Stubble burning causes both loss of life and work revenue

Health Care Comments Off

Air pollution needs to be combated with efforts at all levels

New Delhi, 5 March 2019: The burning of agricultural residue — a contributor to north India’s winter pollution — increases the risk of respiratory illnesses threefold for those who experience it. It may also be responsible for an annual $3 billion (approximately Rs 2 trillion) loss in terms of days of work lost in states affected by crop burning, according to a study by the International Food Policy Research Institute (IFPRI).

The research has found that living in an area where crop burning is practiced was a leading risk factor for respiratory disease in northern India. Whereas the total burden of diseases from air pollution declined between 1990 and 2016 due to efforts to reduce the burning of solid fuel for household use, outdoor air pollution increased by 16.6%.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Whenever we talk of air pollution, suspended particulate matter or PM as it is commonly referred to, is generally taken as representative of the level of pollution. In all there are eight air quality parameters, which are taken into consideration when the Air Quality Index (AQI) is calculated: Suspended particulate matter (PM2.5 and PM10), sulfur dioxide (SO2), ozone (O3), nitrogen oxides (NO2), carbon monoxide (CO), ammonia (NH3) and lead (Pb). Particulate matter consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. It is mainly made up of sulfates, nitrates, ammonia, sodium chloride, black carbon, mineral dust and water and allergens (fragments of pollen or mold spores). When outdoor levels of particulate matter are high, their levels also increase indoors.”

According to the WHO, nine out of 10 people breathe air containing high levels of pollutants and around 7 million people die every year from exposure to fine particles in polluted air.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “The larger PM 10 particles can irritate the eyes, nose and throat. PM10 mainly affects the respiratory system and may precipitate an acute asthma attack and acute exacerbation of chronic bronchitis or may cause other respiratory problems such as cough, wheeze. The fine and ultra-fine particles also affect the heart so they may trigger an acute cardiovascular event such as heart attack or stroke or atrial fibrillation as they increase the resting blood pressure due to sympathetic overactivity and cause endothelial dysfunction and thickening of the blood. PM 2.5 and PM 0.1 particles also have a greater association with increased mortality due to heart disease.”

Some tips from HCFI

·       Exercise well as it will help your lungs to function to their full potential. Do exercises that will make you breath fast to ensure healthy lungs.

·       Avoid smoking as it reduces lung function and is a major factor leading to COPD.

·       Eat healthy and food that is rich in omega 3 fatty acids such as fish and nuts for healthy lungs.

·       Avoid exposure to air pollution as it can damage the lungs and make it more prone to infections and diseases. Ensure that you dust furniture frequently and make your home a smoke-free zone.

Postmortem: 48 lakh fine for giving high oxygen to premature baby

Health Care Comments Off

Rajasthan state consumer forum on Friday imposed a fine of Rs 48 lakh on a private hospital situated at Kothputli town on the outskirts of Jaipur, for its negligence that led to an infant turning blind.

Case

Nikita was admitted to Sanjivani Hospital situated at Kothputli on August 30, 2014, when she was told that the infant was underweight.

She was given 30% oxygen.

The infant developed ROP (retinopathy of prematurity)

Allegation: 30% oxygen was too much and caused ROP

Normal O2 should be 21%

Award: 45 lakh compensation

Discussion

Is it negligence, error of judgment or difference of opinion?

What is ROP?

ROP is a developmental vascular proliferative disorder that occurs in the retina of preterm infants with incomplete retinal vascularization.
It is an important cause of severe visual impairment in childhood.
ROP develops in 21% of patients and severe ROP in 5% in infants < 32 weeks gestation. No infant born at >28 weeks GA required surgical intervention.
The incidence of ROP in preterm infants (BW <1251 g) is 68%.
The incidence of ROP is 8%, 19% and 43% among infants born at ≥32 weeks, >27 to 31 weeks, and ≤27 weeks gestation, respectively
Risk factors

The most important risk factor for developing ROP is prematurity. However, more than 50 separate risk factors have been identified.

Low birth weight, low gestational age, assisted ventilation for longer than one week, surfactant therapy, high blood transfusion volume, cumulative illness severity, low caloric intake, hyperglycemia, and insulin therapy, have been independently associated with higher rates of ROP
Other possible risk factors include sepsis, fluctuations in blood gas measurements, intraventricular hemorrhage, bronchopulmonary dysplasia, systemic fungal infection, and early administration of erythropoietin for the treatment of anemia of prematurity.
Poor longitudinal weight gain
Elevated arterial oxygen tension is also thought to contribute. However, ROP is not the only consideration in determining the optimal target oxygen level in preterm infants. Excessive reduction of target oxygenation saturation has been associated with increased mortality.
Infection may worsen the course of ROP.
Breast milk feeding appears to play a protective role in preventing ROP.

Infants with trisomy 21 appear to be at a lower risk for ROP compared with other infants

The optimal SpO2 for preterm infants who receive supplemental oxygen therapy has not been fully established. Based on the available evidence, the most prudent target range for SpO2 in preterm infants is between 90 and 95%. This range minimizes both the low and high extreme oxygenation levels that have been associated with adverse outcomes and mortality.

Oxygen to a newborn is not decided by % of oxygen but by the SPO2 levels

Based on the available evidence the current recommendation is a target oxygen range from 90-95% resulting in minimizing extreme oxygenation levels for all preterm infants
This target range appears to be safe for preterm infants ≥28 weeks gestation.
In the most mature preterm infants (gestational age >34 weeks), the risk of ROP decreases and the upper limit can be increased to 97%.
There is also a paucity of data regarding oxygen target ranges as the preterm infant advances in age. However, by 2-3 weeks postnatal age, the risk of intermittent hypoxia increases, which may aggravate ROP by enhancing retinal proliferation. As a result, with advancing age one should typically raise target saturation to >95% if the infant still needs supplemental oxygen when the corrected PMA is >32 weeks.
Targeted SpO2 levels of infants with congenital heart disease, BPD, or pulmonary hypertension are individualized based upon the clinical status of the neonate due to the paucity of data regarding optimal oxygenation for these disorders.
Opinion

At the most it can be difference of opinion. It does not appear to be negligence unless oxygen was given without measuring SPO2 levels.

What can be done?

Challenge in the higher consumer forum
Defence: Give opinion of experts and published literature

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA