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Indian Pediatr 2016;53: 1119 |
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News in Brief |
Gouri Rao Passi,
Email:
[email protected]
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The Air We Breathe
Air pollution levels reached such alarming levels
after the festival of Diwali in Delhi that schools had to be closed. At
Anand Vihar (Delhi), the Delhi Pollution Control Committee’s data showed
that the concentration of PM2.5 peaked at a whopping 883 µg/m3
– that is more than 14 times the standard of 60 µg/m3. At the same
place, the PM10 was 1680 – 16 times the safe limit of 100 µg/m3.
Urban air pollution is predicted to be the top environmental cause of
premature mortality worldwide by 2050. Thirteen of the 20 most polluted
cities globally are in India, and the country has the world’s highest
rate of deaths caused by chronic respiratory diseases. Air pollution in
India is estimated to kill 1.5 million people every year; it is the
fifth largest killer in India. A study in 2015 revealed that the cost of
air pollution-related illnesses and mortalities amounted to $0.5
trillion in India.
Air quality guidelines relate to four common air
pollutants: particulate matter (PM), ozone (O3), nitrogen
dioxide (NO2) and sulfur dioxide (SO2).The WHO
designates airborne particulates, a Group 1 carcinogen. The PM
(inhalable coarse particles with a diameter between 2.5 µm and 10 µm,
designated PM10 and PM2.5) is the deadliest form of air
pollution due to its ability to penetrate deep into the lungs and blood
streams unfiltered, causing permanent DNA mutations, heart attacks, and
premature death. WHO guideline limits for annual mean of PM2.5 are
10 mg/m3.
PM10 is primarily produced by mechanical processes such as construction
activities, road dust re-suspension and wind, whereas the PM2.5
originates primarily from combustion sources. An annual average
concentration of 10 µg/m3 was chosen as the long-term
guideline value for PM2.5 by the WHO. These findings suggest
that the health risks associated with short-term exposures to PM10
produce an increase in mortality of around 0.5% for each 10 µg/m3
increment in the daily concentration. Therefore, a PM10
concentration of 150 µg/m3 would be expected to translate
into roughly a 5% increase in daily mortality.
Children are more vulnerable to air pollution because
of their developing lungs. The number of alveoli increase from 24
million at birth to 257 million by 4 years. They breathe 50% more air
per kg body weight. Studies from Poland have shown that an increase of
10 mg/m3 in
PM10 exposure was associated with a decrease in growth of FEV1
of 84 mL/year. Besides the increased acute episodes of wheezing and
respiratory infections, there is evidence of increased fetal loss,
preterm deliveries and intrauterine growth retardation in prenatal
exposure to air pollutants. In the great smog in 1952 in London, the
infant mortality doubled.
The emergency in Delhi is a clarion call to all
Indians to clean up the air in their cities.
(The Hindu 31 October 2016, Economic & Political
Weekly 8 October 2016)
WHO Guidelines for Prevention of Surgical Site
Infections
The WHO guidelines for the prevention of surgical
site infections includes 29 recommendations by 20 of the world’s leading
experts. In low- and middle-income countries, 11% of patients who
undergo surgery get infected, and up to 20% of African women who have a
caesarean section contract a wound infection. In the United States,
they contribute to patients spending more than 400 000 extra days in
hospital at a cost of an additional 900 million USD per year. A pilot
study in four African countries showed that implementing a selection of
the new recommendations could result in a 39% reduction in surgical site
infections.
The guidelines include 13 recommendations for the
period before surgery, and 16 for preventing infections during and after
surgery. Many of the guidelines are simple and easily implementable. It
is recommended for patients to have a bath or shower prior to surgery.
Patients with known carriage of nasal S. aureus must receive
perioperative intranasal application of mupirocin 2% ointment. Standard
antibiotic prophylaxis must be administered within 120 minutes prior to
surgical incision but must not be continued after surgery.
Shaving or hair removal prior to surgery is not recommended while
surgical site skin preparation must be done with antiseptic solutions.
Immunosuppressive medications must not be discontinued prior to surgery.
An ounce of prevention is worth pounds of treatment.
(http://www.who.int/gpsc/global-guidelines-web.pdf)
Fighting the Zika Virus
An innovative experiment is being carried out in two South American
cities to fight the spread of the Zika virus. Mosquitoes infected with
the Wolbachia bacteria are to be released in large quantities in
Rio De Janeiro in Brazil and Medellin in Colombia. These bacteria spread
rapidly in the Aedes mosquito, and has the strange property of hindering
the fertility of the host and rendering their offspring infertile. It
also blocks the replication of the Zika and Chikungunya virus in the
mosquito, and may also limit the spread of the Dengue virus. Experiments
in Australia, Vietnam and Indonesia have found some measure of success.
If successful, it will be a game changer in vector control and is being
dubbed the biggest thing after DDT. (Nature 26 October 2016).
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