Prolonged Occupational Exposure Research Articles

Lower Hematocrit is Associated with High Oxidative Stress and Low Antioxidant Status in Men Occupationally Exposed to Petrol

Abstract Context: The organic compounds in petrol are known to adversely affect the hematopoietic system. Occupational exposure to these volatile compounds can lead to heightened oxidative stress and the consumption of antioxidants. Aim: This study aimed to assess the effect of occupational exposure to petrol on hematological parameters and markers of oxidative stress among petrol station pump attendants and roadside black market petrol vendors in a metropolitan city in Nigeria. Settings and Design: This is a comparative cross-sectional study that assessed the effects of occupational petrol exposure on hematological parameters, antioxidant vitamins (C and E), and oxidative stress marker – malondialdehyde (MDA) – of petrol station pump attendants and roadside black-market petrol vendors aged ≥18 years in Kano metropolis. Materials and Methods: Forty (40) participants were recruited from each of the three groups (n = 120). Healthy blood donors were recruited as a control group. Complete blood counts, reticulocyte count, and biochemical assays for vitamins C and E and MDA were performed using standard enzyme-linked immunosorbent assay methods. Analysis Used: Data were analyzed using R Studio v4.3.0. Mean values of laboratory parameters were compared between the three groups using analysis of variance, with Tunkey-HSD post-hoc analyses. A P value of <0.05 was considered significant. Results: There was significantly lower hematocrit (P = 0.0173) and higher mean corpuscular hemoglobin concentration (MCHC, P value = 0.0206) in occupationally exposed individuals (n = 80) compared to healthy controls. When compared by the duration of exposure (<2 yrs vs ≥2 yrs), only the mean granulocyte count was significantly different (P value = 0.009) in the two groups. Exposed individuals have significantly higher MDA (P value = 0.000) and lower vitamin C levels (P value = 0.031), with higher Vitamin E levels (P value = 0.015). Conclusion: Prolonged unprotected occupational exposure to petrol has adverse effects on the human hematopoietic system, possibly through oxidative stress and proinflammatory mechanisms.

The addition of a leaded arm sleeve to leaded aprons further decreases operator upper outer quadrant chest wall radiation dose during fluoroscopically guided interventions

ObjectiveBreast cancer most commonly occurs in the upper outer quadrant (UOQ) chest wall (CW). The effectiveness of routine leaded aprons to protect this region of the body in interventionalists during fluoroscopically guided interventions (FGIs) is unknown. Given the high lifetime attributable risks of prolonged occupational exposure to ionizing radiation and the increasing number of practicing female vascular surgeons and interventionalists, we sought to determine if the use of a leaded arm shield would offer additional protection to the lateral CW and axilla in operators compared with routine leaded aprons. MethodsEffectiveness of leaded sleeves in attenuating radiation dose to the axilla and UOQ was evaluated in clinical practice and simulated scenarios. In the clinical setting, optically stimulated luminescence nanoDot detectors were placed at the UOQ lateral CW position, both over and under a standard leaded apron vest with and without the addition of an antimony/bismuth Enviro-Lite sleeve on two vascular surgeons performing FGIs. In the simulation, nanoDots were similarly placed on an anthropomorphic phantom positioned to represent a primary operator performing right femoral access. Fluorography was performed on 12-inch-thick acrylic scatter phantom at 80 kVp for an exposure of 3 Gy reference air kerma. Experiments were done with and without the sleeve. Paired Wilcoxon and χ2 tests were performed to identify the statistical significance of radiation attenuation. ResultsOperator UOQ CW dose was measured during 61 FGIs: 33 cases (54%) with and 28 cases (46%) without the sleeve. Median procedure reference air kerma and fluoroscopy time was 180 mGy (interquartile range [IQR], 85-447 mGy) and 21 minutes (IQR, 11-39 minutes) when the sleeve was worn vs 100 mGy (IQR, 67-270 mGy) and 11 minutes (IQR, 6.3-25 minutes) without the sleeve. Radiation dose to the operator’s UOQ was reduced by 96% (IQR, 85%-96%) when the sleeve was present and by 62% (IQR, 44%-82%; P < .001) without the sleeve. In the simulated setting, the sleeve reduced the radiation dose to the UOQ compared with the apron alone (96% vs 67%; P < .001). ConclusionsRoutine leaded aprons do attenuate the majority of UOQ chest wall radiation dose; however, the addition of a lead-equivalent sleeve further significantly reduces this dose. Because this area of the body has a high incidence of cancer formation, additional protection, especially to female interventionalists, seems prudent. Vascular surgeons should consider using a protective sleeve with their personal protective equipment when performing complex fluoroscopically guided procedures.

Occupational exposure to potentially toxic elements alters gene expression profiles in formal and informal Brazilian workers

Chemical elements, such as toxic metals, have previously demonstrated their ability to alter gene expression in humans and other species. In this study, microarray analysis was used to compare the gene expression profiles of different occupational exposure populations: a) informal workers who perform soldering of jewelry inside their houses (n = 22) in São Paulo (SP) State; and b) formal workers from a steel company (n = 10) in Rio de Janeiro (RJ) state, Brazil. Control participants were recruited from the same neighborhoods without occupational chemical exposure (n = 19 in SP and n = 8 in RJ). A total of 68 blood samples were collected and RNA was extracted and hybridized using an Agilent microarray platform. Data pre-processing, statistical and pathway analysis were performed using GeneSpring software. Different expression was detected by fold-change analysis resulting in 16 up- and 33 down-regulated genes in informal workers compared to the control group. Pathway analysis revealed genes enriched in MAPK, Toll-like receptor, and NF-kappa B signaling pathways, involved in inflammatory and immune responses. In formal workers, 20 up- and 50 down-regulated genes were found related to antimicrobial peptides, defensins, neutrophil degranulation, Fc-gamma receptor-dependent phagocytosis, and pathways associated with atherosclerosis development, which is one of the main factors involved in the progression of cardiovascular diseases. The gene IFI27 was the only one commonly differentially expressed between informal and formal workers and is known to be associated with various types of cancer. In conclusion, differences in gene expression related to occupational exposure are mainly associated with inflammation and immune response. Previous research has identified a link between inflammation and immune responses and the development of chronic diseases, suggesting that prolonged occupational exposures to potentially toxic elements in Brazilian metal workers could lead to negative health outcomes. Further analysis should be carried out to investigate its direct effects and to validate causal associations.

Combined Infection Control Interventions Protect Essential Food Workers from Occupational Exposures to SARS-CoV-2 in the Agricultural Environment.

Essential food workers experience elevated risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to prolonged occupational exposures in food production and processing areas, shared transportation (car or bus), and employer-provided shared housing. Our goal was to quantify the daily cumulative risk of SARS-CoV-2 infection for healthy susceptible produce workers and to evaluate the relative reduction in risk attributable to food industry interventions and vaccination. We simulated daily SARS-CoV-2 exposures of indoor and outdoor produce workers through six linked quantitative microbial risk assessment (QMRA) model scenarios. For each scenario, the infectious viral dose emitted by a symptomatic worker was calculated across aerosol, droplet, and fomite-mediated transmission pathways. Standard industry interventions (2-m physical distancing, handwashing, surface disinfection, universal masking, ventilation) were simulated to assess relative risk reductions from baseline risk (no interventions, 1-m distance). Implementation of industry interventions reduced an indoor worker's relative infection risk by 98.0% (0.020; 95% uncertainty interval [UI], 0.005 to 0.104) from baseline risk (1.00; 95% UI, 0.995 to 1.00) and an outdoor worker's relative infection risk by 94.5% (0.027; 95% UI, 0.013 to 0.055) from baseline risk (0.487; 95% UI, 0.257 to 0.825). Integrating these interventions with two-dose mRNA vaccinations (86 to 99% efficacy), representing a worker's protective immunity to infection, reduced the relative infection risk from baseline for indoor workers by 99.9% (0.001; 95% UI, 0.0002 to 0.005) and outdoor workers by 99.6% (0.002; 95% UI, 0.0003 to 0.005). Consistent implementation of combined industry interventions, paired with vaccination, effectively mitigates the elevated risks from occupationally acquired SARS-CoV-2 infection faced by produce workers. IMPORTANCE This is the first study to estimate the daily risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across a variety of indoor and outdoor environmental settings relevant to food workers (e.g., shared transportation [car or bus], enclosed produce processing facility and accompanying breakroom, outdoor produce harvesting field, shared housing facility) through a linked quantitative microbial risk assessment framework. Our model has demonstrated that the elevated daily SARS-CoV-2 infection risk experienced by indoor and outdoor produce workers can be reduced below 1% when vaccinations (optimal vaccine efficacy, 86 to 99%) are implemented with recommended infection control strategies (e.g., handwashing, surface disinfection, universal masking, physical distancing, and increased ventilation). Our novel findings provide scenario-specific infection risk estimates that can be utilized by food industry managers to target high-risk scenarios with effective infection mitigation strategies, which was informed through more realistic and context-driven modeling estimates of the infection risk faced by essential food workers daily. Bundled interventions, particularly if they include vaccination, yield significant reductions (>99%) in daily SARS-CoV-2 infection risk for essential food workers in enclosed and open-air environments.

ДОЗИМЕТРИЧЕСКАЯ ХАРАКТЕРИСТИКА КОГОРТЫ ПЕРСОНАЛА СИБИРСКОГО ХИМИЧЕСКОГО КОМБИНАТА В ПЕРИОД 1950–2010 гг.

Purpose: To give a dosimetric characterization of the personnel of the Siberian Chemical Plant (SCP) subjected to prolonged technogenic occupational exposure to ionizing radiation (IR) in the period 1950–2010, as well as the cohort of the personnel of the SCP involved in working with uranium compounds. Material and methods: SCP is one of the largest and oldest complexes of nuclear industry enterprises in the world, having experience in continuous dosimetric monitoring of personnel for more than 60 years. The database of the regional medical-dosimetric register of employees of the SCP (RMDR) contains information about all employees of the SCP for the entire history of the enterprise, including personal data of medical, dosimetric and professional nature of 65.350 employees of the SCP, of which more than 32.000 people were exposed to chronic technogenic occupational radiation in the range of low doses. The archive of the medical documentation of the Seversk Biophysical Research Center contains 55.569 medical histories of the employees of the SCP, 29.800 outpatient records and 11.953 autopsy protocols. Results: Employees of the radiochemical, chemical-metallurgical, sublimate and separation industries of the SCP were subjected to combined (external and internal) irradiation, while the personnel of the reactor production were exposed exclusively to external irradiation. Auxiliary production workers were mainly exposed to non-radiation factors. Individual dosimetric control (IDC) of external exposure was carried out for all workers who were in the zone of exposure to external radiation sources. The average accumulated dose of external radiation for employees of the SCP was 28.3 mSv. IDC of internal irradiation was carried out for all workers employed at the production site, where the excess of the regulatory level of the concentration of radionuclides in the air of the working area was detected. The average value of the activity of radionuclides in the urine of SCP workers does not exceed 0.74 Bq. The life status has been clarified for 80.8 % of the employees of the SCP. About 3.500 employees of the agricultural complex have an IDC for internal irradiation from uranium based on the results of a biophysical examination. The life status is established for 75 % of employees of the uranium cohort. Conclusion: For the first time, a dosimetric characteristic of a cohort of 65.350 workers of the SCP (21 % women) who started work in the period 1950–2010 was given. The cohort of the staff of the SCP is suitable for conducting epidemiological studies in order to establish the risks associated with the impact on the human body of technogenic occupational exposure to IR.

Remote exposure to secondhand tobacco smoke is associated with lower exercise capacity through effects on oxygen pulse, a proxy of cardiac stroke volume.

BackgroundPast exposure to secondhand tobacco smoke (SHS) is associated with exercise limitation. Pulmonary factors including air trapping contribute to this limitation but the contribution of cardiovascular factors is unclear.ObjectiveTo determine the contribution of cardiovascular mechanisms to SHS-associated exercise limitation.MethodsWe examined the cardiovascular responses to maximum-effort exercise in 245 never-smokers with remote, prolonged occupational exposure to SHS and no known history of cardiovascular disease. We estimated the contribution of oxygen-pulse (proxy for cardiac stroke volume) and changes in systolic blood pressures (SBP), diastolic blood pressures and heart rate (HR) towards exercise capacity, and examined whether the association of SHS with exercise capacity was mediated through these variables.ResultsAt peak exercise (highest workload completed (WattsPeak)=156±46 watts (135±33 %predicted)), oxygen consumption and oxygen-pulse (O2-PulsePeak) were 1557±476 mL/min (100±24 %predicted) and 11.0±3.0 mL/beat (116±25 %predicted), respectively, with 29% and 3% participants not achieving their predicted normal range. Oxygen saturation at peak exercise was 98%±1% and remained >93% in all participants. Sixty-six per cent showed hypertensive response to exercise. In models adjusted for covariates, WattsPeak was associated directly with O2-PulsePeak, HRPeak and SBPPeak and inversely with SHS, air trapping (residual volume/total lung capacity) and rise of SBP over workload (all p<0.01). Moreover, SHS exposure association with WattsPeak was substantially (41%) mediated through its effect on O2-PulsePeak (p=0.038). Although not statistically significant, a considerable proportion (36%) of air trapping effect on WattsPeak seemed to be mediated through O2-PulsePeak (p=0.078). The likelihood of having baseline respiratory symptoms (modified Medical Research Council score ≥1) was associated with steeper rise in SBP over workload (p<0.01).ConclusionIn a never-smoker population with remote exposure to SHS, abnormal escalation of blood pressure and an SHS-associated reduction in cardiac output contributed to lower exercise capacity.

Cognitive impact of exposure to airborne particles captured by brain imaging.

Brain imaging can reveal specific characteristics of Cognitive Impairment (CI) related to neurotoxicant exposure. Unique brain characteristic patterns of CI have been revealed among World Trade Center (WTC) responders to the 9/11 terrorist attack, compared to other signatures, including Alzheimer's Disease (AD). Diffuse brain atrophy, reduced cortical thickness and hippocampal subfield volume analyses suggest that reductions in specific subregions are specifically associated with the duration of WTC exposure. These findings support the hypothesis that WTC exposure to neurotoxicants and intense psychological trauma are causing long-term neurodegenerative impacts. The neuro-phenotype of this impairment is distinct from the AD and inconsistent with signatures developed for other known neurodegenerative diseases. The World Trade Center Cognitive Impairment (WTC-CI) may be a WTC-specific encephalopathy with an unknown etiology characterized by widespread cortical atrophy. Applying similar brain imaging modalities, a diffuse brain deposition of fibrillar amyloid-β (Aβ) peptide was observed among ferroalloy workers with prolonged occupational exposure to manganese. These two case studies provide further evidence of how modern brain imaging can improve understanding of relevant mechanisms of neurotoxicity after long term exposure to neurotoxicants.

Genotoxic risk in occupational exposure to petrol and its amelioration by vitamin C and vitamin E

Petrol contains mixture of mutagens and carcinogens which have potential health risk after prolonged occupational exposure. We have compared genotoxicity and its amelioration in blood samples from 70 petrol pump attendants, working in congested area of the Ahmedabad city, India and similar number (n = 70) of Control samples from office workers dwelling in less polluted areas of the city. The cytokinesis-block micronucleus assay showed highly significant frequencies of micronucleus in Exposed than in the Controls. The sister chromatid exchanges were also significantly increased while the cell cycle proliferative index was significantly decreased in the Exposed individuals than the Controls. Addition of standardized doses of vitamin C and vitamin E in the lymphocyte cultures (in vitro) significantly improved all the biomarkers. The long-term occupational petrol exposure causes genotoxic effects and use of vitamins C and E for protection should be further explored in randomized controlled studies.

Expression of serum proteins in noise induced hearing loss workers of mining based industry

Noise Induced Hearing Loss (NIHL) is caused by excessive noise exposure due to occupational activities thus affects communication and quality of life. Prolonged occupational and environmental exposure to loud noise damages key molecules present in the micro-machinery of the ear which are required for the mechano-electrical transduction of sound waves in cochlea. Specific proteins are known to be associated with hearing loss and related structural and functional disabilities in the human inner, outer hair cells and cochlea. Rationale of this study was to identify the cochlear proteins associated with the pathophysiology of NIHL using proteomic approaches in mining based industrial workers. Total (n = 210) samples were collected from mining based industrial workers of central India. Subjects were categorized based on audiometric analysis. Proteome changes of the host serum were investigated using one and two-dimensional electrophoresis in combination with LC-MS/MS and MALDI-TOF-MS. Up-regulated 46 cochlear proteins among confirmed NIHL cases were identified by MASCOT. Shrinkage discriminant analysis provided top 25 discriminating feature proteins namely myosin, transthyretin, SERPIN, CCDC50, enkurin, transferin etc. The identified potential proteins may be used as biomarkers for early detection and to understand the pathogenic mechanism of NIHL. Evaluation of these biomarkers in follow-up cases may further aid in improving NIHL diagnosis. SignificanceHuman proteome study in Noise Induced Hearing Loss (NIHL) cases has not been published till date. This study represents most comprehensive proteomic analysis in NIHL cases taken from Indian mine workers. The identified key twenty-five discriminating feature proteins which are upregulated when an individual develops (or is in stage of development of) NIHL, provides insights into the potential roles of these varied proteins in disease progression. The proteins thus identified by proteomic approach may be used as early diagnostic biomarker to predict the occurrence of disease at very early stage.

Occupational noise exposure and asymmetric hearing loss: Results from the HUNT population study in Norway.

A large population study with adequate data on confounders is required to determine whether asymmetric hearing loss (AHL) is associated with occupational noise exposure. We performed a cross-sectional population study in Norway (the Health Investigation in Nord-Trøndelag: HUNT) with 24 183 participants, using pure-tone audiometry and questionnaires. AHL was defined as a difference in hearing threshold between the right and left ears of greater than or equal to 15 dB for the pure-tone average of 0.5 to 2 or 3 to 6 kHz. The mean age of the participants was 53 years (range, 19-99); 53% were women. The prevalence of AHL in this general Norwegian population was 6% for the 0.5 to 2 kHz range and 15% for 3 to 6 kHz. In unadjusted regression models, subjects reporting prolonged occupational noise exposure to high-level noise sources (N = 1652) had a higher risk of AHL at 3 to 6 kHz than those reporting no prior exposure (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.75-2.25). After adjustment for age and sex, OR was 1.08; (95% CI, 0.95-1.24). After additional adjustment for head trauma, ear infections, blasting or shooting (all associated with AHL), smoking, and diabetes, OR was 1.00 (95% CI, 0.87-1.16). No association between occupational noise and right-ear hearing threshold advantage (left-right ear difference) was observed after adjustment for confounders. Our study suggests that AHL is relatively common in the general population, especially at the high-frequency range in men and elderly subjects. Our study showed no relation between occupational noise exposure and AHL after confounder adjustment.

Evaluation of kidney function and oxidative stress biomarkers in prolonged occupational exposure with mercury in dentists

Inorganic mercury (Hg), which predominant component in dental amalgam, is one of the primary sources of Hg inhalation exposure with several systemic toxicities in dental staff. This research investigated occupational Hg exposure and its effects on kidney function biomarkers (KFBs) and superoxide dismutase (SOD) as an oxidative stress index in dental workers. The participants were classified into two matched groups as an exposed group (G1: n = 30), which occupied in endo, pediatric and restorative wards, and non-exposed (G2: n = 27) occupied in the administrative wards. Blood and urinary level of Hg(B-Hg and U-Hg), SOD blood level(SODB), and KFBs including urinary N-acetyl-β-D-glycosaminidase;U-NAG, microalbumin; U-Micro- Alb, immunoglobulin G; U-IgG, and creatinine; U-Cr were measured in 24 collected urine and blood samples and the correlations of B-Hg and U-Hg concentrations with these markers were analyzed. The mean of BHg and UHg concentrations in G1 with significant difference was higher than G2 (p < 0.05). The SODB in G1 and G2 was 59.40 ± 8.75 IU/L and 64.69 ± 8.56 IU/L, respectively, which had significant difference (p < 0.05). UIgG in G1 was higher than the G2 group with non- significance difference (p = 0.341). U-Hg and B-Hg concentrations had not significant correlation with KFBs and SODB in G1 and G2. Using dental amalgam can lead to the accumulation of Hg in blood and urine and may pose perturbation in oxidative stress index and relevant dysfunctions. So, monitoring of Hg concentration and its influences on kidney function and oxidative stress index in exposed groups is hardly suggested for health status prediction of these groups.

"Worrying About Getting Sick in the Future": Lived Experience of Health Seeking and Healthcare Utilization Among Korean Immigrant Nail Salon Workers.

To understand the health and safety concerns of Korean immigrant women nail salon workers in the Greater New York City area and their experiences of health seeking and health service utilization, 20 semi-structured interviews were conducted and analyzed using interpretive hermeneutic phenomenology. Most worried about working in nail salons and experienced work-related health symptoms. However, they were disinclined toward personal protective device use because of discomfort and inconvenience. Major barriers to healthcare utilization limited their healthcare use to times when they had intolerable symptoms, preventing opportunities for regular screening tests. To overcome these limitations, workers actively sought available resources and health-related information online and through personal networks, the latter facilitated by living in a Korean community. Despite efforts to maintain their health and manage their symptoms, Korean nail salon workers worried about getting sick as they got older due to prolonged occupational chemical exposure and limited healthcare access. Appropriate education and intervention should aim to resolve current barriers to personal protective device use and healthcare use and provide a source of care for uninsured workers.

Occupational exposure to chronic ionizing radiation increases risk of Parkinson's disease incidence in Russian Mayak workers.

Patients receiving radiotherapy demonstrate cognitive deficits, impairment of neurogenesis and neurovascular damage developing as late side effects of radiation exposure to the head. In light of the increasing use of diagnostic radiological procedures, epidemiological data raise concerns about possible harmful effects of low-level radiation on the human brain. A series of studies of chronically exposed Russian nuclear workers have provided information on risks of cancer and non-cancer diseases. This study aimed to assess the risk of Parkinson's-disease (PD) incidence in a cohort of workers occupationally exposed to chronic radiation. The cohort comprised workers of a Russian nuclear production facility who were first employed in 1948-1982 and followed up until the end of 2013 (22377 individuals; 25% female). Using the AMFIT module of EPICURE software, relative risk and excess relative risk per unit dose (ERR/Gy) were calculated based on maximum likelihood. A linear association was found between PD incidence and cumulative γ-dose after adjusting for sex and attained age [ERR/Gy = 1.02 (95% confidence interval, 0.59 to 1.63, p = 5.44 × 10-5)]. The ERR/Gy of external radiation for PD incidence was stable after adjusting for neutron dose (ERR/Gy = 1.03; 95% confidence interval: 0.59 to 1.67, p = 6.86 × 10-5). The risk increased with increasing lag period and decreased notably after adjusting for body mass index, smoking and alcohol consumption. Additional adjustments for hypertension, gout, gastric ulcer, head injuries with loss of awareness and diabetes mellitus did not affect the risk estimate. This study is the first to suggest that PD is associated with prolonged occupational external γ-ray exposure.

Women’s occupational exposure to polycyclic aromatic hydrocarbons and risk of breast cancer

ObjectiveTo estimate the association between occupational polycyclic aromatic hydrocarbon (PAH) exposure and female breast cancer.MethodsLifetime work histories for 1130 cases and 1169 controls from British Columbia and Ontario (Canada) were...

Raising awareness of hand-arm vibration syndrome (HAVS) using posters.

Hand-arm vibration syndrome (HAVS) is caused by prolonged occupational exposure to hand-transmitted vibration. Although HAVS is preventable, disease awareness and prevention knowledge are lacking in high-risk workplaces; this may contribute to under-diagnosis, delays in seeking care, and poor health outcomes. Posters may be used to increase awareness in the workplace. To conduct a pilot survey in workers with HAVS about poster use in their workplaces, their recommendations for poster campaigns and training programs, and their evaluation of HAVS awareness and prevention posters. All eligible HAVS patients in the Occupational Health Clinic at St. Michael's Hospital, in Toronto, Canada, were asked to complete a questionnaire on workplace poster use and to evaluate a set of HAVS posters. Fifty workers participated; almost all were males, aged 50 and older, working in construction. Most indicated having non-HAVS specific awareness posters in their workplaces. There was a positive evaluation of the design, content, and potential usefulness of the posters. The poster depicting finger blanching stood out most. The poster depicting anti-vibration gloves rated highest for relatability and effectiveness at conveying disease importance. Participants supported the proposed use of industry-specific HAVS awareness posters in their workplaces. Future research should evaluate the effectiveness of these posters in the workplace.

CHRONIC EOSINOPHILIC PNEUMONIA IN AN AIR-BRUSH PAINTER WITH POOR RESPONSE TO SYSTEMIC STEROIDS

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Diseases SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Air-brush paints contain low molecular weight chemicals that can cause occupational asthma, respiratory sensitization and hypersensitivity pneumonitis; however, its relationship to Chronic Eosinophilic Pneumonia (CEP) has never been reported. Hereby, we describe a case of CEP in a patient who was exposed to air-brush paints for a long time. CASE PRESENTATION: A 48-year-old male, who worked as an air-brush painter for 20 years, presented with exertional dyspnea and cough productive of clear sputum for 4 weeks. He also had pleuritic chest pain, low grade fever, chills, malaise, and 10 lbs. weight loss. He had 12 pack-year smoking history and quit 2 years ago. Chest exam revealed bilateral basilar coarse crackles. White Blood Cell (WBC) count showed mild leukocytosis with Eosinophils (E) 5%, absolute E count 500/μL, elevated CRP and negative Procalcitonin. Computed Tomography (CT) of the chest (Figure 1) showed bilateral lower lobes infiltrates and ground glass opacities. After 2 days, his WBC count jumped to 17,000 with E% 7.5 and absolute E count 1300/μL with worsening oxygen requirement. Bronchoscopy was not performed due to his high oxygen requirement. However, because of patient’s progressive symptoms and despite being at high risk, open lung biopsy was done for definitive diagnosis. Pathological examination (Figure 2) revealed CEP with organizing pneumonia pattern. He was then started on high-dose systemic steroids with gradual tapering but adequate clinical recovery was not achieved. His hospital course was also complicated by pneumothorax and trapped lung too, and he continued to have high oxygen requirement. A repeat CT of the chest (Figure 3) showed worsening of lung infiltrates and fibrosis. DISCUSSION: Our patient was exposed to air-brush paints for 20 years and presented with CEP; thus, we believe it is warranted to investigate the relationship between CEP and occupational exposures, such as air-brush painting. Generally, patients with CEP have excellent response to systemic steroids and avoidance of the hypothetical inciting factor; however, our patient had poor response to systemic steroids. We believe that his prolonged exposure to air-brush paints and the additional pathology of organizing pneumonia might have contributed to the unsatisfactory response to systemic steroids, prolonged hypoxia, and the overall worse prognosis. CONCLUSIONS: We are presenting a unique association between CEP and prolonged exposure to air-brush paints. In this case, the patient had poor response to systemic steroids too, which was likely due to prolonged occupational exposure in addition to the evolution of progressive fibrosis and organizing pneumonia. Reference #1: Plitnick LM, Loveless SE, Ladics GS, Holsapple MP, Smialowicz RJ, Woolhiser MR, et al. Cytokine mRNA profiles for isocyanates with known and unknown potential to induce respiratory sensitization. Toxicology 2005; 207: 487-99. Reference #2: Di Stefano F, Di Giampaolo L, Verna N, Di Gioacchino M. Occupational eosinophilic bronchitis in a foundry worker exposed to isocyanate and a baker exposed to flour. Thorax 2007; 62: 368-70. Reference #3: Carrington CB, Addington WW, Goff AM, Madoff IM, Marks A, Schwaber JR, et al. Chronic eosinophilic pneumonia. New Engl J Med 1969; 280: 787-98. DISCLOSURES: No relevant relationships by Ravindra Bharadwaj, source=Web Response No relevant relationships by Manish Patel, source=Web Response No relevant relationships by Nethuja salagundla, source=Admin input No relevant relationships by AHMED TAHA, source=Web Response No relevant relationships by Thien Vo, source=Web Response

Immunological Markers of Chronic Occupational Radiation Exposure.

This study aimed to identify immunological biomarkers for prolonged occupational radiation exposure and thus studied a random sample of the Mayak Production Association worker cohort (91 individuals). The control group included 43 local individuals never employed at the Mayak Production Association. To identify biomarkers, two groups of workers were formed: the first one included workers chronically exposed to external gamma rays at cumulative doses of 0.5-3.0 Gy (14 individuals); the second one included workers exposed to combined radiation-external gamma rays at doses ranging from 0.7 to 5.1 Gy and internal alpha radiation from incorporated plutonium with 0.3-16.4 kBq body burden (77 individuals). The age range of the study individuals was 66-91 y. Peripheral blood serum protein concentrations of cytokines, immunoglobulins, and matrix metalloproteinase-9 were analyzed using enzyme-linked immunoassay following the manufacturer's protocol. Flow cytometry was used to analyze levels of various lymphocyte subpopulations. The findings of the current study demonstrate that some immunological characteristics may be considered as biomarkers of prolonged chronic radiation exposure for any radiation type (in the delayed period after the exposure) based on fold differences from controls: M immunoglobulin fold differences were 1.75 ± 0.27 (p = 0.0001) for external gamma-ray exposure and 1.50 ± 0.27 (p = 0.0003) for combined radiation exposure; matrix metalloproteinase-9 fold differences were 1.5 ± 0.22 (p = 0.008) for external gamma-ray exposure and 1.69 ± 0.24 (p = 0.00007) for combined radiation exposure; A immunoglobulin fold differences were 1.61 ± 0.27 (p = 0.002) for external gamma-ray exposure and 1.56 ± 0.27 (p = 0.00002) for combined radiation exposure; relative concentration of natural killer cell fold differences were 1.53 ± 0.23 (p = 0.01) for external gamma-ray exposure and 1.35 ± 0.22 (p = 0.001) for combined radiation exposure; and relative concentration of T-lymphocytes fold differences were 0.89 ± 0.04 (p = 0.01) for external gamma-ray exposure and 0.95 ± 0.05 (p = 0.003) for combined radiation exposure. Based on fold differences from controls, interferon-gamma (3.50 ± 0.65, p = 0.031), transforming growth factor-beta (2.91 ± 0.389, p = 0.026), and relative blood serum levels of T-helper cells (0.90 ± 0.065, p = 0.02) may be used as immunological markers of chronic external gamma-ray exposure. Moreover, there was a significant inverse linear association of relative concentration of T-helper cells with dose from external gamma rays accumulated over an extended period.

Effect of prolonged and chronic occupational exposure to lead (Pb) poison metal on anterior segments of the eye

Background: Lead is a naturally occurring toxic metal found in the earth's crust. Its widespread use has resulted in extensive environmental contamination, human exposure, and significant public health problems in many parts of the world. Aim: This study aimed to assess the effect of prolonged occupational lead exposure and the outer eye abnormalities among workers of military industrial factory as well as to assess the knowledge and practice of the workers toward lead exposure and hazards of lead poisoning. Materials and Methods: This is a comparative cross-sectional study of 100 workers selected randomly from the lead factory, and their ages ranged from 21 to 67 years, with a mean age of 39.1 ± 10.3 years. They were divided into two groups according to their duration of work (duration of exposure) group of short duration ( Results: The finding revealed that 8% of the workers of long duration had VA Conclusion: Lead poison has a great effect on vision and eye health of the workers, its lead to decrease of vision result in development amblyopia, it also has influence on ocular media and causes severe allergic reaction Thus, all the workers in this field should wear the protection tools provided in the factory, and there is a critical need for examining their ocular health annually.

Early detection of lung cancer potential among Egyptian wood workers.

Wood dust is known to be a human carcinogen, with a considerable risk of lung cancer. The increased cancer risk is likely induced through its genotoxic effects resulting from oxidative DNA damage. This study aimed at assessing the genotoxicity of wood dust and demonstrating the role of sputum PCR as a screening tool for early prediction of lung cancer among wood workers. The study was carried out in the carpentry section of a modernized factory involved with the manufacture of wooden furniture in Greater Cairo, Egypt. Environmental assessment of respirable wood dust concentrations was done. Frequency of chromosomal aberrations (CA%) and sister chromatid exchanges (SCE%) in peripheral blood lymphocytes (PBL) was assessed and comet assays were performed in samples from among the study population (n=86). Levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) enzymes were measured. The polymerase chain reaction (PCR) was used to study hypermethylation of p16 and ̸or O6-methylguanine-DNA methyltransferase (MGMT) gene promoters in sputum DNA. The concentrations of respirable wood dust exceeded the Egyptian and international permissible limits with highest levels generated by sawing operations. Laboratory investigations revealed statistically significantly higher frequencies of CA and SCE as well as increased comet tail length associated with significant decrement in the levels of SOD and GPx among exposed group. A statistically significant elevation in the extent of hypermethylation was detected for the p16 and MGMT gene promoters in the sputum DNA of studied wood workers. The study results support the conclusion that prolonged unprotected occupational exposure to wood dust is associated with possible genotoxicity and oxidative stress that might raise the risk for carcinogenesis including lung cancer.

New insights on the biomineralisation process developing in human lungs around inhaled asbestos fibres

Once penetrated into the lungs of exposed people, asbestos induces an in vivo biomineralisation process that leads to the formation of a ferruginous coating embedding the fibres. The ensemble of the fibre and the coating is referred to as asbestos body and is believed to be responsible for the high toxicological outcome of asbestos. Lung tissue of two individuals subjected to prolonged occupational exposure to crocidolite asbestos was investigated using synchrotron radiation micro-probe tools. The distribution of K and of elements heavier than Fe (Zn, Cu, As, and Ba) in the asbestos bodies was observed for the first time. Elemental quantification, also reported for the first time, confirmed that the coating is highly enriched in Fe (~20% w/w), and x-ray absorption spectroscopy indicated that Fe is in the 3+ oxidation state and that it is present in the form of ferritin or hemosiderin. Comparison of the results obtained studying the asbestos bodies upon removing the biological tissue by chemical digestion and those embedded in histological sections, allowed unambiguously distinguishing the composition of the asbestos bodies, and understanding to what extent the digestion procedure altered their chemical composition. A speculative model is proposed to explain the observed distribution of Fe.