Nanotechnology and nanomaterial toxicity

34-42Nanotechnology, a field of research and innovation concerned with building 'things' - generally, materials and devices - on the scale of atoms and molecules. Nanotechnology is hailed as having the potential to increase the efficiency of energy consumption, help clean the environment, and solve major health problems. It is said to be able to massively increase manufacturing production at significantly reduced cost. The new and unique applications offered by nanotechnology in diverse areas have made it so popular that it is being applied today in almost all aspects of daily life. Although the small size and subsequent larger surface area of nanoparticles endow them with some highly useful and specific properties, it also renders them more active leading to unexpected and unanticipated consequences on interaction with biological systems. The biokinetics of nanoparticles are different from larger particles. When inhaled, they are efficiently deposited in all regions of the respiratory tract; they evade specific defence mechanisms; and they can translocate out of the respiratory tract via different pathways and mechanisms (endocytosis and transcytosis). Some of these nanoparticles not only possess inflammatory and pro-oxidant potential for biological systems, but also have antioxidant activity, which can explain early findings showing mixed results in terms of toxicity of nanoparticles to environmentally relevant species. Manufactured nanomaterials are likely to enter the environment for several reasons. Some are and others will be produced in tons, and any material produced in such mass quantities is likely to reach the environment from manufacturing effluent or from spillage during shipping and handling. They are being used in personal-care products such as cosmetics and sunscreens and can therefore enter the environment on a continual basis from washing off of consumer products. They are being used in electronics, tires, fuel cells, and many other products and it is still unknown whether some of these materials may leak out or be worn off over the period of use. They are also being used in disposable materials such as filters and electronics and may therefore reach the environment through landfills and other methods of disposal. The fate of nanomaterials in aqueous environment is controlled by many biotic/abiotic processes such as solubility, interactions between the nanomaterials and natural/anthropogenic chemicals in the ecosystem. Although humans have been exposed to airborne nanosized particles throughout their evolutionary stages but such exposure has increased dramatically over the last century due to anthropogenic sources. The rapidly developing field of nanotechnology is likely to become yet another source of toxicity through inhalation, ingestion, skin uptake, and injection of engineered nano-materials. Information about ecological risk, safety and potential hazards is urgently needed. Additional considerations for assessing safety of engineered nanoparticles include careful selections of appropriate and relevant doses/concentrations, the likelihood of increased effects in a compromised organism, and also the benefits of possible desirable effects. Before unknowingly dumping a huge amount of dangerous nanomaterials into the environment, we need to investigate the solubility and degradability of engineered NPs in soils and waters, to establish baseline information on their safety

Therapeutic plasma exchange in acute fatty liver of pregnancy: a case report and literature review

Acute fatty liver of pregnancy(AFLP) is characterised by acute liver failure that occurs most commonly in the third trimester of pregnancy. Emergent delivery of the foetus reverses liver failure in most cases. Rarely, termination of pregnancy may not reverse liver failure, and adjunct interventions may be required. Therapeutic plasma exchange (TPE) has been described in AFLP in very few reports. We describe a patient in whom liver failure and extrahepatic organ failure persisted four days after delivery. She underwent TPE for persistent liver failure which resulted in prompt clinical improvement. We propose that TPE be considered as a measure to salvage AFLP patients with liver failure that does not reverse after termination of pregnancy

Physician behaviour for antimicrobial prescribing for paediatric upper respiratory tract infections: a survey in general practice in Trinidad, West Indies

BACKGROUND: Upper respiratory tract infections (URTIs) are among the most frequent reasons for physician office visits in paediatrics. Despite their predominant viral aetiology, URTIs continue to be treated with antimicrobials. We explored general practitioners' (GPs) prescribing behaviour for antimicrobials in children (≤ 16 years) with URTIs in Trinidad, using the guidelines from the Centers for Disease Control and Prevention (CDC) as a reference. METHODS: A cross-sectional study was conducted on 92 consenting GPs from the 109 contacted in Central and East Trinidad, between January to June 2003. Using a pilot-tested questionnaire, GPs identified the 5 most frequent URTIs they see in office and reported on their antimicrobial prescribing practices for these URTIs to trained research students. RESULTS: The 5 most frequent URTIs presenting in children in general practice, are the common cold, pharyngitis, tonsillitis, sinusitis and acute otitis media (AOM) in rank order. GPs prescribe at least 25 different antibiotics for these URTIs with significant associations for amoxicillin, co-amoxiclav, cefaclor, cefuroxime, erythromycin, clarithromycin and azithromycin (p < 0.001). Amoxicillin alone or with clavulanate was the most frequently prescribed antibiotic for all URTIs. Prescribing variations from the CDC recommendations were observed for all URTIs except for AOM (50%), the most common condition for antibiotics. Doctors practicing for >30 years were more likely to prescribe antibiotics for the common cold (p = 0.014). Severity (95.7%) and duration of illness (82.5%) influenced doctors' prescribing and over prescribing in general practice was attributed to parent demands (75%) and concern for secondary bacterial infections (70%). Physicians do not request laboratory investigations primarily because they are unnecessary (86%) and the waiting time for results is too long (51%). CONCLUSIONS: Antibiotics are over prescribed for paediatric URTIs in Trinidad and amoxicillin with co-amoxiclav were preferentially prescribed. Except for AOM, GPs' prescribing varied from the CDC guidelines for drug and duration. Physicians recognise antibiotics are overused and consider parents expecting antibiotics and a concern for secondary bacterial infections are prescribing pressures. Guidelines to manage URTIs, ongoing surveillance programs for antibiotic resistance, public health education on non-antibiotic strategies, and postgraduate education for rational pharmacotherapy in general practice would decrease inappropriate antibiotic use in URTIs

Healthcare utilisation and expenditure patterns for cardio-metabolic diseases in South Asian cities: The CARRS study

Objective: To estimate average annual expenditures per person, total economic burden and distress health financing associated with the treatment of five cardio-metabolic diseases (CMDs-hypertension, diabetes, heart disease (angina, myocardial infarction and heart failure), stroke and chronic kidney disease) in three metropolitan cities in South Asia.Design: Cross-sectional surveys.Setting: We analysed community-based baseline data from the Centre for cArdio-metabolic Risk Reduction in South Asia (CARRS) Study collected in 2010-2011 representing Chennai and New Delhi (India), and Karachi (Pakistan).Participants: We used data from non-pregnant adults (≥20 years) from the aforementioned cities that responded to a cost-of-illness questionnaire. We estimated health utilisation and expenditures among those reporting taking treatment(s) for the aforementioned CMDs in the last 1 year. We converted all costs to International Dollars (Int$2011) and inflated to 2018 values. The annual costs per person were stratified by city, sociodemographic characteristics, contributor of costs and financing methods. The total economic burden of CMDs for each city was projected using age-standardised prevalence and per-person costs of diseases reported in CARRS, applying these to population data from the most recent census. We also calculated distress financing (DF) as having to borrow or sell assets to pay for CMD treatment and identified sociodemographic groups at most risk of DF using multiple regression.Results: Of 16 287 CARRS participants, 2883 (17.7$358 to Int$2425. Medications constituted 46$0.42 billion, Int$3.4 billion and Int$1.4 billion in Chennai, New Delhi and Karachi, respectively. Overall, 36.1% experienced DF, and women (OR=4.4), unemployed (OR=10.7) and uninsured (OR=8.1) adults experienced higher odds of DF.Conclusion: CMDs are associated with large economic burdens in South Asia. Due to most payments coming from OOP expenditures and limited insurance, the odds of DF are high

India

This article surveys significant legal developments in India during the year 2014

Health-related quality of life variations by sociodemographic factors and chronic conditions in three metropolitan cities of South Asia: The CARRS study

Objectives: Health-related quality of life (HRQOL) is a key indicator of health. However, HRQOL data from representative populations in South Asia are lacking. This study aims to describe HRQOL overall, by age, gender and socioeconomic status, and examine the associations between selected chronic conditions and HRQOL in adults from three urban cities in South Asia.Methods: We used data from 16 287 adults aged ≥20 years from the baseline survey of the Centre for Cardiometabolic Risk Reduction in South Asia cohort (2010-2011). HRQOL was measured using the European Quality of Life Five Dimension-Visual Analogue Scale (EQ5D-VAS), which measures health status on a scale of 0 (worst health status) to 100 (best possible health status).Results: 16 284 participants completed the EQ5D-VAS. Mean age was 42.4 (±13.3) years and 52.4% were women. 14% of the respondents reported problems in mobility and pain/discomfort domains. Mean VAS score was 74 (95% CI 73.7 to 74.2). Significantly lower health status was found in elderly (64.1), women (71.6), unemployed (68.4), less educated (71.2) and low-income group (73.4). Individualswith chronic conditions reported worse health status than those without (67.4 vs 76.2): prevalence ratio, 1.8 (95% CI 1.61 to 2.04).Conclusions: Our data demonstrate significantly lower HRQOL in key demographic groups and those with chronic conditions, which is consistent with previous studies. These data provide insights on inequalities in population health status, and potentially reveal unmet needs in the community to guide health policies