Sulfur dioxide and emergency department visits for stroke and seizure

Association of outdoor air and noise pollution with unprovoked seizures and new onset epilepsy: A systematic review and meta-analysis

Research has indicated that certain environmental exposures may increase the risk of unprovoked seizures and new onset epilepsy. This study aimed to synthesize the literature that has estimated the associations between short- and long-term exposure to outdoor air and noise pollution and the risk of unprovoked seizures and new onset epilepsy. We searched Embase, MEDLINE, Scopus, Web of Science, BIOSIS Previews, Latin American and Caribbean Health Sciences Literature, Proquest Dissertations and Theses, conference abstracts, and the gray literature and conducted citation tracing in June 2023. Observational and ecological studies assessing the associations of air and noise pollution with unprovoked seizures or new onset epilepsy were eligible. One reviewer extracted summary data. Using fixed and random effects models, we calculated the pooled risk ratios (RRs) for the studies assessing the associations between short-term exposure to air pollution and unprovoked seizures. Seventeen studies were included, 16 assessing the association of air pollution with seizures and one with epilepsy. Eight studies were pooled quantitatively. Ozone (O3; RR = .99, 95% confidence interval [CI] = .99-.99) and nitrogen dioxide (NO2) exposure adjusted for particulate matter (RR = 1.02, 95% CI = 1.01-1.02) on the same day, and carbon monoxide (CO) exposure 2 days prior (RR = 1.12, 95% CI = 1.02-1.22), were associated with seizure risk. A single study of air pollution and epilepsy did not report a significant association. The risk of bias and heterogeneity across studies was moderate or high. Short-term exposure to O3, NO2, and CO may affect the risk of seizures; however, the effect estimates for O3 and NO2 were minimal. Additional research should continue to explore these and the associations between outdoor air pollution and epilepsy and between noise pollution and seizures and epilepsy.

Effects of sulfur dioxide inhalation on human health: a review

Sulfur dioxide (SO2) is one of the most important gaseous air pollutants and the chemical index of sulfur oxides (SOx). SO2 is one of the six criteria pollutants in the air quality index (AQI). SO2 can be emitted by natural and anthropogenic sources. Although efforts have been made to reduce sulfur dioxide emissions worldwide, this pollutant and its adverse effects remain a major concern, especially in developing countries. The aim of this study was the investigated the effects of sulfur dioxide inhalation on human health. This narrative review was done based on the literature published from 2000 to 2022 through PubMed, Springer, Web of Science, Science Direct, and Google Scholar databases. In this study, was done screened first based on the abstract and Final assessment done based on the full text of the article. Finally, 38 articles were selected for inclusion in the study. The results of this study showed that sulfur dioxide has adverse health effects on the human respiratory, cardiovascular, and nervous systems and causes type 2 diabetes and non-accidental deaths. Although some evidence suggests that sulfur dioxide in given concentrations has no adverse health effect, its synergistic effects in combination with other air pollutants may be significant. Among the most important practical results of this study can be mentioned to increase the health awareness of the general public, help the politicians of the health sector in making decisions in the health field, creating awareness among polluting producing units and industries and efforts to reduce the emission of Sulfur dioxide.

Fire and Brimstone: SO2 as a Chemical Weapon in History

Sulfur dioxide (SO2), a chemical produced from the burning of sulfur-containing materials, has a long history in chemical warfare. While it was largely used during ancient sieges, there were numerous proposals to weaponize it for the open battlefield in the early modern age.

Multivariate analysis of the impact of weather and air pollution on emergency department visits for unprovoked seizure among children: A retrospective clinical observational study

BACKGROUND

An unprovoked seizure is a seizure or a cluster of seizures occurring within 24 h in a patient older than 1 month of age without precipitating factors. Recent studies have reported that extrinsic factors, such as meteorological conditions and air pollutants, may be important in seizure occurrence. Thus, this study aimed to examine the association between the number of visits to the emergency department (ED) by children for nighttime unprovoked seizures and exposure to multi-faceted factors, such as meteorological conditions and air pollution.

METHODS

We conducted a clinical observational analysis and reviewed consecutive patients younger than 16 years of age who visited the primary ED center in Kobe City, Japan, during nighttime (7:30 p.m.-7:00 a.m.) between January 1, 2011 and December 31, 2015. We investigated the effects of meteorological factors and air pollutants on the number of patients with unprovoked seizures using multivariate analysis of Poisson regression estimates.

RESULTS

In total, 151,119 children visited the ED, out of which 97 patients presented with unprovoked seizures. The mean age of the patients was 4.7 years (range, 1 month to 15.3 years), and 54.6% of them were boys. The total number of patients with unprovoked seizures showed no significant changes with the seasons; however, there were dominant peaks during the fall and fewer visits during the summer. The multivariate analysis of Poisson regression estimates revealed a significant positive relationship between the number of patients presenting with unprovoked seizures and precipitation (+1 patient/87 mm; p = 0.03) and methane (+1 patient/0.14 ppm; p = 0.03) levels and a negative relationship between the number of patients presenting with unprovoked seizures and nitrogen dioxide level (-1 patient/0.02 ppm; p = 0.04).

CONCLUSIONS

The present study is the first to evaluate the association between the number of children who presented to the ED with nighttime unprovoked seizures and environmental factors after controlling for confounding factors.

Association between long-term exposure to air pollutants and cardiopulmonary mortality rates in South Korea

Background

The association between long-term exposure to air pollutants, including nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂), ozone (O₃), and particulate matter 10 μm or less in diameter (PM₁₀), and mortality by ischemic heart disease (IHD), cerebrovascular disease (CVD), pneumonia (PN), and chronic lower respiratory disease (CLRD) is unclear. We investigated whether living in an administrative district with heavy air pollution is associated with an increased risk of mortality by the diseases through an ecological study using South Korean administrative data over 19 years.

Methods

A total of 249 Si-Gun-Gus, unit of administrative districts in South Korea were studied. In each district, the daily concentrations of CO, SO₂, NO₂, O₃, and PM₁₀ were averaged over 19 years (2001–2018). Age-adjusted mortality rates by IHD, CVD, PN and CLRD for each district were averaged for the same study period. Multivariate beta-regression analysis was performed to estimate the associations between air pollutant concentrations and mortality rates, after adjusting for confounding factors including altitude, population density, higher education rate, smoking rate, obesity rate, and gross regional domestic product per capita. Associations were also estimated for two subgrouping schema: Capital and non-Capital areas (77:172 districts) and urban and rural areas (168:81 districts).

Results

For IHD, higher SO₂ concentrations were significantly associated with a higher mortality rate, whereas other air pollutants had null associations. For CVD, SO₂ and PM₁₀ concentrations were significantly associated with a higher mortality rate. For PN, O₃ concentrations had significant positive associations with a higher mortality rate, while SO₂, NO₂, and PM₁₀ concentrations had significant negative associations. For CLRD, O₃ concentrations were associated with an increased mortality rate, while CO, NO₂, and PM₁₀ concentrations had negative associations. In the subgroup analysis, positive associations between SO₂ concentrations and IHD mortality were consistently observed in all subgroups, while other pollutant-disease pairs showed null, or mixed associations.

Conclusion

Long-term exposure to high SO₂ concentration was significantly and consistently associated with a high mortality rate nationwide and in Capital and non-Capital areas, and in urban and rural areas. Associations between other air pollutants and disease-related mortalities need to be investigated in further studies.

Laboratory markers of cardiac and metabolic complications after generalized tonic-clonic seizures

Background

Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac complications. Our goal was to assess the nature and frequency of complications occurring in association with GTCS.

Methods

We retrospectively extracted data from emergency protocols and discharge letters of adult patients admitted to the Department of Epileptology between 01/2010 and 06/2015. Inclusion criteria were diagnosis of GTCS and admission via emergency services. Exclusion criteria were status epilepticus prior to admission to hospital and non-generalized seizures.

Results

A total of 223 patients (of 986 screened cases) were included. Overall, 1.8% required intubation while 1.3% had less severe respiratory problems. In 5.6% of patients, a transient hypoxemia was measured. Hypertensive urgencies affected 7.8% of the patients, sinus tachycardia occurred in 41.2%. Troponin I (cTNI) was determined in 75 patients and was increased in 12% of these cases. Occurrence of elevated cTNI levels was significantly correlated with patient’s age. Four patients were diagnosed with NSTEMI and one patient with STEMI. Creatine kinase (CK) was increased in 59.4% of the patients, with <5-fold increases in 47%, <10-fold in 5.8% and >10-fold increases in 4.3%. Rhabdomyolysis with an >50 fold increase in CK was detected in 1.9% of patients. Prolonged disturbances of consciousness affected 5% of cases while agitation, delirium, and psychotic episodes occurred in 6.3%. Minor traumatic injuries affected 45.7% of patients.

Conclusions

Troponin elevations in association with GTCS are one of the more common complications after emergency admissions especially in older patients. In our selected patient population, serious complications such as intracranial hemorrhage, myocardial infarction and acute renal failure occurred in <1% of GTCS only.

Particulate Matter and Hospital Admissions for Stroke in Beijing, China: Modification Effects by Ambient Temperature

Background

The impact of particulate matter (PM) on stroke may vary by particle size, stroke subtype, and patient characteristics and temperature. We examined the association of stroke admissions with PM in different subgroups in Beijing, China, during 2013–2014.

Methods and Results

A time‐stratified case‐crossover design was used to assess the relation between PM of different particle sizes and hospital admissions for ischemic and hemorrhagic stroke. Stratified analyses were performed by age, sex, and temperature. In total, there were 147 624 stroke admissions during the study period. In the whole‐period analysis, both PM_2.5 and PM₁₀ were positively associated with ischemic stroke admissions on the day of hospital admission and negatively associated with ischemic stroke at lag2 and lag3 day. In warm days (>13.5°C), the odds ratios of ischemic stroke admissions were 2.071 (95% CI 1.959–2.190), 1.470 (95% CI 1.391–1.554), and 1.590 (95% CI 1.493–1.694) per IQR increase in the same‐day PM_2.5 (82.0 μg/m³), PM_2.5–10 (36.6 μg/m³), and PM₁₀ (93.5 μg/m³), respectively. For hemorrhagic stroke, the corresponding values were 1.941 (95% CI 1.658–2.273), 1.590 (95% CI 1.366–1.851), and 1.527 (95% CI 1.278–1.826). The positive associations were also observed in the other lag structures and were higher than in cold days (≤13.5°C).

Conclusions

This study suggests that the associations of PM_2.5, PM_2.5–10, and PM₁₀ with stroke admissions differed across levels of temperature. Short‐term exposure to PM_2.5, PM_2.5–10, and PM₁₀ was positively associated with hospital admissions for ischemic and hemorrhagic stroke on warm days (>13.5°C).

Short term exposure to air pollution and stroke: systematic review and meta-analysis

OBJECTIVE

To review the evidence for the short term association between air pollution and stroke.

DESIGN

Systematic review and meta-analysis of observational studies

DATA SOURCES

Medline, Embase, Global Health, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science searched to January 2014 with no language restrictions.

ELIGIBILITY CRITERIA

Studies investigating the short term associations (up to lag of seven days) between daily increases in gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate matter (<2.5 µm or <10 µm diameter (PM2.5 and PM10)), and admission to hospital for stroke or mortality.

MAIN OUTCOME MEASURES

Admission to hospital and mortality from stroke.

RESULTS

From 2748 articles, 238 were reviewed in depth with 103 satisfying our inclusion criteria and 94 contributing to our meta-estimates. This provided a total of 6.2 million events across 28 countries. Admission to hospital for stroke or mortality from stroke was associated with an increase in concentrations of carbon monoxide (relative risk 1.015 per 1 ppm, 95% confidence interval 1.004 to 1.026), sulphur dioxide (1.019 per 10 ppb, 1.011 to 1.027), and nitrogen dioxide (1.014 per 10 ppb, 1.009 to 1.019). Increases in PM2.5 and PM10 concentration were also associated with admission and mortality (1.011 per 10 μg/m(3) (1.011 to 1.012) and 1.003 per 10 µg/m(3) (1.002 to 1.004), respectively). The weakest association was seen with ozone (1.001 per 10 ppb, 1.000 to 1.002). Strongest associations were observed on the day of exposure with more persistent effects observed for PM(2·5).

CONCLUSION

Gaseous and particulate air pollutants have a marked and close temporal association with admissions to hospital for stroke or mortality from stroke. Public and environmental health policies to reduce air pollution could reduce the burden of stroke.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO-CRD42014009225.