The relationship between air pollution exposure and chronic obstructive pulmonary disease in Ahvaz, Iran

BACKGROUND: Air pollutants can have harmful effects on human health. Chronic obstructive pulmonary disease (COPD) is represented by a spectrum of obstructive airway diseases. The aim of this study was to evaluate the relationship between air pollution exposure and COPD in Ahvaz, Iran. METHODS: The present epidemiological study was performed in Ahvaz city. Data were obtained from the Ahvaz Department of Environment (ADoE). Sampling was performed for 24 hours in 4 stations. Raw data processing was performed using Microsoft Excel software, and after the impact of meteorological parameters, data were converted as input file into the model. Data analysis was performed using SPSS for Windows. RESULTS: The results of this study showed that the annual average PM10 concentration during 2012 was 727 μg/m3. According to the research findings, the two stations of Bureau of Meteorology and the city center had the highest and the lowest PM10 concentrations during 2012, respectively. The results showed a strong correlation between visits to a hospital due to COPD and PM10 emission in Ahvaz city. Approximately, 6.2% of hospital admissions for COPD occurred when the PM10 concentration was higher than 30 μg/m3. CONCLUSION: The findings of the present study showed that the total mean of particle matter was higher than the standard concentration. The higher percentage of hospital admission could be the result of the dust storm, higher average PM10, and sustained high concentration days in Ahva

In vitro assessment of Tribulus terrestris aqueous extract and Benzoxacin fraction against Helicobacter pylori isolates from biopsy samples of Iranian patients

Background & Objectives:  Helicobacter pylori (Hp) is related to gastritis, gastric ulcer, duodenal ulcer, and mucosal carcinoma. Emergence of multidrug resistant Hp strains encouraged the researchers to find new effective drugs. Especially medicinal herbs and plants which usually shows less side effects. The aim of this study was in vitro assessment of anti Hp activity of total extract of Tribulus terrestris (T. terrestris Benzoxacin, a local Iranian medicinal plant and its fraction Benzoxacin.Methods: total aqueous extract of aerial parts of the plant was prepared and liquid extraction with petroleum ether was used to separate its components. LC/MS system proved the existence of Benzoxazine derivative in the water fraction and the third's fraction. Anti (Hp) effects of total extract and its third fraction were examined by cup plate method and using standard MacFarland. 50 biopsy samples of antrum were detected from patients who were endoscopic candidates in Milad and Fayazbakhsh  hospitals of Tehran during 2011. All samples were isolated, diagnosed based on standard methods and biochemical tests and confirmed by PCR method for ureC gene, too.  Different dilutions (250, 500,750 and 1000 mg/ml) of total extract were prepared. Clarythromycin (Clr) E-test strips and an identified Hp OC1096 was used, simultaneously.Results: Of 50 biopsy samples, 12 Hp strains were isolated. Rapid urease test were positive in all expect one biopsy sample. Existence of ureC gene in all isolates were confirmed expect one strain by PCR. By cup plate method, resistant to concentrations of 1000 and 750mg/ml were detected in 50% of Hp isolates and 66.6% of them were resistant to concentrations 250 and 500 mg/ml .Also, 83.3% of Hp strains were resistant to Benzoxacin fraction. Clarythromycin sensitivity detected in 83% of Hp isolates, simultaneously.Conclusion: This study was done as a pilot study for in vitro evaluation of antibacterial effect of total extract of T. terrestris by cup plate method. Existence of high resistant rate (≥50%) to different concentrations T. terrestris aqueous extract seems doing test on more Hp strains  in future studies is highly  recommended .  In contrast of the similarity of Benzoxazin structure to Ofloxacin, existence of 83.3% of resistance among tested isolates showed no anti Hp effectiveness of this fraction.

The relationship between air pollution exposure and chronic obstructive pulmonary disease in Ahvaz, Iran

BACKGROUND: Air pollutants can have harmful effects on human health. Chronic obstructive pulmonary disease (COPD) is represented by a spectrum of obstructive airway diseases. The aim of this study was to evaluate the relationship between air pollution exposure and COPD in Ahvaz, Iran. METHODS: The present epidemiological study was performed in Ahvaz city. Data were obtained from the Ahvaz Department of Environment (ADoE). Sampling was performed for 24 hours in 4 stations. Raw data processing was performed using Microsoft Excel software, and after the impact of meteorological parameters, data were converted as input file into the model. Data analysis was performed using SPSS for Windows. RESULTS: The results of this study showed that the annual average PM10 concentration during 2012 was 727 μg/m3. According to the research findings, the two stations of Bureau of Meteorology and the city center had the highest and the lowest PM10 concentrations during 2012, respectively. The results showed a strong correlation between visits to a hospital due to COPD and PM10 emission in Ahvaz city. Approximately, 6.2% of hospital admissions for COPD occurred when the PM10 concentration was higher than 30 μg/m3. CONCLUSION: The findings of the present study showed that the total mean of particle matter was higher than the standard concentration. The higher percentage of hospital admission could be the result of the dust storm, higher average PM10, and sustained high concentration days in Ahva

Health endpoints caused by PM10 Exposure in Ahvaz, Iran

PM10 emissions are defined as PM emissions that are less than ten microns in diameter. Long exposure of suspended particles as showed in his personal life. PM10 can cause harmful health effects such as the prevalence of bronchitis and reduced lung function in children and adults. Major sources of emissions are causing by human intervention particulate road traffic, stationary combustion and industrial processes. The aim of this study was to evaluate health- effects of carbon monoxide exposure in Ahvaz city (located in south-western Iran), during 2012. PM10 data were collected through Ahvaz Meteorological Organization and the Department of Environment. Raw data processing by Excel software includes (instruction set correction of averaging, coding and filtering) and after the impact of meteorological parameters was converted as input file to the Air Q model. Finally, respiratory mortality, cardiovascular death and hospital admissions respiratory disease of PM10 exposure was calculated. The results showed that the approximately 17% of total respiratory mortality, cardiovascular death and hospital admissions respiratory disease happened when the PM10 concentrations were more than 30μg/m3. The results showed that the concentration of PM10 was related to Ahvaz with an annual average 321 μg/m3. Sum of cardiovascular and respiratory death attributed to PM10 were 1055 and 189 cases in 2012. The higher percentage of these deaths perhaps could be the result of higher average PM10 or because of sustained high concentration days in Ahvaz. Therefore, the higher relative risk value can depict mismanagement in urban air quality

Cardiovascular deaths related to Carbon monoxide Exposure in Ahvaz, Iran

Carbon monoxide is an odorless, colorless and toxic gas that emitted from combustion. Carbon monoxide can cause harmful health effects by reducing oxygen delivery to the body's organs (like the heart and brain), tissues, fibrinolysis effects, abortion and death at extremely high levels. The aim of this study was to assess health- effects of carbon monoxide exposure in Ahvaz city. Data were collected through Ahvaz Meteorological Organization and Department of Environment. Raw data processing by Excel software includes (instruction set correction of averaging, coding and filtering) and after the impact of meteorological parameters was converted as input file to the Air Q model. Finally, health-effects of carbon monoxide exposure were calculated. The results showed that the concentration of carbon monoxide was 7.41 mg/m3 in Ahvaz as annual average. Sum of total numbers of deaths attributed to carbon monoxide was 16 cases within a year. Approximately 4.3% of total Cardiovascular deaths happened when the carbon monoxide concentrations was more than 20 mg/m3. This could be due to higher fuel consumption gasoline in vehicles, Oil industry, steel and Heavy industries in Ahwaz. Mortality and Morbidity risks were detected at current ambient concentrations of air pollutants

Correction to: Health risk assessment on human exposed to heavy metals in the ambient air PM10 in Ahvaz, southwest Iran

Heavy metals (HM) are one of the main components of urban air pollution. Today, megacities and industrial regions in southwest of Iran are frequently suffering from severe haze episodes, which essentially caused by PM10-bound heavy metals. The purpose of this study was to evaluate the health risk assessment on human exposed to heavy metals and Zn) in the ambient air PM10 in Ahvaz, southwest Iran. In this study, we estimated healthy people from the following scenarios: (S3) residential site; (S2) high-traffic site; (S1) industrial site in Ahvaz metropolitan during autumn and winter. In the current study, high-volume air samplers equipped with quartz fiber filters were used to sampling and measurements of heavy metal concentration. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was utilized for detection of heavy metal concentration (ng m−3 ). Also, an estimate of the amount of health risk assessment (hazard index) of Cr, Ni, Pb, and Zn of heavy metal exposure to participants was used. Result of this study showed that the residential and industrial areas had the lowest and the highest level of heavy metal. Based on the result of this study, average levels of heavy metal in industrial, high-traffic, and residential areas in autumn and winter were 31.48, 30.89, and 23.21 μg m−3 and 42.60, 37.70, and 40.07 μg m−3 , respectively. Based on the result of this study, the highest and the lowest concentration of heavy metal had in the industrial and residential areas. Zn and Pb were the most abundant elements among the studied PM10-bound heavy metals, followed by Cr and Ni. The carcinogenic risks of Cr, Pb, and the integral HQ of metals in PM10 for children and adults via inhalation and dermal exposures exceeded 1 × 10−4 in three areas. Also, based on the result of this study, the values of hazard index (HI) of HM exposure in different areas were significantly higher than standard. The health risks attributed to HM should be further investigated from the perspective of the public health in metropolitans. The result of this study showed increasing exposure concentrations to heavy metal in the studied scenarios have a significant potential for generating different health endpoints, while environmental health management in ambient air can cause disorders in citizenship and causing more spiritual and material costs

An evaluation of hospital admission respiratory disease attributed to sulfur dioxide ambient concentration in Ahvaz from 2011 through 2013

There is no doubt that air pollutants have adverse impacts on human health. The main objective of this study was to evaluate hospital admission respiratory disease (HARD) attributed to sulfur dioxide levels in Ahvaz during three successive years. Data was taken from Iranian Environmental Protection Agency (EPA). The AirQ2,2,3 model is used to quantify the impact of SO2 on inhabitants of Ahvaz and in terms of hospital admission respiratory diseases. This is a kind of statistical model which is based on some epidemiological indices such as relative risk, baseline incidence, and attributable proportion. Sampling was already performed for 24 h in four stations during 2011–2013. Four stations are good representative for residential, high traffic, industry, and background sites which cover the whole area of the Ahvaz city. Regarding to gravimetric scale, raw data of sulfur dioxide was processed using Excel software. Encoding, filtering, and processing were conducted to prepare input file for the Air Q2,2,3 model. After running model,1 Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2 Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 3 Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran 4 Razi Teaching Hospital, Clinical Research Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 5 Department of Internal Medicine, Division of Pulmonology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 6 Nutrition&Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 7 Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran 8 Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran 9 Department of Environmental Health Engineering, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran 10 The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Research Center, Bushehr University of Medical Sciences, Bushehr, Iran 11 Hyperlipidemia Research Center, Department of Laboratory Sciences School of Paramedical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR, Iran 12 Environmental Research Institute, Academic Center for Education, Culture and Research (ACECR), Rasht, Iran 13 Department of Anaesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 14 Occupational Hazards Control Research Center and Department of Environmental Health Engineering, School of Public Health Environmental, Shahid Beheshti University of Medical Sciences, Tehran, Iran 15 Faculty of Food Science & Technology, Tehran University, Tehran, Iran 16 Student Research Committee, Department of Environmental Health Engineering, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Environ Sci Pollut Res DOI 10.1007/s11356-016-7447-xoutputs presented in term of hospital admissions respiratory cases. Based on our result, the highest mean and maximum of seasonal and annual levels for sulfur dioxide were observed in 2013. We concluded that obnoxious quality of fuel and some deficiencies in maintenance and operation of industries lead to worse quality of ambient air especially in 2013. Cumulative cases of HARD attributed to sulfur dioxide level at central of relative risk (RR) were estimated 24, 25, and 30 persons for 2011, 2012, and 2013, respectively. The finding of this study showed that total mean of sulfur dioxide was higher than standard concentration. We also noticed that wintertime concentrations of sulfur dioxide during three successive years were higher than of those levels in summer

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study

Background: The SARS-CoV-2 delta (B.1.617.2) variant was first detected in England in March, 2021. It has since rapidly become the predominant lineage, owing to high transmissibility. It is suspected that the delta variant is associated with more severe disease than the previously dominant alpha (B.1.1.7) variant. We aimed to characterise the severity of the delta variant compared with the alpha variant by determining the relative risk of hospital attendance outcomes. Methods: This cohort study was done among all patients with COVID-19 in England between March 29 and May 23, 2021, who were identified as being infected with either the alpha or delta SARS-CoV-2 variant through whole-genome sequencing. Individual-level data on these patients were linked to routine health-care datasets on vaccination, emergency care attendance, hospital admission, and mortality (data from Public Health England's Second Generation Surveillance System and COVID-19-associated deaths dataset; the National Immunisation Management System; and NHS Digital Secondary Uses Services and Emergency Care Data Set). The risk for hospital admission and emergency care attendance were compared between patients with sequencing-confirmed delta and alpha variants for the whole cohort and by vaccination status subgroups. Stratified Cox regression was used to adjust for age, sex, ethnicity, deprivation, recent international travel, area of residence, calendar week, and vaccination status. Findings: Individual-level data on 43 338 COVID-19-positive patients (8682 with the delta variant, 34 656 with the alpha variant; median age 31 years [IQR 17–43]) were included in our analysis. 196 (2·3%) patients with the delta variant versus 764 (2·2%) patients with the alpha variant were admitted to hospital within 14 days after the specimen was taken (adjusted hazard ratio [HR] 2·26 [95% CI 1·32–3·89]). 498 (5·7%) patients with the delta variant versus 1448 (4·2%) patients with the alpha variant were admitted to hospital or attended emergency care within 14 days (adjusted HR 1·45 [1·08–1·95]). Most patients were unvaccinated (32 078 [74·0%] across both groups). The HRs for vaccinated patients with the delta variant versus the alpha variant (adjusted HR for hospital admission 1·94 [95% CI 0·47–8·05] and for hospital admission or emergency care attendance 1·58 [0·69–3·61]) were similar to the HRs for unvaccinated patients (2·32 [1·29–4·16] and 1·43 [1·04–1·97]; p=0·82 for both) but the precision for the vaccinated subgroup was low. Interpretation: This large national study found a higher hospital admission or emergency care attendance risk for patients with COVID-19 infected with the delta variant compared with the alpha variant. Results suggest that outbreaks of the delta variant in unvaccinated populations might lead to a greater burden on health-care services than the alpha variant. Funding: Medical Research Council; UK Research and Innovation; Department of Health and Social Care; and National Institute for Health Research