Dr. Fathi Neana, MDChief of Orthopaedics

Dr. Fakhry & Dr. A. Al-Garzaie HospitalSaudi Arabia

September, 21 - 2017

هم بعض ال ذي عملوا لعل ليذيقهم اس ظهر الفساد في البر والبحر بما كسبت أيدي الن

الروم( 41)يرجعون Mischief has appeared on land and sea because of (the meed) that the hands of men have earned, that

(Allah) may give them a taste of some of their deeds: in order that they may turn back (from Evil). (Quran 30:41)

The rate at which the man has made progress in terms of technology and industrialization is in direct proportion with the increase of an evil we know as pollution

Millions of deaths occur all around the world due to various types of pollution.

Nearly 50% of deaths per year world over occur due to pollution.

The harmful effects of pollution take the life very slowly (silent killer).

Air pollution is one of the most dangerous types of pollution

Global warming the biggest natural threat ever

Pollution the silent killer

The Consequences of Pollution

Physical effects of pollution

Ecosystem dysfunction

Environment, greenhouse phenomena

Climate change, global warming vs. dimming

Infrastructure and Development

Biological effects of pollution

People

Animals

Plants

Health

As defined by World Health Organization (WHO). Health is a "State of complete physical, mental, and social well being, and not merely the absence of disease or infirmity."

Health is a dynamic condition resulting from a body's constant adjustment and adaptation in response to stresses and changes in the environment for maintaining an inner equilibrium called homeostasis.

Read more: http://www.businessdictionary.com/definition/health.html

Human Health

DiseaseAcute

chronic

PathogenBacteria

viruses

PollutionRisksObesity

smoke

Chemicals

Types

Neurotoxines

Carcinogenes

Teratogenes

Endocrine diruptors

Allergens

Dose – response Duration

Bioaccumulation

Biomagnification

Stockholm convention

LD50

Bioaccumulation

•Bioaccumulation is the accumulation of harmful substances like pesticides, organic chemicals in an organism.•Bioaccumulation happens when an organism absorbs substances that are toxic at a greater rate than at which the substance is lost.•The longer the half-life of the substance the greater is the risk of poisoning though levels of toxins are not very high in the environment.•Bioconcentration is the uptake and accumulation of toxic substances from water alone.

Biomagnification

•Biomagnification is also known biological magnification or bioamplification.•Biomagnification is a process where substances like pesticides or heavy metals move up the food chain.•When chemicals or pesticides are let into rivers or lakes they are consumed by aquatic organisms like fish, which in turn are consumed by large birds, animals or humans.•These harmful substances become concentrated in tissues, internal organs as it moves up the food chain.•These are substances that increase in concentration in living organisms as they are taken in due to contaminated air, water or food as these substances are metabolized or excreted very slowly.

What is the meaning of Bioaccumulation and Biomagnification

Bioaccumulationand

Biomagnification

We are sinking in different types of pollution

Water Pollution.

Land pollution (Soil contamination by lead, heavy metals).

Air Pollution.

Noise Pollution.

Littering (spilling of oils in oceans).

Radioactive contamination.

Ionized radiation.

Non ionized radiation (EMFs – Wi-Fi).

Visual Pollution.

Thermal pollution.

Drugs, Alcohol, Smoke.

Mental pollution.

1- Climate changea- global warming

b- global dimming

2- Human health effectsa- Climate change

b- Pollutants

3- Plants and animals Natural habitats become hostile

The Consequences of Pollution

Climate change

Greenhouse phenomenon

Global warmingEl Niño

Heavy rains & flooding in new sites (Cities)

Desertification of original sites (Africa ..)

Tropical cyclones

Methane clathrate emission

Earthquakes

Volcano eruptions

Global DimmingHuman, agricultural, animal effect

Human health effects1- Climate change 2- Pollutants

Human health effects1- Climate change 2- Pollutants

Human health effectsTop 45 diseases caused by pollution

Air pollution 1. Asthma attacks - chronic obstructive pulmonary disease –COPD2. Weakening of lung function3. Pulmonary cancer4. Mesothelioma5. Pneumonia6. Bronchitis7. Emphysema8. Leukemia9. Birth defects and immune system defects10. Cardiovascular problems11. Neurobehavioral disorders12. Liver and other types of cancer13. Premature death14. Autism

Water pollution15. Typhoid16. Giardiasis17. Amoebiasis18. Ascariasis19. Hookworm20. Gastroenteritis21. Diarrhea 22. Encephalitis23. Stomach cramps and aches24. Vomiting25. Hepatitis26. Respiratory infections27. Liver damage and even cancer28. Kidney damage29. Neurological problems30. Weak sexual power31. Thyroid system disorders32. Malaria 33. Rashes on skin34. Ear aches35. Pink eyes

Soil pollution36. Cancer37. Brain and Nerve Damage38. Kidney and Liver Disease

Noise pollution39. Efficiency decrease of people40. Lack of concentration41. Fatigue42. Abortion43. Blood Pressure44. Temporary or permanent deafness45. Anxiety

Light PollutionMelatonin

Radioactive contaminationIonized radiation.

Non ionized radiation (EMFs – Wi-Fi).

Thermal pollution

Drugs, Alcohol, Smoke

Mental - psychological

Air Pollution

Air pollution 1. Asthma attacks - chronic obstructive pulmonary disease –COPD2. Weakening of lung function3. Pulmonary cancer4. Mesothelioma5. Pneumonia6. Bronchitis7. Emphysema8. Leukemia9. Birth defects and immune system defects10. Cardiovascular problems11. Neurobehavioral disorders12. Liver and other types of cancer13. Premature death14. Autism

Human health effectsTop 45 diseases caused by pollution

Not only respiratory and cardiovascular system disordersMusculoskeletal system disorders too (Bone is a specialized connective tissue - minerals, Collagen)1- Arthritis systemic chronic inflammatory diseases such as rheumatoid arthritis.

2- Osteoporosis more than 8.9 million fractures annually worldwide

3- Vitamin D deficiency Osteomalacia , UVB rays 4- Lead poisoning and growth5- Fluorosis6- 2nd to systemic disorders ( ex: Glycation of collagen - Hypoxia)

Air pollutionMusculoskeletal system disorders

How to limit the impact1- Drink sufficient water to get rid of the pollutants accumulation2- Consuming liver-friendly foods such as carrots, lemons and bitter greens3- Fight inflammation , Cinnamon, ginger and turmeric .4- Ensure sufficient intake of Vit D and Calcium especially in post partum and post menopausal women5- Sun light daily 6- Regular exercise strengthen muscles and bones

Effects of air pollution in general

– The air we breathe 26000 times per day contains nitrogen, oxygen, CO2, water, argon, other trace gases, and a volume of 14,000 liters

– Vegetation is effected when absorbed through pores, soil, and water

– Wildlife and animals can get affected

– Deposition on water bodies affecting its quality, and organisms in water

– Severity and symptoms experienced depend on the pollutant, its concentration in air, length of exposure and individual sensitivity

– Organic nature of particulate matter (PM) could vary

– Health effects in general • Healthy individuals may not notice effects from air pollution, except when the

pollution is very high.

• Individuals who have asthma, heart conditions or lung diseases, may experience distress and other health effects, even at lower levels of

pollution.

History

• The Great Smog of London, or Great Smog of 1952

• December 4th 1952, → fog;

• Smog lasted for 5 days & led to 4000 more deaths than usual.

• The deaths were attributed to the increase in air pollution during the period, with 7 fold ↑ in SO2, and 3-fold ↑ in smoke than before

• The peak in the number of deaths coincided with the peak in both smoke and SO2 pollution levels.

Health effects: London smog 1952

Respiratory effects• Large number of deaths occurred due to influenza• Exacerbation in Asthma, Bronchitis, Tuberculosis • Short term decrease in breathing ability • Increase in chest pains • Inflammation of the lungs and damage to

respiratory cells • Permanent lung damage & reduced life quality due

to ozone. • Increased number of asthma attacks due to

nitrogen dioxide.

Cardiovascular effects• Heart failure • A lack of oxygen in the blood stream in those with

heart disease due to carbon monoxide.

Figure 1

SO2 & SMOKE LEVELS BY DEATH RATE

Air Pollution Kills > 5 million people around the World Every Year

Justin Worland, Feb 12, 2016(Compared with >3.7 million in 2012)

Poor quality air blamed for > 6 million deaths a year

Number of deaths caused by urban air pollution (UAP) per 1,000 people

Traffic emissions and death

Near-road group had:

Almost double the death rate from heart and lung disease

1.4 times higher overall death rate

Hoek, G., et al. “Association between Mortality and Indicators of Traffic-related Air Pollution in the

Netherlands: A Cohort Study”

Lancet 360 (2002) 1203

Diesel exhaust permanently changes immune response

More Asthmatic and Allergic responses

Polycyclic aromatic hydrocarbons (PAH) are the culprits

Diesel and vehicle exhaust and coal smoke

Nel, A.E., et al., J of Allergy and Clinical Immunology, 2001

Air pollution is contamination of the indoor or outdoor environment

By any chemical, physical or biological agent that modifies the natural characteristics of the atmosphere

Air Pollution

Sources of air pollution

Man made (Outdoor - Indoor) • Traffic motor vehicles

• Factories, industrial facilities

• Power stations

• Airplanes

• Household combustion devices

• Domestic coal, wood, biomass, rice husk, etc

• Lack of ventilation (AC)

Natural • Forest fires

• Gases and ash from volcanoes, windborne dust, grit and pollen

• Human body is designed to cope with some of natural pollutants

• Air passages produce mucus to trap particles from dust and grit from nose to lower bronchioles; mechanism of sneezing and cough are further extremes

Sources of air pollution

Indoor pollution deaths per millionpopulation

Some or all of the following health effects characterize poor indoor air quality:

Sick Building Syndrome (SBS) and Multiple Chemical Sensitivity (MCS).1- Headaches2- Blurred vision3- Irritations of the eyes, nose and throat4- Difficulty concentrating5- Fatigue6- Nausea7- Shortness of breath, wheezing8- Sinus congestion9- Occupational allergies

Poor indoor air quality

Pollutants

• Particulate matter (PM) especially PM 2.5

• Carbon monoxide

• Ozone, nitrogen dioxide

• Sulfur dioxide

• Mercury

Particulate Matter PM2 level

Most PM particles form in the atmosphere as a result of chemical reactions between pollutants.

Particulate matter (PM), also known as particle pollution, is a complex mixture of extremely small particles and liquid droplets that get into the air.

Once inhaled, these particles can affect the heart and lungs and cause serious health effects.

On April 28, 2017 - The U.S. Environmental Protection Agency completes determinations of attainment for 10 nonattainment areas for the 2006 24-hour fine particle standards.

Particulate Matter pathophysiology

Penetrate deeply into lungs to alveoli, Irritate lung linings-more asthma, Stimulate immune system inflammatory proteins

Short term exposure to particulates (PM2.5) increases the incidence of heart attacks for one day following exposure

As air pollution goes up the risk of heart attack goes up

Increased Particulate Air Pollution and the Triggering of Myocardial Infarction

Peters, et al.; Circulation, June 12, 2001, vol. 103

Blood• Altered rheology

• Increased coagulability

• Translocated particles• Peripheral thrombosis

• Reduced oxygen saturationSystemic Inflammation

Oxidative Stress

• Increased CRP• Proinflammatory mediators

• Leukocyte & platelet activation

PM Inhalation

Brain

• Increased cerebrovascular ischemia

Heart

• Altered cardiacautonomic function

• Increased dysrhythmicsusceptibility

• Altered cardiac repolarization

•Increased myocardialischemia

Vasculature• Atherosclerosis,

accelerated progression of and destabilization of plaques• Endothelial dysfunction

• Vasoconstriction and Hypertension

Lungs• Inflammation

• Oxidative stress• Accelerated progressionand exacerbation of COPD

• Increased respiratory symptoms

• Effected pulmonary reflexes• Reduced lung function

There are multiple mechanistic pathways have complex interactions and interdependencies

Figure 2

Carbon Monoxide (CO)

• HB binds with CO to form carboxy-hemoglobin (COHB)

• Prevents O2 transport to tissues → hypoxia

• Binding affinity of CO to HB is 250 times > O2

• Brain, heart, & muscles are sensitive to hypoxia;

– 80% of COHB levels lead to death

– 60% to loss of consciousness

– 40% to confusion and collapse upon exercise

– 30% to headache, fatigue, and impaired judgment

– 5-20% to ↓ visual perception, manual dexterity, learning, complex tasks

– 2.9-4.5%--decreased exercise capacity in healthy men

• Importance for those vulnerable to cardiac conditions (e.g. angina)

• Other nervous system effects are disturbances in hand eye coordination

• Reported to cause Low Birth Weight

• Volatile organic compounds (VOC) react with sunlight to form NO2; a by-product of high temperature & automobile combustion

• organic chemicals like gasoline; vaporize easily

Short term effects • Breathing difficulty during outdoor activities • Shortness of breath • Headaches • Nausea • Throat and lung irritation

Long-term effects • Premature aging of the lungs • Decreased lung function • Worsened symptoms of asthma, emphysema, and other lung diseases • Inflammation and damage of the lining of the lungs

Other Effects• Allergy symptoms• Respiratory infections • Ear infections • Emphysema attacks • Overall death rates

Oxidant air pollutants : Ozone, NO, and NO2

The difference depends on which layer of the earth's atmosphere the ozone is found.

Good ozone, or Stratospheric ozoneThe Stratospheric layer 10 – 31 miles above the earth's surfaceWithin this layer, good ozone is made and destroyed naturally all of the time.Stratospheric ozone varies in thickness Stratospheric ozone acts as a filter and absorbs the sun's harmful ultraviolet rays

Bad ozone, or ground-level ozone, or Tropospheric ozone The Tropospheric layer, from the ground up to 10 miles (also known as ambient air).Composed of natural atmospheric gases, volatile organic compounds (VOCs), nitrogen oxides, and sunlightGround-level ozone levels are usually higher on hot, sunny daysCars produce most of the nitrogen oxides and VOCs (increased vehicle use also increases the amount of ozone in the troposphere)Ground-level ozone is one of the "criteria pollutants," those that are most prevalent in the ambient air.

What is the difference between good ozoneand bad ozone?

Good ozone or Stratospheric ozone

Bad ozone, or Ground-level ozone, or Tropospheric ozone

Sulphur Dioxide

• Sulphur dioxide (SO2) is a water soluble, colorless, gas with a sharp odor; that reacts with airborne solid particles

• Irritates the eyes and air passages.

• The most common source is burning of fossil & fuel, combustion, smelting, manufacture of . acid, conversion of wood pulp to paper, incineration of refuse and production of elemental sulphur.

• Coal burning accounts for about 50% of annual global emissions, with oil burning accounting for a further 25-30%.

• The natural source is volcanoes.

Consequences of air pollution

Health effects• Effects on cardiovascular

health

• Effects on breathing (asthma).

• Links to cancer

• Effects on children

• Health effects in relatively "clean" areas

Who is at Risk? Children

Elderly

Prior heart or lung disease patients

Diabetics

Persons who work/exercise outdoors

Otherwise healthy adults and children

TYPE SOURCES HEALTH EFFECTS

NO2 Vehicles

Domestic

airway irritation; respiratory infection &

impaired lung function

PM Traffic, industry

Biomass

Respiratory, Cardiovascular

Long-term effects? IMR, LBW?

CO Traffic, fuel, industry COHB, Headaches, nausea, dizziness

SO2 Coal & heavy oil

combustion

Breathing difficulties, irritation of eyes, nose,

throat and lungs. Asthmatics

Lead Petrol, paints

industry

Intellectual development, poisoning

Benzene/

Butadiene

Petrol, deisel

Rubber tyre

Cancer (long term effect)

Ozone Photochemical

pollutant

Short term respiratory symptoms; irritant effect

on lungs & airway inflammation

Types of air pollutants and health effectsIMR, Ischemic Mitral Regurgitation. LBW, low birth weight. COHB, Carboxy haemoglobin

Pyramid of effects

lung function changes, immune cell responses, heart rate or heart rate variability responses

Asthma attacks, medication use, symptoms

Doctor visits

Hospital

Admissions

Death

• Maintaining a healthy distance between the industrial and residential areas.

• The chimneys should be constructed tall in size so that the emissions must be released higher up in the environment

• The sulphur must be removed after burning.

• The gasoline must have anti knocking agents.

• The mining area should be planted with trees.• The coal fuel should be replaced with gas fuel to control the air pollution.

How to control air pollution?

• The wastes must be removed and recycled in the industrial plants and refineries.

• Plants like pine and ribes need to be planted to metabolize the nitrogen oxides and other pollutants.

How to control air pollution?

• The automobiles must be designed with emission control system.

• Timely servicing of the car helps to keep it in a good condition, and also minimizes fuel exhaustion

• Using public transportation helps to prevent the air pollution

How to control air pollution?

• Using alternative energy sources like

Solar energyHydroelectric energyWind energyElectric energy

How to control air pollution?

How to control air pollution?

Re balance between emission and dispersion1- Plant trees2- alternative energy sourceslike Solar energy, Hydroelectric energy, and Wind energy

Final points about air pollution

• Health and economic issue

• Prioritize air quality improvement in decision making

• Over half the problem is traffic

• Massive hidden health costs in transportation and power pollution

• Imposed risk on all population groups, especially our children and elderly