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Introduction: A causal link between air pollution exposure and cardiovascular events has been suggested. However fewer studies have investigated the shape of the associations at low levels of air pollution and identified the most important temporal window of exposure. Here we assessed long-term associations between particulate matter 40) from the UK Biobank cohort, we investigated the associations between 1-year, 3-year and 5-year time-varying averages of PM2.5 and incidence of major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure, atrial fibrillation and flutter and cardiac arrest. We also investigated outcome subtypes for MI and stroke. Events were defined as hospital inpatient admissions. We fitted Cox proportional hazard regression models applying extensive control for confounding at both individual and area level. Finally, we assessed the shape of the exposure–response functions to assess effects at low levels of exposure. Results: We analysed data from 377,736 study participants after exclusion of prevalent subjects. The average follow-up (2006–2021) was 12.9 years. We detected 19,353 cases of MACE, 6,562 of acute MI, 6,278 of heart failure, 1,258 for atrial fibrillation and flutter, and 16,327 for cardiac arrest. Using a 5-year exposure window, we detected positive associations (for 5 μg/m3 increase in PM2.5) for 5-point MACE of [1.12 (95 %CI: 1.00–1.26)], heart failure [1.22 (1.00–1.50)] and cardiac arrest [1.16 (1.03–1.31)]. We did not find any association with acute MI, while non-ST-elevation MI was associated with the 1-year exposure window [1.52 (1.12–2.07)]. The assessment of the shape of the exposure–response relationships suggested that risk is approximately linear for most of the outcomes. Conclusions: We found positive associations between long-term exposure to PM2.5 and multiple cardiovascular outcomes for different exposure windows. The cardiovascular risk tends to rise even at exposure concentrations below 12–15 μg/m3, indicating high risk below UK national and international thresholds.

Abstract Older adults are generally amongst the most vulnerable to heat and cold. While temperature-related health impacts are projected to increase with global warming, the influence of population aging on these trends remains unclear. Here we show that at 1.5 °C, 2 °C, and 3 °C of global warming, heat-related mortality in 800 locations across 50 countries/areas will increase by 0.5%, 1.0%, and 2.5%, respectively; among which 1 in 5 to 1 in 4 heat-related deaths can be attributed to population aging. Despite a projected decrease in cold-related mortality due to progressive warming alone, population aging will mostly counteract this trend, leading to a net increase in cold-related mortality by 0.1%–0.4% at 1.5–3 °C global warming. Our findings indicate that population aging constitutes a crucial driver for future heat- and cold-related deaths, with increasing mortality burden for both heat and cold due to the aging population.

Double antibody positive renal vasculitis (anti GBM antibody and pANCA) is a rare form of small vessel vasculitis associated with poor outcome. It is difficult to decide which antibody is the precursor in these cases. We report here such a rare case of double antibody positive renal vasculitis which was started on anti tubercular medicine for a positive mantoux test and interferon gamma release assay. The possible reasons for these antibodies in this may be a complication of COVID-19 infection or vaccine, adverse drug effect of antitubercular medicines or a paradoxical reaction during the tuberculosis treatment. The patient could not survive beyond two months of diagnosis because of rapidly declining renal functions. This case highlights the importance of a meticulous clinical approach, supports two week tuberculosis medicines trial and an early and careful dealing of non responders during tuberculosis treatment especially in patients whose diagnosis is not microbiologically confirmed.

Silver Diamine Fluoride (SDF) is a clear liquid that combines the remineralising effects of fluoride with the antibacterial effects of silver. It is a promising therapeutic agent for managing carious lesions in young children and those with special care needs. However, a major complication of SDF is black staining of the skin, mucosa, lips, tongue, and cheeks if improperly applied. This case report presents a complication following SDF application and its management. A 24-month-old girl presented with decayed teeth in the upper back tooth region of the jaw, and SDF application was performed on tooth no. 54 and 64. However, due to the child’s extremely negative behavior and movement during the application of SDF, staining occurred on the chin and lower lip a few hours later. Watchful observation, patient reassurance, and follow-up led to adequate patient management.

Abstract Heatwaves are one of the leading causes of climate-induced mortality. Using the examples of recent heatwaves in Europe, the United States and Asia, we illustrate how the communication of dangerous conditions based on temperature maps alone can lead to insufficient societal perception of health risks. Comparison of maximum daily values of temperature with physiological heat stress indices accounting for impacts of both temperature and humidity, illustrates substantial differences in geographical extent and timing of their respective peak values during these recent events. This signals the need to revisit how meteorological heatwaves and their expected impacts are communicated. Close collaboration between climate and medical communities is needed to select the best heat stress indicators, establish them operationally, and introduce them to the public.

Abstract Background Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. Methods Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. Results CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. Conclusions Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.

A new study characterizes adaptation in mitigation pathways, and shows that climate adaptation can lead to higher energy demand, power system costs and carbon prices, with mitigation’s benefits compensating decarbonization costs.

BackgroundFibroblast growth factor 21 (FGF21) is an essential metabolic regulator that adapts to changes in nutritional status. Severe childhood undernutrition induces elevated FGF21 levels, contributing to growth hormone (GH) resistance and subsequent linear growth attenuation potentially through a direct action on chondrocytes.MethodsIn this study, we assessed expression of the components of both GH and FGF21 pathways in rare and unique human growth plates obtained from children. Moreover, we investigated the mechanistic interplay of FGF21 on GH receptor (GHR) signaling in a heterologous system.ResultsChronic FGF21 exposure increased GH-induced GHR turnover and SOCS2 expression, leading to the inhibition of STAT5 phosphorylation and IGF-1 expression. The clinical significance of FGF21 signaling through GH receptors was tested in nutritionally driven growth failure seen in very preterm (VPT) infants right after birth. VPT infants display an immediate linear growth failure after birth followed by growth catch-up. Consistent with the in vitro model data, we show that circulating FGF21 levels were elevated during deflection in linear growth compared to catch-up growth and were inversely correlated with the length velocity and circulating IGF1 levels.ConclusionsThis study further supports a central role of FGF21 in GH resistance and linear growth failure and suggests a direct action on the growth plate.

Abstract Background Nephrotic syndrome is characterized by proteinuria, hyperlipidemia, and edema. The annual incidence of nephrotic syndrome is 2–7 cases/100,000 children. Methods and results The present study included 32 control, 32 steroid-sensitive nephrotic syndrome cases, and 32 steroid-resistant nephrotic syndrome cases aged ≤ 17 years. Serum samples were handled to check serum albumin, creatinine, calcium, and total cholesterol in SSNS and SRNS. Pearson’s correlation test was performed to investigate the relationship between the parameters. The independent sample t-test was done to compare the mean differences between two parameters by SPSS (Statistical Package for the Social Sciences). We found a significant positive correlation in SSNS in serum albumin, creatinine, calcium, and total cholesterol. In SRNS, we did not find a correlation between serum calcium and total cholesterol. Conclusions The combination of serum albumin, creatinine, and total cholesterol with serum calcium improves the diagnostic sensitivity of SSNS and SRNS. Thus, serum calcium may be used as an equivalent marker in the early diagnosis and treatment of nephrotic syndrome in children.

Climate change could lead to high economic burden for individuals (i.e. low income and high prices). While economic conditions are important determinants of climate change vulnerability, environmental epidemiological studies focus primarily on the direct impact of temperature on morbidity and mortality without accounting for climate-induced impacts on the economy. More integrated approaches are needed to provide comprehensive assessments of climate-induced direct and indirect impacts on health. This paper provides some perspectives on how epidemiological and economic impact assessments could be better integrated. We argue that accounting for the economic repercussions of climate change on people’s health and, vice versa, the consequences of health effects on the economy could provide more realistic scenario projections and could be more useful for adaptation policy.

The development of innovative tools for real-time monitoring and forecasting of environmental health impacts is central to effective public health interventions and resource allocation strategies. Though a need for such generic tools has been previously echoed by public health planners and regional authorities responsible for issuing anticipatory alerts, a comprehensive, robust and scalable real-time system for predicting temperature-related excess deaths at a local scale has not been developed yet. Filling this gap, we propose a flexible operational framework for coupling publicly available weather forecasts with temperature-mortality risk functions specific to small census-based zones, the latter derived using state-of-the-art environmental epidemiological models. Utilising high-resolution temperature data forecast by a leading European meteorological centre, we demonstrate a real-time application to forecast the excess mortality during the July 2022 heatwave over England and Wales. The output, consisting of expected temperature-related excess deaths at small geographic areas on different lead times, can be automated to generate maps at various spatio-temporal scales, thus facilitating preventive action and allocation of public health resources in advance. While the real-case example discussed here demonstrates an application for predicting (expected) heat-related excess deaths, the framework can also be adapted to other weather-related health risks and to different geographical areas, provided data on both meteorological exposure and the underlying health outcomes are available to calibrate the associated risk functions. The proposed framework addresses an urgent need for predicting the short-term environmental health burden on public health systems globally, especially in low- and middle-income regions, where rapid response to mitigate adverse exposures and impacts to extreme temperatures are often constrained by available resources.

Abstract Epidemiological analyses of health risks associated with non-optimal temperature are traditionally based on ground observations from weather stations that offer limited spatial and temporal coverage. Climate reanalysis represents an alternative option that provide complete spatio-temporal exposure coverage, and yet are to be systematically explored for their suitability in assessing temperature-related health risks at a global scale. Here we provide the first comprehensive analysis over multiple regions to assess the suitability of the most recent generation of reanalysis datasets for health impact assessments and evaluate their comparative performance against traditional station-based data. Our findings show that reanalysis temperature from the last ERA5 products generally compare well to station observations, with similar non-optimal temperature-related risk estimates. However, the analysis offers some indication of lower performance in tropical regions, with a likely underestimation of heat-related excess mortality. Reanalysis data represent a valid alternative source of exposure variables in epidemiological analyses of temperature-related risk.

Climate change can substantially affect temperature-related mortality and morbidity, especially under high greenhouse gas emission pathways. Achieving the Paris Agreement goals require not only drastic reductions in fossil fuel-based emissions but also land-use and land-cover changes (LULCC), such as reforestation and afforestation. LULCC has been mainly analysed in the context of land-based mitigation and food security. However, growing scientific evidence shows that LULCC can also substantially alter climate through biogeophysical effects. Little is known about the consequential impacts on human health. LULCC-related impact research should broaden its scope by including the human health impacts. LULCC are relevant to several global agendas (i.e. Sustainable Development Goals). Thus, collaboration across research communities and stronger stakeholder engagement are required to address this knowledge gap.

Abstract Cooling and heating degree‐days (CDD/HDD) are important metrics used in energy studies as a proxy for determining demand and consumption patterns of residential/commercial buildings and work spaces. Driven by the requirements of energy impact modellers, policymakers and building design experts; a new historical high‐spatial resolution, global gridded dataset of degree‐days constructed using various base (threshold) temperatures (Tb) is presented in this study. Derived using sub‐daily temperature from a quality‐controlled reanalysis data product (Global Land Data Assimilation System—GLDAS), the dataset called ‘DegDays_0p25_1970_2018’ includes monthly and annual (i) CDD; (ii) HDD; and (iii) CDD computed using wet‐bulb temperature (CDDwb) at 0.25° × 0.25° gridded resolution, covering 49 years over the period 1970–2018. The Tb used for assembling DegDays_0p25_1970_2018 include 18, 18.3, 22, 23, 24, 25°C for CDD and CDDwb; and 10, 15, 15.5, 16, 17 and 18°C for HDD, respectively. The data of individual indices are made publicly available in the commonly used scientific Network Common Data Form 4 (NetCDF4) and Georeferenced Tagged Image File (GeoTIFF) formats. DegDays_0p25_1970_2018 fills gaps in existing energy indicators’ datasets by being the only high‐resolution historical global gridded time series based on multiple threshold temperatures, thus offering applications in wide‐ranging climate zones and thermal comfort environments. The richness of DegDays_0p25_1970_2018 lies in its flexibility by allowing users to aggregate the degree‐days not only at varying spatial scales (such as administrative levels, national boundaries, economic organizations e.g. OECD; with or without population weights), but also at varying temporal scales (such as seasons), thereby offering climatologists with a potential to examine global teleconnection patterns more discretely.