Environmental toxins harm fetal auditory pathways

Dr. Carol Tan Maternal exposure to environmental toxic products may damage fetal auditory pathways and cause hearing loss,
according to a study by Dr. Charlotte Chiong, et al. from the Philippine General Hospital, Department of Otorhinolaryngology
[Acta Medica Philippina. 2012;46(3):5-10].

In this study, all pregnant women who consulted at the Bulacan Regional Hospital from April 2002 to February 2003 were
assessed for exposure to environmental toxins. Maternal blood and hair samples were collected at the time of recruitment and
during delivery. Infant cord blood, hair and meconium samples were also obtained. Pesticide levels of these samples were
determined and correlated with hearing loss among infants as measured by otoacoustic emissions (OAE) and confirmed by
diagnostic auditory brainstem responses (ABR). Pesticide exposure was also correlated with mental development using the
Griffiths Mental Developmental Scale (GDMS) scores. A total of 686 newborns were examined: 365 males (53.2 percent) and
321 females (46.8 percent).

Results of the study showed that significant delays in the ABR wave latencies were noted in the group exposed to pesticides. The
risk of hearing loss among infants with cypermethrin exposure was 6.25 percent, in contrast to the 1.34-percent risk among the
unexposed group. The computed relative risk of cypermethrin exposure is 4.53 (confidence interval: 0.61 to 33.64). There was
also a 6.25-percent risk of hearing loss among infants exposed to pretilachlor, while the unexposed group had a 1.99-percent
risk.

The relative risk of pretilachlor exposure is 3.13 (confidence interval: 0.44 to 22.30). Interestingly, infants exposed to propoxur,
which was the most common toxic product identified, had a lower risk of hearing loss at 1.4 percent, compared to the 2.7-percent
risk among the unexposed group. The relative risk of propoxur exposure is 0.52 (confidence interval: 0.12 to 2.30). There was no
significant difference among the GDMS scores of the exposed and unexposed group.

The authors explained that while an association seems to exist between cypermethrin and pretilachlor exposure with hearing
loss, further analysis using multivariate regression must be done to delineate the effects of these pesticides from other
confounding factors. They also stressed the importance of newborn hearing screening for early identification and intervention of
hearing loss to prevent subsequent neurodevelopmental delays.

The authors concluded that all pregnant women must be advised to avoid exposure to environmental toxins in order to protect
their infants from auditory damage.
Hospitals urged to correctly report new coronavirus
Ian Carlos Achero Health Secretary Dr. Enrique Ona instructed hospitals to correctly report cases of the new coronavirus using
forms available from the National Epidemiology Center. There are twelve confirmed cases of the new coronavirus reported to
the WHO from various countries. Other member states are also urged to report new cases. Presently, there are no travel or trade
restrictions raised for the virus. Treatment is based on findings presented by the patient as no specific treatment is yet available.

The main sign of respiratory illness due to the new coronavirus is severe respiratory difficulty, typically leading to admission to
the intensive care unit. Based on a limited number of cases, the infection presents as pneumonia, with some cases leading to
kidney failure and death. Laboratory confirmation is necessary due to various common diseases presenting with the same signs
and symptoms. The WHO recommends testing for the new coronavirus in patients with unexplained severe, progressive or
complicated respiratory illness not responding to treatment and unexplained pneumonia. Patient samples can be sent to the
Research Institute for Tropical Medicine for confirmation. Interim case definitions from the WHO are available for reporting
purposes.

The exact method of transmission is not yet known. Unlike severe acute respiratory syndrome (SARS), the new coronavirus does
not appear to be easily transmissible. Studies are underway to determine the source of the virus, type of exposure that leads to
disease, and clinical patterns of the infection. There are reported cases of infections occurring within a family which raise the
possibility of human-to-human transmission. However, it is also possible for family members to have been exposed to the same
source of infection which led to disease. No sustained person-to-person transmission has been seen.

There is no specific treatment or vaccine available yet that targets the virus. However, symptoms caused by the virus can be
treated. Supportive care for respiratory difficulty and pneumonia can be highly effective.

In order to prevent the spread of the new coronavirus, people are instructed to observe proper cough etiquette, frequent hand
washing, maintain good hygiene and avoid close contact whenever possible with anyone showing signs of the illness. Health
care workers are instructed to consistently apply appropriate infection prevention and control measures.

The new strain of coronavirus has not been previously identified in humans. Coronaviruses are a group of viruses known to
cause a wide variety of diseases in humans and animals, ranging from the common cold to SARS. This group of viruses
primarily infect the upper respiratory and gastrointestinal tract of mammals and birds. In 2003, the SARS coronavirus resulted in
an epidemic of 8,000 infections around the world.
Important benefits for women who quit smoking early
Elvira Manzano Smoking nearly triples the risk of premature death in women and quitting the habit well before middle-age
reduces this risk, according to the Million Women Study.

In this prospective study, the largest in the history of studying the dangers of smoking, 12-year mortality rates among women
who smoked throughout their adult years were almost three times higher than those of women who never smoked (rate ratio
2.97, 95% CI, 2.88-3.07). Even light smokers (those who smoked fewer than 10 cigarettes per day) had twice the mortality rate
of never-smokers (rate ratio 1.98, 95% CI, 1.91-2.04). [Lancet 2012.DOI.org/10.1016/S0140-6736(12)61720-6]

What was encouraging, however, was the positive effect that quitting seemed to have on womens life span. Stopping the habit
before age 40 avoided more than 90 percent of excess mortality from cigarettes. Quitting before age 30 avoided 97 percent of
this added risk.

Smokers who stop before reaching middle-age will on average gain about an extra 10 years of life, said study author Professor
Sir Richard Peto, of the University of Oxford, Oxford, UK.

This does not, however, mean that it is safe to smoke until age 40 and then stop, the authors warned. Decades later throughout
life, women who smoked and stopped still have 1 to 2 times the mortality rate of never-smokers. For those who continued to
smoke past age 40, the risk is 10 times greater.

The study enrolled 1.3 million women (age 50-65) in the UK followed for 12 years. At baseline, 20 percent were smokers, 28
percent were former smokers and 52 percent never smoked.

By 2011, 66,000 had died. Compared with non-smokers, smokers lost at least 10 years of life and died from smoking-related
diseases such as lung cancer, heart disease and stroke. While the absolute hazards of prolonged smoking are substantial, so are
the benefits of quitting.

Even cessation at about 50 years of age avoids at least two-thirds of the continuing smokers excess mortality in later middle
age, the authors said. The benefits are, however, greater in those who quit earlier.

In a linked comment, Dr. Rachel Huxley, from the University of Minnesota, Minneapolis, US, and Dr. Mark Woodward, from
the University of Sydney, Australia, welcomed the findings. Aside from its impressive sample size, the Million Women Study
is distinct from previous large cohortsand superior for assessment among women of the full hazards of prolonged smoking and
the full benefits of long-term cessation because the participants were among the first generation of women in the UK in which
smoking was widespread in early adult life, and although many continued smoking, many stopped before age 30 or 40 years.

The results emphasize the need for effective sex-specific and culturally-specific tobacco control policies that encourage adult
smokers to quit and discourage children and young adults from starting smoking, they concluded.
SARS
severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated
coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003. Over the next few months, the illness spread to
more than two dozen countries in North America, South America, Europe, and Asia before the SARS global outbreak of 2003
was contained.
Background:
This atypical pneumonia has been named Severe Acute Respiratory Syndrome (SARS) by World Health Organization (WHO).
SARS is an infectious disease of the respiratory system characterized by atypical inflammation of the lungs (pneumonia).
Scientists at CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS. This new
coronavirus is the leading hypothesis for the cause of SARS.
SARS appears to be primarily spread from person-to-person through droplet transmission when in direct close contact with a
person with SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are
contaminated with infectious droplets and then touching your eye(s), nose, or mouth. SARS is an emerging disease. Knowledge
about its clinical behavior, response to treatment, and modes and risks of transmission are continually evolving.
Early symptoms in patients with SARS have included fever (>100F), muscle aches, dry cough, shortness of breath, or difficulty
breathing. The illness usually begins with a fever (measured temperature greater than 100.4F [>38.0C]) which is sometimes
associated with chills or other symptoms, including headache, general feeling of discomfort and body aches. Some people also
experience mild respiratory symptoms at the outset.
After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by or progress to the point
where insufficient oxygen is getting to the blood. Ten percent of 20 percent of SARS cases may progress to requiring the use of
a respirator. No specific treatment recommendations can be made at this time, however, medical personnel is instructed to treat
general clinical signs. CDC currently recommends that patients with SARS receive the same treatment that would be used for
any patient with serious community-acquired atypical pneumonia. The virus suspected to be the cause of SARS (coronavirus) is
being tested against various antiviral drugs to see if an effective treatment can be found.
Epidemiologic Criteria:
1. Travel (including transit in an airport) within ten days of onset of symptoms to an area with current or previously documented
or suspected community transmission of SARS.
2. Close contact within ten days of onset of symptoms with a person known or suspected to have SARS.
Mode of Transmission:
1. The primary mode of transmission appears to be direct mucous membrane (eye, nose, and mouth)
2. Contact with infectious respiratory droplets and/or through exposure to fomites.
3. Transmission through casual and social contacts has occasionally occurred as a result of intense exposure to a case of SARS
(in work place, in vehicles) or in high risk transmission settings, such as health care settings, and in household settings.
4. Contamination of inanimate materials or objects by infectious respiratory secretions or body fluids (saliva, tears, urine, and
stool) which have been found to contain the virus.
For how long will the SARS virus exist on surfaces?
1. The virus is stable in urine and feces at room temperature for at least one to two days, in stool from patients with diarrhea for
up to four days.
2. It survives on paper, on a plastered wall after 36 hours, on plastic surface and stainless steel after 72 hours, on a glass slide
after 96 hours.
3. Hospital environmental samples from a number of sites, including walls and the ventilation system, tested positive for SARS
virus.
4. Virus loses infectivity after exposure to different commonly used disinfectants and fixatives. Heat at 56C rapidly kills the
virus.
5. Other risk factors:
a. Household contact with a probable case of SARS
b. Increasing age
c. Male sex
d. Presence of co-morbidities
What are the signs and symptoms of SARS?
1. Sudden onset of high grade fever, usually greater than 38C
2. Headache and overall feeling of discomfort and body aches
3. Mild respiratory symptoms at the start and after two days, the patient develops dry cough and have respiratory difficulty.
Treatment:
No specific treatment recommendations can be made at this time. Empiric therapy should include coverage for organisms
associated with any community-acquired pneumonia of unclear etiology, including agents with activity against both typical and
atypical respiratory pathogens. Treatment choices may be influenced by severity of the illness. Consultation is recommended.
Clinical Course and Management of SARS:
1. It is difficult to decide on the appropriate time to discharge a SARS patient.
2. SARS appears to have lingering after effects once the acute phase of the disease ends.
3. Psychosocial aspects of this illness should not be underestimated.
Preventive Measures:
1. Consult a doctor promptly if there are respiratory symptoms such as fever, malaise, chills, headache, joint pain, dizziness,
rigors, cough, sore throat and runny nose. Early treatment is the KEY.
2. Build up good body immunity. This means taking proper diet, having regular exercise and adequate rest, reducing stress, and
avoiding smoking.
3. Maintain good personal hygiene. Cover nose and mouth when sneezing or coughing.
4. Wear mask if you develop runny nose, sore throat and cough.
5. Wear protective mask in public areas, classrooms, computer rooms, public transports, and communal areas in hostels.
6. Wash hands properly and keep them clean. Use liquid soap for hand washing and disposable towels for drying hands.