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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 6 | Issue 3
Page Nos. 65-107

Online since Friday, October 22, 2021

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REVIEW ARTICLES  

Wind turbines and adverse health effects: Applying Bradford Hill's criteria for causation Highly accessed article p. 65
Anne Dumbrille, Robert Y McMurtry, Carmen Marie Krogh
DOI:10.4103/ed.ed_16_21  
The weight of evidence indicates occurrences of adverse health effects (AHEs) from living and working near industrial wind turbines (IWTs). Descriptions of the AHEs being reported by those living or working near the turbines are similar. While these occurrences have been associated with exposure to audible and inaudible noise annoyance, the causation of reported wind turbine-associated health effects remains controversial. Establishing an argument of causation of adverse health outcomes has important clinical, scientific, and societal implications. Bradford Hill (BH) criteria have been widely used to establish causality between an environmental agent and risk of disease or disability, but have not previously been used to evaluate the relationship between IWTs and AHEs. The objective was to apply the BH criteria to evaluate the relationship between IWTs and AHEs. The nine criteria include the strength of the association, consistency, specificity, temporal sequence, biological gradient, plausibility, coherence, experimental evidence, and analogous evidence. These nine criteria have been applied to IWT exposure and reported AHEs using peer-reviewed and other published literature that describes clinical, animal, and laboratory studies, testimony and reported experiences, and internet sources. Applying the BH criteria to the IWT-related clinical, biological, and experimental data demonstrates that the exposure to IWTs is associated with an increased risk of AHEs. This analysis concludes that living or working near IWTs can result in AHEs in both people and animals. Our findings provide compelling evidence that the risk of AHEs should be considered before the approval of wind energy projects and during the assessment of setback distances of proposed and operational projects.
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Liver: Could it lead us to a promised land to deflame the brain? p. 88
Ho Jun Yun, Yuchuan Ding
DOI:10.4103/ed.ed_20_21  
Ischemic stroke occurs with disruption of blood perfusion to the brain. Damages from ischemia result in inflammation of the brain cells. Biologics and immunomodulators have been developed to mitigate neuroinflammation after ischemic stroke. Several druggable targets have been identified, including microglia/macrophages, receptors of the complement pathway, inhibition of tumor necrosis factor-ɑ, and others. However, the efficacy of the immunomodulators is in their infant stage largely due to our incomplete understanding of neuroinflammation. Hypothermia has been utilized to alleviate systemic inflammation though its negative effects have been reported. The roles of the liver in systemic inflammation and its association to ischemic stroke are fairly well-known. Local hypothermic induction to the liver may be a desirable treatment option for ischemic stroke while minimizing the systemic side effects of hypothermia. In this mini-review, we briefly summarize the current understanding of the involvement of active inflammatory response in ischemic stroke and the associated organs, particularly the liver.
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ORIGINAL ARTICLE Top

Urinary metabolites as exposure biomarkers of benzene, toluene, ethylbenzene, and xylene in footwear workers and assessment of pulmonary function p. 91
Anupa Yadav, Asim Saha, Amit Chakrabarti, Geoffrey Nengzapum, Anirban Das, Surajit Das
DOI:10.4103/ed.ed_5_21  
Aim: This pilot cross-sectional study focused on biological monitoring of the benzene, toluene, ethylbenzene, and xylene (BTEX) urinary metabolites trans, trans-muconic acid (tt-MA), s-phenyl mercapturic acid (SPMA), hippuric acid (HA), mandelic acid (MA), and methylhippuric acid (MHA) and measured the effects of workplace BTEX exposure on pulmonary function of workers engaged in footwear manufacturing. Materials and Methods: Urinary metabolites tt-MA, SPMA, HA, MA, and MHA concentration in urine samples of study participants (N = 35) were analyzed by reverse-phase high-pressure liquid chromatography. Pulmonary function parameters were measured by spirometer and peak flow meter. Demographic information and work exposure information of study participants were collected by questionnaire interview. Results: In exposed workers, concentration of urinary SPMA, tt-MA, and HA was significantly higher (P < 0.01, in all) than the control group. Reduction in both force expiratory volume in 1 s (Forced expiratory volume in one second) and peak expiratory flow rate (PEFR) were inversely associated (P < 0.01) with growing years of age among all workers. Inverse association was measured between urinary tt-MA and decline in forced vital capacity and PEFR (P < 0.05, for each) in workers. Based on the questionnaire interview, workers were not found to be aware of workplace exposure hazards. Conclusions: Exposure biomarkers of benzene (tt-MA and SPMA) and toluene (HA) were significantly higher in workers than the control group. Study results evident the presence of occupational exposure to benzene and toluene in footwear workers. Deterioration in FEV1 and PEFR were also measured among all workers with growing years of age. The sample size was small in the present study, so further research required to confirm our results.
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SHORT COMMUNICATION Top

High burden to high impact: Strengthening services for malaria elimination p. 98
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ed.ed_10_21  
Malaria is a major public health concern, and for many decades, consistent efforts have been taken to reduce the incidence of the disease as well as the associated deaths. In-fact, in the year 2019, a total of 229 million cases of the disease were reported globally. Malaria elimination has to be given utmost public health importance as the sufferings, complications of the infection, impairment in the quality of life, and the burden on the health-care delivery system are very much preventable. In the vision to accomplish malaria elimination, it is quite essential to understand the geographic conditions and the local predisposing factors before drafting the final strategy. In order to deal with this emerging situation, the World Health Organization in collaboration with the Roll Back Malaria partnership has come up with a high burden to high impact plan. It is a nation-owned and led approach developed in accordance with the set Sustainable Development Goals. In conclusion, the need of the hour is to strengthen services for elimination of malaria, and it will essentially require a multi-pronged approach involving different stakeholders, multiple sectors, and a well-co-ordinated team approach to bridge the existing lacunae and move considerable progress in the global aim to minimize sufferings and mortality attributed to a totally preventable and curable disease.
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COMMENTARY Top

The overestimation of medical consequences of low-dose exposures: Cui bono? p. 101
Sergei V Jargin
DOI:10.4103/ed.ed_13_21  
After the Chernobyl disaster appeared papers overestimating medical consequences of low-dose radiation exposures. Examples have been discussed previously; an updated overview of selected studies is provided here. Various kinds of bias can be found in the epidemiological research reporting elevated health risks from low doses of ionizing radiation: Interpretation of spontaneous conditions as radiation-induced, dose comparisons disregarding the natural background, publication bias, etc. Admittedly, all relevant parameters cannot always be taken into account in epidemiological research. Several examples of potentially biased reports on Mayak Production Association workers and Techa river valley residents are analyzed here. Doubtful correlations between exposures to low radiation doses and nonmalignant conditions, discussed in this commentary, call into question the cause-effect character of such correlations for malignancies revealed by the same scientists. Correlations can be caused or influenced by dose-dependent selection and self-selection. Individuals with higher doses were probably more motivated to undergo medical checkups and given more attention. The medical surveillance of exposed populations is important; but more consideration should be given to potential bias. A promising approach to the study of dose-response relationships are lifelong experiments in different animal species that can reveal the net harm or potential benefit (within a certain range according to the concept of hormesis) from low-dose exposures to ionizing radiation.
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