Air pollution increases the risk of diabetes

Air pollution increases the risk of diabetes

Dr KK Aggarwal
National President iMA

Air pollution has been dominating headlines in the past few days and has been at an all-time high in Delhi. The air quality in Delhi continues to remain in the severe category, with no respite.

There is increasing evidence for the role of environment in pathogenesis in many diseases with air pollution emerging as the largest environmental health risk globally. Exposure to the toxic air can affect the lungs, blood, vascular system, brain and the heart leading to significant adverse health effects and associated high overall morbidity and mortality.

Environmental pollution, with traffic associated pollutants, gaseous, nitrogen dioxide, especially high particulate matter PM 2.5 exposure, has been linked with risk of incident diabetes. Several studies have shown a positive association between long-term exposure to air pollution and increased risk of type 2 diabetes. Individuals who have prediabetes are especially vulnerable to the effects of air pollution.

According to the WHO, the air content of PM2.5 should be less than 10 μg/m3 but in India the levels are always more than 60 μg/m3 as 60 μg/m3 concentration has been accepted as normal in India. That means that an Indian is already six times more exposed to PM2.5. However, recently, extremely high levels of PM2.5, crossing 400, have been recorded. The risk of future diabetes associated with exposure to 10 μg/cu mm increase of PM2.5 ranges between 10 and 27% (Endocrine. 2016 Jan;51(1):32-7).

Any particulate matter of less than 2.5 µm in size can get absorbed from respiratory system, enter into the blood. The exact mechanisms as to how air pollution causes diabetes Air pollutants are hypothesized to exert their effects via impaired endothelial function, elevated systemic inflammation, mitochondrial dysfunction, and oxidative stress, all of which are hallmarks of type 2 diabetes (Trends Endocrinol Metab. 2015 Jul;26(7):384-94). Increased oxidative stress leads to insulin resistance, β-cell dysfunction, impaired glucose tolerance, and, ultimately, type 2 diabetes.

India has the second highest number of people living with diabetes 69.2 million with a prevalence of 8.7%. China has the highest number of people living with diabetes with 109 million cases of diabetes in the year 2015 and a prevalence of 10.6%.

This scenario calls for high priority action to minimize the air pollution to contain the rising incidence of type 2 diabetes in the country.

The responsibility towards this end lies with each one of us as it does with the government.

Air pollution at an all-time high in Delhi

Air pollution at an all-time high in Delhi

IMA strictly advises against exercising outdoors in the morning among other things

New Delhi, 04 November 2017: As per a recent study, air pollution has led to five lakh premature deaths across India. The weather conditions in the national capital are rapidly deteriorating and there is only one advise for those going for an early morning walk or run --- stay indoors. The reason is that air pollution is at an all-time high and the morning air can have drastic repercussions on one’s health. As per the IMA, exposure to this toxic air can affect the lungs, blood, vascular system, brain, heart, and even the reproduction system.

Concentration of PM 2.5 can cause tiny, hazardous particles to enter the lungs. This in turn can cause problems such as chronic obstructive pulmonary disorder and also impact lung functioning. The IMA has also advised strongly against running a marathon in this condition, as doing so can deposit about two tablespoons of toxic ash in the lungs.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Delhi has been experiencing high air pollution levels these past days. The air quality is particularly poor early in the morning, when pollution is extremely high. While this can be fatal for those with existing health issues such as asthma or cardiovascular ailments, it can also be detrimental to healthy individuals. Elderly people and children also form the high-risk category. As per a recent study, those living in the NCR are losing out on almost 6 years of life because of the dangerous air pollution levels.[2] If WHO standards were met in NCR, people would live 9 years longer. The IMA will be writing to the Hon’ble Delhi Chief Minister, Chief Justice Delhi High Court and the Chairperson, National Green Tribunal regarding urgent cancellation/postponing of the half marathon scheduled this month until there is significant improvement in the air quality.”

The Air Quality Index (AQI) in Delhi has ranged from “very unhealthy” to “hazardous” in the last couple of days itself. In many parts of the city, the levels have even crossed the 300 ‘danger’ mark.

Adding further, Dr Aggarwal, said, “The current level of pollution in Delhi can affect even an unborn child in the womb. A normal adult breathes about 6 litres of air per minute at rest, which increases to about 20 litres during physical activity. Given the alarming levels of pollution currently, this will only increase the amount of toxins in the lungs. Although one should ensure that exercise areas are at least 200 meters away from roads, construction sites, and smoke-emitting industry, even this cannot guarantee clean air.”

Here’s how different parts of the body are affected by air pollution.

• Toxic particles pass through blood vessel walls and affects blood flow. They can also lead to thrombosis.
• Toxins can lead to atherosclerosis reducing the diameter of blood vessels. This condition can also cause hypertension.
• Toxic air can lead to strokes and brain ischemia as also cognitive disorders and neuro-degenerative illnesses.
• Toxins in the air can adversely impact heart function and increase heart rhythm problems.
• Inhaling toxic air can make women prone to miscarriage, cause fetal growth problems, premature birth, and also low birth weight. 

IMA calls for immediate cancellation of Airtel Delhi Half Marathon

IMA calls for immediate cancellation of Airtel Delhi Half Marathon

New Delhi, 03 November 2017: Indian Medical Association (IMA) has called for the immediate cancellation of the Airtel Delhi Half Marathon to be held at 7.00 a.m. on Sunday, November 19, 2017 in view of the alarmingly high levels of air pollution in the capital.

The Air Quality Index (AQI) in Delhi has constantly ranged from ‘very unhealthy’ to ‘hazardous’ levels since the last few days with AQI crossing the 300 ‘danger’ mark at many places.

In a joint statement, Padma Shri Awardee Dr KK Aggarwal, National President IMA & President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA, said, “Delhi has been experiencing high air pollution levels these past days. The air quality is particularly poor in the early morning when pollution is extremely high. This is also the time when the proposed Half Marathon is scheduled to start. Air pollution not only affects the performance of the runner, the dangerously high pollution levels may have disastrous health consequences, even for the healthy participants, including the volunteers involved in the organization of the event.

“There is scientific evidence to show that poor air quality can aggravate asthma or other existing lung disease such as chronic obstructive pulmonary disease (COPD). High PM2.5 levels can increase BP and can also increase the risk of acute cardiovascular events such as heart attack, stroke. Also, patients of heart disease are at a risk of sudden cardiac death. Hence, we demand that the event be cancelled immediately and postponed to a later date when air pollution levels are better. IMA will be writing to Hon’ble Delhi Chief Minister, Chief Justice Delhi High Court and the Chairperson, National Green Tribunal in this regard.”

Dr Aggarwal further added, “The organizers of such events while deciding the dates of the event should take into consideration the air quality at the time of the marathon so that no runner suffers any adverse health effects on account of exposure to hazardous levels of air pollution.

There have been instances from around the world, from USA, Malaysia, Singapore (1-5) when marathons and other sports events have been cancelled due to poor air quality. If the AQI is above 100, it is prudent for race administrators to warn participants and volunteers, particularly those with lung conditions, about the potential risk.”

Delhi High Court sets aside Centre's decision to ban 344 fixed dose combination medicines

Delhi High Court sets aside Centre's decision to ban 344 fixed dose combination medicines

The Delhi High Court has set aside the Centre's decision to ban 344 fixed dose combination (FDC) medicines, including well-known brands like Corex cough syrup, Vicks Action 500 Extra and D'Cold, reports TOI. 

The court gave the order after hearing arguments of companies like Pfizer, Glenmark, Procter and Gamble and Cipla, the central government and some NGOs like All India Drug Action Network (AIDAN).

The court had on March 14 stayed the Centre's March 10 ban on 344 FDC drugs and this interim order was passed in each and every case filed before it thereafter.

According to the drug companies, the government has not properly implemented the powers under section 26A (power to prohibit manufacture of drugs and cosmetics in public interest) of Drugs and Cosmetics Act, under which the ban was ordered. The ban order was passed without considering clinical data and the grounds that safer alternatives were available. The government had banned over 300 FDC drugs on the ground that they involve "risk" to humans and safer alternatives were available.

As per the March 10 notification, "On the basis of recommendations of an expert committee, the central government is satisfied that it is necessary and expedient in public interest to regulate by way of prohibition of manufacture for sale, sale and distribution for human use of said drugs in the country."

The Centre had argued that the FDC medicines are "new drugs" and thus, require licence from Drugs Controller General of India (DCGI) for sale and manufacture. Also there were no valid licences for making any of the banned FDCs and added it was difficult to implement any action at state level. However, it had also said that the lack of approval for these FDCs were a secondary issue and the primary focus was that they "lacked safety and efficacy" and thus, "ban was the only answer". According to them, the banned FDCs had no "therapeutic justification".

AIDAN, argued that there were nearly 40,000 FDC drugs in Indian market and since the regulatory control over such medicines was allegedly "illusory", the Centre's decision to ban some of them "was the only move". 

IMA View

IMA is only concerned with safety and quality of a drug. The job of DCGI is to maintain both. If the DCGI cannot take the guarantee of the quality and safety of any drug, how will doctors treat patients? 

In Malay Kumar Ganguly vs Sukumar Mukherjee & Ors on 7 August, 2009, the Supreme Court of India relied on the drug package insert, which is always cleared by the DCGI.

DCGI should either challenge the order or label these combinations as safe drugs. 

Beware of Chikungunya Encephalitis: IMA

Beware of Chikungunya Encephalitis: IMA

Severe encephalitis related to chikungunya infection has been reported in Delhi tweeted Padma Shri Awardee Dr K K Aggarwal National President Elect IMA.

Chikungunya virus (CHIKV) disease can cause CHIKV-associated encephalitis. One can detect CHIKV RNA or anti-CHIKV immunoglobulin M in cerebrospinal fluid, warns IMA.

IMA was the first to report chikungunya cases in West Kidwai Nagar in NBCC construction area and is now first to report spurt of cases of encephalitis in Delhi linked to chikungunya, said Dr Aggarwal.

In a U-shaped distribution, children younger than 1 year and adults age 65 or older have the highest incidence of CHIKV-associated encephalitis.

The overall case fatality rate for CHIKV-associated encephalitis as per literature is 16.6%, and the 3-year rate of neurologic sequelae range from 30% to 45%. The risk for death or neurologic sequelae is significantly higher in adults than in children (53% vs. 18%).

CHIKV is an alphavirus transmitted by Aedes species mosquitoes. Symptomatic CHIKV infections typically result in a self-limited systemic febrile illness associated with rash and arthralgia. However, cases of severe disease, including meningoencephalitis and death, have also been reported.

CHIKV may present similarly to numerous other infectious causes of systemic febrile illness in the tropics, including malaria, dengue, and other arthropod-borne infections.

Central India Institute of Medical Sciences, Nagpur in May 2006, during a large Chikungunya virus infection (CHIKV) described various neurological syndromes: Encephalitis, myelopathy, peripheral neuropathy, myeloneuropathy, and myopathy.

Of the 300 patients with CHIKV infection seen during the study period, June-December 2006, 49 (16.3%) [M : F: 42:7] had neurological complications.

The neurological complications included Encephalitis (27, 55%), myelopathy (7, 14%), peripheral neuropathy (7, 14%), myeloneuropathy (7, 14%), and myopathy (1, 2%).

Reverse Transcriptase polymerase chain reaction (RT-PCR) and real-time PCR was positive in the CSF in 16% and 18%, respectively.

It suggest neurotropic nature of the virus. The outcome of the neurological complications is likely to be good.

Literature reports a cumulative incidence rate of 8.6 per 100,000 people.

Delhi is in a grip of Chikungunya

Delhi is in a grip of Chikungunya
 Symptoms, Diagnosis & Treatment of Chikungunya

Symptoms

• Most people infected with chikungunya virus will develop some symptoms.
• Symptoms usually begin 3 to 7 days after being bitten by an infected mosquito.
• The most common symptoms are high-grade fever and severe arthralgia (joint pain).
• Other symptoms may include headache, fatigue, throat discomfort, muscle pain, joint swelling, or skin rash.
• Chikungunya disease does not often result in death, but the symptoms can be severe and disabling.
• Symptoms usually resolve within a week. But, the joint pain may persist for months in some people.
• People at risk for more severe disease include newborns infected around the time of birth, adults aged 65 years or older and people with medical conditions such as high blood pressure, diabetes, or heart disease.
• Once a person has been infected, he or she is likely to be protected from future infections.

Diagnosis

• The symptoms of chikungunya are similar to those of dengue and Zika, diseases spread by the same mosquitoes that transmit chikungunya.
• A history of travel or residence in areas where chikungunya is found in a suspected case.
• Blood tests to look for virus specific antibodies for chikungunya or other similar viruses like dengue and Zika. 

Treatment

• There is no vaccine to prevent or medicine to treat the Chikungunya virus.
• Treatment is symptomatic and supportive.
• - Plenty of rest.
• - Adequate fluids to prevent dehydration.
• - Paracetamol to reduce fever and pain.
• -  Avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) until dengue can be ruled out to reduce the risk of bleeding).
• - If you are taking medicine for another medical condition, talk to your healthcare provider before taking additional medication. 
• Patients with Chikungunya should take precautions to prevent mosquito bites for the first week of the illness.
• - During the first week of infection, Chikungunya virus can be found in the blood and passed from an infected person to a mosquito through mosquito bites.
• - An infected mosquito can then spread the virus to other people