MediUnite Journal Monthly Magasine "Vital" - May 2024

MEDIUNITE

THE JOURNAL’S VITAL MAGAZINE

MEDICAL AWARENESS, HOW WE’RE CHANGING GLOBAL WELLBEING

Pg2.RhinitisMedicamentosa, ReadthearticleonitsCongestionVia Decongestants

Pg4. PotentialofStemCell TherapyForAutismSpectrum Disorders,Readthearticleonits impacts

Pg5 TheNewModernDanger? Readthearticleontheundersideof processedfood

Pg7. LongCOVID?Readthearticle onCOVID-19onRespiratory Disabilities

Pg8. BattleAgainstHypertensive Urgency,Readthearticleonthe warrantedfocus

Pg9 ExtendedSmokeExposure? Readthearticleonlong-termeffects

RHINITIS MEDICAMENTOSA: CONGESTION VIA DECONGESTANTS

By Firas Jumaili

What is Rhinitis Medicamentosa?

Rhinitis Medicamentosa, also known as Rebound Rhinitis, is a common drug-induced non-allergic form of nasal inflammation (7) It is exacerbated by improper and abusive use of nasal decongestants for an extended period of time. Nasal decongestants (i.e. xylometazoline) are used to alleviate nasal blockage in cold, flu and other diseases by offering a rapid symptom relief and it is only intended to be used for short periods – between 5-7 days – to prevent any damage to the tissue and any rebound congestion (6). However, it has been found that nasal decongestant overuse causes nasal blockage or can aggravate currently existing nasal obstruction if used for more than 5 days (5)

What is the mechanism behind it?

The pathophysiology behind Rhinitis Medicamentosa remains unknown, but there have been some hypotheses. One thought is that it may be related to the decreased production of norepinephrine that is produced inside the body which leads to the inability of maintaining a vasoconstriction. This leads to less blood flow, resulting in less congestion in the nostril. When there is congestion, vasodilation follows which leads to an excess amount of blood (5).

Benzalkonium chloride (BKC), a quaternary ammonium compound used as a preservative to prevent bacterial contamination in many nasal sprays (5), may increase the risk of developing Rhinitis Medicamentosa by inducing mucosal swelling. It is recommended to use BKC-free nasal decongestants, even though there is no evidence of worsening congestion in subjects who use nasal glucocorticosteroids containing BKC (9).

How to treat it?

The patient must stop using nasal decongestants to allow the nose cells to recover (2) An abrupt cessation however might induce a significant nasal obstruction that might affects one’s breathing and sleeping. This is hard to endure, and some patients might re-start taking nasal decongestants to alleviate the congestion and a vicious cycle is created.

Therefore, topical corticosteroids have been used to help with the process of cessation. In one study, ten patients were treated with budesonide nasal spray for 6 weeks after stopping their nasal decongestant spray. Results were significant reduction symptoms and a 100% success in recovery (3).

Another study (1) examined the effect of fluticasone propionate nasal spray of 200 micrograms once daily for 14 days. The results were significant reduction in nasal swelling and stiffness within 7 days. In both studies, patients discontinued the use of any nasal decongestant prior to starting the corticosteroid therapy highlighting the importance of removing the root cause. The nasal corticosteroid should be used for 4-6 weeks under a medical doctor supervision (4).

Fig 2 S Knipping, Epithelium of nasal mucosa of patient with rhinitis medicamentosa illustrated under electron microscope showing loss of cilia and damaged epithelial cells; intraepithelial numerous vacuoles (V) and mitochondria (M); dilated intercellular spaces (arrows), 2008 (Original magnification 7,000 )

References:

1

Hallén H, Enerdal J, Graf P Fluticasone propionate nasal spray is more effective and has a faster onset of action than placebo in treatment of rhinitis medicamentosa Clin Exp Allergy 1997 May;27(5):552-8 PMID: 9179430

3

Fleece L, Mizes JS, Jolly PA, et al Rhinitis medicamentosa: conceptualisation, incidence and treatment. Ala J Med Sci 1984; 21: 205-8

2 Kumlien J Rhinitis medicamentosa, a resurrected disease? [letter]. Lakartidningen, 1984; 21: 205-8 1991; 88: 4117

Graf P, Hallen H, Juto J-E The pathophysiology and treatment of rhinitis medicamentosa Clin Otolaryngol 1995; 20: 224-9

5

4 Graf P, Juto J-E Decongestion effect and rebound swelling of the nasal mucosa during 4-week use of oxymetazoline ORL 1994; 56:131-4

6. Black MJ, Remsen KA Rhinitis medicamentosa. Can Med Assoc J. 1980;122:881-884

Self-medication in persistent rhinitis: overuse of decongestants in half of the patients. Mehuys E, Gevaert P, Brusselle G, et al J Allergy Clin Immunol Pract 20141;2:313–319.

7 Graf P. Rhinitis medicamentosa: a review of causes and treatment Treat Respir Med 2005; 4:21-9

9

8. Marple B, Roland P, Benninger M Safety review of benzalkonium chloride used as a preservative in intranasal solutions: an overview of conflicting data and opinions. Otolaryngol Head Neck Surg. 2004; 130:131-41

POTENTIAL OF STEM CELL THERAPY BY STUDYING GENETICS AND REGULATING THE IMMUNE SYSTEM FOR AUTISM SPECTRUM DISORDERS

By Kateryna Luchko

Autism spectrum disorders (ASD) are a group of widespread neurodevelopmental disorders. These are characterized by difficulties in social interaction, verbal and nonverbal communication, limited interests, repetitive body movements, and rigid routine activities. According to the latest global statistics, the prevalence of autism is 1:100(1)...

Many factors are associated with the development of autism, however, scientists believe that the two main reasons are genetics and environmental factors. Researchers have identified more than 1,000 genetic factors associated with autism spectrum disorder (2). One of these factors is gene mutation such as Engrailed 2, UBE3A, and NRXN1.(3). The influence of environmental factors on the development of this disorder can also not be ignored. Although the pathophysiology of autism remains not clearly understood, accumulating evidence suggests that one potential etiology for the development of the disease may involve immune dysregulation (4).

Researchers have suggested that immunodeficiency directly affects the development of autism. A recent scientific study has found that the degree of reduction in the levels of the main classes of immunoglobulins in the blood serum correlates with the severity of ASD in children (5). Another study suggests that an abnormally low concentration of IgG in the blood serum of a newborn is an independent risk factor for the development of ASD in the future (6). Therefore, it can be concluded that immune disorders are not only evidence of a pathological process in autism but also an active participant in pathogenesis. It is the disorders of the immune status that can explain several known characteristics of children with ASD (for example, a tendency to generate allergic and autoimmune complications, poor tolerance to vaccines, etc.).

Fig. 2. Newschaffer CJ, Immunoglobulin levels in children and diagnoses, 2008

Despite extensive research conducted on the topic, a universal approach to treating autism is yet to be discovered. Several reasons lead to the disease, therefore, each patient needs an individual plan. Stem cell transplantation may offer a unique treatment strategy for autism due to the immune and neural dysregulation observed in this disease. Recent studies have shown that mesenchymal stem cells (MSCs) have immunoregulatory properties by suppressing T cell and B cell and natural killer (NK) cell proliferation and function, modulating dendritic cell (DC) activity, and inducing regulatory T cells (7,8).

In 2013, human umbilical cord: cord blood mononuclear cells (cbMNCs) and umbilical cord-derived mesenchymal stem cells (UC-MSCs) were transplanted into children with autism while assessing the safety of the treatment through laboratory studies and clinical evaluation of side effects. The studies demonstrated the success of allogeneic cbMNCs and UC-MSCs transplantation in improving some behavioural symptoms and functions observed in children with autism in addition to traditional behavioural therapy (9). A later open-label study was conducted in 12 children with ASD aged 4 to 9 years who received intravenous infusions of UC-MSCs prepared from unrelated donor umbilical cord tissue. Results showed that 6 of 12 participants showed improvement on at least two ASD-specific measures (10).

Despite the encouraging results of research into stem cell treatments for autism, many preclinical trials still need to be conducted to develop the exact dosage and method of administration of the drug and to select a more appropriate stem cell type, which will enhance the therapeutic effect.

References:

1.

Jinan Zeidan, Eric Fombonne, Julie Scorah, Alaa Ibrahim, Maureen S Durkin, Shekhar Saxena, Afiqah Yusuf, Andy Shih, Mayada Elsabbagh Global prevalence of autism: A systematic review update // Autism Res. – 2022. – V.15 (5). – P.778-790.

2

Risch N, Hoffmann TJ, Anderson M, et al Familial recurrence of autism spectrum disorder: Evaluating genetic and environmental contributions //Am J Psychiatry – 2014 – V 171 – P 120613

3

El-Fishavy P , State M W The genetics of autism: key issues, recent and findings and clinical implications // The Psychiatric Clinics of North America – 2010 – V 33 – P 83-105

4

5

Onore C, Careaga M, Ashwood P The role of immune dysfunction in the pathophysiology of autism // Brain Behav. Immun. – 2012. – V. 26(3). – P.383–392.

Luke Heuer, Paul Ashwood, Joseph Schauer, Paula Goines, Paula Krakowiak, Irva HertzPicciotto, Robin Hansen, Lisa A. Croen, Isaac N. Pessah Reduced levels of immunoglobulin in children with autism correlates with behavioral symptoms // V 1, Issue5 – 2008 – P 275-283

6.

Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE, Mandell DS, Miller LA, Pinto-Martin J , Reaven J , Reynolds AM, Rice CE, Schendel D, Windham GC The epidemiology of autism spectrum disorders // ANNUAL REVIEW OF PUBLIC HEALTH. – V. 28 – 2007.

7

De Miguel MP, Fuentes-Julián S, Blázquez-Martínez A, Pascual CY, Aller MA, Arias J, ArnalichMontiel F. Immunosuppressive properties of mesenchymal stem cells: advances and applications // Curr Mol Med – 2012 – V 12(5) – P 574–591

8

9

Shi M, Liu ZW, Wang FS Immunomodulatory properties and therapeutic application of mesenchymal stem cells // Clin Exp Immunol – 2011 – V 164 (1) P 1–8

Yong-Tao Lv, Yun Zhang, Min Liu, Jia-na-ti Qiuwaxi, Paul Ashwood, Sungho Charles Cho, Ying Huan, Ru-Cun Ge, Xing-Wang Chen, Zhao-Jing Wang, Byung-Jo Kim, Xiang Hu Transplantation of human cord blood mononuclear cells and umbilical cord-derived mesenchymal stem cells in autism // Transl Med – 2013 – V 11 – P 196

Sun, J M , Dawson, G , Franz, L , Howard, J , McLaughlin, C , Kistler, B Kurtzberg, J Infusion of human umbilical cord tissue mesenchymal stromal cells in children with autism spectrum disorder // Translational Medicine – 2020 – V 9, Issue 10 – P 1137–1146

HOW THE MODERN DANGER OF PROCESSED FOODS IMPACT GENERAL LIFESTYLE

By Sherifatu Adamu Musa (Rifa Coolheart)

The modern way of living has brought with it a range of conveniences and technological advancements that have significantly transformed our lives However, these advancements also come with certain pitfalls that have a significant impact on public health. This report aims to shed light on the hidden dangers of processed foods and their adverse effects on our well-being, emphasising the urgent need for a shift towards healthier dietary habits.

Over the past few decades, processed foods have become a versatile part of our diets. These foods are typically manufactured using refined ingredients and artificial additives, designed to extend shelf life and enhance taste. (4) While they offer convenience and affordability, the nutritional quality of processed foods is often compromised during their production.

Processed foods are usually high in added sugars, unhealthy fats, and sodium, and low in essential nutrients, such as fibre, vitamins, and minerals. Regular consumption of these foods can contribute to nutrient deficiencies, leading to various health problems. A diet rich in processed foods has been linked to a higher risk of obesity, type 2 diabetes, cardiovascular diseases, and certain types of cancer. (6) Moreover, the excessive intake of added sugars and unhealthy fats found in processed foods can disrupt metabolism, promote inflammation, and contribute to the development of chronic conditions. (2)

The impact of processed foods goes beyond physical health, affecting mental well-being as well. Studies have shown a strong correlation between the consumption of highly processed foods and cases of mental health issues. The lack of essential nutrients and the presence of additives in these foods can affect neurotransmitter function and alter brain chemistry, potentially exacerbating symptoms of mental health conditions. (4)

SapienLabs,2023

The majority of processed foods also has far-reaching environmental implications. The production and processing of these foods contribute to deforestation, water pollution, greenhouse gas emissions, and excessive energy consumption. The heavy dependence on packaging materials further worsens the waste management crisis and adds to the burden on our ecosystems. (3)

To combat the negative effects of processed foods on public health, it is important to encourage healthier dietary habits and raise awareness of the importance of whole, unprocessed foods. Governments, healthcare professionals, and the food industry must collaborate to implement policies that promote access to fresh, nutritious foods and educate the public on making informed choices. (1)

Individuals can take small but impactful steps to improve their health by prioritising whole foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Cooking meals at home using fresh ingredients, reducing the consumption of processed snacks and beverages, and reading food labels for hidden additives are effective strategies to adopt. (5)

Additionally, schools should emphasise nutrition education and incorporate healthier food options into their meal programs. Employers can play a role by providing wellness programs that encourage employees to make healthier choices and reduce stress levels.

The modern lifestyle is heavily reliant on processed foods which poses a substantial threat to both physical and mental health. It is crucial that we prioritise the consumption of whole and ernatives to ensure better overall health.

References:

1

Beyond ultra-processed: Considering the future role of food processing in human health. (n.d.). Cambridge Core.

https://www cambridge org/core/journals/proceedings-of-the-nutritionsociety/article/beyond-ultraprocessed-considering-the-future-role-offood-processing-in-humanhealth/F0C80692DBC8871DE4BC4ED1AACF7D8F

2

The hidden dangers of fast and processed food (2018, September 3) PubMed Central (PMC) https://www ncbi nlm nih gov/pmc/articles/PMC6146358/

3

How does processed food harm the environment? (2023, February 28) Wicked Leeks. https://wickedleeks.riverford.co.uk/features/how-doesprocessed-food-harm-the-environment/

4.

The link between highly processed foods and brain health. (2023, May 18).

The New York Times - Breaking News, US News, World News and Videos https://www.nytimes.com/2023/05/04/well/eat/ultraprocessed-foodmental-health html

5.

Processed foods and health. (2023, August 10). The Nutrition Source. https://www hsph harvard edu/nutritionsource/processed-foods/

Scientists link ultra-processed foods to 32 health problems (2024, February 29) euronews

https://www euronews com/health/2024/02/29/scientists-link-ultraprocessed-foods-to-32-adverse-healthoutcomes#: :text=A%20new%20umbrella%20review%20found,cancers%2C %20and%20Type%202%20diabetes

IMPACT OF COVID-19 ON RESPIRATORY DISABILITIES

By Evelina Pak

What is a respiratory disability?

Respiratory disabilities or Chronic respiratory diseases (CRDs) are the conditions under which the airways and lung structure are affected and do not function properly. Some of the common diseases are asthma, occupational lung diseases, and pulmonary hypertension. Tobacco smoke, air pollution, chemicals, and respiratory infections are considered the major risk factors (WHO, 2023).

Higher Risks Associated with COVID-19

One of the most dangerous respiratory infections humanity has faced in recent years is COVID-19, which causes mild to severe illnesses and even death. Aside from the other symptoms, COVID-19 affects the lungs due to the airways cell infection. Some people may feel short of breath, while those with respiratory disabilities are at higher risk of severe symptoms of pneumonia, acute respiratory distress, and acute respiratory failure. These include acute respiratory distress syndrome (ARDS), asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, pulmonary fibrosis, and pulmonary hypertension.

One of the recent studies using the Qresearch database found that CRDs (COPD, asthma, bronchiectasis, idiopathic pulmonary fibrosis, and lung cancer) were associated with an increased risk of hospitalisation and fatal outcomes (Lancet Respir Med, 2021). However, it is important to note that the CRDs consist of various diseases and might require a more detailed analysis. Moreover, such factors as the severity of the disease and the use of medications might alter the clinical outcomes. Therefore, the association between CRDs and the outcomes of COVID-19 is not completely proven.

COVID-19 can cause lasting lung damage

Not only does the virus complicate the conditions of patients with prior pulmonary impairment, but it also causes complications such as pneumonia, acute respiratory distress syndrome (ARDS), and sepsis. A newer coronavirus variant may cause severe bronchitis. Data from severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggests that as many as 50% of people who have had COVID19 may have some lung damage (UC Health, 2020).

Doctor Panagis Galiatsatos, an expert on lung disease at Johns Hopkins Bayview Medical Center, explains some of the lung problems related to coronavirus (Galiatsatos, P., 2022).

In pneumonia, air sacs in the lungs are filled with fluid, limiting the ability to breathe. In some cases, breathing problems can be severe enough to require oxygen treatment and ventilation. Acute respiratory distress syndrome (ARDS) is a result of pneumonia progression when more of the air sacs are filled with fluid leading to a lung failure. Patients with ARDS are unable to breathe on their own. In many cases the disease is fatal, and people who recover have lasting pulmonary scarring. Sepsis occurs when the infection reaches the bloodstream and causes tissue damage. The cooperation between organs fails leading to system dysfunction. In COVID-19 bronchitis, the excessive amount of sputum produced in the airways leads to cough and chest congestion. The airways also narrow making breathing difficult.

What do patients with respiratory conditions need to know?

In his interview for News Today, Louis R. DePalo, System Clinical Director of the Respiratory Institute, discusses preventative measures and precautions for patients with respiratory diseases. Those include both general recommendations such as handwashing, social distancing, and wearing a mask, and some specific such as screening visitors (asking whether they traveled or contacted an infected person), having a supply of needed medications (DePalo, L., 2020)

Being vaccinated also helps to achieve the best outcome. But overall, the process of recovery highly depends on three important factors: disease severity, health conditions, and treatment. Lung recovery is possible, doctors say, but it takes time it may take up to a year or more. The consequences of the pandemic are still present, therefore both patients and healthcare providers must be prepared for challenges.

References:

DePalo, L (2020, March 18) Covid-19: Impact on respiratory conditions - physician's channel - Mount Sinai New York. COVID-19: Impact on Respiratory Conditions

https://physicians mountsinai org/videos/covid-19-impact-onrespiratory-conditions

2

1 Galiatsatos, P (2022, February 28) Covid-19 Lung Damage Johns Hopkins Medicine

https://www hopkinsmedicine org/health/conditions-anddiseases/coronavirus/what-coronavirus-does-to-the-lungs

3

P Aveyard, M Gao, N Lindson, J Hartmann-Boyce, P Watkinson, D. Young, et al. Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. Lancet Respir Med, (2021)

4

UC Health (2020, November 8) Short- and Long-Term Lung Damage from COVID-19. https://www.uchealth.com/en/mediaroom/covid-19/short-and-long-term-lung-damage-from-covid19

5

World Health Organization (2023, March 22) Chronic Respiratory Diseases World Health Organization

https://www who int/health-topics/chronic-respiratorydiseases#tab=tab 1

A WARRANTED FOCUS ON HYPERTENSIVE URGENCY

By Mary Odozi

Hypertensive urgency is characterized by a marked elevation in blood pressure, with no notable damage to the target organs. It is diagnosed in cases where the systolic blood pressure is greater than 180 mmHg or the diastolic blood pressure is greater than 110 mmHg (1). The causes behind these acute spikes in blood pressure are multifaceted, ranging from poor blood pressure control to underlying conditions like chronic hypertension and thyroid dysfunction Stress and medication non-adherence also play significant roles in triggering hypertensive urgency.

Associated with a higher incidence of adverse cardiovascular events over the long term, the condition warrants an approach focused on ensuring better blood pressure control. While hypertensive urgency may lurk without symptoms, common indicators include pounding headaches, chest pain, and altered mental status (2) Navigating through these warning signs requires keen observation and timely intervention.

In managing hypertensive urgency, the primary goal is to rule out target organ damage and prevent further complications (3) Diagnostic measures such as urinalysis and electrocardiograms aid in the assessment process, alongside a comprehensive history and a physical examination. For some patients, a period of monitoring rest, and taking medication may be sufficient, while others may require outpatient follow-up and long-

term management strategies (3).

With hypertension affecting over 1.3 billion people worldwide, the stakes are high (4). The prognosis for individuals with hypertensive urgency is sobering, with a one-year mortality rate of approximately 9% (1). Males and older individuals, particularly those of AfroCaribbean origin, are more prone to hypertensive crises. Certain risk factors, such as diabetes, obesity, and cardiovascular disease history, heighten the likelihood of experiencing acute blood pressure elevations. Left untreated, hypertension poses a grave risk to long-term health and well-being.

In conclusion, understanding and addressing hypertensive urgency is paramount in safeguarding individual health and reducing the global burden of cardiovascular disease. Raising awareness and implementing proactive management strategies can pave the way towards a healthier future for all.

References: Alley, W D , & Copelin II, E L (2020) Hypertensive Urgency PubMed; StatPearls Publishing https://www ncbi nlm nih gov/books/NBK513351/

1 Hypertensive Urgency And Emergency - CardiovascularMedbullets Step 2/3 (n d ) Step2 Medbullets com https://step2 medbullets com/cardiovascular/120008/hypertensiveurgency-and-emergency?section=bullets

2 Somand, D (n d ) Management of Hypertensive Urgency and Emergency. https://medicine umich edu/sites/default/files/content/downloads/ Somand%20David%20June%2024%20Hypertensive%20Urgency.pdf

4

3 First WHO report details devastating impact of hypertension and ways to stop it. (2023, September 19). Www.who.int. https://www who int/news/item/19-09-2023-first-who-reportdetails-devastating-impact-of-hypertension-and-ways-to-stopit#:~:text=The%20number%20of%20people%20living

THE RESPIRATORY IMPACT OF LONG-TERM SMOKE INHALATION IN URBAN AREAS

By Kaitlin Brown

Pollution is one of the many known problems of urban living. Although most think of water or light when they think of the term, air pollution, caused by smoke, is one variation that should be considered. It is thus important to note the commonness and abundance of smoke in any urban area, especially when the symptoms become more than just a cough but a long-term effect.

Qualities of Smoke: Nitrogen dioxide, nitrogen oxides, carbon monoxide, sulfur dioxide, and other volatile organic compounds make up the majority of smoke. These gasses are present in multiple types of smoke, including tobacco, wood, fire, and oil, all of which are prevalent in urban spaces Thus, whether indoors, such as in schools or homes, or outside, almost everyone is inhaling polluted air.

This over time can worsen or create symptoms of asthma, chronic bronchitis, pneumonia, and COPD (2) Some notable side effects include lung function reduction, higher airway sensitivity, increased wheezing and coughing, decreased exhalation, and inflammation.

Qualities of Urban Living: Urban environments produce around 78% of pollutants, affecting 50% of residents (3). But beyond the characteristics of smoke, other aspects such as socioeconomic status

and geography can impact who and why someone is affected by or inhaling smoke. Access to green spaces (trees, parks, urban forests, etc) helps filter air particles but is more absent in densely populated areas like slums (1). This, combined with heavy traffic, can dramatically increase air pollution, especially in countries with a high urban population

There may also be a link between obesity, ethnicity, and race in terms of how much some are affected by smoke inhalation. Obesity is higher in urban populations and can worsen asthmatic symptoms (5). As for ethnicity, those of African or Hispanic descent are more likely to experience obstructive lung disease-type symptoms in urban areas, which may be linked to socioeconomic status, as there is a higher chance of living in poorer areas or a genetic factor.

Conclusion: Air pollution due to smoke is widespread in urban spaces. Gasses and compounds that make smoke can lead to various long-term lung diseases that impact the health of many residents, predominantly those living in densely populated areas or who are at a higher risk due to weight and ethnicity. Thus, it is crucial to help reduce the effects of smoke inhalation to decrease polluted air and aid those already affected.

References

5

1 Drummond, B (n d ) (2015) Obstructive Airway Disease in Urban Populations - PMC NCBI Retrieved April 30, 2024, from https://www ncbi nlm nih gov/pmc/articles/PMC4131542/ 2 Liang, L , & Gong, P (2020) Urban and air pollution: a multi-city study of long-term effects of urban landscape patterns on air quality trends Nature Retrieved April 30, 2024, from https://www nature com/articles/s41598-020-74524-9

Benefits of Green Infrastructure | US EPA (2024, February 21) Environmental Protection Agency. Retrieved April 30, 2024, from https://www.epa.gov/green-infrastructure/benefitsgreen-infrastructure

3 Vignal, C , Pichavant, M , Alleman, L Y , Djouna, M , Dingreville, F , Perdrix, E , Waxin, C , Ouali Alami, A , Gower-Rousseau, C , Desreumaux, P , & Body-Malapel, M (2017) Effects of urban coarse particles inhalation on oxidative and inflammatory parameters in the mouse lung and colon BioMed Central Retrieved April 30, 2024, from https://particleandfibretoxicology biomedcentral com/articles/10 1186/s12989-017-0227-z

4 Tooba, R (MD), Wu, T D (MD MHS) (2023) Obesity and Asthma: A Focused Review PMC NCBI Retrieved on May 6, 2024 from https://www ncbi nlm nih gov/pmc/articles/PMC9671155/

THIS LETTER WAS APPROVED BY CO-FOUNDERS KAMRAN SHUKOOR AND IBRAHIM TARIQ

DESIGNED BY ANN ZEHRA

JAFRI

EDITED BY

RABIA MASOOD, ANDREA RUSU, ALICE-NAYEON KIM, LYNN NGUYEN, MON MYAT NOE ZAY, PARVEN AVCI, SIYA PATEL, AND KAREEM ELMASSRI