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Environment International May 2021Air pollution is a major environmental hazard to human health and a leading cause of morbidity for asthma worldwide. (Meta-Analysis)
Meta-Analysis
Short-term exposure to ozone, nitrogen dioxide, and sulphur dioxide and emergency department visits and hospital admissions due to asthma: A systematic review and meta-analysis.
BACKGROUND
Air pollution is a major environmental hazard to human health and a leading cause of morbidity for asthma worldwide.
OBJECTIVES
To assess the current evidence on short-term effects (from several hours to 7 days) of exposure to ozone (O), nitrogen dioxide (NO), and sulphur dioxide (SO) on asthma exacerbations, defined as emergency room visits (ERVs) and hospital admissions (HAs).
METHODS
We searched PubMed/MEDLINE, EMBASE and other electronic databases to retrieve studies that investigated the risk of asthma-related ERVs and HAs associated with short-term exposure to O, NO, or SO. We evaluated the risks of bias (RoB) for individual studies and the certainty of evidence for each pollutant in the overall analysis. A subgroup analysis was performed, stratified by sex, age, and type of asthma exacerbation. We conducted sensitivity analysis by excluding the studies with high RoB and based on the E-value. Publication bias was examined with the Egger's test and with funnel plots.
RESULTS
Our literature search retrieved 9,059 articles, and finally 67 studies were included, from which 48 studies included the data on children, 21 on adults, 14 on the elderly, and 31 on the general population. Forty-three studies included data on asthma ERVs, and 25 on asthma HAs. The pooled relative risk (RR) per 10 µg/m increase of ambient concentrations was 1.008 (95%CI: 1.005, 1.011) for maximum 8-hour daily or average 24-hour O, 1.014 (95%CI: 1.008, 1.020) for average 24-hour NO, 1.010 (95%CI: 1.001, 1.020) for 24-hour SO, 1.017 (95%CI: 0.973, 1.063) for maximum 1-hour daily O, 0.999 (95%CI: 0.966, 1.033) for 1-hour NO, and 1.003 (95%CI: 0.992, 1.014) for 1-hour SO. Heterogeneity was observed in all pollutants except for 8-hour or 24-hour O and 24-hour NO. In general, we found no significant differences between subgroups that can explain this heterogeneity. Sensitivity analysis based on the RoB showed certain differences in NO and SO when considering the outcome or confounding domains, but the analysis using the E-value showed that no unmeasured confounders were expected. There was no major evidence of publication bias. Based on the adaptation of the Grading of Recommendations Assessment, Development and Evaluation, the certainty of evidence was high for 8-hour or 24-hour O and 24-hour NO, moderate for 24-hour SO, 1-hour O, and 1-hour SO, and low for 1-hour NO.
CONCLUSION
Short-term exposure to daily O, NO, and SO was associated with an increased risk of asthma exacerbation in terms of asthma-associated ERVs and HAs.
Topics: Adult; Aged; Air Pollutants; Air Pollution; Asthma; Child; Emergency Service, Hospital; Hospitals; Humans; Nitrogen Dioxide; Ozone; Particulate Matter; Sulfur Dioxide
PubMed: 33601224
DOI: 10.1016/j.envint.2021.106435 -
Environmental Research Jan 2018The construction of high-voltage direct current (HVDC) lines for the long-distance transport of energy is becoming increasingly popular. This has raised public concern... (Review)
Review
BACKGROUND
The construction of high-voltage direct current (HVDC) lines for the long-distance transport of energy is becoming increasingly popular. This has raised public concern about potential environmental impacts of the static electric fields (EF) produced under and near HVDC power lines. As the second part of a comprehensive literature analysis, the aim of this systematic review was to assess the effects of static EF exposure on biological functions in invertebrates and plants and to provide the basis for an environmental impact assessment of such exposures.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to guide the methodological conduct and reporting.
RESULTS
Thirty-three studies - 14 invertebrate and 19 plant studies - met the eligibility criteria and were included in this review. The reported behavioral responses of insects and planarians upon exposure strongly suggest that invertebrates are able to perceive the presence of a static EF. Many other studies reported effects on physiological functions that were expressed as, for example, altered metabolic activity or delayed reproductive and developmental stages in invertebrates. In plants, leaf damage, alterations in germination rates, growth and yield, or variations in the concentration of essential elements, for example, have been reported. However, these physiological responses and changes in plant morphology appear to be secondary to surface stimulation by the static EF or caused by concomitant parameters of the electrostatic environment. Furthermore, all of the included studies suffered from methodological flaws, which lowered credibility in the results.
CONCLUSION
At field levels encountered from natural sources or HVDC lines (< 35kV/m), the available data provide reliable evidence that static EF can trigger behavioral responses in invertebrates, but they do not provide evidence for adverse effects of static EF on other biological functions in invertebrates and plants. At far higher field levels (> 35kV/m), adverse effects on physiology and morphology, presumably caused by corona-action, appear to be more likely. Higher quality studies are needed to unravel the role of air ions, ozone, nitric oxide and corona current on alterations in physiological functions and morphology.
Topics: Animals; Invertebrates; Plants; Static Electricity
PubMed: 28963966
DOI: 10.1016/j.envres.2017.09.013 -
PloS One 2015Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined.
OBJECTIVE
We sought to quantify the associations between short-term exposure to air pollutants [ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter ≤10 μm (PM10) and PM2.5] and the asthma-related emergency room visits (ERV) and hospitalizations.
METHODS
Systematic computerized searches without language limitation were performed. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) were estimated using the random-effect models. Sensitivity analyses and subgroup analyses were also performed.
RESULTS
After screening of 246 studies, 87 were included in our analyses. Air pollutants were associated with significantly increased risks of asthma ERVs and hospitalizations [O3: RR(95%CI), 1.009 (1.006, 1.011); I2 = 87.8%, population-attributable fraction (PAF) (95%CI): 0.8 (0.6, 1.1); CO: RR(95%CI), 1.045 (1.029, 1.061); I2 = 85.7%, PAF (95%CI): 4.3 (2.8, 5.7); NO2: RR(95%CI), 1.018 (1.014, 1.022); I2 = 87.6%, PAF (95%CI): 1.8 (1.4, 2.2); SO2: RR(95%CI), 1.011 (1.007, 1.015); I2 = 77.1%, PAF (95%CI): 1.1 (0.7, 1.5); PM10: RR(95%CI), 1.010 (1.008, 1.013); I2 = 69.1%, PAF (95%CI): 1.1 (0.8, 1.3); PM2.5: RR(95%CI), 1.023 (1.015, 1.031); I2 = 82.8%, PAF (95%CI): 2.3 (1.5, 3.1)]. Sensitivity analyses yielded compatible findings as compared with the overall analyses without publication bias. Stronger associations were found in hospitalized males, children and elderly patients in warm seasons with lag of 2 days or greater.
CONCLUSION
Short-term exposures to air pollutants account for increased risks of asthma-related ERVs and hospitalizations that constitute a considerable healthcare utilization and socioeconomic burden.
Topics: Aged; Air Pollutants; Air Pollution; Ambulatory Care; Asthma; Child; Emergency Service, Hospital; Environmental Exposure; Humans; Male; Particulate Matter; Patient Admission; Seasons; Time Factors
PubMed: 26382947
DOI: 10.1371/journal.pone.0138146 -
International Wound Journal Aug 2018Chronic wounds present a significant burden to the health care system and the patient. Ozone therapy has been proposed as a treatment for chronic wounds, potentially...
Chronic wounds present a significant burden to the health care system and the patient. Ozone therapy has been proposed as a treatment for chronic wounds, potentially acting by eliciting mild oxidative stress or disinfection. The purpose of this systematic review is to evaluate the potential benefits and harms of ozone therapy as an advanced care intervention for chronic wounds. Studies were extracted from Google Scholar, PubMed, the Cochrane Library, and reference lists. General inclusion criteria included English-language randomised human trials reporting the use of ozone therapy in the topical treatment of chronic wounds. Primary outcome data included the extent of chronic wound healing, and secondary outcomes included adverse effects. Studies were assessed for level of bias and data quality. Nine studies (n = 453 patients) matched the inclusion criteria and underwent meta-analysis. Overall, there was a significant improvement in wound closure with ozone therapy. Results consistently favour the application of ozone as a treatment for chronic wounds; however, there is no conclusive evidence of ozone therapy as superior compared with standard treatments. Compared with standard care, ozone therapy as an advanced wound care treatment may improve the proportion of chronic wounds healed in a shorter amount of time, but further research is required.
Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Chronic Disease; Female; Humans; Male; Middle Aged; Ozone; Surgical Wound Infection; Varicose Ulcer; Wound Healing
PubMed: 29536625
DOI: 10.1111/iwj.12907 -
Environment International Nov 2021Maternal wildfire exposure (e.g., smoke, stress) has been associated with poor birth outcomes with effects potentially mediated through air pollution and psychosocial... (Review)
Review
BACKGROUND
Maternal wildfire exposure (e.g., smoke, stress) has been associated with poor birth outcomes with effects potentially mediated through air pollution and psychosocial stress. Despite the recent hike in the intensity and frequency of wildfires in some regions of the world, a critical appraisal of the evidence on the association between maternal wildfire exposure and adverse birth outcomes has not yet been undertaken. We conducted a systematic review that evaluated the scientific evidence on the association between wildfire exposure during pregnancy and the risk of adverse birth outcomes.
METHODS
Comprehensive searches in nine bibliographic databases were conducted from database inception up to June 2020. Observational epidemiological studies that evaluated associations between exposure to wildfire during pregnancy and adverse birth outcomes were eligible for inclusion. Studies were assessed using the National Toxicology Program's Office of Health Assessment and Translation (NTP OHAT) risk of bias tool and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Screening of retrieved articles, data extraction, and risk of bias assessment were performed by two independent reviewers. Study results were synthesized descriptively.
RESULTS
Eight epidemiological studies conducted in four countries and involving 1,702,252 births were included in the review. The exposure to wildfire during pregnancy was assessed in individual studies by measurement of PM (n = 2), PM (n = 1), Total Ozone Mapping Spectrometer (TOMS)aerosol index (n = 1), heat spots (n = 1), and by proximity of maternal residence to wildfire-affected areas (n = 3). There is some evidence indicating that maternal wildfire exposure associates with birth weight reduction (n = 7) and preterm birth (n = 4), particularly when exposure to wildfire smoke occurred in late pregnancy. The association between wildfire exposure and small for gestational age (n = 2) and infant mortality (n = 1) was inconclusive.
CONCLUSION
Current evidence suggests that maternal exposure to wildfire during late pregnancy is linked to reduced birth weight and preterm birth. Well-designed comprehensive studies are needed to better understand the perinatal effects of wildfires.
Topics: Air Pollution; Female; Humans; Infant, Newborn; Infant, Small for Gestational Age; Maternal Exposure; Pregnancy; Pregnancy Outcome; Premature Birth; Wildfires
PubMed: 34030071
DOI: 10.1016/j.envint.2021.106644 -
British Journal of Anaesthesia Mar 2024Nitrous oxide (NO) is a common adjuvant to general anaesthesia. It is also a potent greenhouse gas and causes ozone depletion. We sought to quantify the influence of NO... (Review)
Review
BACKGROUND
Nitrous oxide (NO) is a common adjuvant to general anaesthesia. It is also a potent greenhouse gas and causes ozone depletion. We sought to quantify the influence of NO as an adjuvant to general anaesthesia on postoperative patient outcomes.
METHODS
We searched Medline, EMBASE, and Cochrane Central for works published from inception to July 6, 2023. RCTs comparing general anaesthesia with or without NO were included. Risk ratios (RRs) and standardised mean differences (SMDs) were calculated, along with 95% confidence intervals (CIs), using a random-effects model. Outcomes were derived from the Standardised Endpoints for Perioperative Medicine (StEP) outcome set. Primary outcomes were mortality and organ-related morbidity, and secondary outcomes were anaesthetic and surgical morbidity.
RESULTS
Of 3305 records, 179 full-text articles were assessed, and 71 RCTs, totalling 22 147 patients, were included in the meta-analysis. Addition of NO to general anaesthesia did not influence postoperative mortality or most morbidity outcomes. NO increased the incidence of atelectasis (RR 1.62, 95% CI 1.24 to 2.12) and postoperative nausea and vomiting (RR 1.27, 95% CI 1.15 to 1.40), and decreased intraoperative opioid consumption (SMD -0.19, 95% CI -0.35 to -0.04) and time to extubation (MD -2.17 min, 95% CI -3.32 to -1.03 min).
CONCLUSIONS
NO did not influence postoperative mortality or most morbidity outcomes. Considering the environmental effects of NO, these findings confirm that current policy recommendations to limit its use do not affect patient safety.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO CRD42023443287.
PubMed: 38471989
DOI: 10.1016/j.bja.2024.02.011 -
The Cochrane Database of Systematic... Feb 2019Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth...
BACKGROUND
Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'.
OBJECTIVES
To assess whether ozone is effective in arresting or reversing the progression of dental caries.
SEARCH METHODS
We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 3); MEDLINE and PREMEDLINE (OVID) (1966 to November 2003); EMBASE (OVID) (1980 to November 2003); CINAHL (OVID) (1982 to November 2003); AMED (OVID) (1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials.
SELECTION CRITERIA
Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months.
DATA COLLECTION AND ANALYSIS
Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies.
MAIN RESULTS
Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events.
AUTHORS' CONCLUSIONS
Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.
Topics: Cariostatic Agents; Dental Caries; Dental Fissures; Humans; Ozone; Randomized Controlled Trials as Topic
PubMed: 30731019
DOI: 10.1002/14651858.CD004153.pub3 -
International Wound Journal Nov 2022Ozonated water and oil are emerging as potential dermatologic therapeutics, particularly for the treatment of various wounds. However, the safety of these liquids has... (Review)
Review
Ozonated water and oil are emerging as potential dermatologic therapeutics, particularly for the treatment of various wounds. However, the safety of these liquids has not been extensively studied. The aim of this systematic review was to evaluate the risks of ozonated liquids to human skin tissue based on the available literature. We completed a structured search of five scientific databases and identified 378 articles for consideration. Based on pre-established inclusion/exclusion criteria, nine studies were included in this review. Two studies specifically evaluated the cytotoxicity of ozonated liquids on human cells, five studies evaluated ozonated liquids in randomised controlled trials (RCTs), one was a post-market surveillance study, and one was a crossover study in humans. None of the included studies found any significant human dermatologic risks associated with ozonated water or liquid. Because of the small sample size, however, additional short- and long-term RCTs specifically designed to evaluate the dermatological risks of ozonated liquids are recommended.
Topics: Humans; Wound Healing; Administration, Topical; Water; Ozone; Skin; Randomized Controlled Trials as Topic
PubMed: 35083865
DOI: 10.1111/iwj.13760 -
Journal of Clinical Medicine Apr 2022Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular... (Review)
Review
INTRODUCTION
Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains.
MATERIAL AND METHODS
The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis.
RESULTS
The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas.
DISCUSSION
Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis.
CONCLUSIONS
The most promising substances appear to be bone marrow and adipose tissue.
PubMed: 35566431
DOI: 10.3390/jcm11092305 -
Therapeutic Advances in Musculoskeletal... 2021We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP). (Review)
Review
OBJECTIVES
We aim to evaluate the benefits and harms of intervertebral disc therapies (IDTs) in people with non-specific chronic low back pain (NScLBP).
METHODS
We conducted a systematic review and meta-analysis of randomized trials of IDTs placebo interventions, active comparators or usual care. EMBASE, MEDLINE, CENTRAL and CINHAL databases and conference abstracts were searched from inception to June 2020. Two independent investigators extracted data. The primary outcome was LBP intensity at short term (1 week-3 months), intermediate term (3-6 months) and long term (after 6 months).
RESULTS
Of 18 eligible trials (among 1396 citations), five assessed glucocorticoids (GCs) IDTs and were included in a quantitative synthesis; 13 assessed other products including etanercept ( = 2), tocilizumab ( = 1), methylene blue ( = 2), ozone ( = 2), chymopapaine ( = 1), glycerol ( = 1), stem cells ( = 1), platelet-rich plasma ( = 1) and recombinant human growth and differentiation factor-5 ( = 2), and were included in a narrative synthesis. Standardized mean differences (95% CI) for GC IDTs for LBP intensity and activity limitations were -1.33 (-2.34; -0.32) and -0.76 (-1.85; 0.34) at short term, -2.22 (-5.34; 0.90) and -1.60 (-3.51; 0.32) at intermediate term and -1.11 (-2.91; 0.70) and -0.63 (-1.68; 0.42) at long term, respectively. Odds ratios (95% CI) for serious and minor adverse events with GC IDTs were 1.09 (0.25; 4.65) and 0.97 (0.49; 1.91).
CONCLUSION
GC IDTs are associated with a reduction in LBP intensity at short term in people with NScLBP. Positive effects are not sustained. IDTs have no effect on activity limitations. Our conclusions are limited by high heterogeneity and a limited methodological quality across studies.
REGISTRATION
PROSPERO: CRD42019106336.
PubMed: 34349845
DOI: 10.1177/1759720X211028001