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  • Novel treatment in Asthma and COPD with Biologic agents.

    Novel treatment in Asthma and COPD with Biologic agents.

    ​Asthma management has evolved significantly with the introduction of biologic therapies, especially for patients with severe, uncontrolled asthma . Like type 2 asthma with stimulations to T helper 2 and some cytokines releasing which cause an uncontrolled , severe asthma or exacerbation of COPD. These agents target specific components of the immune system involved in airway inflammation, offering tailored treatment options. Below is an overview of notable biologic agents, including recent advancements

    Omalizumab (Xolair) : Omalizumab target at IgE , preventing the IgE – receptor action. Approved for using in various IgE mediated food allergy , chronic spontaneous urticaria (CSU) and severe asthma , Chronic rhinosinusitis with nasal Polyp (CRSwNP)

    Tezepelumab (Tezspire): Tezepelumab is a human monoclonal antibody that inhibits thymic stromal lymphopoietin (TSLP), a cytokine implicated in initiating airway inflammation. Approved for use in individuals aged 12 and older with severe asthma, it has demonstrated efficacy in reducing asthma exacerbations across various patient populations. Dosage 210 mg sc every 4 weeks.

    Mepolizumab (Nucala) : Injection .The agent interact with interleukin-5 receptor (IL-5R) to prevent IL-5 targeted receptor . Using in severe asthma in child and adult , CRSwNP , Eosinophilic granulomatosis with polyangiitis (EGPA) , Hypereosinophilic syndrome (HES) dosage 100-300 mg sc every 4 weeks.

    Benralizumab (Fasenra): Benralizumab targets the interleukin-5 receptor (IL-5R) on eosinophils, leading to their depletion. It is approved for the treatment of severe eosinophilic asthma. Recent studies suggest that benralizumab may be more effective than traditional oral steroids during acute asthma attacks, reducing the need for further treatment by 30%. , also useful for EGPA

    Astegolimab: Astegolimab is an investigational monoclonal antibody targeting the ST2 receptor, which is involved in the inflammatory response associated with asthma. It is being evaluated for its potential to treat asthma and chronic obstructive pulmonary disease (COPD), particularly in patients with low eosinophil counts.

    Dupilumab (Dupixent): Dupilumab is a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling, key drivers of type 2 inflammation. While primarily approved for conditions like eczema, atopic dermatitis , severe asthma , CRSwNP , Prurigo nodularis , EoE and recent developments have expanded its use to treat COPD to prevent exacerbation(300 mg alternate week), marking it as the first biologic treatment for this condition.

    These biologic agents represent significant advancements in asthma treatment, offering personalized approaches based on the underlying inflammatory pathways of the disease. Ongoing research continues to refine their efficacy and safety profiles, aiming to enhance outcomes for patients with severe asthma.

  • Acute Febrile Illness (AFI) Causes

    Acute Febrile Illness (AFI): Causes

    Acute Febrile Illness (AFI) is characterized by a sudden onset of fever and associated systemic symptoms lasting for a short duration, typically less than two weeks. It is a common presentation in clinical settings and can be caused by a wide range of infectious and non-infectious etiologies. Proper identification of the underlying cause is crucial for effective management and treatment. This article provides a comprehensive list of all possible causes of AFI, including rare causes.

    Causes of Acute Febrile Illness (AFI)

    Table 1: Causes of AFI (Including Rare Causes)

    TypeCauseExamples
    Infectious CausesBacterial InfectionsTyphoid Fever, Pneumonia, Meningitis, UTIs, Endocarditis, Brucellosis, Tularemia, Anthrax, Q Fever, Melioidosis, Leprosy, Lyme Disease, Rickettsial infections (Rocky Mountain Spotted Fever, Scrub Typhus)
    Viral InfectionsDengue, Influenza, COVID-19, Chikungunya, Measles, Mumps, Rabies, Hantavirus, Viral Hemorrhagic Fevers (Ebola, Marburg), West Nile Virus, Zika, Crimean-Congo Hemorrhagic Fever (CCHF), Lassa Fever, Nipah Virus
    Parasitic InfectionsMalaria, Leptospirosis, Trypanosomiasis, Toxoplasmosis, Babesiosis, Schistosomiasis, Amoebiasis, Fascioliasis, Filariasis, Echinococcosis
    Fungal InfectionsCandidiasis, Histoplasmosis, Coccidioidomycosis, Cryptococcosis, Blastomycosis, Paracoccidioidomycosis, Sporotrichosis, Aspergillosis
    Non-Infectious CausesAutoimmune DisordersSystemic Lupus Erythematosus (SLE), Rheumatic Fever, Still’s Disease, Sarcoidosis, Vasculitis, Adult-onset Still’s Disease (AOSD), Polyarteritis Nodosa
    Malignancies (Neoplastic)Lymphoma, Leukemia, Renal Cell Carcinoma, Hepatocellular Carcinoma, Multiple Myeloma, Metastatic Cancers, Paraneoplastic Syndromes
    Drug-Induced FeversAntibiotics, Anticonvulsants, Chemotherapy, NSAIDs, Antiarrhythmics, Vaccines, Biologics, Illicit Drug Reactions
    Environmental CausesHeat StrokeHeat Stroke, Hyperthermia due to extreme environments, Neuroleptic Malignant Syndrome (NMS)
    Hyperthermia from ToxinsCocaine, Amphetamines, Anticholinergics, Salicylate Toxicity, Serotonin Syndrome
    Unknown CausesFever of Unknown Origin (FUO)Idiopathic Fevers, Familial Mediterranean Fever (FMF), Adult-onset Immunodeficiency Syndrome (AOIS), Periodic Fever Syndromes

    Pathophysiology

    1. Infectious Causes (Most Common)

    • Bacterial Infections:
      • Pathophysiology: Activation of immune response via endotoxins or exotoxins leading to cytokine release (IL-1, TNF-α).
      • Examples:
        • Typhoid Fever (Salmonella typhi)
        • Pneumonia (Streptococcus pneumoniae, Haemophilus influenzae)
        • Meningitis (Neisseria meningitidis, Streptococcus pneumoniae)
        • Urinary Tract Infections (E. coli)
    • Viral Infections:
      • Pathophysiology: Viral replication causing cell lysis, immune activation, and cytokine storm.
      • Examples:
        • Dengue Fever
        • Influenza
        • COVID-19 (SARS-CoV-2)
        • Chikungunya
        • Measles, Mumps
    • Parasitic Infections:
      • Pathophysiology: Immune response to parasitic antigens; inflammation and tissue damage.
      • Examples:
        • Malaria (Plasmodium spp.)
        • Leptospirosis (Leptospira spp.)
        • Trypanosomiasis (African Sleeping Sickness)
    • Fungal Infections:
      • Pathophysiology: Invasive fungal infections trigger inflammatory responses, especially in immunocompromised individuals.
      • Examples:
        • Candidiasis
        • Histoplasmosis

    2. Non-Infectious Causes

    • Autoimmune Disorders:
      • Pathophysiology: Autoimmune activation causing systemic inflammation and fever.
      • Examples:
        • Systemic Lupus Erythematosus (SLE)
        • Rheumatic Fever
        • Still’s Disease
    • Malignancies (Neoplastic):
      • Pathophysiology: Release of pyrogens from cancer cells or tumor necrosis.
      • Examples:
        • Lymphoma
        • Leukemia
        • Renal Cell Carcinoma (Paraneoplastic syndromes)
    • Drug-Induced Fevers:
      • Pathophysiology: Hypersensitivity reactions or alteration in thermoregulation.
      • Examples:
        • Antibiotics (e.g., Beta-lactams)
        • Anticonvulsants (e.g., Phenytoin)
        • Chemotherapy agents

    3. Environmental Causes

    • Heat Stroke:
      • Pathophysiology: Failure of thermoregulation leading to hyperthermia and systemic inflammatory response.
    • Hyperthermia from Toxins:
      • Pathophysiology: Direct effect on hypothalamic regulation or increased metabolic rate.
      • Examples:
        • Cocaine, Amphetamines
        • Anticholinergic overdose

    4. Unknown/Idiopathic Causes

    • Fever of Unknown Origin (FUO):
      • Pathophysiology: Persistent fever (>3 weeks) without clear etiology despite thorough investigation.

    References

    1. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 9th Edition.
    2. Harrison’s Principles of Internal Medicine, 21st Edition.
    3. Kumar & Clark’s Clinical Medicine, 10th Edition.
    4. Fauci AS, et al. (2020). Harrison’s Principles of Internal Medicine. McGraw-Hill.
    5. Shapiro DS, et al. (2019). Infectious Disease: A Clinical Short Course. McGraw-Hill.
    6. Longo DL, et al. (2019). Fever of Unknown Origin. New England Journal of Medicine.

  • The Impact of PM2.5 on Platelet Activity and Cardiovascular Health

    The Impact of PM2.5 on Platelet Activity and Cardiovascular Health

    Introduction

    Fine particulate matter (PM2.5), comprising particles with a diameter of 2.5 micrometers or less, is a significant air pollutant known to penetrate deep into the respiratory tract and enter the bloodstream. Chronic exposure to PM2.5 has been linked to various adverse health outcomes, particularly affecting cardiovascular health. Emerging research indicates that PM2.5 exposure may influence platelet activity, thereby contributing to cardiovascular diseases.

    How PM2.5 Affects Platelets:

    Increased levels of inflammatory cytokines like IL-6 and TNF-α from PM2.5 exposure can enhance platelet activation.

    Inflammation and Oxidative Stress:

    PM2.5 exposure induces systemic inflammation and oxidative stress, which can activate platelets and promote their aggregation.

    Pro-thrombotic Effects:

    Activated platelets can contribute to blood clot formation, increasing the risk of thrombosis, which is a common underlying mechanism for heart attacks and strokes.

    Altered Platelet Count and Function:

    Some studies have reported changes in platelet count (either increased or decreased) and altered platelet function in individuals exposed to high levels of PM2.5.

    Endothelial Dysfunction:

    PM2.5 exposure can damage the endothelial cells lining blood vessels, which in turn promotes platelet adhesion and activation.

    Inflammatory Cytokine Release:

    Increased levels of inflammatory cytokines like IL-6 and TNF-α from PM2.5 exposure can enhance platelet activation.

    The activation and aggregation of platelets due to PM2.5 exposure have significant health implications:

    Multiple studies have found that short-term and long-term exposure to PM2.5 is associated with increased platelet aggregation, higher mean platelet volume (MPV), and elevated levels of platelet activation markers (e.g., P-selectin).

    Increased Thrombosis Risk: Enhanced platelet activity can lead to the formation of blood clots, increasing the risk of thrombosis, heart attacks, and strokes. from the study : Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country :The cohort comprised 3081 participants over 35 years old who were free of CVDs. Mean three-year PM2·5 exposure for the cohort was measured at 45.28 μg/m3, ranging from 20.01 to 69.80 μg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. In well-adjusted models, 10 μg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] but No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality.
    Increase Platelet production :
    A study involving 362,396 Taiwanese adults found that each 10 μg/m³ increase in the 2-year average PM2.5 concentration was associated with a 0.42% increase in platelet counts in men and a 0.49% increase in women. This suggests that long-term exposure to PM2.5 may enhance blood coagulability.

    Cardiovascular Disease Incidence: Long-term exposure to PM2.5 has been associated with higher rates of cardiovascular diseases, partly due to its effect on platelet activation.

    reference :

    1. https://ehjournal.biomedcentral.com/articles/10.1186/s12940-021-00797-w
    2. https://pubmed.ncbi.nlm.nih.gov/29753251/
  • flu vaccination this year 2025

    flu vaccination this year 2025

    Flu vaccination this year 2025 :

    Start the flu season now in Thailand and you should have all 4 strains of flu vaccination now.

    Influenza Vaccine Strain Recommendations for 2025 by WHO

    The World Health Organization (WHO) has announced the recommended influenza vaccine strains for the 2025 influenza season, with separate recommendations for the Southern Hemisphere and Northern Hemisphere. These recommendations are based on the analysis of global influenza virus surveillance data by the WHO Global Influenza Surveillance and Response System (GISRS) and are critical for ensuring vaccine effectiveness against circulating strains .

    Southern Hemisphere (2025 Season)


    For the 2025 Southern Hemisphere influenza season, the WHO recommends the following strains for trivalent vaccines:

    Egg-based vaccines:

    A/Victoria/4897/2022 (H1N1)pdm09-like virus

    A/Croatia/10136RV/2023 (H3N2)-like virus

    B/Austria/1359417/2021 (B/Victoria lineage)-like virus

    Cell culture-, recombinant protein-, or nucleic acid-based vaccines:

    A/Wisconsin/67/2022 (H1N1)pdm09-like virus

    A/District of Columbia/27/2023 (H3N2)-like virus

    B/Austria/1359417/2021 (B/Victoria lineage)-like virus

    For quadrivalent vaccines, the B/Yamagata lineage component remains unchanged:

    B/Phuket/3073/2013 (B/Yamagata lineage)-like virus .

    Northern Hemisphere (2025-2026 Season)


    The WHO has not yet finalized the recommendations for the 2025-2026 Northern Hemisphere influenza season. However, a meeting is scheduled for February 2025 to analyze global influenza activity and determine the vaccine composition. This meeting will involve experts from WHO Collaborating Centres, regulatory agencies, and vaccine manufacturers .

    Key Changes and Rationale


    H3N2 Update: The H3N2 component for the Southern Hemisphere has been updated to A/Croatia/10136RV/2023 (H3N2)-like virus to reflect the latest circulating strains .

    B/Yamagata Exclusion: The B/Yamagata lineage has not been detected in circulation since March 2020, leading to a shift toward trivalent vaccines in many regions. However, quadrivalent vaccines still include this component for regions where it remains in use .

  • Health effects of pm2.5

    Health effects of pm2.5

    Health Effects of PM2.5
    Mortality and Morbidity:

    Long-term exposure to PM2.5 contributed to 4.14 million deaths globally in 2019, accounting for 62% of all air pollution-related deaths. This represents a 23% increase over the past decade(2).

    In China, PM2.5 exposure in 2019 was linked to 21,113 all-cause deaths, with significant declines in cardiovascular and respiratory deaths compared to 2015 due to improved air quality measures(9).

    Cardiovascular and Respiratory Diseases:

    PM2.5 is associated with premature death in individuals with heart or lung disease, nonfatal heart attacks, irregular heartbeat, and aggravated asthma(3).

    It can penetrate deep into the lungs and bloodstream, causing inflammation, oxidative stress, and genotoxicity, which contribute to cardiovascular and respiratory disorders(10)(12).

    Systemic Effects:

    Beyond the lungs and heart, PM2.5 exposure affects the renal, neurological, gastrointestinal, and reproductive systems. It has been linked to chronic kidney disease, neurodegenerative disorders like Alzheimer’s, and adverse birth outcomes(10)(12).

    Vulnerable Populations:

    Children, older adults, and individuals with preexisting conditions are more susceptible to PM2.5-related health issues. Low socioeconomic status and minority populations often face higher exposure levels(3).

    Mechanisms of PM2.5-Induced Health Damage
    Oxidative Stress and Inflammation:

    PM2.5 triggers the production of reactive oxygen species (ROS), leading to cellular damage and inflammation. This process is a key mechanism behind its toxic effects(10)(12).

    Immune System Activation:

    Exposure to PM2.5 activates immune responses, including the release of pro-inflammatory cytokines like IL-6 and TNF-α, which exacerbate tissue damage(10).

    Genotoxicity:

    PM2.5 can cause DNA damage, increasing the risk of cancer and other chronic diseases(12).

    Can I go Outdoor during PM 2.5 ?

    Yes , if air quality is fine (0-12 microgram/m3 PM2.5)

    What pm2.5 range should I consider to avoid prolong outdoor exercise?

    Moderate (12-35 µg/m³):
    Air Quality: Acceptable
    Recommendation: Generally safe for most people. Those who are unusually sensitive to air pollution should consider reducing prolonged or heavy exertion.

    When I have to avoid outdoor exercise?

    Unhealthy for Sensitive Groups (35-55 µg/m³):
    Air Quality: May cause health issues for sensitive individuals (e.g., people with asthma, heart disease, or respiratory conditions).
    Recommendation: Sensitive groups should reduce prolonged or heavy outdoor exertion. Healthy individuals can usually continue outdoor activities but should monitor for symptoms like coughing or shortness of breath.
    Unhealthy (55-150 µg/m³):
    Air Quality: Everyone may begin to experience health effects.
    Recommendation: Limit prolonged or heavy exertion outdoors. Sensitive groups should avoid outdoor exercise. Consider indoor activities instead.

    What level is very hazardous level?

    Very Unhealthy (150-250 µg/m³):
    Air Quality: Health warnings of emergency conditions.
    Recommendation: Avoid outdoor exercise. Everyone, especially sensitive groups, should stay indoors and keep activity levels low.
    Hazardous (250+ µg/m³):
    Air Quality: Health alert: everyone may experience more serious health effects.
    Recommendation: Stay indoors and avoid all physical activity outdoors.

    reference

    (1)ScienceDirect2024/12/011

    An update on adverse health effects from exposure to PM2.5

    The suggested mechanisms by which PM 2.5 induces adverse health effects include the initiation of oxidative stress, inflammation, genotoxicity, and immunotoxicity. These findings provide insights into the mechanisms linking PM 2.5 exposure and health effects.

    (2)State of Global Air2

    Health Impacts of PM2.5 – State of Global Air

    Health effects attributable to long-term exposure to PM 2.5 include ischemic heart disease, lung cancer, chronic obstructive pulmonary disease (COPD), lower-respiratory infections (such as pneumonia), stroke, type 2 diabetes, and adverse birth outcomes.

    (3)U.S. Environmental Protection Agency2024/07/163

    Health and Environmental Effects of Particulate Matter (PM)

    Particles less than 10 micrometers in diameter pose the greatest problems, because they can get deep into your lungs, and some may even get into your bloodstream. Fine particles (PM2.5) are the main cause of reduced visibility (haze).

    (4)ScienceDirect2023/05/014

    Overview of PM2.5 and health outcomes: Focusing on components, sources …

    This study provides a systematic overview of (1) the relationship between PM 2.5 exposure and health risks, (2) the sources and toxic effects of different PM 2.5 compositions, and (3) the health impacts of interactions between PM 2.5 and other pollutants.

    (5)ScienceDirect2021/10/155

    Assessing the health impacts attributable to PM2.5 and ozone pollution …

    Specifically, the objectives of this study are (1) to assess the annual PM 2.5 – and ozone-related health impacts on all Chinese cities from 2015 to 2020; (2) to discuss the spatio-temporal characteristics of health impacts in Chinese cities; (3) to evaluate the health effects of air pollution prevention and control in China during the 13th-FYP …

    (6)ScienceDirect2016/06/016

    The health effects of ambient PM2.5 and potential mechanisms

    Epidemiological and toxicological studies have shown that PM 2.5 does not only induce cardiopulmonary disorders and/or impairments, but also contributes to a variety of other adverse health effects, such as driving the initiation and progression of diabetes mellitus and eliciting adverse birth outcomes.

    (7)Nature2023/12/157

    First close insight into global daily gapless 1 km PM2.5 pollution …

    Exposure to PM 2.5 (particulate matter with aerodynamic diameters ≤ 2.5 µm) pollution is associated with a variety of circulatory and respiratory diseases 2, 3, 4, 5, contributing to 4…

    (8)pmc.ncbi.nlm.nih.gov8

    Toxicological Effects of Fine Particulate Matter (PM2.5): Health Risks …

    Previous studies focused on investigating particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) have shown the risk of disease development, and association with increased morbidity and mortality rates. The current review investigate …

    (9)Nature2024/05/169

    Changes of PM2.5 and O3 and their impact on human health in the …

    PM 2.5 and O 3 pose significant risks to human health, as they can irritate the respiratory tract, leading to symptoms such as coughing, wheezing, and shortness of breath 13. These pollutants…

    (10)link.springer.com2023/05/2410

    Toxicological Effects of Fine Particulate Matter (PM2.5): Health Risks …

    The current review investigate epidemiological and experimental findings from 2016 to 2021, which enabled the systemic overview of PM2.5’s toxic impacts on human health. The Web of Science database search used descriptive terms to investigate the interaction among PM2.5 exposure, systemic effects, and COVID-19 disease.

    (11)WHO2021/09/2211

    WHO global air quality guidelines: particulate matter (‎PM2.5 and PM10 …

    In 2015, the World Health Assembly adopted a landmark resolution on air quality and health, recognizing air pollution as a risk factor for noncommunicable diseases such as ischaemic heart disease, stroke, chronic obstructive pulmonary disease, asthma and cancer, and the economic toll they take.

    (12)PubMed12

    The health effects of ambient PM2.5 and potential mechanisms

    The proposed underlying mechanisms whereby PM2.5 causes adverse effects to public health include inducing intracellular oxidative stress, mutagenicity/genotoxicity and inflammatory responses. The present review aims to provide an brief overview of new insights into the molecular mechanisms linking ambient PM2.5 exposure and health effects …

    (13)mdpi.com2022/10/1013

    Health Effects of PM2.5 Exposure in China from 2004 to 2018: A … – MDPI

    A systematic review shows that there are 30 diseases and 46 health effect outcomes with clear concentration–response relationships with PM2.5 in China. Seven health effects were investigated by meta-analysis.

    (14)pmc.ncbi.nlm.nih.gov14

    Recent Insights into Particulate Matter (PM2.5)-Mediated Toxicity in …

    According to the most recent data, fine particulate matter, or PM 2.5, is responsible for nearly 4 million deaths globally from cardiopulmonary illnesses such as heart disease, respiratory infections, chronic lung disease, cancers, preterm births, and other illnesses.

    (15)ACS Publications2021/12/2315

    Tracking PM2.5 and O3 Pollution and the Related Health Burden in China …

    Recent clean air policies brought great health benefits dominated by decrease in PM 2.5, but short-term O 3 -associated deaths has become nonnegligible. 1. Introduction. Air pollution has been a threat to public health and the ecological system in China.

    (16)Springer2022/03/1616

    Health Effects of Long-Term Exposure to Ambient PM2.5 in Asia-Pacific …

    Health effects of long-term exposure to ambient PM 2.5 vary with regions, and 75% of the deaths attributable to PM 2.5 were estimated in Asia-Pacific in 2017. This systematic review aims to summarize the existing evidence from cohort studies on health effects of long-term exposure to ambient PM 2.5 in Asia-Pacific.

    (17)Nature2024/12/1917

    Health burdens related to emission sources and cross … – Nature

    The health impacts of PM 2.5 and ozone can be attributed to their precursor emissions, by source category, species, and region. Such analysis is valuable, as it allows for targeted and…

    (18)pmc.ncbi.nlm.nih.gov2016/01/1918

    The impact of PM2.5 on the human respiratory system – PMC

    Understanding how PM2.5 leads to respiratory diseases will assist in preventing and diagnosing the corresponding health issues and the evolution of more effective methods and technologies for the treatment of PM2.5-induced diseases.

    (19)The Lancet19

    The Lancet Countdown on PM2·5 pollution-related health impacts of China …

    We calculated the PM 2·5 concentrations and compared the health impacts and implementation costs between two scenarios that reflect CO 2 and air pollutant emissions—the reference (REF) scenario (no climate policy) and the NDC scenario (100% realisation of NDC targets: CO 2 emission intensity needs to be about 40% below 2010 emissions by 2030 …

    (20)PubMed2022/03/2220

    Health Effects of Long-Term Exposure to Ambient PM2.5 in Asia-Pacific …

    This systematic review aims to summarize the existing evidence from cohort studies on health effects of long-term exposure to ambient PM 2.5 in Asia-Pacific. Recent findings: In Asia-Pacific, 60 cohort studies were conducted in Australia, Mainland China, Hong Kong, Taiwan, and South Korea.

    (21)ScienceDirect2023/06/1521

    Tracing the sources of PM2.5-related health burden in China

    Fine particulate matter (PM2.5) poses a major environmental risk to human health. We estimated PM2.5-related premature deaths in 30 Chinese provinces in 2020 using an integrated exposure response model based on monitored concentrations and obtained regional and sectoral contributions based on the atmospheric transport of the atmospheric …

    (22)U.S. Environmental Protection Agency2024/08/0122

    Clinical Outcomes Related to Particulate Matter Exposure and …

    Hundreds of scientific studies have found that breathing in fine particulate matter (PM2.5) over the course of hours to days (short-term) and months to years (long-term) can lead to a variety of health effects, including harmful effects on blood vessels and the heart.

    (23)ACS Publications2016/04/1123

    Economic Impacts from PM2.5 Pollution-Related Health Effects in China …

    This study evaluates the PM2.5 pollution-related health impacts on the national and provincial economy of China using a computable general equilibrium (CGE) model and the latest nonlinear exposure–…

    (24)ACS Publications2024/06/0524

    Association between Long-Term Exposure to PM2.5 Inorganic Chemical …

    Long-term exposure to higher levels of PM 2.5 inorganic compositions was associated with significantly increased cardiopulmonary mortality, with SO 42– potentially being the primary contributor. These findings offer insights into how PM 2.5 sources impact health, aiding the development of more effective governance measures. CC-BY-NC-ND 4.0 .

    (25)AGU Publications2022/03/1425

    A Health Impact and Economic Loss Assessment of O3 and PM2.5 Exposure …

    Based on ozone (O 3) and fine particulate matter concentration (PM 2.5) monitoring data in 331 Chinese cities from 2015 to 2020, this study evaluated the health effects and the corresponding economic losses of O 3 and PM 2.5 pollution on three health endpoints.

    (26)Cell Press2024/10/2526

    Long-term exposure to PM2.5 has significant adverse effects on …

    Evidence suggests that long-term exposure to fine particulate matter (PM 2.5) may be an important risk factor for developing asthma. However, inconsistencies in findings from earlier epidemiological studies have left this potential health risk under debate.

    (27)ACS Publications27

    Economic Impacts from PM2.5 Pollution-Related Health Effects: A Case …

    In this study, we examine the health and economic impacts from PM 2.5 pollution under various air pollution control strategies and climate policies scenarios in the megacity of Shanghai.

    (28)ScienceDirect2023/05/2028

    Substantial short- and long-term health effect due to PM2.5 and the …

    For PM 2.5 constituents, organic carbon leads to the most short-term exposure deaths. We find an amplified health effect due to compound events compared to single events. Heavy pollution events of fine particulate matter (PM 2.5) frequently occur in China, seriously affecting the human health.

    (29)BMC Public Health2025/01/2929

    Ambient air pollution and Alzheimer’s disease and … – BMC Public Health

    Stratified analyses by Global North–South divide and human development index were performed to explore the potential inequity in air pollution impacts. During 1990–2019, the global ASMR, DALYs and O3 increased by 0.11%, 0.09%, and 0.17% per year, respectively. In contrast, PM2.5 and NO2 decreased by 0.33% and 0.14% per year, respectively.

    (30)PubMed2022/03/1530

    Long-term PM2.5 exposure and various health outcomes: An umbrella …

    Adverse effects from exposure to particulate matter <2.5 μm in diameter (PM 2.5) on health-related outcomes have been found in a range of experimental and epidemiological studies. This study aimed to assess the significance, validity, and reliability of the relationship between long-term PM 2.5 exposure and various

    (31)ScienceDirect2020/05/1531

    Acute and chronic health impacts of PM2.5 in China and the influence of …

    Although heavy pollution episodes and their related health impacts attract substantial public attention, we find that the long-term health impacts caused by ambient PM 2.5 concentration are more important for the overall public health burden. These results suggest that policy makers need not only to control and prevent heavy pollution episodes …

    (32)UN News2025/02/0732

    Toxic air threatens children’s lives across East Asia and the Pacific …

    Nearly half of PM2.5 pollution in the worst-affected countries comes from the burning of fossil fuels, biomass, and agricultural waste – also major contributors to climate change. As extreme weather events worsen due to climate change, air pollution is expected to become an even greater threat, UNICEF warned. Impacts beyond health

    (33)Springer2024/05/0233

    The effect of fine particulate matter (PM2.5) pollution on health …

    This research introduces PM2.5 pollution into the intergenerational health transmission model, and estimates its impact on health inequality in China using Ordered Logit Regression (OLR) and Multi-scale Geographically Weighted Regression (MGWR) model.

    (34)Nature2025/02/0434

    Rising socio-economic costs of PM2.5 pollution and medical service …

    The harmful impact of fine particulate matter (PM2.5) air pollution on public health remains a pressing concern. Detrimental effects of such pollution on elderly populations can be exacerbated by …

    (35)PubMed2025/02/0735

    Long-Term Exposure to Fine Particulate Matter (PM2.5 … – PubMed

    Background: The increasing incidence of precocious puberty is a major health challenge for Chinese children, while related risk factors remain less well explored. Exposure to ambient fine particulate matter (PM2.5) is a leading environmental hazard in China. Although certain components of PM2.5 have been reported to be endocrine disruptors for sex hormones, population-based evidence is still …

    (36)ACP2025/02/0436

    Impacts of meteorology and emission reductions on haze pollution during …

    Fine particulate matter (PM 2.5) is a critical issue for both policymakers and the general public due to its widespread presence and adverse impacts on human health (Lelieveld et al., 2018), agriculture productivity (Dong and Wang, 2023), and the Earth’s radiation balance (Li et al., 2022; Yang et al., 2021).The formation and accumulation of anthropogenic PM 2.5 result from a complex …

    (37)Medical Xpress2025/02/0737

    Air pollution’s dual threat: Health and economic impacts on aging societies

    Air pollution is a growing health issue worldwide, and its impacts are often underestimated in aging societies like Japan. … Rising socio-economic costs of PM2.5 pollution and medical service …

    (38)pmc.ncbi.nlm.nih.gov38

    Long- and Short-Term Exposure to PM2.5 and Mortality: Using Novel …

    Multiple studies in the United States and worldwide have shown associations between exposure to ambient particulate matter (PM) and adverse health effects. 1–6 These adverse health effects include asthma, 7 cardiovascular problems, 3,8–12 respiratory infections, 13–17 lung cancer, and mortality. 18–22

    (39)ScienceDirect2022/03/0139

    Assessing the evolution of PM2.5 and related health impacts resulting …

    The mean PM 2.5 concentration in the first half of 2021 was 34 μg/m 3 (the World Health Organization (WHO) guideline suggests that PM 2.5 should not exceed 5 μg/m 3 annual mean). Therefore, it is necessary to review the long-term evolution of air pollution in China and the effect of policies implemented to better formulate new plans and …

    (40)Springer2024/08/0240

    Short-term Exposure to PM2.5 and Cardiorespiratory Mortality and …

    Exposure to ambient fine particulate matter (PM2.5) is a substantial environmental health issue for urban inhabitants in Ho Chi Minh City (HCMC). The effects of short-term exposure to ambient PM2.5 on cardiorespiratory mortality and morbidity were determined in HCMC by a retrospective, hospital-based, unidirectional, and symmetric bidirectional case-crossover study. Ambient PM2.5 …

    (41)Harvard T.H. Chan School of Public Health2025/01/3141

    The health impacts of wildfires: Frequently asked questions | Harvard T …

    One study estimated chronic health impacts from indoor exposures to various air pollutants and found PM 2.5 to account for the greatest burden, … Look for one that measures airborne particles (PM2.5) and airborne gases (TVOCs). These are imperfect measures, but will give you a sense of how your space is being impacted or not. For more …

    (42)ScienceDirect2019/09/0142

    Human health impact and economic effect for PM2.5 … – ScienceDirect

    Exposure to hazardous PM 2.5 would not only trigger human health impact, but also result in an economic loss for both society and individual. In this study, the PM 2.5-related health impact and corresponding economic loss are assessed in

    (43)ScienceDirect43

    Population exposure evaluation and value loss analysis of PM2.5 and …

    These results were based on well-continued large spatial scale PM 2.5 and O 3 concentration data, and population data, and highlighted the significant impacts of both on public health in

  • Disseminated Gonorrhea

    Disseminated Gonorrhea

    Disseminated Gonorrhea or Neisseria Gonorrhoeae. Disseminated gonococcal infection (DGI)

    Many of my patients with Gonorrhea( pus per urethra) present with rash , some have joint pain (Gonococcal arthritis)

    (DGI) follows untreated mucosal infection in about 0.5-3 per- cent of patients. Skin lesions are the most common manifestation of DGI and occur in 50-70 percent of patients. The eruption typically appears during the first day of symptoms and may recur with each bout of fever. The skin lesions associated with DGI begin as tiny red papules or petechiae 1-5 mm in diameter, many of which evolve rapidly through vesicular or pustular stages to develop a gray necrotic center, often on a hemorrhagic base. Papules, bullae, pustules, and hemorrhagic lesions may all be present simultaneously. The lesions tend to be scanty but widely distributed. The distal portions of the extremities are most commonly involved, with sparing of the scalp, face, trunk, and oral mucous membranes. Histologic examination will reveal local vasculitis, fibrin deposition, necro- sis, and neutrophil infiltration. Gram-stained smears of material from skin lesions infrequently reveal organisms, although most smears are positive for gonococci when examined by immunofluorescence techniques. Circulating immune complexes may play a role in the pathogenesis.

  • Fever and rash in Thailand

    Fever and rash in Thailand

    Fever and rash in Thailand (part1/2)

    If you have fever while traveling in Thailand or fever with a rash in a tropical country , what can you do? and what’s possible cause? Today I will give you some ideas.
    Fever can be caused by various infectious and non-infectious conditions. The possibilities depend on factors like how many days of the illness (acute or chronic), type of rash, other associate symptoms, and exposure or traveling history. Below are common causes:

    Infections

    Infection can be virus , bacteria or other but most common is virus. in my experience here in Pattaya , tourists concern about Dengue fever but it’s not common one .


    Dengue Fever :

    I will give more details in another post , but if you were here in rainy season ( Approx June till October ) And you had exposed to mosquito , it can be Dengue. Remember that in typical case the fever comes before the rash for 3-4 days.

    Rash: Blotchy or pinpoint red spots (petechiae), often appears after fever subsides.
    Other symptoms: High fever, severe headache, muscle/joint pain, eye globe pain, and bleeding tendencies , poor appetite or even vomiting, tiredness.
    Chikungunya Virus:

    Chikungunya also a virus transmitted by mosquito .

    Rash: Maculopapular rash, usually widespread. Sometimes at the same time of fever , or after few days.
    Other symptoms: High fever, severe joint pain, fatigue, and headache.


    Corona and other Virus

    Many viral disease including Covid and coronavirus , can cause fever with rash

    Rash: Maculopapular, often accompanied by conjunctivitis.
    Other symptoms: Mild fever, muscle pain, headache, and malaise.


    Rubella (german measles)

    Rash: Fine maculopapular rash evenly distributed all body.
    Other symptoms: fever (usually low grade)and rash appear simultaneously at the first day , or no fever , malaise .


    Typhus (Scrub Typhus)

    Rash: Starts on the trunk and spreads to extremities, maculopapular or petechial.
    Other symptoms: Fever, headache, and swollen lymph nodes; eschar at the bite site.


    Measles

    Rash: Starts on the face and spreads downward, blotchy and red.
    Other symptoms: High fever, cough, conjunctivitis, and Koplik spots in the mouth.

  • Norovirus outbreaks in 2024

    Norovirus outbreaks in 2024

    In 2024, there has been a notable increase in norovirus outbreaks across various regions of the world , USA , Europe and China:

    United Kingdom: Health officials observed a 33% increase in norovirus cases from mid-November to early December 2024, with the total number of infections more than doubling compared to previous years.
    (THE SUN)

    United States: The Centers for Disease Control and Prevention (CDC) reported 495 norovirus outbreaks between August 1 and December 11, 2024, a significant rise from 363 outbreaks during the same period in the previous year.
    (CDC)

    Students from various schools in China reported symptoms such as vomiting and abdominal pain, which were later confirmed as Norovirus infections. In one case, 18 students were affected. Similarly, 48 children at a kindergarten in Xi’an, Shaanxi Province, tested positive for the virus, experiencing vomiting and diarrhoea.(TheNation)

    Foodborne Outbreaks: In December 2024, the U.S. Food and Drug Administration (FDA) issued advisories regarding norovirus contamination in certain oyster and clam products distributed nationwide.
    (EATINGWELL)

    Norovirus is highly contagious, leading to symptoms such as vomiting, diarrhea, nausea, and stomach pain. It spreads through direct contact with infected individuals, consumption of contaminated food or water, and touching contaminated surfaces. Preventive measures include thorough handwashing with soap and water, proper food handling, and disinfecting contaminated surfaces. Individuals experiencing symptoms are advised to stay home and avoid preparing food for others until at least 48 hours after symptoms subside.

    In Thailand , many experts predict that the transmission will be via children , or people traveling from China , and expecting some outbreak in tourist destinations like in Pattaya , Bangkok , Phuket.

    In case you are sick , can come to see our doctor at https://pattayadoctor.com

  • How are Chinese Sinovac and Sinopharm Covid vaccines?

    How are Chinese Sinovac and Sinopharm Covid vaccines?

    How are Chinese Sinovac and Sinopharm Covid vaccines?

    China appears to have made two frontier vaccines from two front runners , Sinovac and Sinopharm . What do we know about these firms?

    The Beijing-based biopharmaceutical company Sinovac is behind the CoronaVac, an inactivated vaccine. It use killed viral particles to expose the body’s immune system , like old style vaccine such as rabies vaccine , to stimulate the immune without risking a serious disease.

    Which , by comparison , the Pfizer and Moderna vaccines being developed by mRNA virus , means that the virus’s genetic part is injected into the body , triggering the body to begin making viral proteins, but not the whole virus , which enough to train the immune system to attack.

    The firm said that “”mRNA vaccines are a new type of vaccine and there is [currently] no successful example [of them] being used in the population,”

    On paper , one of The Sinovac’s main advantages is that it can be stored in a standard refigerator at 2-8 C , like the vaccine from Oxford , which is made from genetically engineered common cold virus. The other two , Moderna’s vaccine needs -20 C and Pfizer’s vaccine at whopper -70 C .

    How effective is it? It’s hard to tell right now.

    A Chinese study published in the scientific journal The Lancet only has information from the first and second phase trials of CoronaVac in China. Zhu Fengcai, one of the authors of the article, said those results – based on 144 participants in the phase one trial and 600 in the phase two trial – meant that the vaccine was “suitable for emergency use.” CoronaVac has undergone phase three trials in several countries. Interim data from late-stage trials in Turkey and Indonesia showed that the vaccine was 91.25% and 65.3% effective, respectively.

    Researchers in Brazil initially said it was 78% effective in their clinical trials, but in January 2021 they revised that figure to 50.4% after including more data in their calculations.

    In early November, this trials were briefly stopped after the death of a volunteer, but resumed after death was not found to have no link to the vaccine. Sinovac has been approved for emergency use in high-risk groups in China since July. In September, Mr. Yin from Sinovac said the tests were conducted on more than 1,000 volunteers, of whom “some showed only minor fatigue or discomfort ,no more than 5%.”

    And the Sinopharm vaccine?

    Sinopharm, a Chinese state-owned company, is developing two Covid-19 vaccines, which, like Sinovac, are also inactivated vaccines that work in a similar way.

    Sinopharm announced on December 30 that trials of the third phase of the vaccine showed it to be 79% effective, lower than that of Pfizer and Moderna. However, the United Arab Emirates, which approved a synopharmaceutical vaccine earlier this month, said the vaccine was 86% effective, based on interim results from its phase three trial.

    A company spokeswoman declined to explain the discrepancy, saying detailed results would be released later, a Reuters report said. But even before the results of the third phase trials, the vaccine had already been distributed to nearly a million people in China as part of an emergency program.

    Professor Dale Fisher of the National University of Singapore said at the time that it was “unconventional” to step up a vaccine program without going through late-stage trials first. “It is normal to wait for an analysis of the third phase trials before intensifying a vaccine program by authorizing emergency use,” he told the CNBC news site.

    In early December, Peru suspended trials for the synopharm vaccine due to a “serious adverse event” that affected a volunteer. It later said it lifted the suspension. A pause in a clinical trial is not unusual. In September, the UK halted trials for another Covid-19 vaccine after a participant had a suspected adverse reaction, resuming after the vaccine was ruled out as the cause.

    The spread of the coronavirus within China has for the most part been contained – and life is slowly but surely returning to a “new normal.”

    Any other vaccine candidates?

    At least two other Covid-19 vaccines are in development in China, according to a recent article in The Conversation. One of them is CanSino Biologics, which is reported in phase three clinical trials in countries including Saudi Arabia. The other is being developed by Anhui Zhifei Longcom. Its vaccine uses a purified piece of the virus to trigger an immune response, and it has recently entered phase three testing, according to the report