Can Hot Weather Cause Non-ST Elevation Myocardial Infarction in Young Athletic Male Runners?

Athletes are a group of people who have good activity, regular muscular exercise, an almost standard lifestyle, and should be in good condition with low rates of medical, particularly cardiovascular, complications. However, cardiac attacks, sudden cardiac deaths, and fatal arrhythmogenic syndromes have been reported in athletes with low incidences. We can determine external and internal factors that lead to cardiac attacks in athletes. The former include abnormal cardiac structures and genetics, while the latter include environmental conditions like extreme temperatures, smoking, and drug abuse. Here, we report a case of a cardiac attack with non-ST elevation myocardial infarction (NSTEMI) in a young athlete who was a non-smoker, did not have any abnormal heart structures or a history of drug abuse, and did not have a family history of cardiac disease or arrest. High humidity levels and temperatures were the main causes of the cardiac attack, which occurred during a sports exercise at high temperatures with high humidity levels. We hope to prevent the recurrence of such a case. We need to understand when and where sports exercises can be performed without the risk of medical complications.

Ceftazidime/Avibactam, Polymyxin or Tigecycline as a Rescue Strategy for the Treatment of Carbapenem-Resistant Klebsiella pneumoniae in Bloodstream Infection: A Retrospective Cohort Study

Objective

To analyze the clinical characteristics, outcomes, and risk factors of patients treated with ceftazidime/avibactam, polymyxin, or tigecycline (CPT) compared with those receiving a conventional therapy (CT) (ie, imipenem, levofloxacin, or gentamicin).

Methods

A single-center retrospective cohort study included patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) treated at one Chinese tertiary hospital between March 2012 and November 2022 was performed. Clinical characteristics, outcomes, and risk factors of patients treated with CPT or CT were compared. Predictors of 30-day mortality of patients with CRKP-BSI were also analysed in our study.

Results

Among 184 recruited patients with CRKP-BSI, 39.7% (73/184) were treated with CPT, while 60.3% (111/184) were treated with CT. Compared to patients treated with CT, patients treated with CPT had worse conditions, as evidenced by a higher rate of underlying diseases and invasive procedures; however, they also had a better prognosis and lower rates of 14-day treatment failure (p = 0.024). In addition, univariate analysis and multivariate analysis showed that SOFA score [odds ratio (OR) = 1.310, 95% confidence interval (CI) 1.157-1.483; p < 0.001] and cold weather (OR = 3.658, 95% CI 1.474-9.081; p = 0.005) were independent risk factors for 30-day mortality.

Conclusion

Compared to CRKP-BSI patients treated with CT, patients treated with CPT had worse conditions but better prognoses. CRKP-BSI occurred more frequently in hot weather; however, higher 30-day mortality was associated with cold weather. A randomized trial is needed to confirm these observational results.

The Effects of Daily Temperature on Crime Events in Urban Hanoi, Vietnam Using Seven Years of Data (2013-2019)

The effects of temperature on behavior change and mental health have previously been explored, but the association between temperature and crime is less well understood, especially in developing countries. Single-city-level data were used to evaluate the association between the short-term effects of temperature on crime events in urban Hanoi, Vietnam. We used quasi-Poisson regression models to investigate the linear effects and distributed lag non-linear models to investigate the non-linear association between daily temperature and daily crime events from 2013 to 2019. There were 3884 crime events, including 1083 violent crimes and 2801 non-violent crimes during the 7-year study period. For both linear and non-linear effects, there were positive associations between an increase in daily temperature and crime, and the greatest effects were observed on the first day of exposure (lag 0). For linear effects, we estimated that each 5 °C increase in daily mean temperature was associated with a 9.9% (95%CI: 0.2; 20.5), 6.8% (95%CI: 0.6; 13.5), and 7.5% (95%CI: 2.3; 13.2) increase in the risk of violent, non-violent, and total crime, respectively. For non-linear effects, however, the crime risk plateaued at 30 °C and decreased at higher exposures, which presented an inverted U-shape response with a large statistical uncertainty.

Current and Future Burdens of Heat-Related Hyponatremia: A Nationwide Register-Based Study

CONTEXT

A seasonal variation in hyponatremia, with higher incidence rates during hot summer days, has been demonstrated. Whether this applies to cool temperate regions is currently unknown.

OBJECTIVE

The aim of this study was to investigate the influence of ambient temperature on hyponatremia in the Swedish population under current and future climate scenarios.

METHODS

This nationwide cohort study identified all patients hospitalized with a first-ever principal diagnosis of hyponatremia between October 2005 and December 2014. Incidence rates for hyponatremia were calculated as number of hospitalizations divided by person-days at risk in the adult Swedish population at a given temperature, in increments of 1 °C.

RESULTS

The incidence of hyponatremia was stable at 0.3 per million person-days from -10 to 10 °C, but increased rapidly at 24-hour mean temperatures above 15 °C, with 2.26 hospitalizations per million days at the highest recorded temperature of 25 °C. Women and elderly carried the greatest risk, with an incidence of 35 hospitalizations per million days in individuals ≥ 80 years of age on the hottest days, corresponding to a 15-fold increase in incidence compared with cool days. A future 1 or 2 °C increase in mean temperature is expected to increase the incidence of hyponatremia by 6.3% and 13.9%, respectively.

CONCLUSION

The risk of hospitalization due to hyponatremia increases rapidly at temperatures above 15 °C, indicating a threshold effect. Over the next decades, rising global temperatures are expected to increase the inpatient burden of hyponatremia by approximately 10%. Strategies for protecting vulnerable groups are necessary to reduce this risk.

Seasonality of Hypoosmolar Hyponatremia in Medical Inpatients - Data from a Nationwide Cohort Study

CONTEXT

Hyponatremia is the most prevalent electrolyte disturbance in hospitalized patients. Previous studies have shown a seasonal variation of profound hyponatremia with higher prevalence during warmer months.

OBJECTIVE

This study aimed at analyzing the seasonal prevalence and sex- and age-specific differences of hyponatremia in medical inpatients.

DESIGN

Nationwide cohort study from January 2009 and December 2015 using prospective administrative data.

SETTING

Medical inpatients.

PATIENTS

Diagnosis of hypoosmolar hyponatremia.

MAIN OUTCOME MEASURES

The primary outcome was the monthly alteration in hyponatremia prevalence. Secondary outcomes were the association of outdoor temperature with hyponatremia prevalence and differences among sex and age groups.

RESULTS

Of 2 426 722 medical inpatients, 84 210 were diagnosed with hypoosmolar hyponatremia, of whom 61% (n = 51 262) were female. The highest overall prevalence of hyponatremia was observed in July (4.5%, n = 8976); the lowest in December (2.7%, n = 6530). The overall prevalence of hyponatremia in women compared with men was higher by 58% (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.56-1.60). The sex-specific difference was most pronounced in the warmest month of July (mean temperature 20.1°C (OR, 1.76; 95% CI, 1.68-1.84). We observed the strongest association between seasonality and hyponatremia in elderly (>80 years) female inpatients admitted during the month of July (OR, 2.40; 95% CI, 2.20-2.62]).

CONCLUSION

The prevalence of diagnosed hypoosmolar hyponatremia in medical inpatients increases during summer months with higher outdoor temperature. Elderly female inpatients were most susceptible to the seasonal rise in hyponatremia prevalence.

A Survey of Rural Residents' Perception and Response to Health Risks from Hot Weather in Ethnic Minority Areas in Southwest China

Ethnic minority areas in southwestern China are facing frequent high-temperature heatwaves. The health risk perceptions and responses of the local residents need to be investigated in order to formulate public policies to mitigate the impacts of climate change on health. In this study, a household survey was conducted in Pengshui Miao and Tujia Autonomous County of Chongqing from January to February 2019. A total of 624 local residents were sampled using the multi-stage sampling method. We used multivariate logistic regression models to explore the factors affecting risk perceptions and responses with regard to hot weather. The results showed that despite a relatively high level of risk perception, the study population had a very low level of willingness to see a doctor (24.4%), especially ethnic minority residents (17.5%). In particular, 80% of residents were aware of climate warming and 79% of residents were aware of the health risks of hot weather. Almost all survey participants reported a response to hot weather, with more than half of the participants stating that they would go somewhere cooler (58.5%) and drink more water (56.3%). Compared with the Han Chinese, ethnic minority participants had a higher perception of warm temperature (p <0.001) and associated health risks (p <0.001) but a lower perception of physical discomfort (p <0.001) and aggravated diseases (p = 0.001). The logistic models indicated that ethnic minority, residence time, outdoor working hours, and health status can significantly influence perceptions and subsequently significantly affect coping behaviors. In conclusion, our findings provide significant implications for the development of policies and health education and promotion programs for ethnic minorities in southwest China to aid them in maintaining good health during future hot weather events.

Air temperature exposure and agricultural occupational injuries in the Autonomous Province of Trento (2000-2013, North-Eastern Italy)

OBJECTIVES

The aim of this study was to evaluate the relationship between high air temperatures and occupational injuries (OIs) occurred during the summer seasons 2000-2013 in agricultural workers from the Autonomous Province of Trento (APT), North-Eastern Italy.

MATERIAL AND METHODS

Data about OIs for the APT from 2000 to 2013 occurring during the warm season (N = 7325) was provided by the National Institute of Insurance for Occupational Illness and Injury. Daily average and daily maximum temperatures values for the specific geographical site of events were retrieved. Daily temperatures were then assessed in 3 time lags: for the day of the event (lag 0), and for the previous 24 h (lag 1) and 48 h (lag 2). Daily temperatures were then categorized in 3 exposure groups (< 75th, 75-95th and > 95th percentiles). The risk of OIs was assessed as odds ratio (OR) calculated through a Poisson regression model controlled for age, sex, ethnicity and time period, and assuming OI rates for days on which temperature was comprised in < 75th percentile exposure groups as the referent ones.

RESULTS

Estimated incidence of OIs during the study period was 3.4±2.3 events/day. The peak of work-related accidents occurred on days characterized by severe thermal conditions, and in particular during heat waves (incidence rate ratio = 1.09, 95% confidence interval (CI): 1.02-1.17, p = 0.0165). Days having temperatures higher than 95th percentile, assessed as daily average, both on current days (OR = 1.119, 95% CI: 1.008-1.242) and in lag 1 (OR = 1.125, 95% CI: 1.013-1.249), as well as daily maximum temperatures, were at the highest risk of work-related injuries (OR = 1.144, 95% CI: 1.029-1.272).

CONCLUSIONS

In conclusion, presented findings recommend policymakers to develop appropriate warning/alert systems for agricultural workers regarding high environmental temperatures. Int J Occup Med Environ Health 2018;31(3):317-331.

Effect of probiotic supplementation and genotype on growth performance, carcass traits, hematological parameters and immunity of growing rabbits under hot environmental conditions

The effect of dietary inclusion of probiotics and genetic groups on rabbit performance under hot environmental conditions was studied. A total of 80 rabbits aged 8 weeks were distributed into a completely randomized design in a 4 × 3 factorial arrangement, including four genetic groups and three concentrations of dietary probiotic (0, 200 and 400 g/t feed). The utilized probiotic contained 4 × 10⁹  colony-forming units/g of Bacillus subtilis. Jabali local breed (J), imported Spanish V-line (V) and their crossbreds (¼J¾V and ¾J¼V) were included in the current study. Final weight and body weight gain were not significantly affected by dietary probiotic levels or genetic group. The feed conversion ratio was better for purebreds than that of crossbreds. A significant improvement in percentage of dressed carcass, mid and hind parts was recorded for rabbits fed a diet containing 400 g probiotic/t feed compared with those fed a basal diet or low probiotic level. Probiotic supplementation had a significant decrease in serum cholesterol. Rabbits given 400 g probiotic/t feed had higher hemoglobin, red blood cells and platelets. Adding 400 g probiotic/t feed to rabbit's diet significantly (P ≤ 0.05) improved cell-mediated immunity compared to the other treatments 48 h post-injection.

Impact of high ambient temperature on unintentional injuries in high-income countries: a narrative systematic literature review

OBJECTIVES

Given the likelihood of increased hot weather due to climate change, it is crucial to have prevention measures in place to reduce the health burden of high temperatures and heat waves. The aim of this review is to summarise and evaluate the evidence on the effects of summertime weather on unintentional injuries in high-income countries.

DESIGN

3 databases (Global Public Health, EMBASE and MEDLINE) were searched by using related keywords and their truncations in the title and abstract, and reference lists of key studies were scanned. Studies reporting heatstroke and intentional injuries were excluded.

RESULTS

13 studies met our inclusion criteria. 11 out of 13 studies showed that the risk of unintentional injuries increases with increasing ambient temperatures. On days with moderate temperatures, the increased risk varied between 0.4% and 5.3% for each 1 °C increase in ambient temperature. On extreme temperature days, the risk of injuries decreased. 2 out of 3 studies on occupational accidents found an increase in work-related accidents during high temperatures. For trauma hospital admissions, 6 studies reported an increase during hot weather, whereas 1 study found no association. The evidence for impacts on injuries by subgroups such as children, the elderly and drug users was limited and inconsistent.

CONCLUSIONS

The present review describes a broader range of types of unintentional fatal and non-fatal injuries (occupational, trauma hospital admissions, traffic, fire entrapments, poisoning and drug overdose) than has previously been reported. Our review confirms that hot weather can increase the risk of unintentional injuries and accidents in high-income countries. The results are useful for injury prevention strategies.

Relationship between a high mortality rate and extreme heat during the summer of 1999 in Hokkaido Prefecture, Japan

In order to describe the relationship between mortality rate and extreme heat during the summer of 1999 in Hokkaido, we calculated the monthly age-adjusted death rates, average monthly mean temperature and average monthly high temperature for the years 1995 to 1999 in Hokkaido. The materials were derived from Statistics and Information Department, Minister's Secretariat, Ministry of Health, Labour and Welfare of Japan, Statistical Bureau Management and Coordination Agency Government of Japan and the Japan Meteorological Agency. Trends in the monthly age-adjusted death rates and temperature changes in the same period were analyzed. The highest average monthly high temperature for August and September (28.8 degrees C and 23.8 degrees C, respectively) occurred in 1999; the similar trend was observed in the highest average monthly mean temperature. In August 1999, there were 14 days with highest temperatures of 30 degrees C and over. The age-adjusted rate in August 1999 was significantly higher compared with those for the years 1995 to 1998 (p<0.01). We concluded that an unusually hot spell in 1999 was followed by a high mortality rate in Hokkaido.