Environmental risk factors for persistent asthma in Lucknow

Spatial distribution of the four invasive plants and their impact on natural communities' dynamics across the arid and semi-arid environments in northwest Pakistan

Introduction

Non-native species are globally successful invaders with negative impacts on vegetation communities' social, economic, and ecological values. Hence, the current research was carried out to assess the spatial distribution patterns and vegetative diversity of the four non-native species in severely invaded areas of the semi-arid parts of northern Pakistan.

Methods

The research was conducted using data from 1065 plots spread across 165 sites. These sites represented habitats throughout Northern Province, such as farm countryside, highlands, and abandoned places in rural and urban areas.

Results and discussion

The communities were floristically diverse, represented by 107 plant species, and dominated mainly by annual and perennial life forms with herbaceous habits. Similarly, the floristic structure shows significant variation tested by the χ2 test (P< 0.05) for plant status, life forms, life cycle, and habitat base distribution. In addition, the diversity indices show significant variation having the highest diversity in C-III (P. hysterophorus-dominated sites) and lowest in C-IV (S. marianum-dominated sites, i.e., primarily pure communities), indicating non-native species may increase or decrease site diversity. The diversity communities were further supported by higher quantities of soil nutrients, i.e., organic percentage (2.22 ± 0.04). Altitude, soil nutrients, and texture were shown to be the environmental factors most associated with communities that non-native species had invaded.

Recommendation

It is recommended that relevant, additional soil and climatic parameters be integrated into species distribution models to improve our understanding of the ecological niches of different species and to make a collective approach for preserving and conserving native plant communities.

Spatially Resolved Distribution, Sources, Exposure Levels, and Health Risks of Heavy Metals in <63 μm Size-Fractionated Road Dust from Lucknow City, North India

In the present study, a total of 64 road dust samples were collected from five different functional areas (residential, commercial, parks, high-traffic, and industrial) in urban Lucknow to assess the accumulation, distribution, and health risk of heavy metals (HMs) (i.e., Fe, Mn, Zn, Cu, Pb, Cd, As, Cr and Ni). Acid digestion methods were used to analyze HMs, followed by inductively coupled plasma-mass spectrometry (ICPMS). The ascending frequency of HMs was Cd < As < Ni < Cr < Pb < Cu < Zn < Mn < Fe for all different functional areas. Almost all HMs exceed the limits of Indian natural soil background values (INSB) across all functional areas. The pollution assessment results reveal that the urban road dust of Lucknow is highly enriched with Zn and Pb, causing deterioration of dust quality. The spatial distribution of HMs shows that road dust found in the central and southwestern zones of the Lucknow urban area are more contaminated than in other areas. The ecological risk assessment demonstrates that Cd was the highest risk contributor, followed by Pb, Zn and Cu. The result of the health risk assessment i.e., the cumulative hazard index (HI) and the cumulative lifetime cancer risk (LCR), reveal that children (mean HIchildren = 1.26, LCRchildren = 0.000187) are more vulnerable to HM exposure than adults (HIadults = 0.14, LCRadults = 0.0000804). For carcinogenic and non-carcinogenic risk, ingestion appears to be the major pathway of HM exposure in both age groups. It is alarming that all studied four carcinogenic HMs were found in concentrations higher than 1 × 10-6 (the permissible limit for humans). This indicates slight chances of developing cancer for both age groups in all functional areas.

Invasive Species as Rivals: Invasive Potential and Distribution Pattern of Xanthium strumarium L

Xanthium strumarium L. is a globally successful invasive herb that has had significant negative ecological, economic and social impacts in many world regions. The present study was therefore conducted to evaluate the invasive potential and spatial distribution patterns of X. strumarium in heavily invaded plant communities of the semiarid regions of northern Pakistan. Investigations were based on data from 20 plants grown in the Herbarium at the University of Malakand, and from observations in 450 plots distributed across 45 stands representing habitats across Northern Province including open fields, hillocks and abandoned areas in both urban and rural areas. Multivariate analysis identified elevation, organic matter and organic carbon as the environmental variables most associated with communities invaded by X. strumarium. Increased soil silt was positively associated and available water was negatively associated with X. strumarium–invaded communities. These key environmental characteristics allowed us to identify four main associations: Group I: X. strumarium-C. sativa, Group II: X. strumarium-P. hysterophorus, Group III: X. strumarium-A. aspera and Group IV: X. strumarium-C. sativa. Other invasive species were observed, either exotic, such as P. hysterophorus, or indigenous, such as C. sativa and D. inoxia, often co-occurring and responding similarly to these factors. The results suggest that high temperature with drought stress could be a determinant of increasing population at lower elevations, whereas colder climates with adequate moisture are related to reduced populations at higher elevations, near the species’ upper range limits. It is recommend that the inclusion of appropriate, additional soil and climatic variables in species distribution models be implemented in order to better explain species’ ecological niches and help guide conservation and protection plans for native plant communities.

A systematic review of the evidence of outdoor air pollution on asthma hospital visits in children and adolescents in South Asia - a call for data

Background: Outdoor air pollution and childhood asthma are increasing problems in South Asian countries. However, little is known about the associations between levels of air pollution and severe childhood asthma requiring hospital treatment in these regions. Methods: We undertook a systematic review to assess the evidence between outdoor air pollution exposure and childhood and adolescent asthma hospitalization in South Asia. MEDLINE, Web of Science, Google Scholar, CINAHL, Embase, Scopus, ProQuest Central databases were searched for peer-reviewed papers, and examination of reference lists was conducted for additional studies. We identified all the literature published in English up to January 2021 for the study population comprised of children aged less than 19 years. The search strategy was designed to identify all the studies and screen them as per the inclusion criteria. The method of qualitative synthesis using the standard tool determined the comprehensiveness of the assessment of bias. Results: Of the original 367 studies screened three studies were ultimately included from India, Pakistan and Sri Lanka and a narrative synthesis was conducted. Although studies reported adverse effects of outdoor pollution on asthma hospitalizations, limitations in exposure assessments, varying definitions of asthma hospitalizations and limited data analysis were identified. Conclusions: There is currently limited evidence that can provide meaningful risk estimates of the impact of outdoor air pollution on asthma hospitalizations during childhood and adolescence. Studies with comparable outcome definitions, appropriate exposure assessments and study designs are needed to inform future public and environmental health policy. PROSPERO registration: CRD42020156714 (28/04/2020).

Screening for the Most Common Mutations of CFTR Gene among Egyptian Children with Difficult-to-Treat Asthma

Cystic fibrosis (CF) is panethnic autosomal recessive disease that affects the exocrine glands of pancreas, lungs, and intestine. It is often misdiagnosed in developing countries as difficult-to-treat asthma. We enrolled 150 Egyptian families with one or more probands who were complaining of difficult-to-treat asthma, and 112 cases were studied extensively through history taking including pedigree construction and clinical examination. In addition, spirometry and computed tomography of the chest were done in selected cases. All cases were subjected to quantitative sweat chloride test and molecular screening for the three most common mutations of cystic fibrosis transconductance regulator ( CFTR ) gene ( ΔF508 , G542X , W1282X ) using amplification refractory mutation system (ARMS) technique. Probands of difficult-to-treat asthma comprised 66 males and 46 females; their age range was 1 to 14 years. Sixty-one probands (54.5%) were carriers of one or more of the studied mutations (36 cases and 25 carriers). Six carriers of single mutations had mild respiratory symptoms and negative sweat test. The most common allele was ΔF508 , 60 alleles in 56 individuals (4 were homozygous ΔF508 / ΔF508 ) followed by W1282X in 25 individuals and G542X in 12 individuals. Allele W1282X had an increased risk of recurrent chest infection and bronchiectasis. Moreover, cases with two mutations had more severe symptoms compared with those with a single mutation. CFTR mutations and CF-related syndromes are not rare as thought in Egypt, especially among the high-risk difficult-to-treat asthma. The readily available ARMS technique is recommended for ΔF508 and/or W1282X screening on priority basis among these children.

Documentation of asthma control and severity in pediatrics: analysis of national office-based visits

Objective: To evaluate the extent of documentation of asthma control and severity and associated characteristics among pediatric asthma patients in office-based settings. Methods: This cross-sectional study utilized data from the 2012-2015 National Ambulatory Medical Care Survey (NAMCS). Patients aged 6-17 years with a diagnosis of asthma were included. Weighted descriptive analysis examined the extent of documentation and uncontrolled asthma; while logistic regression evaluated associated characteristics. Results: Overall, there were 2.47 million (95% confidence interval, 95% CI: 2.04-2.90) average annual visits with asthma as a primary diagnosis. Asthma control and severity was documented in only 36.1% and 33.8% of the visits, respectively. An established patient (odds ratio, OR = 3.81), Hispanic ethnicity (OR = 2.10), chronic sinusitis (OR = 5.59), and visits in the Northeast (OR = 2.12) and Midwest (OR = 2.25) regions had higher odds of documented asthma control status, whereas undocumented asthma severity (OR = 0.02), and visits in spring (OR = 0.34), had lower odds. Osteopathic doctors (OR = 0.18), visits in the Northeast region (OR = 0.23), chronic sinusitis (OR = 0.08), and undocumented asthma control status (OR = 0.03) had lower odds of documented asthma severity, whereas visits in spring (OR = 3.88) and autumn (OR = 3.32) had higher odds. Moderate/severe persistent asthma (OR = 15.35) had higher odds of uncontrolled asthma (as compared to intermittent asthma), while visits in the summer (OR = 0.14) had lower odds. Conclusion: The findings of this study suggest a critical need to increase the documentation of asthma severity and control to improve quality of asthma care in children.

Assessment of asthma severity in adults with ever asthma: A continuous score

BACKGROUND

In epidemiological studies, continuous measures of asthma severity should be used to catch the heterogeneity of phenotypes. This study aimed at developing and validating continuous measures of asthma severity in adult patients with ever asthma from the general population, to be used in epidemiological studies.

METHODS

Respiratory symptoms, anti-asthmatic treatment and lung function were measured on 520 patients with ever asthma aged 20-64 years from the general Italian population (GEIRD study; 2007/2010). The variables that represent the same dimension of asthma severity were identified through an exploratory factor analysis and were summarized through a multiple factor analysis.

RESULTS

Only respiratory symptoms and anti-asthmatic treatment were summarized in a continuous score (STS). STS ranges from 0 (no symptoms/treatment) to 10 (maximum symptom frequency and treatment intensity). STS was positively correlated with the Global Initiative for Asthma classification of asthma severity computed on the 137 cases with a doctor's diagnosis (Spearman's coefficient = 0.61, p-value<0.0001) (concurrent validity). Furthermore, using a cohort of 1,097 European asthmatics (ECRHS II study; 1999/2002), increasing STS levels at baseline (1991/1993) were positively associated with long-term outcomes (hospitalization and lost workdays for breathing problems, asthma attack frequency and use of asthma controllers) (predictive validity). Finally, the STS scores computed from the GEIRD and ECRHS II data were comparable (Lin's coefficient = 0.95, p-value<0.0001) (replication analysis).

CONCLUSIONS

STS is a valid and replicable measure of asthma severity in adults, which could be used in association studies.

Trends in exposure to second hand smoke at home among children and nonsmoker adolescents

Data from National Health and Nutrition Examination Survey (NHANES) for the years 1999-2012 were used to evaluate trends in exposure to second hand smoke (SHS) at home among children aged 3-11 years and nonsmoker adolescents aged 12-19 years. A total of 12,815 children and 10,269 adolescents were included in the analyses. Serum cotinine was used as a biomarker for exposure to SHS at home. Regression models with log10 transformed values of serum cotinine as dependent variables and age, race/ethnicity, NHANES survey year, and family poverty income ratio as a surrogate measure of socioeconomic status were used in models for those with and without exposure to SHS at home. In addition, for those with exposure to SHS at home, number of smokers smoking inside home and number of cigarettes smoked at home every day were also used as independent variables. There was a biennial increase of 1.05 ng/L in adjusted serum cotinine levels for children with exposure to SHS at home over the period of 1999-2012. Serum cotinine levels among nonsmoker adolescents with exposure to SHS at home did not change over time. When there was no exposure to SHS at home, there was a statistically significant downward trend for serum cotinine levels for both children and nonsmoker adolescents. Serum cotinine levels attributable to SHS exposure increased with age among nonsmoker adolescents (p≤0.02) but decreased with age among children (p<0.01). For a unit decrease in family poverty income ratio, SHS exposure as measured by serum cotinine levels (Table 6) increased by 1.18 ng/L among children and by 1.30 ng/L among nonsmoker adolescents. In general, observed serum cotinine levels associated with SHS exposure at home were higher for children than they were for nonsmoker adolescents.

CRHR1 Gene SNPs and Response to Systemic Corticosteroids in Indian Asthmatic Children During Acute Exacerbation

OBJECTIVE

To determine association of corticotrophin releasing hormone receptor 1 (CRHR1) gene single nucleotide polymorphisms (SNPs), rs242939 (A>G) and rs242941 (G>T) with response to systemic corticosteroids in North Indian asthmatic children during acute exacerbation.

METHODS

This was a hospital based cross-sectional study. Sixty-eight children aged 1 to 12 y with acute exacerbation of asthma were included in the study. The study was approved by the institutional ethics committee and written informed consent was obtained from parents/guardians of recruited children. GINA guidelines 2008, were used for classification and treatment of acute exacerbation of asthma. As per the GINA guidelines 2008, children who had good response to injectable corticosteroid were classified as "Corticosteroid Responders" (CR). Rest of the children with incomplete or poor response to injectable corticosteroid were classified as "Corticosteroid Non Responders" (CNR).

RESULTS

Among 68 hospitalized children, 45 (66.17 %) children were CR whereas 23 (33.83 %) children were CNR. On analyzing as dominant model, children with one or two copies of mutant allele of SNP rs242941 had statistically significant better response to systemic corticosteroid (OR = 5.00; 95 %CI = 1.32-19.64; p 0.013) as compared to children with no mutant allele.

CONCLUSIONS

Thus, CRHR1 gene SNP rs242941 polymorphism is associated with better response to systemic corticosteroid during acute exacerbation of asthma.

Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province--Bolivia: a cross-sectional study

BACKGROUND

In recent years, the prevalence of asthma, rhinoconjunctivitis and eczema symptoms in childhood has considerably increased in developing countries including Bolivia, possibly due to changes in lifestyle, environmental and domestic factors. This study aimed to assess the association between environmental factors and asthma, rhinoconjuctivitis and eczema symptoms in school-aged children from Oropeza Province in Chuquisaca, Bolivia.

METHODS

A cross-sectional study was performed in 2340 children attending the fifth grade in 36 randomly selected elementary schools in Oropeza province. The prevalence of symptoms was determined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Environmental factors were assessed by the ISAAC environmental questionnaire including questions related to exposure to pets, farm animals, indoor and outdoor pollution, presence of disease vectors at home and precarious household conditions. Generalized linear mixed-effects models were adjusted for age, sex and place of living.

RESULTS

Thirty seven percent of children reported that at least one of their parents smoked at home. Wood or coal was used as cooking fuel in 19% of the homes and 29% reported intense truck traffic on the street where they lived. With respect to hygiene conditions, 86% reported exposure to dogs, 59% exposure to cats and 36% regular contact to farm animals. More than one precarious household condition was reported by 8% of children. In the adjusted model exposure to dog (adjusted OR 1.4; CI 95% 1.0-1.9), cat (1.2; 1.0-1.5), farm animals (1.5; 1.2-1.8); intense truck traffic (1.3; 1.0-1.6), parents smoking at home (1.2; 1.0-1.5), presence of disease vectors at home (fourth quartile vs. first quartile: 1.6; 1.2-2.3) and two or more precarious household conditions (1.5; 1.0-2.2) were significantly associated with rhinoconjunctivitis symptoms. The associations were similar for asthma and eczema symptoms; however it did not reach the level of statistical significance for all items.

CONCLUSION

Our results support previous findings reported for poor communities especially in Latin America, showing that lower hygiene conditions did not have protective effect against asthma and rhinoconjunctivitis and eczema symptoms.

Genetic variations of the FCER2 gene and asthma susceptibility in north Indian children: a case-control study

CONTEXT AND OBJECTIVE

The findings showed that the low-affinity IgE receptor plays a pivotal role in allergic immune response and it is a pharmacogenetic predictor in asthma disease. This study aims to investigate the association of genetic variations: rs28364072 and rs7249320 with asthma and its severity in north Indian children.

METHODS

Case-control-based genetic association study was performed among 550 children.

RESULTS

Statistical analysis demonstrated significant association between asthma and genotypes frequency of both the SNPs.

CONCLUSIONS

Our data indicate that the studied variations are strongly associated with asthma susceptibility and might be risk factor among north Indian asthmatic children.