readers and increase the progress of medical surgery and review interesting, rare cases. Experienced by colleagues around the world, whose contributions are welcome.

 CICRJ of international journal of surgery case reports tries to publish journals that are exciting to read, educate, and keep the user updated on leading edge research within the fields of science, technology, medicine, surgery, oncology and oral health.

CICRJ, an international journal in the field of surgery, seeks to update, read, educate and publish journals on leading research in the fields of science, technology, medicine, surgery, oncology and oral health.

 CICRJ aims to provide critical analysis, surgical case report journals and detailed overviews of surgical developments, in addition to facilitating and encouraging conversations to give experts, researchers and surgeons from around the world a place to share their research findings. .

Submit your International Journal of Surgery Case Reports via Online Submission at: http://www.literaturepublishers.org/submit.html or as an e-mail attachment to the Editorial Office at E-mail id: editor.cicrj@literaturepublishers.org

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Hatha Yoga Effect on Airway Resistances of Tobacco Smokers with Allergic Rhinitis -Juniper Publishers

Juniper Publishers- Journal of Yoga and Physiother 

Abstract

Background: There have been limited studies on Hatha yoga training as a complementary therapy to manage the symptoms of Allergic Rhinitis and also to check the effect of yoga on airway resistances in tobacco smokers with Allergic Rhinitis.

Aim: The main Aim of the study was to check the effect of Hathayogasanas on the Airway resistances in tobacco smokers with allergic rhinitis.

Materials and Methods: This is a prospective non blinded study of 20Tobacco smokers with allergic rhinitis. In the age group of (18-30). The subjects chosen for the study underwent an ENT examination and Hatha yoga training was giving for a period of 90 days. The objective analysis for upper airway resistance and lower airway resistance was done using a Rhino manometer and Spiro meter. The subjective analysis was done using a SF-12 Health survey questionnaire and a SNOT questionnaire. Both the objective and subjective analysis was done before and after the practice of Yogasanas. The compiled data was analyzed with the paired (2-tailed) T-Test, using SPSS (Software package for social sciences) version 16.

Results: The total nasal airway resistance was found to be increased before doing yoga and it was significantly reduced at 150 Pa pressure after doing yoga. The mean FEV1/FVC% before doing yoga was less when compared with the post yoga measurement. The mean Physical component score (PCS) and Mental component score (MCS) of the SF-12 health survey questionnaire had significantly improved and the mean SNOT questionnaire score had significantly reduced after the practice of yoga.

Keywords: Hatha yoga; Tobacco smokers; Allergic rhinitis; Rhino manometer; Spiro meter; SF-12 Health survey questionnaire; Snot questionnaire

Abbreviations: AR: Allergic Rhinitis; SF-12: Short Form 12 Health Survey Questionnaire; SNOT: Sino Nasal Outcome Test Questionnaire

Opinion

Allergic Rhinitis (AR) is the most common allergic disease, affecting 30% of population around the world. The disease is predominantly associated with exposure to some aeroallergens like cigarette smoking [1]. Allergic Rhinitis (AR) is usually defined as the presence of at least one or more of the symptoms of congestion, rhino rhea, sneezing, nasal itching, and nasal obstruc-tion [2,3]. The disease is an Immunoglobulin E (IgE) medi-ated reaction of Th2-type T cell response [4,5]. Due to the chronicity of disease and the variable response to therapy, a large number of patients resort to complimentary and alternate medication for Allergic rhinitis. Nasal breathing exercise is a simple and cost effective measure to reduce symptoms of Allergic Rhinitis and improve patient satisfaction [6].

Yoga is an alternative to traditional (Western) aerobic exercise that may have promise as a complementary treatment for smoking cessation. Yoga contains a number of components that contribute to stress reduction including asanas, yoga postures that have been shown to improve mood and well-being similar to the effects of traditional Western exercise, [7-10] and pranayama, breathing exercises that involve regulation of breath and conscious deep breathing that stimulates pulmonary stretch receptors similar to the deep in halation associated with smoking [11]. While yoga is associated with health benefits similar to exercise, the goal of yoga practice is also to create a calm state of mind through the combination of physical postures, breathing techniques, and directed meditative focus [12,13]. Several studies have shown that the practice of yoga reduces perceived stress and negative effect. Thus, the practice of yoga may also improve the chances of successful smoking cessation [14-17].

Yoga training can readjust the autonomic imbalance, controls the rate of breathing, and thus alters various physiological variables. These changes are attributed to the decreased sympathetic reactivity and relaxation of voluntary Inspiratory and expiratory muscles [18,19]. The proportion of adolescents with symptoms of asthma or allergic rhinitis who reported smoking experimentation is a cause for concern, because there is strong evidence that active smoking is a risk factor for the occurrence and increased severity of allergic diseases [20]. Passive and active smokings are both risk factors for asthma and allergic rhinitis in adolescents [21-23]. Cost effective options and alternative therapy such as yoga will serve as a solution to manage Allergic rhinitis. The ancient science of yoga includes physical postures, voluntarily regulated breathing, and meditation, among other techniques [24]. Practicing yoga can bring positive effects on well-being and human health with respect to biological and physiological parameters [25]. Voluntarily regulated yoga breathing techniques have been found to increase the oxygen consumption (and correspondingly the metabolic rate) both as an immediate effect [26,27] and as a longitudinal effect [26]. Certain yoga voluntarily regulated breathing techniques offer an opportunity to study the effects of changes in the respiratory pattern on metabolism [28]. Voluntary regulation of breathing in yoga alters autonomic activity with an improvement in cardiovascular and psychological health [29]. Nose is the main channel for the entry of air to the respiratory system, but this also exerts a resistance to the airflow. This nasal airflow resistance consists of half to 2/3rd of total airway resistance [30]. Nasal resistance is defined as resistance offered to the air entry by the nasal cavity [31]. This resistance is rather important as it prevents catastrophic collapse of lung [32]. Nasal airway resistance accounts for more than 50% of total airway resistance [33].The nasal cavity has been modeled as 2 resistors in parallel [34,35]. The 3 components of nasal resistance are as follows: the nasal vestibule, nasal valve, and nasal cavum [33].Information regarding nasal resistance is essential for management of anatomic and physiologic diseases of the na-sal airway. However, there are often inconsistencies between subjective nasal obstructive symptoms and the objective appear-ance of the nasal cavity [36]. Due to this discrepancy, objective diagnostic tools for the assessment of nasal patency or resistance are needed [37].The upper airway resistance can be measured with the help of a rhino manometer and lower airway resistance can be measured with a spiro meter. Anterior active rhino manometer is the most frequently used method in clinical practice according to the International Standardization Committee of Rhinomanometry, ICSR [38, 39]. The word rhinomanometry means 'rhino' for nose and 'manometer' for measurement of pressure [40]. Spirometry is a safe, practical and reproducible maximum breathing test that can be used in primary care to objectively determine the ventilatory capacity of the lungs. As already emphasised earlier in this article, it is the 'gold standard’ for detecting and quantifying airflow obstruction [41]. A spiro meter is a medical device that allows measurement of how much air is expelled and how quickly the lungs can be emptied, in a maximal expiration from full inflation [42]. The test is relatively quick to perform, well tolerated by most patients and the results are immediately available to clinician [43]. Sofar there has not been much studies done to check the efficiency of Hatha yogasanas on the airway resistances of tobacco smokers with allergic rhinitis. Hence Hatha yogasanas comprising of breathing exercises were taught to the recruited subjects in the study and effect of these asanas on the airway resistances of tobacco smokers with allergic rhinitis was studied.

Materials and Methods

This study was conducted at the Department of Otorhinolaryngology, St. John's national academy of health sciences, Bangalore. The study is a prospective non blinded study. 20 Tobacco smokers with Allergic rhinitis between the age group of 18-30, willing to practice yoga for a period of 90 days and with full compliance and reduce the number of cigarettes were recruited for the study. The Nasal resistance was measured at day0, that is before the start of practicing yoga and then after a period the 90 days. Written and informed consent was taken before the procedure. A thorough otorhinolaryngologicalexamination of all subjects was done prior to the study. The subjects were taught Hatha yogasanas by a trained yoga tutor. The following are the list of specific asanas which were taught

a) Tadasana (mountain pose)

b) Ardhachakrasana(Half-Wheel Posture )

c) Ardhakatichakrasana (Lateral arc posture)

d) Bhujangasana ( Cobra Pose )

e) Vrksasana ( Tree Pose )

f) Veerabadrasana(Warrior Pose)

g) Gomukasana ( Cow Face Pose )

h) Ustrasana ( Camel Pose )

i) Dhanurasana ( Bow Pose )

j) Surya Namaskara

k) Nadi Shodhana Pranayama ( Alternate Nostril Breathing Technique )

l) Bhastrika Pranayama ( The Bellows Breathing )

m) Bhramari Pranayama ( Humming Bee Breathing Technique )

n) Kapalabhati ( Hyperventilating Practice )

o) Jalaneti

The rhino manometer and spirometer was used to assess objectively the effect of Hatha yogasanas on the airway resistance. Regular calibration was ensured. The technique of the whole procedure was explained in full detail to all subjects. Series of trial recordings were performed with an intention that they were familiar with the technique and equipment thereby eliminating any anxiety which is a known factor for reducing nasal resistance. Rhinomanometry examination was performed during quiet breathing with close mouth in an upright sitting position and the following parameters were recorded [44].

Equipment used had following features:

1. During spontaneous respiration transnasal pressure differences and nasal air flow were recorded simultaneously.

2. Nasal air flow and pressure curve was displayed on a visual display unit (VDU) which allowed controlling the regularity of patients breathing.

3. Data obtained in the form of printed graph which contained nasal airflow and pressure-flow relation at 150mm Pa pressure [30].

Nasal resistance was kept static at 150 Pa because at this pressure difference both laminar and turbulent airflow were prevailed and nasal resistance can be assessed with minimal physical effort. Calculations of transnasal resistance were made according to Ohm's law. Nasal resistance to airflow was calculated by following equation

R = ∆P/V

R is total nasal airflow resistance in Pa/cm3/s,

∆P is 150 Pa pressure, V is nasal airflow (sum of left and right) during inspiration.

Total nasal airflow resistance reflects the resistance of both side of nasal cavity. The advantage of measuring the total nasal airflow resistance is to avoid the effect of nasal

Cycle over unilateral nasal airflow resistance as the nasal cycle may lead to a change of 4-fold in unilateral nasal airflow resistance [45]. The subjective analysis was done using the SF- 12 Health survey questionnaire and SNOT questionnaire.

Result

The Objective analysis parameters pre yoga and post yoga was found to be as follows, Total Nasal Airway Resistance in the 20 subjects was 0.44 Pa/cm3/s pre yoga and 0.39Pa/cm3/s post yoga at 150Pa with P<0.05. Pulmonary function test parameter FEV1/FVC% pre yoga was 66.12 and 79.51 post yoga with P<0.001***. . The subjective analysis parameters was found to be as follows, the Physical component score of the SF-12 health survey questionnaire was 38.62 pre yoga and 41.99 post yoga with P<0.05* and Mental component score of the SF-12 health survey questionnaire was 40.04 pre yoga 45.07 post yoga with P<0.01**, and the SNOT questionnaire score was 12.77 pre yoga and 10.05 post yoga P<0.001***.

Discussion

Allergic Rhinitis (AR) is defined as inflammation of the membranes lining the nose, and is characterized by nasal congestion, rhino rhea, sneezing, itching of the nose and/or post-nasal discharge [46]. It is often viewed, as a trivial disease but can significantly affect the quality of life (QOL) by causing fatigue, headache, sleep disturbances and cognitive impairment [47] Allergic Rhinitis is also closely related to asthma and, 10-40% of people with rhinitis have concomitant asthma [47]. According to WHO (2007), the global burden of allergic rhinitis was estimated to be 400 million [48] and the prevalence among adults ranges between 10% and 32% in Asia Pacific region [49]. Despite the high burden, there is paucity of community based studies in India, determining the burden and factors associated with allergic rhinitis. Medications provide some relief, but improvement is only partial. Anti-IgE shots show better efficacy, but are still very expensive [50].

Tobacco smoke exposure remains common and has been linked with an increased risk of multiple upper respiratory conditions in various age groups. Significant associations have been suggested between tobacco smoke exposure and chronic sinusitis [51], asthma [52] and allergic rhinitis [53]. In developing countries such diseases pose a serious socio economic burden. Cost effective options and alternative therapy such as yoga will serve as a solution to manage Allergic rhinitis. Pranayama is an integral part of Hatha yogasanas. As a deep breathing technique, pranayama reduces dead space ventilation and decreases work of breathing. It also refreshes the air throughout the lungs, in contrast with shallow breathing that refreshes the air only at the base of the lungs [54]. Regular practice of pranayama improves cardiovascular and respiratory functions, improves autonomic tone toward the parasympathetic system, decreases the effect of stress and strain on the body and improves physical and mental health [55-57]. Pulmonary function parameters (PFT) provide important clinical information to identify and quantify the defects and abnormalities in the functioning of the respiratory system. A study by Dinesh etal ,after 12 weeks of fast pranayama training FEV1 /FVC, PEFR, and FEF25-75 were significantly improved (P = 0.02, P< 0.001, and P< 0.001, respectively) compared with the values at baseline. Yadav and Das attributed that improvement in the PFT parameters by yogic practices due to increased respiratory muscle strength, clearing of respiratory secretions and using the diaphragmatic and abdominal muscles for filling the respiratory apparatus more efficiently and completely. Furthermore, the improvement in the PFT parameters may be due to rise in thoracic - pulmonary compliances and broncho dilatation by training in Nadisodhana pranayamas [58]. Stimulation of pulmonary stretch receptors by inflation of the lung reflexely relaxes smooth muscles of larynx and tracheo bronchial tree. Probably, this modulates the airway caliber and reduces airway resistance [59]. Previous investigators demonstrated the effect of pranayama on enhancement of the respiratory muscle efficiency and lung compliance due to reduction in elastic and viscous resistance of lung [60]. Furthermore, pranayama acts as stimulus for release of lung surfactant and prostaglandins into alveolar spaces, which increases the lung compliances [61]. Total nasal resistance gives an overall measure of nasal functions and also reflects the degree of nasal obstruction during breathing [45].

In our study Table 1 shows the Total Nasal Airway resistance in 20 subjects where in during preying it was 0.44 and post yoga it was 0.39 with the p value <0.05*. Graph 1 shows the decrease in total nasal airway resistance post yoga. Table 2 shows the Spiro metric measurements i.e, FEV1/FVC% during pre yoga it was 66.12 and post yoga it was 79.51 with the p value <0.001***. Graph 2 shows the significant improvement of the FEV1/FVC% parameter post yoga in the 20 subjects. Table 3 shows the SF- 12 Health survey components i.e the physical component score during pre yoga was 38.62 and post yoga was 41.99with the p value <0.05* and the mental component score during preying was 40.04 and post yoga was 45.07 with the p value <0.01**. Graph 3 shows the significant improvement in the physical and mental component scores post yoga. Table 4 shows the SNOT scores which was 12.77 during pre yoga and 10.05 post yoga with the p value 0.001***. Graph 4 shows the significant reduction in the SNOT score post yoga.

Conclusion

The study shows that there is decrease in the total nasal airway resistance and the FEV1/FVC% parameter also show significant improvement in 20 tobacco smokers with allergic rhinitis after the regular practice of yoga. The Quality of life of the subjects has been better as per the SNOT and SF 12 Questionnaire. There have been no scientific studies concerning the effect of yoga on the airway resistances of tobacco smokers with allergic rhinitis. Thus this study may form a basis for future studies focused on the effect of yoga on the tobacco smokers with allergic rhinitis.

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Global Anaesthesia And Respiratory Devices Market

Global Anaesthesia And Respiratory Devices Market Size, Share, Growth, Industry Trends and Forecast 2020-2030

The global anaesthesia and respiratory devices market valued 32.3 billion USD in 2020 and is expected to reach 66.0 billion USD by 2030 with the CAGR of 7.4% during the forecast period.Anaesthesia devices are those devices that are used mainly during surgeries to induce coma. They provide an appropriate and uninterrupted supply of medical gases mixed with anaesthetic vapour which serves the purpose of an induced coma. The application of anaesthesia in patients results in loss of sensation or awareness.  Anaesthesia devices can control conditions like pain, breathing, blood flow, blood pressure, and heart rate. Respiratory devices aid in improving pulmonary functions by eliminating mucus from the respiratory airways. They are mainly used in the diagnosis and treatment of respiratory diseases like chronic obstructive pulmonary disease (COPD), asthma, tuberculosis, pneumonia, and others. Respiratory devices are leading the market when compared to anaesthesia devices because of their wide usage and the limited usage of anaesthetic devices due to limited number of end-users. Initially, anaesthesia and respiratory devices were developed for operating purposes only. However, rising awareness amongst people and technological advancements have enabled the usage of these devices in post-operative care units, delivery rooms, and critical care units and enhanced their market demand. 

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Market Dynamics and Factors:

The growing geriatric population in developed and developing countries, increasing tobacco consumption resulting in occurrence of chronic respiratory diseases; rising number of surgeries; increased healthcare expenditure; and rising demand in home healthcare. These factors contribute significantly towards the growth of anaesthesia and respiratory devices market. Furthermore, rapid urbanisation and industrialisation has led to the rise in the air pollution levels which further leads to chronic respiratory diseases and enhances the market growth of anaesthesia and respiratory devices. For instance, according to World Health Organisation in 2016, around 251 million cases of chronic obstructive pulmonary disorder (COPD) were reported. Technological advancements and rising innovations in the development of anaesthesia and respiratory devices are going to fuel the market growth in the near future. For instance, B. Braun Medical Inc. made an announcement of introducing Clorotekal, which is a U.S Food & Drug Administration approved anaesthetics for spinal anaesthesia. However, certain factors like high costs involved in the installation and maintenance of anaesthesia and respiratory devices; stringent regulations for the adoption of anaesthetic devices; and low adoption rate in underdeveloped economies are restraining the growth of the anaesthesia and respiratory devices market.

Market Segmentation:

Global Anaesthesia And Respiratory Devices Market – By Product Type

Anaesthesia Machines

Delivery Machines

Monitors

Ventilators

Workstations

Anaesthesia Disposables

Disposable Masks

Disposable Accessories

Respiratory Machines

Equipment

Ventilators

Nebulizers

Humidifiers

Inhalers

Oxygen Concentrators

Reusable Resuscitators

Respiratory Measurement Devices

Pulse Oximeters

Capnographs

Spirometers

Peak Flow Meters

Respiratory Disposables

Disposable Oxygen Masks

Resuscitators

Tracheostomy Tubes

Oxygen Cannula

Global Anaesthesia And Respiratory Devices Market – By End-User 

Hospitals

Ambulatory Service Centres

Homecare

Clinics

Global Anaesthesia And Respiratory Devices Market – By Geography

North America

U.S.

Canada

Mexico

Europe

U.K.

France

Germany

Italy

Rest of Europe

Asia-Pacific

Japan

China

India

Australia

Rest of Asia Pacific

ROW

Latin America

Middle East

Africa

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Geographic Analysis:

North America is expected to dominate the global anaesthesia and respiratory devices market in the forecast period in terms of market share. Factors such as rising geriatric population; growing healthcare expenditure; high adoption rate of technologically advanced devices; and increasing investments of major players of the anaesthesia & respiratory devices market are the key factors attributing to the market dominance of the region. For instance, almost 12 million people in the U.S suffer from COPD. The Asia Pacific region is expected to witness maximum growth during the forecast period. Major countries like China, Japan, and India are going to be key contributors for the market growth of anaesthesia and respiratory devices in the APAC region. For instance, according to the International Journal of Pulmonary and Respiratory Sciences in 2016, COPD is the second largest cause of death in India.   

Competitive Scenario:

The key players operating in the global anaesthesia and respiratory devices market are –

GE Healthcare, Philips Healthcare, Covidien, Teleflex Inc., Pfizer, Johnson & Johnson, Draegerwerk AG, AstraZeneca, Hamilton Medical AG, Invacare Corporation, Masimo Corporation, Dickson & Company.      

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How will this Market Intelligence Report Benefit You?

The report offers statistical data in terms of value (US$) as well as Volume (units) till 2030.

Exclusive insight into the key trends affecting the Global Anaesthesia And Respiratory Devices industry, although key threats, opportunities and disruptive technologies that could shape the Global Anaesthesia And Respiratory Devices Market supply and demand.

The report tracks the leading market players that will shape and impact the Global Anaesthesia And Respiratory Devices Market most.

The data analysis present in the Global Anaesthesia And Respiratory Devices Market report is based on the combination of both primary and secondary resources.

The report helps you to understand the real effects of key market drivers or retainers on Global Anaesthesia And Respiratory Devices Market business.

The 2021 Annual Global Anaesthesia And Respiratory Devices Market offers:

100+ charts exploring and analysing the Global Anaesthesia And Respiratory Devices Market from critical angles including retail forecasts, consumer demand, production and more

15+ profiles of top producing states, with highlights of market conditions and retail trends

Regulatory outlook, best practices, and future considerations for manufacturers and industry players seeking to meet consumer demand

Benchmark wholesale prices, market position, plus prices for raw materials involved in Global Anaesthesia And Respiratory Devices Market type

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U.S Intravenous Solution Market Size Share Trends Forecast 2026

U.S Intravenous Solution Market, by Solution Type (Saline (Normal saline 0.9% NaCl and Hypertonic saline), Dextran (D5W 5% dextrose in water and Analog Hypertonic Saline), Lactated Ringer’s, Amino Acid, Vitamins & Minerals, Heparin and trace elements, and Mixed Solutions), By Packaging (Ampules, Vials, Cartridges, Bottles, Bags (Large Volume Bags-greater than 250ml and Small Volume Bags-less than 250ml), By Indication (Oncology, Post-Operative Care, General Medicine, Burn Management, Pulmonary Disorders, Cardiovascular Diseases, and Others), and By End User (Hospitals, Clinics, Ambulatory Surgical Centers, Home care Settings, and Others) is estimated to be valued at US$ 2,811.3 million in 2021 and is expected to exhibit a CAGR of 6.1% during the forecast period (2021-2028), as highlighted in a new report published by Coherent Market Insights.

U.S Intravenous Solutions Market- Impact of Coronavirus (COVID-19) Pandemic

Lockdown in various countries due to the pandemic has placed an economic burden on the private healthcare sector. Healthcare providers are facing challenges with regards to declining outpatient’s visits, manpower, equipment, consumables, and other resources to ensure safety in treatment of patients with other diseases. The global COVID-19 pandemic has sharply focused the attention of the world onto critical care of COVID-19 patients. During the early stages of the COVID-19 pandemic, it was a common advice of physicians to aim for a negative fluid balance. Nowadays, a higher occurrence of acute kidney injury requiring renal replacement therapy has been observed, prompting for a more liberal fluid strategy. For instance, the World Health Organization guidelines recommend that patients with COVID-19 in respiratory failure should be treated cautiously with intravenous fluids, especially in settings with limited availability of mechanical ventilation.

Use a conservative fluid management strategy for acute respiratory distress syndrome (ARDS) patients without tissue hypoperfusion

In resuscitation for septic shock in adults, give 250–500 mL crystalloid fluid as a rapid bolus in the first 15–30 minutes and reassess for signs of fluid overload after each bolus

Consider dynamic indices of volume responsiveness to guide volume administration beyond initial resuscitation based on local resources and experience. These indices include passive leg raises, fluid challenges with serial stroke volume measurements, or variations in systolic pressure, pulse pressure, inferior vena cava size, or stroke volume in response to changes in intrathoracic pressure during mechanical ventilation.

Thus, due to lockdown and disruption in supply chain and the increasing demand of healthcare products for patients, this pandemic has hampered the U.S intravenous solution market.

* The sample copy includes: Report Summary, Table of Contents, Segmentation, Competitive Landscape, Report Structure, Methodology.

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However, the increasing number of product approvals from regulatory bodies, collaborations and partnership strategies adopted by key players are some of the major factors which are expected to drive growth of the U.S intravenous solution market during the forecast period. For instance, in November 2016, Mallinckrodt Pharmaceuticals received U.S. Food and Drug Administration’s (FDA) Prior Approval Supplement for its OFIRMEV (acetaminophen) injection (new drug application) available in an intravenous (IV) bag presentation.

Administration of IV fluids in the patients of cardiac arrhythmia helps in improvement of haemodynamic status in critically ill patients. Thus, the increasing number prevalence of cardiac arrhythmia is expected to provide huge opportunities to the U.S intravenous solution market growth in the near future. For instance, the Centers for Disease Control and Prevention 2014, estimated that 2.7–6.1 million people in the U.S. suffered from atrial fibrillation. With increasing aging population, this number is also expected to increase.

The increasing number of patient admissions in ambulatory surgical centers for surgical procedures, which requires intravenous solutions or infusion for administration of drugs is expected to drive the ambulatory surgical centers (ASCs) segment growth. For instance, according to the H-Cup Journal Report 2017, in the U.S., there were around 17.2 million ambulatory hospital visits recorded in the hospitals.

A person suffering from diarrhea also suffers from intense fluid loss and dehydration. Thus, diarrhea patients are highly prescribed with IV fluids such as saline and vitamins. Increasing prevalence of diarrhea is expected to drive growth of U.S intravenous solution market during the forecast period. For instance, according to the article published in New England Journal of Medicine, April 2014, 179 million cases of acute diarrhea are registered annually in the U.S.

Browse 13 Market Data Tables and 40 Figures spread through 169 Pages and in-depth TOC on U.S Intravenous Solution Market, by Solution Type (Saline (Normal saline 0.9% NaCl and Hypertonic saline), Dextran (D5W 5% dextrose in water and Analog Hypertonic Saline), Lactated Ringer’s, Amino Acid, Vitamins & Minerals, Heparin and trace elements, and Mixed Solutions), By Packaging (Ampules, Vials, Cartridges, Bottles, Bags (Large Volume Bags-greater than 250ml and Small Volume Bags-less than 250ml), By Indication (Oncology, Post-Operative Care, General Medicine, Burn Management, Pulmonary Disorders, Cardiovascular Diseases, and Others), and By End User (Hospitals, Clinics, Ambulatory Surgical Centers, Home care Settings, and Others) - Forecast to 2028"

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The increasing number of surgeries are expected to propel demand for large volume of Intravenous (IV) solutions. For instance, according to Healthcare Cost and Utilization Project report 2020, a total of 17.2 million hospital visits (as visits or inpatient stays) in the United States included at least one surgery in 2017.

Key Takeaways of the U.S Intravenous Solution Market:

The U.S intravenous solution market is expected to exhibit a CAGR of 6.1% during the forecast period (2021-2028) owing to the increasing launches of new intravenous solution injections for the treatment of various issues such as neuromuscular blockade and paralysis, this is expected to boost the market growth over the forecast period. For instance, in 2017, Fresenius Kabi USA, LLC, a provider of medicines and technologies for infusion, transfusion, and clinical nutrition, launched Vecuronium Bromide IV injection in the U.S. The drug is indicated for maintenance of neuromuscular blockade and paralysis.

Among solution type, Saline segment is expected to hold major revenue share in 2028, owing to the increasing incidence of gastroenteritis, which is expected to contribute to the growth of the saline segment. For instance, according to the data of National Center of Biotechnology Information 2020, acute viral gastroenteritis accounts for 19 to 21 million cases of diarrheal illnesses annually in the U.S.

Major players operating in the U.S intravenous solution market are B. Braun Melsungen AG., Baxter International Inc., Fresenius Kabi USA, LLC, Grifols, S.A., JW Life Science, Amanta Healthcare, Salius Pharma Private Limited, Axa Parenterals Ltd., Vifor Pharma Management Ltd., ICU Medical, Inc., and Pfizer Inc.

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NIH Research Study Supports Wide Usage Of Gilead’s Remdesivir In COVID-19

The most recent news is positive, however …

For some reason, remdesivir seems to get more negative press than information supports.

Note: I use ‘RDV’ for remdesivir, which is what Gilead ( GILD) does internally, and I state ‘COVID’ in location of COVID-19

Now to the most recent RDV news and some media reaction:

Outcomes of an NIH-sponsored study were summed up in the NEJM Friday. A supplement to the article includes important details about the research study design and scientific information.

The NIH put out a press release concomitant with the online publication of the NEJM post. It was entitled Peer-reviewed data shows remdesivir for COVID-19 improves time to recovery NIH said in part:

… the findings support remdesivir as the standard therapy for patients hospitalized with COVID-19 and needing additional oxygen therapy …

I believe that the findings likewise support use of RDV in all hospitalized patients with pneumonia (or related pulmonary illness) due to COVID, though an argument can be made versus starting it in clients who are already on synthetic ventilation (Classification 7 in the research study’s terminology). In that sense, NIH’s phrasing was a bit careful in not pointing out RDV for Category 4 patients with COVID (i.e. not on additional oxygen).

Some media provided a more unfavorable view of RDV. CNN reported(focus added):

However appearance at the succinct conclusion the private investigators in fact wrote in the post:

Conclusions

Remdesivir was superior to placebo in reducing the time to healing in adults hospitalized with Covid-19 and evidence of lower respiratory tract infection.

That is various from a remedy, and as with some other viral diseases, combination treatment may enhance on RDV alone.

A popular, market-moving example of RDV-bashing came a few weeks back from, at first, the Financial Times.

Prior to going on, some caveats are required.

Science may move quick here, either with what eventually are remarkable drug treatments to RDV and/or prevalent efficient usage of a vaccine which might substantially restrict the need for therapeutics.

Next up …

An appearance at some of the key data

The NIAID/NIH study randomized 1063 patients hospitalized with COVID and defined them as fitting into 4 categories of ascending seriousness of illness.

The information favored RDV.

The information trended better for RDV than placebo in category 4, with a very great ratio of 1.

Trends in mortality favor RDV over placebo

With the benefit of hindsight, it is possible to review the rushed NIAID research study as imperfectly prepared, as it aggregated data amongst a low-risk group (Category 4) with 2 intermediate levels of greater seriousness (Categories 5-6) all the method to critically ill clients on synthetic ventilation (Classification 7).

In General, the RDV group, using a certain type of analytical analysis (Kaplan-Meier price quote), had a 7.1%mortality rate after 2 weeks, versus 11.9%for the placebo group.

Regarding Category 5, as Table 2 programs (bottom selection in the table), there were just 4 deaths (2%) in the RDV group versus 20 deaths (12%) in the placebo group.

Whereas, in the milder Classification 4 group, there was just 1 death in each of the RDV and placebo groups (2%), and no one in the RDV group progressed to require mechanical ventilation versus 4%in the placebo group.

The RDV groups had (mildly) higher percentages of:

diabetes

coronary artery disease

asthma

chronic oxygen therapy pre-COVID

persistent kidney illness

cancer

obesity.

Yet there are now 2 blinded, placebo-controlled research studies of RDV throughout this crisis period, and the results are consistent on trend that utilizing the drug speeds recovery from COVID.

Some have recommended that GILD is doing its RDV advancement without thinking of profit.

Conclusions – RDV’s commercial possible slowly gets much better defined

I think that COVID-19 has a brand-new requirement of care, RDV, and that the FDA will move to authorize it, either as a basic or accelerated approval.

GILD showed in its last conference call that it is working on a subcu variation of RDV as well as the more tough breathed in version.

More info is coming quickly: GILD is planning to release outcomes from its research study of RDV in what amounts to Category 4 patients in about a week.

In summary, the New England Journal of Medicine released a post Friday after the market closed that concluded that remdesivir, or RDV, was superior to placebo in shortening the time to healing (a requirement procedure of antiviral efficacy) in adults hospitalized with COVID-19 and pulmonary involvement.

This conclusion was not customized to just Category 5, or to patients receiving additional oxygen (Classification 4, where RDV revealed perfectly beneficial trends).

More studies, utilizing bigger patient subgroups, would be really practical in delineating how reliable RDV is in different seriousness levels of COVID and when considering comorbidities, period of illness before starting treatment, and so on

Other approaches, such as the antibody treatments that REGN and others are rapidly establishing, might be additive to RDV in hospitalized COVID clients, and may be effective as one-dose treatments for outpatients.

Disclosure: I am/we are long GILD, RHHBY, REGN.

I have no present strategies to cease owning GILD.

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