RESUMEN
Few studies investigate the impact of air pollution on the leading cause of infant morbidity, acute bronchiolitis. We investigated the influence of PM(2.5) and other metrics of traffic-derived air pollution exposure using a matched case-control dataset derived from 1997 to 2003 birth and infant hospitalization records from the Puget Sound Region, Washington State. Mean daily PM(2.5) exposure for 7, 30, 60 and lifetime days before case bronchiolitis hospitalization date were derived from community monitors. A regional land use regression model of NO(2) was applied to characterize subject's exposure in the month prior to case hospitalization and lifetime average before hospitalization. Subject's residential proximity within 150 m of highways, major roadways, and truck routes was also assigned. We evaluated 2604 (83%) cases and 23,354 (85%) controls with information allowing adjustment for mother's education, mother's smoking during pregnancy, and infant race/ethnicity. Effect estimates derived from conditional logistic regression revealed very modest increased risk and were not statistically significant for any of the exposure metrics in fully adjusted models. Overall, risk estimates were stronger when restricted to bronchiolitis cases attributed to respiratory syncytial virus (RSV) versus unspecified and for longer exposure windows. The adjusted odds ratio (OR(adj)) and 95% confidence interval per 10 mcg/m(3) increase in lifetime PM(2.5) was 1.14, 0.88-1.46 for RSV bronchiolitis hospitalization. This risk was also elevated for infants who resided within 150 m of a highway (OR(adj) 1.17, 0.95-1.44). This study supports a developing hypothesis that there may be a modest increased risk of bronchiolitis attributable to chronic traffic-derived particulate matter exposure particularly for infants born just before or during peak RSV season. Future studies are needed that can investigate threshold effects and capture larger variability in spatial contrasts among populations of infants.
Asunto(s)
Contaminantes Atmosféricos/toxicidad , Bronquiolitis Viral/inducido químicamente , Hospitalización , Material Particulado/toxicidad , Infecciones por Virus Sincitial Respiratorio/inducido químicamente , Emisiones de Vehículos/toxicidad , Contaminantes Atmosféricos/análisis , Bronquiolitis Viral/epidemiología , Estudios de Casos y Controles , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Tamaño de la Partícula , Material Particulado/análisis , Infecciones por Virus Sincitial Respiratorio/epidemiología , Riesgo , Emisiones de Vehículos/análisis , Washingtón/epidemiologíaRESUMEN
Selected adverse reactions of penicillamine encountered in our clinic since 1975 are described. They include: proteinuria (26 cases), lupus erythematosus (six cases), myasthenia gravis (two cases), pemphigus (three cases), obliterative bronchiolitis (two cases) and obstructive jaundice (one case).