Medical Meteorology India: Select Aspects  

Deepak Bhattacharya1 , Bijoy Kumar Misra2
1 India Meteorological Society, Bhubaneswar, India, 751002
2 Dept. of Geography, School of Earth Sciences, Ravenshaw University, Cuttack, Odiha
Author    Correspondence author
International Journal of Clinical Case Reports, 2013, Vol. 3, No. 2   doi: 10.5376/ijccr.2013.03.0002
Received: 30 Jan., 2013    Accepted: 05 Mar., 2013    Published: 02 Apr., 2013
© 2013 BioPublisher Publishing Platform
This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

Acute Low pressure assists lung function, specially the impaired ones. COPD cases have been observed, studied. Ease of expiration occur due to low pressure {cyclones}, which in turn becauses relief, that wanes with the pass of the cyclone. K+ disregulation has been suggested as the cause of anoxia and acute pulmonary distress in asthma. Low pressure also assists labor. A reduction in central core pressure of the order 40mb (hPa) is always noted with very sever cyclones. A unique ever present low pressure region is reported from India. It has a coastal location (Dahod-Gujarat - western India) and fair weather - with rainlessness. On ground co-relation is done and ease of labor is noted as collinear phenomena. On geographical basis Dahod is compared with another location (Sambalpore-Odisa) on the eastern sea board of India. The contrast is presented in tabulated form based on 30 yrs. average. Numerous interesting and fruitful observations have been adduced. Globally 1st time report. Will assist numerous such studies.

Keywords
Medical meteorology; Severe Cyclone; COPD/Asthma; Expiration problem is the crux; K+ as adjunctive; Natural location; Easy Child Birth. Dahod-India

Introduction
Severe weather events cause abrupt acute changes in the atmospheric conditions, which in turn can affect the status of disease and or general physiological processes. Pioneering the concept of medical meteorology, author has discussed how severe cyclones effect amidst administrators (Bhatt-acharya, 2006a) basic scientists; meteorologists (Bhatt-acharya, 2006b) field engineers (Bhatt-acharya, 2010a), human geographers (Bhatt-acharya, 2010b) and local experts (Bhatt-acharya, 2011) as run up to this communication, that focuses on clinical and community health aspects. Medical meteorology is new and unique domain. Therefore, any full presentation needed preliminary validative presentations of the various parameters of the discovery. This multi-disciplinary study (involving numerous similar cases) is also in the culmination of 2 decades long study involving the eastern and western shore boards of India. It posit meteorological data as a tool for the altruistic administrations, specially in the developing world. Herein we present two components of medical meteorology {i} Chronic Pulmonary Obstructive Disease (COPD)Asthma and Tropical Severe Cyclonic Storms-TSCS {ii} a new discovery, that, Dahod in Gujarat (western shore board of India) is a unique year round meteorology assisted natural labor locus. This case study is 1st of its kind on pan global basis.

Asthma  during  atmospheric  low  pressure 
Mrs. Itishree, female, aged about 28 yrs. employed, mother, is a known congenital case of Bronchial asthma, and a permanent resident of Paradip (20°16′ N 86°41E; 10 m above MSL). This port town is in the direct path of cyclone pass. She survive on daily inhalation of non-steroidal bronchodilator. Had no other ailments (psychological included) This makes this patient (geographic domain based) a good representative candidate. She was examined {over long period}, observed along with a Pulmonary Function Test, during a pass of a depression over Paradeep (Orissa), in July, 2006, using the standard technique of a digital spirometer.

 Pre-clinical examination indicated as ‘chest clear’. Blood pressure 180/70. Weight-54kgs. Wheezing with non productive cough. No other abnormality detected. All at  seated, at rest position. Creepeting sound that is persistent with such patient (s) on normal days, is also not detectable (in general) during system pass. This is because of  low atmospheric pressure, which facilitates optimum filling of the impaired lungs with wet atmospheric gases. Gusts induced random non generalised variation inside room, whereas outside facilitated a generalised heightened expiration (Table 1, column e). These clinical observations and findings are for the first time being related to atmospheric conditions and severe weather events.

 


Table 1 Gives the comparative lung function test separately aided by bronchodialator and abetted by cyclone


Figure 1~figure 3 are graphs produced during lung function test done by a spirometer (with graph print out facility). These are of  another congenital asthma patient of adolescent  age (16 yrs), male, who is also acutely asthmatic. A resident of Vishakhapatnam (17°41′18″N//83°13′07.5″E) port town too is in the direct path of cyclone pass. He is entirely dependent on inhalers through the day and even requires nocturnally. This makes both the patient as chronic-stable and a good representative candidate. O-Y represents the time component i.e. 1 breath cycle comprised of inspiration and expiration ~2 seconds. O-X represents volume in milliliter. The isolated graph was scanned and redrawn {for prominence, sans clutter} via computer tracing technique using Coral Draw soft ware. Figure 1 is that of  unaided, at 40 meters above MSL, when the atmospheric pressure was of the order 1 004 hPa. The lower half represents inhalation volume and the upper half denotes expiration volume. Figure 2 is that of  post 2 continuous puffs of Salbutamol+Beclomethasone dipropionate 50 g (i.e. medically aided) at near similar atmospheric conditions (test done on another day). Figure 3 is that of unaided condition when a TSCS was ragging and had localized around that city on 03-08-2006. We may note that, under atmospheric low conditions, the lungs of a asthma patient not only expirates more, but also inspirates (deflates) more. It is relevant to relate here, that, the OTBM (Weatherhall et al., 1983) and as well Harrison (Kasper et al., 2005) states, that, the lungs of the asthma patient (s) have non to little destructive emphysema i.e. there is no irreversible damaged irrespective of acuity and chronicity. While our previous reports were limited to only observations about ease in expiration, we subsequently noted that, the inspiration inducing atmospheric thrust factor had a very wide range. This  finding is consistent with the known position of science, that, even at elevated altitudes, the lungs inspirate at optimum volumes at rest or when alpinesupine. It is only under physical stress, gross deviation occur, and that too perceptibly in the non-acclimatised and in the non native (non mountain tribes). So, cyclones, prima-facie appears not to effect adversely the lung’s inhalation capacity. What happens is due  to increased volumes of expiration, complementary volumes are inhaled. Higher inspiration means greater oxygenation of blood, more number of alveolis operating at optimum osmotic thrust. Smooth and synchronised function also effects the cardiac out put. All this results in “feel good factor”, that is perceived by a chronic patient, and is interpreted as ‘relief’. Asthma which most of the clinician know as ‘pulmonary distress’ is in fact ‘pseudo’. It registers as an aberration of the air-way bio-mechanics having a deep seated bio-chemistry. Our finding is that, atmospheric low, which too is a aberration in the atmospheric general pattern, aids and abets expiration volumes and down-regulates respiratory organ related aberration superficially via a bio-mechanical route.
 


Figure 1 At 40 meters above MSL, when the atmospheric pressure was of the order 1 004 hPa

 


Figure 2 Post 2 continuous puffs of Salbutamol+Beclomethasone dipropionate 50 g at near similar atmospheric conditions

 


Figure 3 Unaided condition when a TSCS was ragging and had localized around that city on 03-08-2006


Pulmonary C-fiber receptors have a greater mechanosensitivity (Humbert et al., 2009) and whereas the bronchial C-fiber receptors have a higher chemosensitivity, with a variable conduction velocity ranging between 7~12 m/sec/sec (Hansen et al., 1982), has reported, that, asthma, induces anoxia (deficient O2 supply to brain), which adversely effects ion distribution in the brain cortex, resultant bio-electrical activity and rapid onset of morbidity, which at time is irreversible and is always associated with cerebral damage, and no damage to cardio-thoracic-pulmonary systems. The underlying bio-chemical, psychosomatic etiology and the cascade remains. It may also be (getting) stoked. Asthma, is a cascade. In unstable asthma and COPD cases the cascade invariably goes askew. In this regard, we have noted, that, blood pressure show no generalized pattern of change. There is gross variation from case to case, even when segregated on age, weight or any combination thereof. Hence asthma posited as a response pathology, which for us was a lesson cum direction finder. A refractile blood pressure suggests the involvement of the cardio system. In relation to severe weather events, we therefore had to discuss heart input-output kinematics in the next chapter. It helps in appreciating this paradox (Bhatt-acharya, 2006).

Figure 4  is a schematic diagram drawn out of sustained observations. OY represents expiration volume. OX represents reducing atmospheric pressure. OC represents unaided lung’s expiration, at rest. AB represents fall in barometric pressure. The architecture created by the 2 intersecting curves, suggests homology with the established and well accepted graphic architecture of peak expiration volume (s)  under medically aided condition. It also suggests a shift towards the ‘X’, which is the reducing barometric factor. Barometric ‘Low’, then positions itself as the aid.
 


Figure 4 A schematic diagram drawn out of sustained observations


Asthma the problem of the airways is primarily caused by constriction of the bronchial lumen (Goodman et al., 2001).  Persey it is not a disease but is a mechanical aberration in normal function. It is a constituent of a broader group of maladies termed as chronic pulmonary obstructive disorders-COPD. The eastern shore board of India is frequented by TSCS. In 2006, 16 depressions had crossed into the Indian peninsula, of which 14had transgressed across Odisha’s shore line. Hence Odisha-north Andhra regions i.e. our focus domain is ideal for observation cum evidence based studies relating to thrustpressure related health issues, non-voluntary muscles and meteorology. Here Figure 5 is graphical representation of the Bronchus of a asthma patient (Jagatsingpur, Odisha, 03-07-2006, near Paradip). These are drawn out of physical examination, observation and primary examination, using Bronchoscopy methods. The 2 circular rings represent the outer and the midestinal layers of the bronchus, respectively. The zagged interior alias lumen is the internal configuration, layed with heavy stringy mucosa. It shows constriction of the air way. We have  drawn a constant area circle within the lumen and juxtaposed it into all the conditions, to demonstrate our findings. Figure 6 is of the same patient after inhalation of  steroidal broncho-dilator. We can see the lumen has widen. Figure 7, is that of the same patient viewed during the pass of a weather system {approx. 980 hPa, central core pressure}. yet he was not requiring any drugs, nor was he given any, neither was he having any spasm. No wheezing. No creepeting (saturated air at ambient). He was  expirating at near peak volumes with easy, and was happy, reporting a feel good factor. However on performing a Bronchoscopy, it was noted, his airways had no perceptible increase in lumen size.
 


Figure 5 Graphical representation of the Bronchus of a asthma patient (Jagatsingpur, Odisha, 03-07-2006, near Paradip)

 


Figure 6 A patient after inhalation of  steroidal broncho-dilator

 


Figure 7 A patient viewed during the pass of a weather system {approx. 980 hPa, central core pressure}


It is a known fact of clinical science, that, spray based medicines are composed of micro particulates. Particulates of the size <0.5 m gets exhaled. Only 10% of  the inhaled spray comprising of particulates of the range 1~5 m reach the bronchus and get settled. That, 90% of the inhaled drug gets deposited (wasted) in the region of the fossa i.e., oropharynx (Clark and Godfrey, 1977). This means, when the outside pressure reduces, expiration volumes increase, followed by efficiency and generally in the overall timing, aided and abetted by a never before like, ‘feel good factor’. In other words, the barometric low assists the lungs perform better, at the alveoli level, by catalysing a well timed inhalation-expiration  involuntary smooth muscle function, although the bronchus may be constricted andor loaded with mucus exudates. This is because atmosphereic fluid is highly compressible. Hence we aver, that, (i) that there is suo-sponte signal based balance between the mechanosensitivity pulmonary C-fiber receptors and the chemosensitive bronchial C-fiber receptors. As the alveoli expirates well {exhausts the used gases} the chemosensitive bronchial C-fiber receptors {snooze} do not cause any constriction (ii) the pulmonary-thorax mechanical miss-match is initially triggered primarily due to impaired expiration at normal atmospheric pressure (iii) is accentuated by an involuntary constriction of the air-ways to force enhance expiration, which gradually up-regulates into a self infracting cadence, all being pseudo. Yet altered heart rate (substantive) creates clinical crisis. At normalheightened pressure, the lungs are auto inflated and loaded. Expiration cadence miss-match interferes with the inhalation performance cadence, triggering a mild anoxia. It is the failure to expirate at optimum/required volumes that prima-facie is the initial-principal cause of the onset of the pseudo distress syndrome, otherwise known as ‘spasms’. At heightened state/extended periods, such mechano aberration caused pseudo distress, shortened breath, posits as life threatening. Atmospheric lowlack of opposition to expiration is effective anti-dote. The TSCS have no perceptible effect on the lumen diameter and does not work as do broncho-dilators.  TSCS  also do not have any alveoli performance enhancing role {which in asthma are intact}. Long period field experience of juxtaposing severe weather events with problems of the patients having chest diseases, indicates, that, the otherwise cheerful patient is invariably lead into crisis, post pass of the cyclone. SOS is thence the only relief out. And, SOS is unavailable in the rural of the remote. Long period observation had to be adhered to.

We noted, that in the wards of all the hospitals in the severe cyclone effected regions, post pass of a weather system, all cardio-thoracic in-patients experience heightened bouts of cough and seizure {idiopathic} as the atmospheric pressure returns to 1 000 hPa, with preponderance around mid-night of the local winter period {numerous pass away}, and particularly post the zenithal pass of the sun/moon during new/full moon period. Even asthmatic clinicians and the meteorologists get afflicted as much seriously and know not why and how? Often it is misunderstood as mass affliction, community problem, radical steps are called for. Our study indicates that, at zenithal location (new/full moon), the astrals impart maximum buoyancy to the atmospheric fluid column (greater height dimension), which imparts boundaryresistance effect. Post zenithal pass the buoyant fluid is unleashed as ‘gravity waves’ (Niranjan Kumar and Ramkumar, 2008).  Gravity waves of greater magnitude are more associated with depression/cyclone pass. They are intense and have grave prognosis. Because maximum number of casualties. Over two decades we followed such nature based inspiration.

Moreover, when  the lower lungs of a chronic asthma/COPD patient inflates beyond the daily average {restoration of normal atmospheric pressure}, it also means higher diastole (higher back pressure on the heart), which we know is fraught with danger. There is also a concurrent higher systole. As the atmospheric pressure switches back to normalcy, the patient starts indicating persistent cough, wheeze, right ventricle stress, perspiration, and complications. SOS becomes necessary. Therefore, it may be inadvisable to introduce an alveoli performance enhancer. Bronchodilators are here to stay. Atmospheric low systems ingresses deep inland, hence SOS may become necessary in greater regions of India. If a COPD patient is quarantined in a room having a barometric pressure ranging between 960~980 with moist oxygen, then she/he will revive early. The long term panacea is breathing exercises, on and often through the day, on sustained basis {Gold standard}.
Hindu apex lexicon the  Sabdakalpadrum cites Hemachandra the grammarian of yore to indicate that SWÄ€SA (popular call name of asthma) means air-flow and again cites Rajnirghanta another linguist of yore, who qualifies it with the term ‘life’, so it amounts to SWÄ€SA=‘life air flow’ (Sabdakalpadrum, 1886). In 1892, William Osler (www.collectionscanada.gc.ca) suggested that inflammation played an important role in asthma. Histamins are part of physiological defense mechanism primarily associated with (contraction) the smooth muscles of the respiratory systems. Allergens cause heightened release of bronchial histamine receptors. Results in efficient and intensified uptake of Histamins (1 & 2 ) causes inflammation and also in vessel tonus (constriction in general), It results in influx of Ca+ which increases force of contraction of arterial and ventricular muscles. Histamins also trigger Mast cells from the lungs sub-mucosa (Arrang et al., 1983). Histamin trigger is also via a loop. Thence a deep-seated inflammatory response is initiated. As the cyclone builds up surface air flows towards the core of the cyclonic system. We noted allergens flow away. There is ‘fresh’ feel in the air, even by the non-asthmatic. This is one more underlying cause of ‘feel good’.

Over the period we also noted anoxia wasis not being efficiently addressed by the breathing apparatus with any amount of tweaking the O2 inflow; or altering the patient’s posture. There is no anisocytosis, yet there is pulmonary distress with mental and cerebral disorientation and disregulation; with slackslumped neck and warm- non perspiring nape. We gravitated to the point that anoxia was response pathology {bio-chemical} triggered by the used gas over-loaded alveoli (un-expirated gas). Among the deficiency was K+ {brain has a very narrow range for it}. In continuum of such status of K+ deficiency, rapid onset of the mechanical component of the malady manifests, with a pronounced steep sinking, thereafter.  Cortico-steroids, we theorised were either {i} up-regulating K+ availability andor {ii} becausing a heightened systemic synthesis of that ion. Therefore {as compared to non-infected acute inflammation of the larynx; tendon-cartilage pain}, post treatment of asthma/COPD by steroids were reporting least-to-nill gut and gastric stage steroid related complications. A visit to the KCL re-bottling and KN3 {explosive} units indicated ‘nil’ COPD cases among the salt workers-inspite of severe expouser. Our off the record advisory to take mini-pinches of KCL (pre and post bronchodilator inhalation, as sub lingual or as solution) is being reported to be beneficial across the age, status, place spectrum. All these are first time findings. They merit wider clinical and investigation based co-relationing.

Labor & atmospheric low  pressure
Labor occurs due to contraction of the abdominal musculature. Atmospheric pressure is the sole external opposing force (at partum). Abdominal muscular contraction at human labor generates a pressure gradient of 50 mm Hg during the 2nd stage of labor (actual delivery). This is 1/15th of fair weather barometric pressure at mean sea level i.e 67 gm/cm2 (latitude & orography specific). True for all non-temperate India regions.

In fair weather, due to normal atmospheric pressure, labor requires full muscular contractive thrust. A very severe cyclonic storm/tornado, develops a estimated  central pressure of 970~950 mb(hPa) which is equal to a reduction of the order 30~50 gms/cm2. Hence, atmospheric conditions come close to that, what is generated during the 2nd stage of labor (~50% reduction in natural opposing thrust). Severe cyclones collinearly also induces psychosomatic response in existing pregnancies of final trimester, and hastens onset of the 1st stage  contractions. Atmospheric low smoothens the 2nd  stage labor. There is also expression of extra large doses of Oxytocin by the brain. And Oxytocin upregulates abdominal contraction (Niranjan Kumar and Ramkumar, 2008) Severe cyclones also have high impact causing internal eddies (micro-bursts), that have more steep pressure gradients; wind energy and sonic boom. Actual delivery always seemed to be timed with micro-bursts (The rural mid-wives {non-govt.} in the cyclone prone districts had more than a decade ago brought this to the notice of the author. Not own original data, yet non historical nor cultural; Oxytocin is also released fear and psychotic conditions. We know, deep depressions and the notion of impending killer cyclone does cause a fear psychosis among the would be and being effected sub-populations). Tornados which are micro weather systems also occur in this region (Bhattacharya et al., 2011). The natural phenomena apart, short, easier  labor and child birth also results in ‘nil’ mother andor child mortality; specially in the rural and in the remote; where there aren’t any medical facility.  Due such natural phenomena, the 1st time mothers suffer much less, i.e., least labor pangs. 

During the 2 decades long field study we also noted that, all terrestrial mammals (bovines included) also experience similar convenience at labor. When cyclones rage no primary health center (human or veterinary) is in working mode. A crying need  arises. The out, is vicious. Long before to that the Govt. clinician {being alerted about the impending severe weather event, by the Govt., machineryfree press} leave for their respective cyclone safe city based shelters. The rural is left to lurch.

We now present a pioneering cum novel case study involving a geo-spatial location and a full community. Pan globally there are precedence. Let us now examine the data as in Table 1. It is that of 30 years-long period average (c.1950-80). Is derived from the India Meteorology Department (IMD). This data is cardinal, because it has been physically collected and validated year after year ranging over decades. We have taken 4 meteorological stations namely L-Su & L-Da in Gujarat (west coast); L-Go &  L-Sam in Odisa (east coast), i.e., one off the station of the either pair is located on the either shore side of the Indian peninsula. Geographically, either pair (west coast & east coast stations) are angulated to shore line in near identical manner; almost on the same latitude. They are marked by  paired straight lines (Figure 8). The configuration of the neighbouring seas form near similar types of isosceles triangle-which naturally (theoretically also) generate high and similar hydrodynamic component of the thrust of the ocean-atmosphere couple. The physiography and geomorphology are somewhat similar for the two inland stations; while the orography and the geography make closer call. The sole contrast being L-Da is desert beside. L-Sam, is semi-arid beside.
 


Figure 8 Geographic map of India, showing the location of Gopalpore ↔ Sambalpore and  Surat ↔ Dahod, their inter-distance, inclination from latitude and longitude; and relationship with neighbouring seas


Table 2: L-Su is much more breezy than L-Go while L-Da is more windy (strong) than L-Sam. L-Da as alike L-Sam has half a year of no clouds, while L-Sam has much more rainfall (1 500 mm). That L-Da has a very steep annual average barometric gradient (~40 hPa) as compared to Surat (coast line); which is very sterling and significant. World wide, such low pressure is normally associated with deep depressions/thunder storms (i.e., heavy rain bearing synoptic & meso scale systems). However, L-Da has a rain fall range between 300 mm (in draught year, which is normal) to 1 300 mm as in good years (2007 & 2010). This is very low precipitation with ultra high variability. Hence, L-Da’s is always marked by crop and even grass-land failure as compared to all India similar-inland location basis, specially. 
 


Table 2 Gives the detailed meteorological condition at  Gopalpore - Samabalpore and  Surat- Dahod on spread sheet basis for parameter wise comparison. Courtsey-IMS


The lowest rain fall in L-Sam is more than the amount that precipitates over L-Da in the L-Da -best monsoon year. Yet the relative humidity and temperature between L-Sam and L-Da are almost similar! Again, L-Sam is green. Its neighbourhood district of Bargad also cultivates paddy round the year and consumes the highest amount of fertilizer on district basis (record). L-Da not. Further, Odisa experiences as many as 6-10 monsoon period depressions per year. In 2006, India had 16, of which 14 had crossed Odisa’s coast line & record repeat floods. Annually, L-Da maymay not experience even a single rain bearing weather system; whereas the entire eastern sea board of India (including Gopalpur & L-Sam) annually experiences Cyclones & Tornadoes, which is another distinctive feature (Bhattacharya et al., 2011). 

A consistent ‘deep-low’ should have acted as attractant (natural gradient) for the sea based met-depression to home in on-towards L-Da (sea is so close by, and not in the lee of any highland, which is so in the case of L-Sam). That does not happen (subsequent communication). Unique indeed. The Indian nation is triangular peninsula, either coasts of which are cyclone prone (www.imd.gov.in/section/nhac/dynamic/faq/FAQP.htm).

Discussion 
Discussions among others throws light onto the possible inspirations, collateral matters and levitates. Among the few sciences that ancient India seems not to have was the system of recording constituent elements of the diurnal-nocturnal weather. Going out into the mid-day sun or the dark of the night for astronomical recordings was strongly in vogue even pre to The Christ. Not for meteorological purposes. In c. 1864 a catastrophic storm had struck Calcutta (the London of the eastern hemisphere). It was British dominion period. Subsequently, due to monsoon failure and tackle less export of rice from India to war ravaged and hungry UK, Odisha famine (c.1866) and Bengal famine (c.1940-42) followed in quick succession in which had perished around 2~3 million natives. UK had deficient farm production between 1940~1942 and famine like conditions. The British govt., had thence set up the 1st weather observatory (www.imd.gov.in/doc/history/history.htm) at Alipur, Calcutta. The India Meteorology Dept., transpired out of such beginnings (c.1877). Logically, learned & polite Englishmen were in charge. But, mad dogs and Englishmen go out into mid day sun, goes the saying. The IMD (alike all other British set India-professional institutions, inherent traditions) thus for over a century (1880~2000) went out to the field, into the sun & rain, sweat & dust, hand collected hard data, validated  in-situ and recorded it. Such data are unassailable. We are bound to it. Our Table 1 reflects an infinitely miniscule part of the IMD’s pan-data bank (Indo coast-to-coast). It is a veritable store house.

Sir Winston had said ‘Indians breed like rabbits’ (Owen Jones, 2012). The Census of India (Census of India, GoI, Ministry of Home, gov.in/censusindia.gov.in/) indicates a population of 1.2 Billion, with a birth rate of around 22/1 000 citizens/yr (http://en.wikipedia.org/wiki/Demographics_of_India) and also high mother and child mortality (Registrar General of India, Maternal & Child Mortality And Total Fertility Rates, Sample Registration System (SRS), censusindia.gov.in/vital_statistics/SRS.../MMR_release_070711.pdf). In relation to our caption, meteorology assisted. When it did not, famine and fatality followed. Hence anthropo-mammalian multiplication has been possible. Thus there is a multi-disciplinary case for us. It has remained un-observed and unreported. Severe weather events that are associated with low barometric pressure is associated with  acute consequence (grave prognosis) from the perspective of community health. Such nexus effects  all the residents at the same moment, in superbly variable manner and extents. This is a giant of a problem, if the effected domain census be in the order of the high (India/China). Disaster apart all this spells penury. Naturally occurring low pressure zones for the 1st time leap to the fore as good for labor (progeny). Tropical meteorology is vertical and consequently atmospheric low keep manifesting here, there and everywhere, asyclically. Smooth labor spells monetary savings, apart human welbeing. Policy apart, even concepts are absent. Our nascent findings posit as strong due to our long-period-study-model. It is very clear that the Indian sub-continent does offer a wide spectrum of opportunities to study the nexus between environment and health. This study silently throws up the possibility that Hindus who had learned school of plural health care (Ayurveda) and robust collegiums of practitioners may have sterling contribution, about which no study has been made thus far (supporting discussion). Therefore, the study area is green field and beckons (international) multi-lateral investment of mind & money. Not exhaustive .

Conclusions
Since mismatch of  timing {expiration↔inhalation} that manifests as spasms and to us prima-facie appears as the principal cause of distress. (i) Barometric low makes the lungs perform better, at the alveoli level, by catalysing a well timed expiration↔inhalation involuntary smooth muscle function. Even constricted bronchus allows peak volume inhalation and expiration (ii) failure to expirate at optimum/required volumes is due to boundary effect of the atmospheric column pressure. Atmospheric low alters such condition (iii) systemic availability of K+ has salutarious effect {therapy adjunctive} on the mechanical component of the aberration (iv) it is clear that rain fail syndrome exists over Gujarat specially in the examined domain axis of Surat ↔ Dahod. That such syndrome pre dates the concept of  Global Climate Change & Global Warming notion-motions. L-Da has semi-hot-arid terrestrial conditions and extensive surface denudation~visually much alike the cold arid north Scotland (iii) While there may be numerous geographical domains that may have similar year round, rain deficiency; physiography; et al., we have not been able to find a parable to L-Da that offers year round steep low atmospheric pressure concurrent with low humidity, and a (near) coastal location. No-ii directly assists labor, and No-i causes non perspiring feel good conditions at Labor. Due absence of the sole external opposing force (normal atmospheric pressure), the contractive cycle of the musculature assume a well ordered cadence. Which in turn becauses a correct positioning of the fetal head, leading to eventless, smooth normal delivery. All this offers unique opportunity to also consider specially engineered labor rooms (in high pressure domains) that may have anti-room with a pressure of 930~960 hPa. A short on-foot sample survey confirmed the absence of ‘Breach deliveries’ at Dahod. To our question pertaining to Caesarean/breach/foot first delivery, few natives had shot back “look for it elsewhere”. L-Da is the meteorology caused unique natural labor location. Vis-à-vis child birth & mother’s health care, meteorology posits as peerless a tool. Through the years, at every step, we had asked ‘what is mother nature doing to itself’?  It assisted us with an interesting set of transpirations, that are vetted on a decadal scale. The mind delights at such findings. This is original 1st time report.

Acknowledgement
Thanks to the IMS, which supported this very long period study with official data. The author is indebted to the rural people, the private health workers and Ayurveda clinicians who in the first place always led with the information of atypical cases and above all provided physical support, stay-put and logistics during the severe weather events. To the Collectors and Revenue officials. Our gratitude to patients who never tired in responding to our queries. Numerous professors assisted and participated in personal discussions, specially M S University, Baroda. They all did that with the fond hope that the author-duo would be able to deliver. These presents are to them. 

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