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Frontiers in Pediatrics 2023Subcutaneous immunotherapy (SCIT) has been proved to be effective and safe in adult asthma. But it is still controversial in children. (Review)
Review
BACKGROUND
Subcutaneous immunotherapy (SCIT) has been proved to be effective and safe in adult asthma. But it is still controversial in children.
OBJECT
To evaluate the efficacy and safety of SCIT in asthmatic children with allergy to house dust mite.
METHOD
We searched the databases of Cochrane Library, EMBASE and MEDLINE (from 1 January 1990 to 1 December 2022). Two reviewers independently screened studies, extracted data and critically appraised the risk of bias. We used the Revman 5 to synthesize the effect sizes.
RESULTS
We finally selected 38 eligible studies including 21 randomized controlled trials to evaluate the efficacy and safety of SCIT and 17 observational studies to assess the safety. The results revealed that short-term asthma symptom scores were declined with a standardized mean difference (SMD) of -1.19 (95% CI: -1.87, -0.50) in 12 researches with high heterogeneity. Short-term asthma medication scores were decreased with SMD -1.04 (95% CI: -1.54, -0.54) in 12 heterogeneous researches. One study showed no significant reduction in combined symptom and medication scores without providing details. No studies we reviewed reported long-term efficacy. SCIT resulted in an obviously increased risk of adverse reactions compared with placebo. For secondary outcomes, SCIT improved life quality and reduced the numbers of annual asthma attacks and allergen-specific airway hyperreactivity, but without significant improvement in pulmonary function, asthma control or hospitalization.
CONCLUSIONS
SCIT can reduce the short-term symptom scores and medication scores regardless of different treatment duration or mono/polysensitization, but with an increased incidence of local and systemic adverse effects. Further studies on pediatric asthma are needed to evaluate the long-term efficacy, and clarify the effectiveness of SCIT in specific population using mix allergen extracts or with severe asthma. Overall, it is recommended for children with mild-moderate HDM-driven allergic asthma.
PubMed: 37397157
DOI: 10.3389/fped.2023.1137478 -
Occupational and Environmental Medicine Jan 2023Adverse occupational exposures can accelerate age-related lung function decline. Some longitudinal population-based studies have investigated this association. This... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Adverse occupational exposures can accelerate age-related lung function decline. Some longitudinal population-based studies have investigated this association. This study aims to examine this association using findings reported by longitudinal population-based studies.
METHODS
Ovid Medline, PubMed, Embase, and Web of Science were searched using keywords and text words related to occupational exposures and lung function and 12 longitudinal population-based studies were identified using predefined inclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Lung function decline was defined as annual loss of forced expiratory volume in 1 s (FEV), forced vital capacity (FVC) or the ratio (FEV/FVC). Fixed and random-effects meta-analyses were conducted to calculate pooled estimates for ever and cumulative exposures. Heterogeneity was assessed using the I test, and publication bias was evaluated using funnel plots.
RESULTS
Ever exposures to gases/fumes, vapours, gases, dusts, fumes (VGDF) and aromatic solvents were significantly associated with FEV decline in meta-analyses. Cumulative exposures for these three occupational agents observed a similar trend of FEV decline. Ever exposures to fungicides and cumulative exposures to biological dust, fungicides and insecticides were associated with FEV decline in fixed-effect models only. No statistically significant association was observed between mineral dust, herbicides and metals and FEV decline in meta-analyses.
CONCLUSION
Pooled estimates from the longitudinal population-based studies have provided evidence that occupational exposures are associated with FEV decline. Specific exposure control and respiratory health surveillance are required to protect the lung health of the workers.
Topics: Humans; Fungicides, Industrial; Occupational Exposure; Lung; Forced Expiratory Volume; Vital Capacity; Dust; Gases; Longitudinal Studies
PubMed: 36280382
DOI: 10.1136/oemed-2022-108237 -
PloS One 2023Occupational respiratory disorders are a major global public health concern among workers exposed to dust particles in dust-generating workplaces. Despite fragmented... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Occupational respiratory disorders are a major global public health concern among workers exposed to dust particles in dust-generating workplaces. Despite fragmented research findings on the magnitude of respiratory problems and the lack of a national occupational respiratory disease recording and reporting system at the Ethiopian factory, the prevalence of respiratory symptoms among factory workers were unknown. Therefore, the aim of this meta-analysis was to summarize and pool estimates from studies that reported the prevalence of respiratory symptoms and predictors among Ethiopian factory workers who worked in dusty environments.
METHODS
A systematic literature searches were conducted using electronic databases (PubMed, Science Direct, African Journals Online, and Web of Science). The primary and secondary outcomes were prevalence of respiratory symptoms and predictors, respectively. The STATA version 17 was used to analyze the data. A random effect meta-analysis model was used. Eggers test with p-value less than 5%, as well as the funnel plot, were used to assess publication bias.
RESULTS
The searches yielded 1596 articles, 15 of which were included in the systematic review and meta-analysis. The pooled prevalence of respiratory symptoms among Ethiopian factory workers was 54.96% [95% confidence interval (CI):49.33-60.59%]. Lack of occupational health and safety (OSH) training [Odds Ratio (OR) = 2.34, 95%CI:1.56-3.52], work experience of over 5 years [OR = 3.19, 95%CI: 1.33-7.65], not using personal protective equipment (PPE) [OR = 1.76, 95%CI:1.30-2.39], and working more than eight hours per day [OR = 1.89, 95%CI:1.16-3.05] were all significant predictors of respiratory symptoms.
CONCLUSION
The prevalence of respiratory symptom was found to be high in Ethiopian factory workers. To prevent workers from being exposed to dust, regular provision and monitoring of PPE use, workers OSH training, and adequate ventilation in the workplace should be implemented.
Topics: Humans; Dust; Occupational Exposure; Lung Diseases; Lung; Personal Protective Equipment; Occupational Diseases
PubMed: 37478114
DOI: 10.1371/journal.pone.0284551 -
International Journal of Environmental... Aug 2023Diet is the primary exposure pathway for phthalates, but relative contributions of other exposure sources are not well characterized. This study quantifies the relative... (Meta-Analysis)
Meta-Analysis Review
Characterizing the Contribution of Indoor Residential Phthalate and Phthalate Alternative Dust Concentrations to Internal Dose in the US General Population: An Updated Systematic Review and Meta-Analysis.
Diet is the primary exposure pathway for phthalates, but relative contributions of other exposure sources are not well characterized. This study quantifies the relative contribution of indoor residential dust phthalate and phthalate alternative concentrations to total internal dose estimated from the National Health and Nutrition Examination Survey (NHANES) urinary metabolite concentrations. Specifically, median phthalate and phthalate alternative concentrations measured in residential dust were determined by updating a pre-existing systematic review and meta-analysis published in 2015 and the attributable internal dose was estimated using intake and reverse dosimetry models. Employing a predetermined search strategy, 12 studies published between January 2000 and April 2022 from Web of Science and PubMed measuring phthalates and phthalate alternatives in residential dust were identified. From the data extracted, it was estimated that dust contributed more significantly to the internal dose of low-molecular weight chemicals such as DEP and BBP when compared to high-molecular weight chemicals such as DEHTP. Additionally, findings showed that the chemical profile of residential dust is changing temporally with more phthalate alternatives being detected in the indoor environment. Future studies should seek to characterize the contribution of dust to an overall phthalate and phthalate alternative intake for individuals who have higher than normal exposures.
Topics: Humans; Nutrition Surveys; Phthalic Acids; Dust; Molecular Weight; Thinness
PubMed: 37623174
DOI: 10.3390/ijerph20166589 -
BMC Public Health May 2021While the association between occupational inhalation of silica dust and pulmonary tuberculosis has been known for over a century, there has never been a published... (Meta-Analysis)
Meta-Analysis
BACKGROUND
While the association between occupational inhalation of silica dust and pulmonary tuberculosis has been known for over a century, there has never been a published systematic review, particularly of experience in the current era of less severe silicosis and treatable tuberculosis. We undertook a systematic review of the evidence for the association between (1) silicosis and pulmonary tuberculosis, and (2) silica exposure and pulmonary tuberculosis controlling for silicosis, and their respective exposure-response gradients.
METHODS
We searched PUBMED and EMBASE, and selected studies according to a priori inclusion criteria. We extracted, summarised and pooled the results of published case-control and cohort studies of silica exposure and/or silicosis and incident active tuberculosis. Study quality was assessed on the Newcastle-Ottawa Scale. Where meta-analysis was possible, effect estimates were pooled using inverse-variance weighted random-effects models. Otherwise narrative and graphic synthesis was undertaken. Confidence regarding overall effect estimates was assessed using the GRADE schema.
RESULTS
Nine studies met the inclusion criteria. Meta-analysis of eight studies of silicosis and tuberculosis yielded a pooled relative risk of 4.01 (95% confidence interval (CI) 2.88, 5.58). Exposure-response gradients were strong with a low silicosis severity threshold for increased risk. Our GRADE assessment was high confidence in a strong association. Meta-analysis of five studies of silica exposure controlling for or excluding silicosis yielded a pooled relative risk of 1.92 (95% CI 1.36, 2.73). Exposure-response gradients were observable in individual studies but not finely stratified enough to infer an exposure threshold. Our GRADE assessment was low confidence in the estimated effect owing to inconsistency and use of proxies for silica exposure.
CONCLUSIONS
The evidence is robust for a strongly elevated risk of tuberculosis with radiological silicosis, with a low disease severity threshold. The effect estimate is more uncertain for silica exposure without radiological silicosis. Research is needed, particularly cohort studies measuring silica exposure in different settings, to characterise the effect more accurately as well as the silica exposure threshold that could be used to prevent excess tuberculosis risk.
Topics: Dust; Humans; Occupational Exposure; Risk Factors; Silicon Dioxide; Silicosis
PubMed: 34016067
DOI: 10.1186/s12889-021-10711-1 -
International Journal of Hygiene and... Sep 2021Lead (Pb) is a ubiquitous environmental pollutant and a potent toxic compound. Humans are exposed to Pb through inhalation, ingestion, and skin contact via food, water,... (Review)
Review
Lead (Pb) is a ubiquitous environmental pollutant and a potent toxic compound. Humans are exposed to Pb through inhalation, ingestion, and skin contact via food, water, tobacco smoke, air, dust, and soil. Pb accumulates in bones, brain, liver and kidney. Fetal exposure occurs via transplacental transmission. The most critical health effects are developmental neurotoxicity in infants and cardiovascular effects and nephrotoxicity in adults. Pb exposure has been steadily decreasing over the past decades, but there are few recent exposure data from the general European population; moreover, no safe Pb limit has been set. Sensitive biomarkers of exposure, effect and susceptibility, that reliably and timely indicate Pb-associated toxicity are required to assess human exposure-health relationships in a situation of low to moderate exposure. Therefore, a systematic literature review based on PubMed entries published before July 2019 that addressed Pb exposure and biomarkers of effect and susceptibility, neurodevelopmental toxicity, epigenetic modifications, and transcriptomics was conducted. Finally included were 58 original papers on Pb exposure and 17 studies on biomarkers. The biomarkers that are linked to Pb exposure and neurodevelopment were grouped into effect biomarkers (serum brain-derived neurotrophic factor (BDNF) and serum/saliva cortisol), susceptibility markers (epigenetic markers and gene sequence variants) and other biomarkers (serum high-density lipoprotein (HDL), maternal iron (Fe) and calcium (Ca) status). Serum BDNF and plasma HDL are potential candidates to be further validated as effect markers for routine use in HBM studies of Pb, complemented by markers of Fe and Ca status to also address nutritional interactions related to neurodevelopmental disorders. For several markers, a causal relationship with Pb-induced neurodevelopmental toxicity is likely. Results on BDNF are discussed in relation to Adverse Outcome Pathway (AOP) 13 ("Chronic binding of antagonist to N-methyl-D-aspartate receptors (NMDARs) during brain development induces impairment of learning and memory abilities") of the AOP-Wiki. Further studies are needed to validate sensitive, reliable, and timely effect biomarkers, especially for low to moderate Pb exposure scenarios.
Topics: Adult; Biomarkers; Brain-Derived Neurotrophic Factor; Humans; Infant; Lead; Learning; Saliva
PubMed: 34655857
DOI: 10.1016/j.ijheh.2021.113855 -
Journal of Education and Health... 2021New epidemiological studies acknowledge the detrimental effects of dust storms on health. The aim of this study was to systematically review the effects of dust storms... (Review)
Review
New epidemiological studies acknowledge the detrimental effects of dust storms on health. The aim of this study was to systematically review the effects of dust storms on the morbidity and mortality rates of cardiovascular and respiratory diseases. The results of this study were obtained based on articles published in English-language journals. For the purpose of this study, all articles published until the end of 2020 based on the search in the "Scopus," "Web of Science," and "PubMed" databases were selected. Articles were searched independently by two trained researchers. Dust storms are the cause of many diseases and health-related complications, of which cardiovascular and respiratory diseases are common. It is necessary to recognize and investigate the harmful effects of dust storms to prevent serious harms to human societies. In the reviewed articles, the impact of dust storms on several diseases, including cardiovascular and respiratory diseases, has been analyzed. Most of these articles acknowledge the effect of dust storms on increasing the incidence and mortality rate of these diseases, although in some articles this effect is not statistically significant. Many studies conducted around the world confirm the harmful effects of dust storms on cardiovascular and respiratory diseases, including increase in the number and duration of hospitalizations, as well as increase in mortality and exacerbation of these diseases. However, some studies do not consider the harmful effects of dust storms on the above diseases to be statistically significant.
PubMed: 34250125
DOI: 10.4103/jehp.jehp_1272_20 -
European Urology Focus Jan 2024Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL). (Review)
Review
CONTEXT
Controversy exists regarding the therapeutic benefit of suction use during percutaneous nephrolithotripsy (PCNL).
OBJECTIVE
To review and highlight the options available in the use of suction for PCNL, and to discuss their strengths and limitations.
EVIDENCE ACQUISITION
A systematic literature search was performed using Scopus, EMBASE, and PubMed. Thirty four studies were included. There was one ex vivo study. Among clinical studies, 24 used a vacuum/suctioning sheath and nine a handpiece suction device/direct-in-scope suction. The suction technique was employed in standard, mini-PCNL, supermini-PCNL, and enhanced supermini‑PCNL techniques.
EVIDENCE SYNTHESIS
Handpiece suction devices demonstrated better safety and efficiency in treating large stones than nonsuction PCNL and in a much shorter time. Trilogy and ShockPulse-SE were equally effective, safe, and versatile for standard PCNL and mini-PCNL. The heavier handpiece makes Trilogy less ergonomically friendly. Laser suction handpiece devices can potentiate laser lithotripsy by allowing for better laser control with simultaneous suction of small fragments and dust. Integrated suction-based sheaths are available in reusable and disposable forms for mini-PCNL only. Mini-PCNL with suction reported superior outcomes for operative time and stone-free rate to mini-PCNL. This also helped minimize infectious complications by a combination of intrarenal pressure reduction and faster aspiration of irrigation fluid reducing the risk of sepsis, enhance intraoperative vision, and improve lithotripsy efficiency, which makes it a very attractive evolution for PCNL.
CONCLUSIONS
Suction devices in PCNL are reforming the way PCNL is being done. Adding suction to mini-PCNL reduces infectious complications and improves the stone-free rate. Our review shows that despite the limited evidence, suction techniques appear to improve PCNL outcomes.
PATIENT SUMMARY
In this review, we looked at the intra- and perioperative outcomes of percutaneous nephrolithotripsy (PCNL) with the addition of suction. With better stone fragmentation and fewer postoperative infections, this technology is very useful particularly for mini-PCNL.
Topics: Humans; Kidney Calculi; Suction; Lithotripsy; Lithotripsy, Laser; Postoperative Complications
PubMed: 37442721
DOI: 10.1016/j.euf.2023.06.010 -
PLOS Global Public Health 2023An estimated 44 million artisanal and small-scale miners (ASM), largely based in developing economies, face significant occupational risks for respiratory diseases which...
An estimated 44 million artisanal and small-scale miners (ASM), largely based in developing economies, face significant occupational risks for respiratory diseases which have not been reviewed. We therefore aimed to review studies that describe silicosis and tuberculosis prevalence and respirable crystalline silica (RCS) exposures among ASM and use background evidence to better understand the relationship between exposures and disease outcomes. We searched PubMed, Web of Science, Scopus and Embase for studies published before the 24th March 2023. Our primary outcome of interest was silicosis or tuberculosis among ASM. Secondary outcomes included measurements of respirable dust or silica, spirometry and prevalence of respiratory symptoms. A systematic review and narrative synthesis was performed and risk of bias assessed using the Joanna Briggs Prevalence Critical Appraisal Tool. Logistic and Poisson regression models with predefined parameters were used to estimate silicosis prevalence and tuberculosis incidence at different distributions of cumulative silica exposure. We identified 18 eligible studies that included 29,562 miners from 13 distinct populations in 10 countries. Silicosis prevalence ranged from 11 to 37%, despite four of five studies reporting an average median duration of mining of <6 years. Tuberculosis prevalence was high; microbiologically confirmed disease ranged from 1.8 to 6.1% and clinical disease 3.0 to 17%. Average RCS intensity was very high (range 0.19-89.5 mg/m3) and respiratory symptoms were common. Our modelling demonstrated decreases in cumulative RCS are associated with reductions in silicosis and tuberculosis, with greater reductions at higher mean exposures. Despite potential selection and measurement bias, prevalence of silicosis and tuberculosis were high in the studies identified in this review. Our modelling demonstrated the greatest respiratory health benefits of reducing RCS are in those with highest exposures. ASM face a high occupational respiratory disease burden which can be reduced by low-cost and effective reductions in RCS.
PubMed: 37733799
DOI: 10.1371/journal.pgph.0002085 -
The Science of the Total Environment Apr 2023Due to the rapidly increasing ridership and the relatively enclosed underground space, the indoor air quality (IAQ) in underground subway stations (USSs) has attracted... (Review)
Review
Due to the rapidly increasing ridership and the relatively enclosed underground space, the indoor air quality (IAQ) in underground subway stations (USSs) has attracted more public attention. The air pollutants in USSs, such as particulate matter (PM), CO and volatile organic compounds (VOCs), are hazardous to the health of passengers and staves. Firstly, this paper presents a systematic review on the characteristics and sources of air pollutants in USSs. According to the review work, the concentrations of PM, CO, VOCs, bacteria and fungi in USSs are 1.1-13.2 times higher than the permissible concentration limits specified by WHO, ASHRAE and US EPA. The PM and VOCs are mainly derived from the internal and outdoor sources. CO concentrations are highly correlated with the passenger density and the ventilation rate while the exposure levels of bacteria and fungi depend on the thermal conditions and the settled dust. Then, the online monitoring, fault detection and prediction methods of IAQ are summarized and the advantages and disadvantages of these methods are also discussed. In addition, the available control strategies for improving IAQ in USSs are reviewed, and these strategies are classified and compared from different viewpoints. Lastly, challenges of the IAQ management in the context of the COVID-19 epidemic and several suggestions for underground stations' IAQ management in the future are put forward. This paper is expected to provide a comprehensive guidance for further research and design of the effective prevention measures on air pollutants in USSs so as to achieve more sustainable and healthy underground environment.
Topics: Air Pollution, Indoor; Railroads; Carbon Dioxide; Environmental Monitoring; COVID-19; Particulate Matter; Air Pollutants; Volatile Organic Compounds; Bacteria; Fungi
PubMed: 36708828
DOI: 10.1016/j.scitotenv.2023.161781