BACKGROUND:
Whether cooking with solid fuels, as occurs widely in developing
countries, including Nepal, is a risk factor for pulmonary tuberculosis
(PTB) is uncertain. Epidemiologic studies have produced variable results.
This case-control study sought to resolve this issue with a large sample
size and a population-based control group.
METHODS:
PTB cases (N = 581), aged 18 to 70 were recruited from diagnostic
centers in Kaski and neighboring districts of Nepal. Population-based
controls (N = 1,226) were recruited. Persons who had previously been
diagnosed with TB were excluded. Questionnaires were administered at
participants’ homes.
RESULTS:
Using liquefied petroleum gas (LPG) as the cookstove reference fuel,
for women the odds ratio (OR) for having a primary cookstove that used wood
was 0.21 (95% CI: 0.08,0.52); for men the corresponding OR was 0.80 (0.37,
1.74). For biogas, the OR for women was 0.24 (0.06,0.87) and for men, 1.41
(0.61, 3.23).
CONCLUSIONS:
The unexpected finding of a higher risk for women using LPG
cookstoves, relative to wood or biogas-burning cookstoves, may be
attributable to excluding persons with prior TB. A possible explanation is
that emissions, such as ultrafine particles, formed during LPG combustion
promote PTB manifestation in infected people who have not previously had
PTB. The damage from the initial PTB leaves them susceptible to the
PTB-promoting effects of smoke from wood fires. Further studies, excluding
participants who have previously had TB are needed to confirm these
findings. Use of exhaust hoods to the outdoors for all stoves,
well-ventilated kitchens, and gas stoves raised above ground would reduce
exposures.
Monopolar RF treatment levels that are typically used in the clinical setting were employed in this animal study. RF treatment resulted in measurable and statistically significant histological changes associated with the various filler materials. Additional clinical and histological studies are required to determine the optimal timing of monopolar RF treatment and filler placement for maximal potential aesthetic outcome.
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