Smoke Inhalation Research Articles

783 Use of Multidisciplinary Collaboration to Establish a Standardized Endotracheal Tube Wiring Guideline

IntroductionPediatric patients with facial burns and advanced airway needs precipitate acute situations requiring multidisciplinary team member collaboration. Significant facial burns, particularly involving considerable edema or smoke inhalation, may warrant dental or circum-mandibular endotracheal tube (ETT) wiring for stabilization. Guidelines were created, trialed, and revised based on patient outcomes and clinician feedback at a pediatric verified burn center.MethodsThe guideline was created by the burn team in 2019. This standard work was utilized with pediatric burn cases presenting to the burn center. Guideline variances, such as prolonged time from door to ETT wiring, prompted a gap analysis need to improve the process. Through two case review sessions held in 2020, a multidisciplinary team consisting of the burn providers, emergency department providers, nursing, and respiratory therapists revealed process knowledge deficits, unclear role expectations, and supply issues. Literature was reviewed and a myAmeriburn listserv inquiry of current practice was made to seek additional guidance.ResultsBased on feedback from the multidisciplinary group and data gathered from the literature and collegial burn community, action plans and guideline modifications were developed in 2021. The respiratory therapy department developed education for their staff highlighting use of twill tape and taping. The use of ETT suturing was removed from the guidelines.ConclusionsMultidisciplinary contribution and engagement was necessary to produce, execute, and evaluate the pediatric endotracheal tube wiring guidelines. Through dialogue, patient trial, and constructive feedback, guidelines were amended to produce a smoother team process and better patient experience. The standard work is currently being evaluated in its modified version.

550 Considerations for Ophthalmologic Evaluation to Reduce Ocular Morbidity in Facial Burn Patients

IntroductionAdvances in burn management have led to significant improvement in survival rates, even in patients with high total body surface area (TBSA) affected. Ocular morbidity in facial burn patients remains high, partially attributable to the life-threatening nature of these injuries. Previous studies have shown that early ophthalmologic intervention leads to better outcomes, however, specific risk factors for short and longer term ophthalmologic outcomes have not been elucidated. This study aimed to identify risk factors for short- and long-term ophthalmologic complications in facial burn patients to prioritize patients that require urgent ophthalmologic evaluation.MethodsRetrospective review of facial burn patients presenting to an American Burn Association-verified regional burn center between June 2007 and May 2016 was conducted. Demographics, presentation, time to ophthalmologic consultation, and short- and long-term complications were recorded. Odds ratio and multivariate analyses were performed to assess for significant risk factors.ResultsA total of 1,126 facial burn patients were identified, of which 135 (12%) involved periorbital and orbital injury. Average TBSA burned was 9.68%, with an average facial surface area burned of 1.56%. The most common ocular injury was eyelid burn (65.9%). Ophthalmology was consulted for 118 (87.4%) patients. Short-term ophthalmologic complications were noted in 58 (43%) patients, most commonly chemosis (n = 34, 25.2%). Long-term complications were rare, occurring in only 7 (5.2%) patients.Odds ratio analysis revealed that inhalation injury significantly increased the likelihood of both short- and long-term complications (OR 3.16 and OR 9.81, respectively). Active smoking increased the likelihood of long-term complications (OR 14.76). Ophthalmologic intervention, including need for consult, and use of lubricant, antibiotics, or steroids were each associated with increased risk of short-term complications.On multivariate analysis, those with long-term complications tended to be older (p = 0.045). Those with corneal injury generally had worse outcomes, with higher likelihood of short- and long-term complications (p < 0.001, p = 0.057, respectively).Blindness did not occur in any patient, and no long-term complications occurred in those who did not receive ophthalmologic consult. Neither TBSA nor facial SA burned was associated with the development of short- or long-term complications.ConclusionsProviders should obtain early ophthalmologic evaluation and frequent follow-up exams for facial burn patients presenting with advanced age, active smoking status, corneal injury, or inhalation injury to reduce development of long-term complications.

Exercise Training Attenuates Cardiac Vulnerability and Promotes Cardiac Resistance to Isoproterenol-Induced Injury Following Hookah Smoke Inhalation in Male Rats: Role of Klotho and Sirtuins.

Hookah smoking is on the rise around the world. Present study investigated the heart resistance to harmful stress following long-term waterpipe tobacco smoking (WTS) and moderate-intensity exercise training intervention in male Wistar rats. Animals were randomly divided into a non-ischemic heart control group and four ischemic heart groups including ISO (isoproterenol-treated), Ex + ISO (subjected to exercise plus ISO), S + ISO (exposed to hookah smoke plus ISO), and Ex + S + ISO (subjected to exercise along with hookah smoke plus ISO). After eight weeks of training and WTS, heart ischemia induced by isoproterenol injections. Then, cardiac functional indices and some biochemical and histopathological parameters were assessed. WTS + ISO reduced systolic pressure, ± dP/dt max, and contractility indices (P < 0.001 vs. ISO group) and increased end diastolic pressure and Tau index (P < 0.001 vs. ISO) of the left ventricle. Also, WTS + ISO was associated with an increase in Bax protein level and Bax/Bcl-2 ratio (P < 0.05 and P < 001, respectively, vs. ISO group) as apoptotic markers of heart tissue. Hookah smoke significantly decreased SIRT1 (P < 0.05 and P < 0.001, respectively, vs. ISO) and klotho (P < 0.01 and P < 0.001, respectively, vs. ISO) in serum and heart, and SIRT3 and pS9-GSK-3β (P < 001 and P < 0.05, respectively, vs. ISO) in heart tissue. Combination of exercise with WTS prevented the hookah smoke-induced alterations in apoptotic markers, cardiac functional indices, and SIRT1, SIRT3, klotho, and pS9-GSK-3β proteins. The findings demonstrated that hookah smoke inhalation intensifies ventricular dysfunction and decreases heart resistance to harmful stresses. Moderate-intensity exercise training attenuated these complications partly through recovering the klotho and sirtuins levels and apoptosis-survival balancing.

In vitro and vivo study of tranilast protects from acute respiratory distress syndrome and early pulmonary fibrosis induced by smoke inhalation

BackgroundTranilast (N-[3＇,4＇-dimethoxycinnamoyl]-anthranilic acid) is an analog of a tryptophan metabolite. It was identified with anti-inflammatory and antifibrotic activities, and used in the treatment of a variety of diseases, such as anti - allergy, bronchial asthma, and hypertrophic scars. As a drug with few adverse reactions, tranilast has attracted great attention, but its application is limited due to the uncertainty of dosages and mechanisms. In this study, the protection effects of different doses of tranilast on smoke inhalation mediated lung injury on rats, and on the damage of three kinds of lung cells in vitro were investigated. MethodIn vivo, Sprague-Dawley rats were randomly divided into sham group, smoke group (rats were exposed to pine sawdust smoke three times, each time for 5 min), different doses of tranilast treatment group (doses were 100 mg/kg, 200 mg/kg and 300 mg/kg, ip.) and placebo group. After 1, 3 and 7 days, pulmonary function, pathologic injury by HE staining, cytokines and oxidative stress level by kits were determined. At 7days, lung fibrosis was assessed by Masson’s trichrome staining and the level of hydroxyproline (HYP). In vitro, three kinds of lung cells from normal rats were isolated: type II alveolar epithelial cells (AT-II), pulmonary microvascular endothelial cells (PMVECs) and pulmonary fibroblasts (PFs). To investigate the potential effects of tranilast on cell proliferation, cell cycle and cytokine production of three kinds of lung cells exposed to smoke. ResultsCompared with smoke group and placebo group, tranilast treatment significantly reduced histopathological changes (such as pulmonary hemorrhage, edema and inflammatory cell infiltration, etc.), significantly reduced histopathological score (p < 0.05), increased arterial oxygen partial pressure, and decreased the levels of IL-1β, TNF-α, TGF-β1 (p < 0.05), oxidative stress and the expression of nuclear transcription factor κB (NF-κB) smoke exposed rats (p < 0.01). In particular, the effect of 200 mg/kg dose was more prominent. In vitro, smoke induced AT-II and PMVECs apoptosis, improved PFs proliferation (p < 0.01), activity of SOD and decreased the content of MDA (p < 0.01). However, tranilast seems to be turning this trend well. The inflammatory factor IL-11β, TNF-α and TGF-β1, and the expression of NF-κB were significantly lower in the tranilast treatment than in the smoke group (p < 0.01). ConclusionThis study indicates that tranilast had a protective effect on acute respiratory distress syndrome and early pulmonary fibrosis of rats in vivo. In addition, tranilast promotes proliferation of AT-II and PMVECs but inhibits PFs proliferation, down-regulates secretion of inflammatory cytokines and alleviates oxidative stress of AT-II, PMVECs and PFs after smoke stimuli in vitro.

Epidemiology of out-of-hospital cardiac arrests that occur secondary to chemical asphyxiants: A retrospective series

AimTo determine the epidemiological characteristics, temporal trends and survival outcomes of OHCAs precipitated by chemical asphyxiation. MethodsWe conducted a retrospective cohort analysis of OHCAs attended by paramedics in Queensland, Australia between 2011 and 2020. Patients were classified into two groups depending on the asphyxiating agent involved; simple (argon, carbon dioxide, helium, liquified petroleum gas, nitrogen) and systemic (carbon monoxide, cyanides, hydrogen sulfide, methemoglobin-inducing substances, smoke inhalation). Incidence rates, characteristics and outcomes were described for the entire cohort and independently for each group, with the groups then compared. Temporal trends of asphyxiant utilisation were also described. ResultsDuring the study period, 50,669 OHCAs were attended, with 551 (1.1%) attributable to chemical asphyxiation. The incidence rate was 1.1 per 100,000 population with no significant temporal changes. Suspected suicide was the primary cause of exposure (-95.8%), with systemic asphyixants the dominant agent reported in comparison to simple agents (66.4% vs 33.6%). Over the 10-year period, events precipitated by carbon monoxide decreased by 26.2% (p for trend < 0.001), helium remained unchanged (p for trend = 0.302) and incidents involving nitrogen increased by 28.7% (p for trend < 0.001). Overall, 14.2% (78/551) of the study cohort received a resuscitation attempt by paramedics with 6.4% of these incidents witnessed and 2.6% involving patients presenting in a shockable rhythm. Survival rates were low, with 6.4% surviving the index event, and 1.3% surviving to hospital discharge with a normal neurocognitive function. ConclusionOHCA precipitated by chemical asphyxiation is relatively infrequent and associated with poor survival outcomes.

Exposure and Risk Assessment of Second- and Third-Hand Tobacco Smoke Using Urinary Cotinine Levels in South Korea.

Exposure to environmental tobacco smoke (ETS) is the reason for approximately 1% of global mortality. ETS exposure can happen either as inhalation of direct cigarette smoke (second-hand smoke) or its associated residue particles (third-hand smoke), especially when living with a smoker in the same family. This study investigated the association between the urinary cotinine levels, as biomarkers of exposure to tobacco smoke, of smokers and those exposed to second-hand and third-hand smoke while living in the same family, through a Korean nationwide survey. Direct assessment of ETS exposure and its lifetime effect on human health is practically difficult. Therefore, this study evaluated the internal estimated daily intake (I-EDI) of nicotine and equivalent smoked cigarette per day (CPD). The carcinogenic and non-carcinogenic inhalation risks of ETS exposure were assessed by considering the calculated equivalent CPD and composition of cigarette smoke of high-selling cigarette brands in South Korea. The results show that there is a statistically significant positive correlation between the cotinine levels of smokers and those of the non-smokers living in the same family. The risk assessment results yielded that hazard index (HI) and total excess lifetime cancer risk (ECR) for both second-hand and third-hand smoke exposure can exceed 1 and 1 × 10−6, respectively, especially in women and children. In the composition of the cigarette smoke, 1,3-butadiene and acrolein substances had the highest contribution to HI and ECR. Consequently, the provision of appropriate plans for smoking cessation as a strategy for the prevention of ETS exposure to women and children is deemed necessary.

Evaluation of an Injectable, Solid-State, Oxygen-Delivering Compound (Ox66) in a Rodent Model of Pulmonary Dysfunction-Induced Hypoxia.

Pulmonary dysfunction (PD) and its associated hypoxia present a complication to the care of many service members and can arise intrinsically via comorbidities or extrinsically by infection or combat-related trauma (burn, smoke inhalation, and traumatic acute lung injury). Current supportive treatments (e.g., ventilation and supplemental oxygen) relieve hypoxia but carry a significant risk of further lung injury that drives mortality. Ox66 is a novel, solid-state oxygenating compound capable of delivering oxygen via intravenous infusion. Male Sprague Dawley rats (N = 21; 250-300 g) were surgically prepared for cardiovascular monitoring, fluid infusion, mechanical ventilation, and intravital and phosphorescence quenching microscopy (interstitial oxygen tension; PISFO2) of the spinotrapezius muscle. Baselines (BL) were collected under anesthesia and spontaneous respiration. PD was simulated via hypoventilation (50% tidal volume reduction) and was maintained for 3 hours. Groups were randomized to receive Ox66, normal saline (NS; vehicle control), or Sham (no treatment) and were treated immediately following PD onset. Arterial blood samples (65 µL) and intravital images were taken hourly to assess blood gases and chemistry and changes in arteriolar diameter, respectively. Significance was taken at P < .05. PD reduced PISFO2 for all groups; however, by 75 minutes, both NS and Sham were significantly lower than Ox66 and remained so until the end of PD. Serum lactate levels were lowest in the Ox66 group-even decreasing relative to BL-but only significant versus Sham. Furthermore, all Ox66 animals survived the full PD challenge, while one NS and two Sham animals died. No significant vasoconstrictive or vasodilative effect was noted within or between experimental groups. Treatment with intravenous Ox66 improved interstitial oxygenation in the spinotrapezius muscle-a recognized bellwether for systemic capillary function-suggesting an improvement in oxygen delivery. Ox66 offers a novel approach to supplemental oxygenation that bypasses lung injury and dysfunction.

Cardiovascular and Blood Oxidative Stress Responses to Exercise and Acute Woodsmoke Exposure in Recreationally Active Individuals.

Those who work and recreate outdoors experience woodsmoke exposure during fire season. Exercise during woodsmoke exposure harms the cardiovascular system, but the acute physiologic and biochemical responses are understudied. The purpose of this pilot laboratory-based study was to examine the effect of exercise during woodsmoke exposure on acute indicators of cardiovascular function, including heart rate variability (HRV), pulse wave velocity (PWV), blood pressure (BP), augmentation index (AIx), and blood oxidative stress. Ten participants performed 2 moderate-intensity exercise (70% V˙O2 max) trials (clean air 0 μg·m-3, woodsmoke 250 μg·m-3) in a crossover design. HRV, PWV, BP, AIx, and blood oxidative stress were measured before, after, and 90 min after exercise for each trial. Blood oxidative stress was quantified through lipid damage (LOOH, 8-ISO), protein damage (3-NT, PC), and antioxidant capacity (TEAC). A 45-min woodsmoke exposure combined with moderate-intensity exercise did not result in a statistically significant difference in HRV, PWV, BP, AIx, or oxidative stress (P>0.05). Despite the known deleterious effects of smoke inhalation, moderate-intensity aerobic exercise while exposed to woodsmoke particulate matter (250 μg·m-3) did not result in a statistically significant difference in HRV, PWV, or blood oxidative stress in this methodologic context. Although findings do not negate the negative impact of woodsmoke inhalation, additional research approaches are needed to better understand the acute effects of smoke exposure on the cardiovascular system.

Establishment of Optimal Conditions to Extract Bioactive Substances from Gamazumi Using Supercritical Carbon Dioxide

The fruits of Gamazumi (Viburnum dilatatum THUNB) have been previously reported to suppress the adverse effects of oxidative stress in rats. To reduce time and cost, we attempted to establish optimal conditions for extracting bioactive components from Gamazumi fruits using supercritical carbon dioxide. To verify whether the conventional hexane extraction may be replaced by the supercritical carbon dioxide extraction, component analysis results and antigenotoxic potential in mice were used to compare bioactivity of the supercritical carbon dioxide and hexane extracts. &#x0D; At the same extraction pressure, the extraction rate was maximized when supercritical carbon dioxide with a low temperature was used, and extraction efficiency was improved. GC/MS analysis revealed that vitamins E and stigmasterols were included in supercritical carbon dioxide and hexane extracts, and that no qualitative differences between supercritical carbon dioxide and hexane extracts were observed. The antigenotoxic potential of Gamazumi extracts was studied in mice exposed to cigarette smoke inhalation. Mice received single or 5 consecutive oral administrations of Gamazumi extracts at 0, 3, and 6 h prior to smoke inhalation. Although single administration decreased nuclei tail length in the stomach when both administration and the intervals of smoke inhalation were short, five consecutive administrations decreased tail length in the lung and stomach regardless of the interval. At short intervals, inhaled cigarette smoke and orally administered extracts may be simultaneously present in the gastric cavity, and direct reaction between cigarette smoke and extract is possible. The antioxidant activity of Gamazumi extracts may result in antigenotoxic potential. There were no differences in component analysis and antigenotoxic potential between supercritical carbon dioxide and hexane extracts of Gamazumi; thus, it is possible to replace the conventional hexane extraction with the supercritical carbon dioxide extraction.

Evaluation of Hydrogen Cyanide in the Blood of Fire Victims Based on the Kinetics of the Reaction with Ninhydrin

An original kinetic spectrophotometric procedure was developed for the determination of hydrogen cyanide (HCN) in the whole blood of fire victims. Cyanide poisoning by smoke inhalation is common in forensic medicine, but the blood HCN of fire victims has not been studied in detail so far. In this research project, we developed a simple, fast, sensitive, and selective quantification method for both free and metabolized HCN based on the kinetics of cyanide reaction with ninhydrin. The method was linear in range, from 0.26 to 2.6 μg mL−1, with a coefficient of determination of r = 0.994. A high molar absorptivity of 4.95 × 105 L mol−1 cm−1 was calculated under the reaction conditions. The limit of quantification was 0.052 μg mL−1; the detection limit was 0.012 μg mL−1 and the standard error was ±2.7%. This micro method proved to be accurate, sensitive, and selective and has been successfully applied to the analysis of blood samples, allowing rapid monitoring of blood cyanide in several fire victims.

The expression profile of lung long non-coding RNAs and mRNAs in a mouse model of smoke inhalation injury

ABSTRACT To study the potential expression of lung long non-coding RNAs (lncRNAs) and mRNAs during smoke inhalation injury (SII), using a SII mouse model that we created in our previous work. Microarray was used to investigate the lncRNAs and mRNAs profiles. A bioinformatics analysis was performed. Changes in the top 10 down-regulated and 10 up-regulated lncRNAs were validated using Quantitative Reverse Transcription-PCR (RT-qPCR). The acute lung injury (ALI) mouse model was successfully induced by smoke inhalation, as confirmed by the aberrantly modified cell numbers of red blood cells and neutrophils counts, increased levels of TNF-α, IL-1β, Bax, caspase-7, caspase-3, and decreased Bcl-2 content in lung tissues. When compared to the control mice, 577 lncRNAs and 517 mRNAs were found to be aberrantly expressed in the SII mice. According to the Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses, the altered mRNAs were enriched in acute-phase response, oxidoreductase activity, oxidation-reduction process, glutathione metabolism, the wnt signaling pathway, and ferroptosis. A lncRNA-related competitive endogenous RNA (ceRNA) network, including 383 lncRNAs, 318 MicroRNAs (miRNAs), and 421 mRNAs specific to SII, was established. The changes in NONMMUT026843.2, NONMMUT065071.2, ENSMUST00000235858.1, NONMMUT131395.1, NONMMUT122516.1, NONMMUT057916.2, and NONMMUT013388.2 in the lung matched the microarray results. Our findings help to provide a more comprehensive understanding of the pathogenesis of SII as well as new insights into potential therapeutic targets.

The Effectiveness Of Aerobic Exercise In Improving Functional Status : A Case Report

Chronic obstructive pulmonary disease (COPD) is a lung disease that causes ventilation abnormalities of respiratory tract obstruction that is progressive and not fully reversible. The disease is associated with a switch from a self­limiting inflammatory response, mainly initiated by smoke inhalation, to a chronic persistent inflammatory response after prolonged interaction with cigarette smoke. The pathological mechanisms and clinical manifestations of COPD are not restricted only to pulmonary inflammation and airway remodeling. The known systemic manifestations of COPD include systemic inflammation, cardiovascular comorbidities, and muscle dysfunction, leading to the decreased functional status of COPD. Chronic inflammation in the pulmonary tissue is also associated with systemic effects. Systemic inflammation may then lead to skeletal muscle atrophy and cachexia. It may also initiate and worsen comorbidities.1 It limits the patient’s exercise capacity and the ability to perform activities of daily living (ADL), leading to a reduced quality of life. Quantification of physical ADL revealed that COPD patients spend less time standing and walking daily than healthy elderly individuals.2 Pulmonary rehabilitation is a comprehensive, multidisciplinary intervention designed to reduce symptoms, increase functional status and quality of life, and focus on the primary and secondary impairments associated with respiratory disease in COPD patients. Strategies include exercise training, self-management education, nutritional intervention and psychosocial support.3

Role of oxidative stress in the pathogenesis of COPD.

Chronic inhalation of cigarette smoke is a prominent cause of chronic obstructive pulmonary disease (COPD) and provides an important source of exogenous oxidants. In addition, several inflammatory and structural cells are a source of endogenous oxidants in the lower airways of COPD patients, even in former smokers. This suggests that oxidants play a key role in the pathogenesis of COPD. This oxidative stress is counterbalanced by the protective effects of the various endogenous antioxidant defenses of the lower airways. A large amount of data from animal models and patients with COPD have shown that both the stable phase of the disease, and during exacerbations, have increased oxidative stress in the lower airways compared with age-matched smokers with normal lung function. Thus, counteracting the increased oxidative stress may produce clinical benefits in COPD patients. Smoking cessation is currently the most effective treatment of COPD patients and reduces oxidative stress in the lower airways. In addition, many drugs used to treat COPD have some antioxidant effects, however, it is still unclear if their clinical efficacy is related to pharmacological modulation of the oxidant/antioxidant balance. Several new antioxidant compounds are in development for the treatment of COPD.

Health research priorities for wildland firefighters: a modified Delphi study with stakeholder interviews

ObjectivesThe increase in global wildland fire activity has accelerated the urgency to understand health risks associated with wildland fire suppression. The aim of this project was to identify occupational health...

The Effect of Chronic Inhouse Biomass Fuel Smoke Exposure on Coronary Slow Flow Phenomenon in Women Living in the Eastern Region of Turkey.

Objective:Biomass fuel (BMF) is still widely used in rural areas for cooking and heating worldwide. BMF smoke inhalation is a prominent cause of respiratory and cardiovascular disease. The slow coronary flow (SCF) phenomenon is known as the delayed opacification of distal coronary arteries on a coronary angiogram. SCF is known to be related to cardiovascular morbidity and mortality. Thus, we aimed to investigate the relationship between exposure to BMF and SCF in women in this study.Methods:A total of 457 consecutive women who underwent coronary angiography were retrospectively enrolled in this study. Patients were divided into two groups according to the use of BMF during their lives, from birth to older ages, as biomass exposure group (BEG) and non-exposure group. The presence of SCF was calculated based on thrombolysis in myocardial infarction frame count.Results:Two hundred fifty nine patients were in the BEG, whereas 198 patients were in the non-exposure group. The prevalence of SCF was higher in the BEG compared to the non-exposure group (47.9% vs. 13.1%, respectively, p<0.001). The presence of biomass exposure, body mass index, white blood cell count, low-density lipoprotein cholesterol, C-reactive protein, serum creatinine, and hypertension were independent predictors of SCF. The optimal cutoff point of biomass exposure time in years to detect the presence of SCF was 30 years (Area under the curve: 0.71, sensitivity: 0.65, specifity: 0.71).Conclusions:Exposure to indoor BMF was associated with a SCF phenomenon in women.

Comparative Study on the Chronic Vascular Responses Induced by Regular Versus Occasional Waterpipe Smoke Inhalation in Mice.

Waterpipe smoke (WPS) is the second most prevalent form of smoking in the world. There are ample evidences about the vascular alterations caused by regular WPS (Reg-WPS). Nonetheless, comparison of the chronic vascular response induced by regular versus occasional WPS (Occ-WPS) exposure is very scarce. We investigated, in BALB/c mice, the effects of Occ-WPS (30 minutes/day, 1 day/week) versus Reg-WPS (30 minutes/day, 5 days/week) for 6 months on thrombogenicity and platelet aggregation in vivo and in vitro. Moreover, various markers of endothelial integrity, inflammation and oxidative stress were assessed by enzyme-linked immunosorbent assay and colorimetric assay. Control mice were exposed to air. Our results showed that either Occ-WPS or Reg-WPS exposure shortened the thrombotic time in pial microvessels in vivo. Moreover, in pial venules, this effect was more marked in Reg-WPS group (-47%) compared with Occ-WPS (-34%). Similarly, exposure to either Occ-WPS or Reg-WPS reduced the prothrombin time and activated partial thromboplastin time. Platelet count was increased only in Reg-WPS exposure. Exposure to either Occ-WPS or Reg-WPS induced platelet aggregation in vitro. In addition, there was a statistically significant difference between Occ-WPS and Reg-WPS groups in platelet count and aggregation. Plasma concentration of tissue factor (+98%), P-selectin (+14%) and E-selectin (+16%) were significantly increased in Occ-WPS group compared with air exposed group. Likewise, compared with air group Reg-WPS caused an increase in concentration of tissue factor (+193%), P-selectin (+21%) and E-selectin (+42%). Nevertheless, only Reg-WPS induced a decrease (-38%) in the plasma concentration of tissue plasminogen activator. Notably, our results showed a statistically significant difference between Occ-WPS and Reg-WPS groups in the concentration of tissue factor. Erythrocyte numbers, hemoglobin concentration, hematocrit and lactate dehydrogenase activity were augmented only in Reg-WPS group compared with either control or Occ-WPS groups. Likewise, only Reg-WPS induced an increase in proinflammatory cytokines, tumor necrosis factor-α and interleukin-1β compared with either control or Occ-WPS groups. However, markers of oxidative stress including 8-isoprostane and total antioxidants were enhanced in both Occ-WPS and Reg-WPS compared with control group. Our data confirm the vascular toxicity of the chronic Reg-WPS exposure and shows that even occasional chronic exposure to WPS caused thrombosis, platelet aggregation, endothelial alterations and oxidative stress. The latter findings are an additional cause of concern about the long-term toxicity of occasional waterpipe smoking.

The Protective Effects of Preventive Atomisation Inhalation of Edaravone on the Lung Tissues of Rats with Smoke Inhalation Injury

Objective: To investigate the protective effects of the atomisation inhalation of edaravone on the lung tissues of rats with smoke inhalation injury. Methods: Forty male Sprague-Dawley (SD) rats were randomly divided into four groups of ten rats each: normal control group (group A), normal saline atomisation group (group B), edaravone aerosol group (group C) and edaravone atomisation prevention group (group D). Barring group A, the groups were used to create a model of severe smoke inhalation injury. However, before developing the model, group D rats were made to inhale edaravone (3.6 mg/mL) for 10 min. Six hours following smoke inhalation injury, abdominal artery blood samples were centrifuged, the lung tissue homogenate was prepared and carotid artery blood samples were used for blood gas analysis and oxygenation index (PaO2/FiO2) calculation. The levels of tumour necrosis factor alpha (TNF-α), interleukin (IL) 6 and IL-10 in serum and the levels of cysteine protease 3 (caspase-3), malondialdehyde (MDA), myeloperoxidase (MPO) and superoxide dismutase (SOD) in lung tissues were examined. The wet-dry ratio (W/D) and water content of the lung tissue were calculated, and the TUNEL method was used to determine the rate of lung tissue apoptosis in each group. Tissue specimens were obtained from the partial lung for histopathological examination. Results: Compared with those in group A, the water content of the lung tissue, the rate of lung tissue apoptosis, W/D and the caspase-3, TNF-α, IL-6, IL-10, MDA and MPO levels were significantly greater in other groups (P2/FiO2 were lower (P Compared with those in group B, the levels of W/D, the water content of the lung tissue, the rate of lung tissue apoptosis and the levels of caspase-3, TNF-α, IL-6, MDA and MPO were significantly low (P and the levels of IL-10, SOD and PaO2/FiO2 were significantly high in groups C and D (P The expression of the aforementioned factors was more evident in Group D (P Conclusions: The inhalation of edaravone can reduce smoke inhalation-induced lung injury. This may be related to the inhibition of apoptosis, the reduction of peroxidation injury and the production/release of inflammatory mediators/free radicals. It exerts a remarkable preventive effect.

Effect of Smoke Inhalation on Methaemoglobin, Oxyhaemoglobin and Packed Cell Volume of Plantain (“Bole”) Roasters in Port- Harcourt, Nigeria

Bole is a popular delicacy in Port Harcourt, Nigeria. Bole is roast plantain, roasted above burning charcoal. It is usually roasted alongside yam, and fish. In the course of roasting Bole, women are exposed to smoke which in the long run may produce some effects on the blood. The study examines how the smoke inhaled by these women affects their packed cell volume, methaemoglobin and oxyhaemoglobin levels. This study was carried out on blood samples collected from women who roast Bole (test subjects), in Port Harcourt, specifically in Diobu and Borikiri area. Control subjects were apparently healthy women that were not exposed to smoke. A total of 40 samples (20 from test subjects and 20 from control subjects) were collected through standard vein-puncture technique. Packed cell volume was determined using microhaematocrit method, oxyhaemoglobin and methaemoglobin levels were analyzed using spectrophotometric method. Methaemoglobin level (4.94 ± 4.17%) and PCV level of the test subjects (39.45 ± 1.32%) were significantly greater than that of control subjects (methaemoglobin: 1.64 ± 0.39%) and (packed cell volume: 38.50 ± 1.40%); (p-value = 0.00114 and 0.032887 for methaemoglobin and PCV respectively). The Oxyhaemoglobin levels of test subjects (11.38 ± 1.29g/dl) was significantly lower than the oxyhaemoglobin level of the control subjects (15.39 ± 0.89g/dl); (p- value = 0.000). The study therefore reveals that exposure to smoke increases methemoglobin levels and decreases oxyhaemoglobin level; this does not support adequate physiological oxygen delivery to body tissues and organs and could lead to hypoxia. We therefore recommended that these women use other means which produces less smoke to roast their plantain (bole), increase hydration, and make use of nose masks to reduce smoke inhalation.

POSB121 Economic Evaluation of the Impact Results of Hydroxocobalamin Use in Victims of Suspected Cyanide Poisoning Caused by Smoke Inhalation

Hydroxocobalamin (HC) has demonstrated clinical effectiveness in victims of suspected Cyanide (CN) poisoning caused by smoke inhalation. Though, the economic aspect remains largely unexplored. This analysis aims to assess the costs associated with clinical benefits and its reduction in intensive care unit (ICU) stays at hospital. Methods: The analysis is based on a 2017 published study (Nguyen L. & al.) where patients receiving HC were compared to patients with a non-antidote intervention. The retained model comprises costs related to HC administration, emergency care, lactate assays and hospitalisation stays in the different units (ICU with mechanical ventilation (MV), progressive care unit (PCU), hospital care).

Awareness of Hazard Risks and Prevention Among Orthopaedic Surgery Residents in South East Nigeria.

Background:Orthopaedic surgery is a specialty that deals with a lot of complex and delicate procedures which involve the use of power tools as well as handling of sharp tools and bony spicules, which, among other things, expose trainees to day-to-day hazards which can predispose them to an array of health challenges and burden the health sector. Knowledge of different measures in minimizing some of these risks can go a long way to saving lives and resources.Objectives:This study aims to determine the level of awareness among orthopaedic surgical residents about various hazards and risks and to ascertain their views on the prevention thereof to guide certain decision-making concerning surgical hazard risk reduction.Materials and Methods:A cross-sectional survey of orthopaedic surgery residents in South East Nigeria was conducted using a structured questionnaire designed using the free software Google® Form and was electronically distributed randomly to orthopaedic surgery residents in southern Nigeria using platforms including WhatsApp and Telegram. The data obtained were analysed using Statistical Package for the Social Sciences (SPSS) statistical software version 26. Consent was obtained from all respondents by outlining a clear statement of consent at the beginning of the form.Results:At the end of the study period, 49 surgical residents completed and submitted the questionnaire. There was a significant level of awareness of surgical hazard risks among the surgical residents, with over 90% agreeing to radiation exposure, needlestick injury, and inhalation of smoke being the major surgical hazard risks encountered in orthopaedic surgery practice. Over 95.9% of the respondents agreed that the use of sharp collection devices can help reduce needlestick injuries. All respondents agreed that the provision of adequate personal protective equipment (PPE) can help reduce surgical hazards. It was noted that the majority of the respondents (65.3%) had their preliminary knowledge about exposure to surgical hazard risks and appropriate safety measures during their undergraduate education. About 30.6% were aware of a surgery hazard risk safety guideline in their training centres, whereas only 65.3% of those people have studied the guidelines. There was no statistically significant associations between the level of training and marital status and those who had studied the surgical hazard risk guidelines available in their centres (P = 0.086, χ2= 2.942; P = 0.715, χ2=0.133, respectively). All of the residents know that immunization can help reduce the impact of disease risk among the surgery staff, but only 73.5% have completed a hepatitis B immunization and 55.1% have completed the tetanus immunization.Conclusion:Surgical hazards risks are important issues that need to be addressed and measures regularly reviewed appropriately to ensure and maintain the safety and health of the orthopaedic surgical and all other health personnel. There is a significant level of awareness of surgical hazard risks and prevention measures among orthopaedic residents, but the level of compliance to safety guidelines is not yet optimal.Recommendation:PPEs and sharp collection boxes should always be available in theatres and measures should be taken to encourage residents’ adherence to studying and practicing established surgical safety guidelines in their hospitals and also completing their immunization schedules.