Heat stress and adverse pregnancy outcome: Prospective cohort study

OBJECTIVE

To explore the relationship between occupational heat exposure, physiological heat strain indicators and adverse outcomes in pregnant women.

DESIGN

Prospective cohort.

SETTING

Workplaces in Tamil Nadu, India.

SAMPLE

A cohort of 800 pregnant women engaged in moderate to heavy physical work in 2017-2019 and 2021-2022.

METHODS

Participants were recruited at between 8 and 14 weeks of gestation. Occupational heat exposure and heat strain indicators were captured each trimester. 'Heat exposed' was defined as heat stress exceeding the threshold limit value (TLV) for safe manual work (with maximum wet-bulb globe temperatures of 27.5°C for a heavy workload and 28.0°C for a moderate workload). Physiological heat strain indicators (HSIs) such as core body temperature (CBT) and urine specific gravity (USG) were measured before and after each shift. Heat-related health symptoms were captured using the modified HOTHAPS questionnaire.

MAIN OUTCOME MEASURES

The main outcome measures included (1) a composite measure of any adverse pregnancy outcome (APO) during pregnancy (including miscarriage, preterm birth, low birthweight, stillbirth, intrauterine growth restriction and birth defects), (2) a composite measure of adverse outcomes at birth (3) and miscarriage.

RESULTS

Of the 800 participants, 47.3% had high occupational heat exposure. A rise in CBT was recorded in 17.4% of exposed workers, and 29.6% of workers experienced moderate dehydration (USG ≥ 1.020). Heat-exposed women had a doubled risk of miscarriage (adjusted odds ratio, aOR 2.4; 95% confidence interval, 95% CI 1.0-5.7). High occupational heat exposure was associated with an increased risk of any adverse pregnancy and foetal outcome (aOR 2.3; 95% CI 1.4-3.8) and adverse outcome at birth (aOR 2.0; 95% CI 1.2-3.3).

CONCLUSIONS

High occupational heat exposure is associated with HSIs and adverse pregnancy outcomes in India.

Poor personal protective equipment practices were associated with heat-related symptoms among Asian healthcare workers: a large-scale multi-national questionnaire survey

BACKGROUND

It is pertinent to understand the perceptions of healthcare workers (HCWs) with their associated personal protective equipment (PPE) usage and heat strain symptoms experienced to effectively combat the negative effects of heat stress during treatment and care activities.

METHODS

We evaluated the associated heat stress perceived by HCWs across Asia and validated a questionnaire on perceptions of heat stress, associated PPE usage, and heat strain symptoms experienced. The questionnaire was administered to 3,082 HCWs in six Asian regions. Factor analyses, including Cronbach's alpha, assessed the questionnaire's validity and reliability. Structural equation modelling analysed the effects of knowledge, attitudes and practices, and heat strain symptoms.

RESULTS

The questionnaire was found to be reliable in assessing HCWs' knowledge, and attitudes and practices towards heat stress and PPE usage (both Cronbach's alpha = 0.9), but not heat strain symptoms (Cronbach's alpha = 0.6). Despite knowledge of heat stress, HCWs had negative attitudes and practices regarding PPE usage (β1 = 0.6, p < 0.001). Knowledge (path coefficient = 0.2, p < 0.001), and negative attitudes and practices (path coefficient = 0.2, p < 0.001) of HCWs towards heat stress and PPE usage adversely affected symptoms experienced.

CONCLUSIONS

The questionnaire was not reliable in assessing symptoms. HCWs should, nevertheless, still self-assess their symptoms for early detection of heat strain. To effectively attenuate heat strain, understanding HCWs' attitudes and practices towards PPE usage should guide policymakers in implementing targeted heat management strategies.

Comparison of women's heat risk profiles among those working in indoor and outdoor sectors

Rising temperatures and heat events may affect workers, especially women, by increasing the risk of Heat Related Illnesses (HRIs). We conducted a cross-sectional study among 903 women in outdoor and indoor sectors. We measured Wet Bulb Globe Temperature (WBGT) and physiological Heat Strain Indicators (HSI), as well as self-reported symptoms of HRIs using a HOTHAPS questionnaire. Multivariate Logistic Regression models were used to compare the heat risks. WBGT exposures were high in both the outdoor (Avg. WBGT = 28.8 °C ± 2.4 °C) and indoor (Avg. WBGT = 28.7 °C ± 3.5 °C) sectors. Outdoor Women Workers (OWW) reported higher HRI symptoms (94%vs.81%), and heat exposures were positively correlated with HRIs (AOR: 3.7; 95%CI: 2.4-6.1). OWW showed a 1.5-fold higher risk of measured HSI above safe limits (95%CI: 1.1-2.1) and a 2.1-fold higher risk of urogenital issues (95%CI: 2.1-3.8) than Indoor Women Workers (IWW). Due to direct sun exposure, intensive labor, and a lack of welfare facilities, OWW has a higher HRI risk.

Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India

BACKGROUND

Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce.

METHODS

This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected.

RESULTS

Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval.

CONCLUSION

The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.

Role of yoga in stress management and implications in major depression disorder

Major Depressive Disorder (MDD) is one of the leading causes of disability affecting more than 340 million people and second largest contributor to global burden of disease. Chronic stress is a common risk factor and important contributor for MDD. Stress could be defined as the "perceived inability to cope". Stressful life events are shown to provoke a sequence of psychological and physiological adjustments including nervous, endocrine and immune mechanisms. Stress can lead to elevation of a variety of inflammatory cytokines and stress hormones, can cause autonomic dysfunction and imbalance in neurotransmitters. Yoga can reduce depressive symptoms by alleviating stress. Studies have shown that yoga can reduce inflammation, maintain autonomic balance and also has a role in maintaining the neurotransmitters. It has role on hypothalamic-pituitary-adrenal (HPA) axis, the peripheral nervous system including GABA, limbic system activity, inflammatory and endocrine responses. Yoga along with antidepressants can help in reducing the depressive symptoms in patient with MDD. Yoga is an ideal complementary and alternative therapy for mental health disorders.

Occupational Heat Stress and Kidney Health in Salt Pan Workers

Introduction

Work in heat affects millions of workers. Although kidney function in agricultural workers is increasingly researched, nonagricultural studies are scarce. In coastal salt pans, the absence of occupational exposures to pesticides and other toxicants allows assessment of heat stress alone.

Methods

Seven Indian salt pans were surveyed from 2017 to 2020. Job-specific workload was assessed. Heat stress was characterized as exceeding the wet bulb globe temperature (WBGT)-threshold limit value (TLV) for high and moderate workloads. Preshift and postshift heart rates (HRs), tympanic temperatures, and urine specific gravity (USG) were measured for 352 workers, as were sweat rates (SwR), serum creatinine (SCr), serum uric acid, and urine dipstick. Estimated glomerular filtration rate (eGFR; ml/min per 1.73 m²) was computed. Heat-strain symptoms were assessed using questionnaires.

Results

The mean WBGT was 30.5 ± 1.3 °C (summer) and 27.8 ± 1.9 °C (winter). Water intake during the workday was low, median was one Litre, and most workers (87%) exceeded the TLV for heat stress. Dehydration-related symptoms were frequent in those with high-heat stress, as were cross-shift increases in temperature (≥1°C; 15%), a high USG (≥1.020; 28%), and a high SwR (≥1 l/h; 53%). An eGFR of 60 to 89 ml/min per 1.73 m² was observed in 41% of all workers examined, and 7% had eGFR below 60 ml/min per 1.73 m². The odds ratio for eGFR <90 ml/min per 1.73 m² in workers exceeding the TLV, compared to workers below this limit, adjusted for age and gender was 2.9 (95% CI: 1.3-6.4).

Conclusion

Workplace interventions to prevent heat stress and dehydration in the salt pans and other at-risk industries are urgently required. The findings strengthen the notion that high-heat stress and limited hydration is a risk factor for kidney dysfunction.

Foot reflexology for reduction of blood pressure in hypertensive individual: A systematic review

IMPORTANCE

Hypertension is the modifiable risk factor associated with cardiovascular diseases and all-cause mortality. Foot reflexology has been proposed to reduce the blood pressure for the patients with hypertension but the available evidences are uncertain.

OBJECTIVE

We conducted a systematic review and meta-analysis, know the efficacy of foot reflexology on blood pressure reduction in patients with hypertension.

DATA SOURCES AND SELECTION

A systematic search of electronic databases such as PubMed, Scopus, ClinicalTrials.gov, Embase, and Cochrane library since inception till January 2022. Randomized controlled trial with foot reflexology as an intervention for lowering blood pressure (BP) in hypertensive patients was included in the study.

DATA EXTRACTION AND OUTCOME MEASURES

Data was independently extracted by four authors. Systolic and diastolic blood pressure was the primary outcome measure. Standardized mean difference (SMD) and 95 % confidence interval (CI) were calculated to determine the effect size.

RESULTS

The pooled effect of SBP (SMD: -2.70, 95 % of CI: -6.79, 1.39, I2 - 97 %, P < 0.001) and DBP (SMD: -2.12, 95 % of CI: -5.95, 1.71, I2 - 97 %, P < 0.001) changes are not favorable for foot reflexology in terms of reducing blood pressure.

CONCLUSION

Findings from the studies showed that foot reflexology interventions were not much effective in the reduction of blood pressure among patients with hypertension.

Positioning of Low Alcohol or Alcohol-Free Minoxidil Formulation for the Management of Androgenetic Alopecia: Indian Perspective

Topical minoxidil is used for treating different hair disorders. Even though it is an effective therapy, many patients show poor compliance due to the cost, side effects, and duration of treatment. Topical minoxidil is the mainstay treatment for androgenetic alopecia (AGA). Recently, low alcohol or alcohol-free topical minoxidil formulation has proven to be an alternative for patients suffering from AGA, including those with poor compliance with other therapies. Thus, the current article provides the positioning of low alcohol or alcohol-free topical minoxidil to manage AGA in Indian clinical practice.

Inhaled Silica Nanoparticles Causes Chronic Kidney Disease in Rats

INTRODUCTION

Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats.

METHODS

We administered 200 nm or 300 nm amorphous SiNPs twice weekly (4 mg/dose) or vehicle by oropharyngeal aspiration for 13 weeks to rats followed by sacrifice after an additional 13 weeks (26 weeks total). Tissues were evaluated for presence of SiNPs and evidence of histologic injury.

RESULTS

Both sizes of SiNPs caused kidney damage, with early tubular injury and inflammation (at week 13) that continued to inflammation and chronic fibrosis at week 26 despite discontinuing the SiNP administration. Both sizes of SiNPs caused local inflammation in the lung and kidney and were detected in the serum and urine at week 13, and the 200 nm particles also localized to the kidney with no evidence of retention of the 300 nm particles. At week 26 there was some clearance of the 200 nm silica from the kidneys, and urinary levels of SiNPs were reduced but still significant in both the 200 and 300 nm exposed rats.

CONCLUSIONS

Inhaled SiNPs causes chronic kidney injury that progresses despite stopping the SiNP administration. These findings are consistent with the hypothesis that human exposure to amorphous silica nanoparticles found in burned sugarcane fields could have a participatory role in chronic kidney disease of unknown etiology.

Effect of Yoga on Oxidative Stress in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

BACKGROUND

Diabetes mellitus has a significant impact on public health. Oxidative stress plays a major role in the pathophysiology of Type 2 Diabetes Mellitus (T2DM), leading to various complications of T2DM. Yoga is being widely used in the management of T2DM. The primary objective of this systematic review and meta-analysis is to understand the effects of yoga on oxidative stress parameters among adult patients diagnosed with T2DM.

MATERIALS AND METHODS

Electronic databases such as PubMed, Scopus, Cochrane Library and Science Direct from start of the study till March 2020 were searched to obtain eligible studies. Study designs of all nature were included (except case studies and reviews). The primary outcome was Malondialdehyde (MDA) and secondary outcomes included fasting plasma glucose, HbA1C and Superoxide Dismutase (SOD) levels.

RESULTS

A total of four trials with a total of 440 patients met the inclusion criteria. The results of meta-analysis indicated that yoga significantly reduced MDA (SMD: -1.4; 95% CI -2.66 to -0.13; P = 0.03; I2 = 97%), fasting plasma glucose levels (SMD: -1.87: 95% CI -3.83 to -0.09; P = 0.06; I2= 99%), and HbA1c (SMD: -1.92; 95% CI - 3.03 to -0.81; P = 0.0007; I2 = 92%) in patients with T2DM. No such effect was found for SOD (SMD: -1.01; 95% CI -4.41 to 2.38; P = 0.56; I2= 99%).

CONCLUSION

The available evidence suggests that yoga reduces MDA, fasting plasma glucose and HbA1C, and thus would be beneficial in the management of T2DM as a complementary therapy. However, considering the limited number of studies and its heterogeneity, further robust studies are necessary to strengthen our findings and investigate the long-term benefits of yoga.

Chronic Kidney Disease of Unknown Etiology in India: What Do We Know and Where We Need to Go

Chronic kidney disease (CKD) not associated with known risk factors has been reported from parts of India and is presumed to be similar to CKD of unknown etiology (CKDu) that has been described from Central America. The reports from India have been fragmented without clear description of the disease phenotype or its determinants. This paper summarizes the current state of knowledge around CKDu in India based on a review of literature, multi-stakeholder consultation, and a survey of Indian nephrologists. We also contacted individual research groups to solicit data. Our findings suggest that that CKDu is reported from most regions in India; however, it is interpreted differently from the phenotype described from Central America and Sri Lanka. The differences include lack of a clear demographic or occupation group, older age of affected participants, and presence of mild hypertension and low-grade proteinuria. Well-designed prospective field studies with appropriate diagnostic workup are needed to establish the disease burden and identify etiologies, along with socioeconomic and health consequences, the intersection with the environment, and the public health response. Community-based research should phenotype the entire CKD population rather than be restricted to cases with presumed CKDu based on predefined criteria. Guidelines are needed for clinical evaluation, referral, management, and harmonization of clinical documentation and health records. More data are needed to support the existence of a unique CKDu phenotype in India.

Challenges in conducting epidemiological field studies evaluating associations between heat stress and renal health among workers in informal sectors: experiences from India

Well-designed Environmental Epidemiological Studies (EES) play a crucial role in quantifying the influence of environmental exposures and their associated risks on health in the wider population. They provide critical research evidence for identifying and developing interventions to avert adverse health consequences from those exposures. However, uncertainty and variability inherent to any field based EES could hinder the nature and magnitude of association between an exposure and health outcome. This is particularly pronounced in resource limited settings and resource-tight research projects. The present study evaluated the association between occupational heat stress and renal health among informal work sectors in India which had some significant challenges. Informal workers exposed to chronic occupational heat stress had significantly higher adverse renal health outcomes than the unexposed workers. Our field challenges included gaining access and permissions to conduct the study, participant recalls bias and attrition, accurately estimating exposures, confounding from causes of both exposure and disease, and to a large extent tight-funding. Though opportunities are abundant, we must ensure field conditions are optimized to attain study objectives. A keen understanding and sensitivity towards the cultural and work settings is essential for successful project completion. Based on our experiences, we provide strategies to adopt to improve fieldwork and provide recommendations to help overcome the field challenges and achieve better results for future EES studies in developing country settings.

Effect of six months pranayama training on stress-induced salivary cortisol response among adolescents-Randomized controlled study

BACKGROUND

A combination of yoga practices has been documented to reduce stress and stress-induced cortisol levels. The objective of the current study is to examine the effects of six months of a single pranayama practice (Bhramari [Bhr. P]) on reducing salivary cortisol response to the cold pressor test (CPT) among adolescents.

METHODS

Twenty-six healthy adolescents between the ages of 11 and 19 were randomly assigned to either yoga group (n-13) or control group (n-13). Yoga group participants were trained to do Bhr. P for 45 min, thrice a week for six months. All participants underwent CPT at baseline and at end of six months. Saliva samples were collected at baseline (t0), at 20 min (t1), 40 min (t2), and 60 min after the CPT (t3).

RESULTS

Contradictory to our hypothesis, participants in the yoga group exhibited a higher salivary cortisol response to the CPT at t1 (p = 0.04) when compared to the control group. However, the t3 salivary cortisol levels showed a statistically significant reduction (p = 0.03) in yoga group when compared to the control group. A significant interaction with time (F (1, 88) = 316.5, p = .001, ηp²:0.91) and between the group × time (F (3, 88) = 2.83, p = 0.04, ηp²:0.8) was found after the intervention.

CONCLUSIONS

An increase in the cortisol responsiveness observed in the study is an indication of the adaptive capability achieved through regular yoga training, evidenced by an initial rise in cortisol followed by a rapid fall below baseline after 60 min. Further research is required to conclusively determine the changes in cortisol levels over time in response to stress in long-term yoga practitioners.

Valorization of Seafood Processing Discards: Bioconversion and Bio-Refinery Approaches

The seafood industry generates large volumes of waste. These include processing discards consisting of shell, head, bones intestine, fin, skin, voluminous amounts of wastewater discharged as effluents, and low-value under-utilized fish, which are caught as by-catch of commercial fishing operations. The discards, effluents, and by-catch are rich in nutrients including proteins, amino acids, lipids containing good proportions of polyunsaturated fatty acids (PUFA), carotenoids, and minerals. The seafood waste is, therefore, responsible for loss of nutrients and serious environmental hazards. It is important that the waste is subjected to secondary processing and valorization to address the problems. Although chemical processes are available for waste treatment, most of these processes have inherent weaknesses. Biological treatments, however, are environmentally friendly, safe, and cost-effective. Biological treatments are based on bioconversion processes, which help with the recovery of valuable ingredients from by-catch, processing discards, and effluents, without losing their inherent bioactivities. Major bioconversion processes make use of microbial fermentations or actions of exogenously added enzymes on the waste components. Recent developments in algal biotechnology offer novel processes for biotransformation of nutrients as single cell proteins, which can be used as feedstock for the recovery of valuable ingredients and also biofuel. Bioconversion options in conjunction with a bio-refinery approach have potential for eco-friendly and economical management of seafood waste that can support sustainable seafood production.

Effects of 12 sessions of steam bath intervention on spirometry parameters among healthy adult volunteers

OBJECTIVES

Steam bath is extensively used around the world. However, its physiological influence is not understood in detail. Objective of the current study is to examine the effects of 12 sessions of steam bath on spirometric parameters among healthy participants.

METHODS

Forty healthy adult volunteers of both sex (14 male and 26 female) aged 26.38 ± 8 years participated in the study. A steam bath session (10-15 min) was given once a week for 12 weeks. The spirometric parameters [forced expiratory volume in the 1st second (FEV1, L), forced vital capacity (FVC, L), FEV1/FVC ratio (absolute value), maximal mid-expiratory flow (MMEF, L/s) and peak expiratory flow (PEF, L/s)] were measured by Helios 401 spirometer.

RESULTS

Compared to baseline, post-intervention spirometric parameters showed significant (p<0.05) improvement in the FVC (82.40 ± 11.24 to 96.91 ± 18.76), FEV1 (86.13 ± 14.39 to 91.17 ± 12.48), FEV1/FVC ratio (86.96 ± 3.64 to 93.75 ± 4.80), MMEF 25-75% (86.96 ± 3.64 to 94.16 ± 11.57), peak expiratory flow rate (79.82 ± 14.90 to 92.18 ± 18.96).

CONCLUSIONS

Taking steam bath improves the spirometric parameters of healthy adult participants. However, future randomized controlled trials with on a large scale have to done to validate our findings.

Epidemiological evidence from south Indian working population-the heat exposures and health linkage

Changing climate and rising temperatures are predicted to affect millions of workers due to heat stress risks, especially in tropical settings. We used a cross-sectional study design to profile the heat exposures of ~1500 workers from eight-industrial sectors using a QuesTemp wet bulb globe temperature (WBGT) monitor, quantified the heat-strain indicators viz., rise in Core Body Temperature (CBT), Sweat Rate (SwR), and Urine Specific Gravity (USG) by standard methods and evaluated the health impacts of heat stress using a structured questionnaire. Heat exposures (Avg.WBGT: 28.4 ± 2.6 °C) exceeded the Threshold Limit Value (TLV) for 70% of workers and was significantly associated with the rise in CBT >1 °C in 11.3% and elevated USG >1.020 in 10.5% of the workers. The heat-exposed workers had 2.3 times higher odds of reporting adverse health outcomes (84%) compared to the unexposed workers (95% CI: 1.74-3.19; p value ≤ 0.0001). Mild reduction in kidney function observed in 49% of salt - pan workers, and a high prevalence of kidney stones (33%) among the 91 steelworkers subjected to kidney ultrasound had a significant association with chronic high WBGT exposure above the TLV (p value < 0.034). Further, in-depth assessments are warranted to develop strategies for interventions and protective labor policies to avert adverse occupational health and productivity consequences for millions of workers globally, especially in the rising temperature scenario.

Indian monsoon derailed by a North Atlantic wavetrain

The forecast of Indian monsoon droughts has been predicated on the notion of a season-long rainfall deficit linked to a warm equatorial Pacific. Here we show that nearly half of all droughts over the past century differ from this paradigm in that they (i) occur when Pacific temperatures are near-neutral and (ii) are subseasonal phenomena, characterized by an abrupt decline in late-season rainfall. This severe subseasonal rainfall deficit can be associated with a Rossby wave from mid-latitudes. Specifically, we find that the interaction of upper-level winds with an episodic North Atlantic vorticity anomaly results in a wavetrain that curves toward East Asia, disrupting the monsoon. This atmospheric teleconnection offers an avenue for improved predictability of droughts, especially in the absence of telltale signatures in the Pacific.

Heat Stress and Thermal Perception amongst Healthcare Workers during the COVID-19 Pandemic in India and Singapore

The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1-31.8 °C)) than in Singapore (22.0 °C (IQR 18.8-24.8 °C)) (p < 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p < 0.001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore (p < 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.

Revealing Potential Binding Affinity of FDA Approved Therapeutics Targeting Main Protease (3CLpro) in Impairing Novel Coronavirus (SARSCoV- 2) Replication that Causes COVID-19

Background:

Spread of COVID-19 attains a crucial transition in reveling its pandemic across the boundaries. In combating the infection caused by SARS-CoV-2, there is a spectrum of ideal strategies that have been adopted globally, of which repurposing of approved drugs considerably having high clinical relevance. 3-chymotrypsin-like protease (3CL pro) is considered to be the potential target for the researchers as it is highly essential for cleavage of polyprotein to get 16 nonstructural proteins (called nsp1-nsp16). These proteins are highly essential for viral replication and hence become a primary target for enzyme inhibitors. 3CL pro, having a structural projectile helical chain with biologically active site involved in processing viral polyproteins that are evolved from RNA genome translation.

Objective:

The major objective of the present investigation is to evaluate the enzyme inhibition potential of FDA approved therapeutic leads in targeting 3CLpro that medicates the viral replication.

Methods:

Docking calculations were carried out for an array of FDA approved molecules which leads to a notable few molecules such as Emtricitabine, Oseltamivir, Ganciclovir, Chloroquine, Baricitinib, Favipiravir, Lopinavir, Ritonavir, Remdesivir, Ribavirin, Tenofovir, Umifenovir, Carbapenam, Ertapenem and Imipenam which have both specificity and selectivity in terms of binding efficiency against 3CL proenzyme.

Results:

A combinatorial evaluation employing in-silico screening shows a major lead for remdesivir which possesses a substantial affinity to 3CL pro binding on core amino acid residues, such as Leu 27, His 41, Gly 143, Cys 145, His 164, Met 165, Glu 166, Pro 168 and His 172 which share the biological significance in mediating enzymatic action. Results of docking simulation by Autodock over a host of FDA approved molecules show high degree of selectivity and specificity in the increasing order of binding capacity; Remdesivir> Ertapenem> Imipenam> Tenofovir> Umifenovir> Chloroquine> Lopinavir> Ritonavir> Emtricitabine> Ganciclovir> Baricitinib> Ribavirin>Oseltamivir>Favipiravir> Carbapenam.

Conclusion:

Till date, there is no known cure attained for treating COVID-19 infection. In conclusion, lead molecules from already approved sources provoke promising potential which grabs the attention of the clinicians in availing potential therapeutic candidate as a drug of choice in the clinical management of COVID-19 time-dependently.

Risk of kidney stone among workers exposed to high occupational heat stress - A case study from southern Indian steel industry

BACKGROUND

Predicted temperature rise is likely to increase the risks of development and progression of renal/urologic anomalies for workers engaged in physically exerting and high-heat occupations.

METHODS

We conducted a cross-sectional study with 340 steelworkers engaged in moderate to heavy labour with ≥3 year's heat exposures and assessed Wet Bulb Globe Temperature (WBGT) and heat-strain indicators. We captured self-reported heat-strain and kidney symptoms using validated questionnaires and subjected 91 workers to renal ultrasound upon referral of an occupational health specialist to detect and confirm any structural renal anomalies/stones.

RESULTS

The results show that heat exposures (Avg.WBGT = 33.2 °C ± 3.8 °C) exceeded the Threshold Limit Value (TLV) for 220 workers. 95% of the workers reported symptoms of heat strain and dehydration and significant associations between heat exposures, rise in Core Body Temperature (CBT) (p = 0.0001) and Urine Specific Gravity (USG) (p = 0.018) were observed. Of the 91 workers subjected to renal ultrasound, 33% were positive for kidney/ureteral stones (n = 25) & other structural renal anomalies (n = 5). Renal/urologic anomalies were higher in the heat-exposed workers (AOR = 2.374; 95% C.I = 0.927 to 6.077; p = 0.072) 29% of workers were from exposed group and 4% were from unexposed group. Years of exposure to heat (≥5 vs <5) were significantly associated with the risk of renal anomalies/calculi.

CONCLUSION

The preliminary finding concludes that high-heat stress combined with a heavy workload and chronic dehydration are high-risk factors for adverse renal health and calls for the urgent need for cooling interventions, enhanced welfare facilities, and protective labour policies to avert adverse health consequences for few million workers in the climate change scenario.

Current Strategies and Approaches in Combating SARS-CoV-2 Virus that Causes COVID-19

Abstract:

The pandemic spread of severe acute respiratory syndrome coronavirus (SARS-CoV-2) that causes COVID-19 calls for global health emergency with wide prevalence across 94 countries, and around 3073 deaths reported in china on 7th March 2020 which created red alert zone in the country. It was further noticed other than China, countries like the republic of Korea ranked first with 6767 cases, Italy with 4747 and Iran with 3513 cases. The spread of COVID-19 made a historical transition between December 2019 to March 2020 by extending the paradigm to a newer territory every day with the highest predicted reproductive number <2. Hence, while combating the epidemic spread, there are spectra of strategies that require crucial validation, some of which include drug repurposing, enzyme inhibition, target drug delivery etc. Among these, the category of drugs called enzyme inhibitors has a unique opportunity in the process of new drug discovery as these enzymes possess structural versatility starting from the host viral interface and up to the release of a new virus. Drugs entrapped within liposomes are highly effective against intracellular microorganisms as per published observations. Regulatory authorities like World Health Organization (WHO) and Centre for disease control and prevention (CDC) strongly recommend the need for the PPE’s like N95 respirator to avoid person to person contact. In this context, Electrospun Nanofiber Technology (ENT) offers ultrathin fibres (20-200 nm) with close proximity of 99.97% of high efficient air filtration. Fabrication of ultrafine nano mask by utilizing electospun technology will surely benefit millions of people in a time-dependent manner.

Association between occupational heat stress and DNA damage in lymphocytes of workers exposed to hot working environments in a steel industry in Southern India

Occupational heat stress apart from adverse heat-related health consequences also induces DNA damage in workers exposed to high working temperatures. We investigated the association between chronic heat exposures and Micronuclei (MN) frequency in lymphocytes of 120 workers employed in the steel industry. There was a significant increase in the MN-frequency in exposed workers compared to the unexposed workers (X² = 47.1; p < 0.0001). While exposed workers had higher risk of DNA damage (Adj. OR = 23.3, 95% CI 8.0-70.8) compared to the unexposed workers, among the exposed workers, the odds of DNA damage was much higher for the workers exposed to high-heat levels (Adj. OR = 81.4; 95% CI 21.3-310.1) even after adjusting for confounders. For exposed workers, years of exposure to heat also had a significant association with higher induction of MN (Adj. OR = 29.7; 95% CI 2.8-315.5). Exposures to chronic heat stress is a significant occupational health risk including damages in sub-cellular level, for workers. Developing protective interventions to reduce heat exposures is imperative in the rising temperature scenario to protect millions of workers across the globe.

Environmental & load data: 1:15 Scale tidal turbine subject to a variety of regular wave conditions

Experimental data was obtained in order to investigate the effect of waves on the loads and performance of tidal turbines. An instrumented 1:15 scale tidal turbine was installed in the FloWave Ocean Energy Research Facility, and a wide range of regular wave conditions were generated; systematically varying both wave frequency and height. Waves were generated both following and opposing a fixed mean current velocity of 0.81 m/s. Data are made available of the measured turbine loads and environmental conditions obtained for five repeats of 24 wave conditions via https://doi.org/10.7488/ds/2472. A description of the data collection process, data processing, file structure and naming conventions are provided in this article. The analysis and presentation of the described dataset can be found in Ref. [1].

Clinical and equipment-related factors associated with the adequate peripheral blood stem cell collection in autologous transplant at a tertiary cancer center in Kerala - A retrospective cohort study

BACKGROUND

PBSC collection using apheresis is the preferred source of hematopoietic stem cells transplantation. However, apheresis procedures fail to harvest adequate CD34 yield in 5 to 40% of patients during the first collection. Therefore, this study aimed to study both the clinical- and equipmentrelated factors influencing CD34 yield among the autologous patients and to compare the collection efficiency of two apheresis equipments(Haemonetics MCS+ and Terumo Spectra Optia).

METHODS

Retrospective analysis of 69 patients underwent PBSC collection from 2015 to 2018. Frequency, clinical- and equipment-related factors responsible for adequate CD34+ cells (≥2 x106 cells/kg) yield during the first collection was studied. Factors such as collection efficiency, percentage platelet loss and percentage hemoglobin loss were considered to compare the two apheresis system.

RESULTS

Two-third (72%) patients of the study population had adequate CD34 stem cells yield during the first collection. Factors such as exposure to lenalidomide-based pretreatment regimen, peripheral blood WBC count and CD34 count are associated with the adequate CD34 yield. Optia had a slightly better collection efficiency than MCS+ (50 and 44; p=0.37). Optia had lower product volume (237 vs 298 ml) and lesser procedure duration (277 vs 360 min), whereas the median Hb loss (3.0% and 2.3%) and mean platelet loss (49% and 34%) were higher with MCS.

CONCLUSION

This study infers that the collection efficiency of both the equipments in collecting CD34 stem cells was similar. However, during PBSC collection, procedures using Optia can be preferred to MCS+ on the patients with risk of anemia and thrombocytopenia.

Syntheses and Characterisation of Amide Adducts of Uranyl Bis (β-Diketonates) the Molecular Structure of [UO2(DBM)2.C4H9CON(3-C5H11) (sec-C4H9)]

The first structurally characterised uranyl bis (β-diketonate)-amide adduct compound [UO2(DBM)2. C4H9CON ( 3-C5H11) ( sec-C4H9)] (DBM = dibenzoylmethanate) shows that the amide ligand bonded through its amido oxygen atom to the uranyl group. The average bond distances for U–O(uranyl), U–O(DBM) and U–O(amide) are 1.778(5), 2.346(5) and 2.411(5)Å respectively.

Climate change-induced heat risks for migrant populations working at brick kilns in India: a transdisciplinary approach

During the summer of 2015, India was hit by a scorching heat wave that melted pavements in Delhi and caused thousands of deaths, mainly among the most marginalized populations. One such group facing growing heat risks from both occupational and meteorological causes are migrant brick kiln workers. This study evaluates both current heat risks and the potential future impacts of heat caused by climate change, for the people working at brick kilns in India. A case study of heat stress faced by people working at brick kilns near Chennai, India, is the anchor point around which a transdisciplinary approach was applied. Around Chennai, the situation is alarming since occupational heat exposure in the hot season from March to July is already at the upper limits of what humans can tolerate before risking serious impairment. The aim of the study was to identify new pathways for change and soft solutions by both reframing the problem and expanding the solution space being considered in order to improve the quality of life for the migrant populations at the brick kilns. Technical solutions evaluated include the use of sun-dried mud bricks and other locally "appropriate technologies" that could mitigate the worsening of climate change-induced heat. Socio-cultural solutions discussed for empowering the people who work at the brick kilns include participatory approaches such as open re-localization, and rights-based approaches including the environmental sustainability and the human rights-based approach framework. Our analysis suggests that an integrative, transdisciplinary approach could incorporate a more holistic range of technical and socio-culturally informed solutions in order to protect the health of people threatened by India's brick kiln industry.

Precision medicine for suicidality: from universality to subtypes and personalization

Suicide remains a clear, present and increasing public health problem, despite being a potentially preventable tragedy. Its incidence is particularly high in people with overt or un(der)diagnosed psychiatric disorders. Objective and precise identification of individuals at risk, ways of monitoring response to treatments and novel preventive therapeutics need to be discovered, employed and widely deployed. We sought to investigate whether blood gene expression biomarkers for suicide (that is, a 'liquid biopsy' approach) can be identified that are more universal in nature, working across psychiatric diagnoses and genders, using larger cohorts than in previous studies. Such markers may reflect and/or be a proxy for the core biology of suicide. We were successful in this endeavor, using a comprehensive stepwise approach, leading to a wealth of findings. Steps 1, 2 and 3 were discovery, prioritization and validation for tracking suicidality, resulting in a Top Dozen list of candidate biomarkers comprising the top biomarkers from each step, as well as a larger list of 148 candidate biomarkers that survived Bonferroni correction in the validation step. Step 4 was testing the Top Dozen list and Bonferroni biomarker list for predictive ability for suicidal ideation (SI) and for future hospitalizations for suicidality in independent cohorts, leading to the identification of completely novel predictive biomarkers (such as CLN5 and AK2), as well as reinforcement of ours and others previous findings in the field (such as SLC4A4 and SKA2). Additionally, we examined whether subtypes of suicidality can be identified based on mental state at the time of high SI and identified four potential subtypes: high anxiety, low mood, combined and non-affective (psychotic). Such subtypes may delineate groups of individuals that are more homogenous in terms of suicidality biology and behavior. We also studied a more personalized approach, by psychiatric diagnosis and gender, with a focus on bipolar males, the highest risk group. Such a personalized approach may be more sensitive to gender differences and to the impact of psychiatric co-morbidities and medications. We compared testing the universal biomarkers in everybody versus testing by subtypes versus personalized by gender and diagnosis, and show that the subtype and personalized approaches permit enhanced precision of predictions for different universal biomarkers. In particular, LHFP appears to be a strong predictor for suicidality in males with depression. We also directly examined whether biomarkers discovered using male bipolars only are better predictors in a male bipolar independent cohort than universal biomarkers and show evidence for a possible advantage of personalization. We identified completely novel biomarkers (such as SPTBN1 and C7orf73), and reinforced previously known biomarkers (such as PTEN and SAT1). For diagnostic ability testing purposes, we also examined as predictors phenotypic measures as apps (for suicide risk (CFI-S, Convergent Functional Information for Suicidality) and for anxiety and mood (SASS, Simplified Affective State Scale)) by themselves, as well as in combination with the top biomarkers (the combination being our a priori primary endpoint), to provide context and enhance precision of predictions. We obtained area under the curves of 90% for SI and 77% for future hospitalizations in independent cohorts. Step 5 was to look for mechanistic understanding, starting with examining evidence for the Top Dozen and Bonferroni biomarkers for involvement in other psychiatric and non-psychiatric disorders, as a mechanism for biological predisposition and vulnerability. The biomarkers we identified also provide a window towards understanding the biology of suicide, implicating biological pathways related to neurogenesis, programmed cell death and insulin signaling from the universal biomarkers, as well as mTOR signaling from the male bipolar biomarkers. In particular, HTR2A increase coupled with ARRB1 and GSK3B decreases in expression in suicidality may provide a synergistic mechanistical corrective target, as do SLC4A4 increase coupled with AHCYL1 and AHCYL2 decrease. Step 6 was to move beyond diagnostics and mechanistical risk assessment, towards providing a foundation for personalized therapeutics. Items scored positive in the CFI-S and subtypes identified by SASS in different individuals provide targets for personalized (psycho)therapy. Some individual biomarkers are targets of existing drugs used to treat mood disorders and suicidality (lithium, clozapine and omega-3 fatty acids), providing a means toward pharmacogenomics stratification of patients and monitoring of response to treatment. Such biomarkers merit evaluation in clinical trials. Bioinformatics drug repurposing analyses with the gene expression biosignatures of the Top Dozen and Bonferroni-validated universal biomarkers identified novel potential therapeutics for suicidality, such as ebselen (a lithium mimetic), piracetam (a nootropic), chlorogenic acid (a polyphenol) and metformin (an antidiabetic and possible longevity promoting drug). Finally, based on the totality of our data and of the evidence in the field to date, a convergent functional evidence score prioritizing biomarkers that have all around evidence (track suicidality, predict it, are reflective of biological predisposition and are potential drug targets) brought to the fore APOE and IL6 from among the universal biomarkers, suggesting an inflammatory/accelerated aging component that may be a targetable common denominator.

Effect of a Diet Enriched with Fresh Coconut Saturated Fats on Plasma Lipids and Erythrocyte Fatty Acid Composition in Normal Adults

OBJECTIVE

The objective of this study was to compare the effects of increased saturated fatty acid (SFA) (provided by fresh coconut) versus monounsaturated fatty acid (MUFA) intake (provided by a combination of groundnuts and groundnut oil) on plasma lipids and erythrocyte fatty acid (EFA) composition in healthy adults.

MATERIAL AND METHODS

Fifty-eight healthy volunteers, randomized into 2 groups, were provided standardized diet along with 100 g fresh coconut or groundnuts and groundnut oil combination for 90 days in a Yoga University. Fasting blood samples were collected before and after the intervention period for the measurement of plasma lipids and EFA profile.

RESULTS

Coconut diet increased low-density lipoprotein (LDL) and high-density lipoprotein (HDL) levels significantly. In contrast, the groundnut diet decreased total cholesterol (TC), mainly due to a decrease in HDL levels. There were no differences in the major SFA of erythrocytes in either group. However, coconut consumption resulted in an increase in C14:0 and C24:0 along with a decrease in levels of C18:1 n9 (oleic acid). There was a significant increase in levels of C20:3 n6 (dihomo-gamma linolenic acid, DGLA).

CONCLUSIONS

Consumption of SFA-rich coconut for 3 months had no significant deleterious effect on erythrocytes or lipid-related factors compared to groundnut consumption. On the contrary, there was an increase in the anti-atherogenic HDL levels and anti-inflammatory precursor DGLA in erythrocyte lipids. This suggests that coconut consumption may not have any deleterious effects on cardiovascular risk in normal subjects.

Wave directional spreading from point field measurements

Ocean waves have multidirectional components. Most wave measurements are taken at a single point, and so fail to capture information about the relative directions of the wave components directly. Conventional means of directional estimation require a minimum of three concurrent time series of measurements at different spatial locations in order to derive information on local directional wave spreading. Here, the relationship between wave nonlinearity and directionality is utilized to estimate local spreading without the need for multiple concurrent measurements, following Adcock & Taylor (Adcock & Taylor 2009 Proc. R. Soc. A465, 3361–3381. (doi:10.1098/rspa.2009.0031)), with the assumption that directional spreading is frequency independent. The method is applied to measurements recorded at the North Alwyn platform in the northern North Sea, and the results compared against estimates of wave spreading by conventional measurement methods and hindcast data. Records containing freak waves were excluded. It is found that the method provides accurate estimates of wave spreading over a range of conditions experienced at North Alwyn, despite the noisy chaotic signals that characterize such ocean wave data. The results provide further confirmation that Adcock and Taylor's method is applicable to metocean data and has considerable future promise as a technique to recover estimates of wave spreading from single point wave measurement devices.

Occupational Heat Stress Impacts on Health and Productivity in a Steel Industry in Southern India

BACKGROUND

Workers laboring in steel industries in tropical settings with high ambient temperatures are subjected to thermally stressful environments that can create well-known risks of heat-related illnesses and limit workers' productivity.

METHODS

A cross-sectional study undertaken in a steel industry in a city nicknamed "Steel City" in Southern India assessed thermal stress by wet bulb globe temperature (WBGT) and level of dehydration from urine color and urine specific gravity. A structured questionnaire captured self-reported heat-related health symptoms of workers.

RESULTS

Some 90% WBGT measurements were higher than recommended threshold limit values (27.2-41.7°C) for heavy and moderate workloads and radiational heat from processes were very high in blooming-mill/coke-oven (67.6°C globe temperature). Widespread heat-related health concerns were prevalent among workers, including excessive sweating, fatigue, and tiredness reported by 50% workers. Productivity loss was significantly reported high in workers with direct heat exposures compared to those with indirect heat exposures (χ2 = 26.1258, degrees of freedom = 1, p < 0.001). Change in urine color was 7.4 times higher among workers exposed to WBGTs above threshold limit values (TLVs).

CONCLUSION

Preliminary evidence shows that high heat exposures and heavy workload adversely affect the workers' health and reduce their work capacities. Health and productivity risks in developing tropical country work settings can be further aggravated by the predicted temperature rise due to climate change, without appropriate interventions. Apart from industries enhancing welfare facilities and designing control interventions, further physiological studies with a seasonal approach and interventional studies are needed to strengthen evidence for developing comprehensive policies to protect workers employed in high heat industries.

Heat stress and inadequate sanitary facilities at workplaces - an occupational health concern for women?

Background

Health concerns unique to women are growing with the large number of women venturing into different trades that expose them to hot working environments and inadequate sanitation facilities, common in many Indian workplaces.

Objective

The study was carried out to investigate the health implications of exposures to hot work environments and inadequate sanitation facilities at their workplaces for women workers.

Design

A cross-sectional study was conducted with 312 women workers in three occupational sectors in 2014–2015. Quantitative data on heat exposures and physiological heat strain indicators such as core body temperature (CBT), sweat rate (SwR), and urine specific gravity (USG) were collected. A structured questionnaire captured workers perceptions about health impacts of heat stress and inadequate sanitary facilities at the workplace.

Results

Workplace heat exposures exceeded the threshold limit value for safe manual work for 71% women (Avg. wet bulb globe temperature=30°C±2.3°C) during the study period. Eighty-seven percent of the 200 women who had inadequate/no toilets at their workplaces reported experiencing genitourinary problems periodically. Above normal CBT, SwR, and USG in about 10% women workers indicated heat strain and moderate dehydration that corroborated well with their perceptions. Observed significant associations between high-heat exposures and SwR (t=−2.3879, p=0.0192), inadequate toilet facilities and self-reported adverse heat-related health symptoms (χ²=4.03, p=0.0444), and prevalence of genitourinary issues (χ²=42.92, p=0.0005×10⁻⁷) reemphasize that heat is a risk and lack of sanitation facilities is a major health concern for women workers.

Conclusions

The preliminary evidence suggests that health of women workers is at risk due to occupational heat exposures and inadequate sanitation facilities at many Indian workplaces. Intervention through strong labor policies with gender sensitivity is the need of the hour to empower women, avert further health risks, and also enhance productivity for the few million women workers who contribute largely to the country's economy.

Enzymes from Seafood Processing Waste and Their Applications in Seafood Processing

Commercial fishery processing results in discards up to 50% of the raw material, consisting of scales, shells, frames, backbones, viscera, head, liver, skin, belly flaps, dark muscle, roe, etc. Besides, fishing operations targeted at popular fish and shellfish species also result in landing of sizeable quantity of by-catch, which are not of commercial value because of their poor consumer appeal. Sensitivity to rapid putrefaction of fishery waste has serious adverse impact on the environment, which needs remedial measures. Secondary processing of the wastes has potential to generate a number of valuable by-products such as proteins, enzymes, carotenoids, fat, and minerals, besides addressing environmental hazards. Fishery wastes constitute good sources of enzymes such as proteases, lipases, chitinase, alkaline phosphatase, transglutaminase, hyaluronidase, acetyl glycosaminidase, among others. These enzymes can have diverse applications in the seafood industry, which encompass isolation and modification of proteins and marine oils, production of bioactive peptides, acceleration of traditional fermentation, peeling and deveining of shellfish, scaling of finfish, removal of membranes from fish roe, extraction of flavors, shelf life extension, texture modification, removal of off-odors, and for quality control either directly or as components of biosensors. Enzymes from fish and shellfish from cold habitats are particularly useful since they can function comparatively at lower temperatures thereby saving energy and protecting the food products. Potentials of these applications are briefly discussed.

Influence of occupational heat stress on labour productivity – a case study from Chennai, India

Purpose

– Raise in temperatures due to climate change is likely to increase the heat stress in occupations that are physically exerting and performed outdoors which might potentially have adverse health and productivity consequences. The purpose of this paper is to estimate the productivities in construction work under the influence of heat stress using the predicted mean vote (PMV) index.

Design/methodology/approach

– Field studies were conducted during May 2014 which is summer time in Chennai. Continuous heart rate of workers and wet bulb globe temperature measurements are conducted for workers engaged in different jobs in construction. Metabolic rates and the workload of the workers from heart rate were calculated using the ISO method 8996 and the PMV values are calculated using the tool developed by Malchaire based on the method ISO 7730. Direct observations and personal interviews were conducted to substantiate the productivity estimations.

Findings

– The results showed that workers working outdoors with moderate and heavy workload exceeded the threshold limit value of 28°C and had adverse productivity impacts (18-35 per cent productivity loss), whereas the workers engaged in light indoor work was not affected by heat stress and consequent productivity losses. The productivity estimations using the PMV index is found to be statistically significant for three types of construction works (Pearson correlation coefficient value of −0.78) and also correlated well with the observations and self-reported productivities of the workers.

Originality/value

– The method used in this paper provides a scientific and reliable estimation of the productivities which may benefit the industry to set realistic project completion goals in hot weather and also implement interventions and policies to protect workers’ health. Developing adaptive strategies and implementing control measures are the need of the hour to protect worker’s health and economic losses in the face of climate change.

Research in occupational heat stress in India: Challenges and opportunities

Occupational heat stress is a major health burden with several potential negative health and well-being outcomes. It is only in the recent years medical research has addressed this risk factor. The aim of this paper is to present an overview of studies in the area of occupational heat stress and its health impacts. Research in occupational heat stress in developing countries like India is limited because of several challenges and constraints. Few challenges are permission from industries to publish the data, resistance for change from employers and workers, improper record of heat/any occupational disease by the employer or worker, study design, and paucity in number of studies. Proper education and guidelines can help to overcome some of the constraints. Proper and correct guidelines will help in mitigating the effects of excessive heat exposure on the health of workers. The studies in this area are limited, and the association between occupational heat exposure and health impacts is not clearly established. Hence, carefully designed studies are required to examine this association and thereby provide valuable information to protect worker's health.