Anup Kumar Srivastava

Adverse respiratory health and hematological alterations among agricultural workers occupationally exposed to organophosphate pesticides: a cross-sectional study in North India.

Background Non-protective work practices followed by farm workers during spraying of pesticides lead to occupational exposure among them. Objective This study is designed to explore the respiratory health and hematological profile of agricultural workers occupationally exposed to OP pesticides. Materials and Methods A cross sectional study was undertaken among 166 pesticide sprayers working in mango orchards of Lucknow district in North India compared with 77 controls to assess the respiratory illness, lung functions, cholinesterase levels and hematological profile. A questionnaire based survey and clinical examination for respiratory health were conducted among study subjects. Lung function test was conducted among study subjects by using spirometer. Cholinesterase level as biomarker of OP pesticides and hematological profile of study subjects were investigated in the laboratory by following the standard protocols. Results Overall respiratory morbidity observed among exposed subjects was 36.75%. Symptoms for respiratory illness like dry cough, productive cough, wheezing, irritation of throat and blood stained sputum were found to be significantly more (p<0.05) among pesticide sprayers than controls. Lung function parameters viz. PEFR, FEV1, %PEFR predicted, %FEV1 predicted and FEV1/FVC were found to be significantly decreased (p<0.05) among pesticide sprayers as compared to controls. Exposure wise distribution of respiratory illness and lung functions among pesticide sprayers show that the exposure duration significantly elevates (p<0.05) the respiratory problems and significantly decreases (p<0.001) lung functions among pesticide sprayers. Activities of acetylcholinesterase and butyrylcholinesterase were found to be significantly depleted (p<0.001) among pesticide sprayers as compared to controls which show the exposure of OP pesticides among them. The hematological profile viz. RBC, WBC, monocytes, neutrophils, MCV, MCH, MCHC and platelet count were significantly altered (p<0.001) in pesticide sprayers than controls. Conclusion This study shows that the unsafe occupational exposure of OP pesticides causes respiratory illness, decreased lung functions and hematological alterations among pesticide sprayers.

Assessing hazardous risks of indoor airborne polycyclic aromatic hydrocarbons in the kitchen and its association with lung functions and urinary PAH metabolites in kitchen workers.

BACKGROUND Indoor air pollution is associated with decreased pulmonary function but the relative impact of pollution from kitchen sources on health risks in kitchen workers is not well-known or studied. A study was conducted to measure the kitchen indoor air quality including PAHs estimation and risk assessment based on reported PAHs in indoor air in a central kitchen at North India. METHODS A cross sectional study was undertaken to assess the lung function status using spirometer and urinary PAH metabolite measurements using GC-MS/MS among 94 male kitchen workers and their corresponding controls. Assessment of the indoor air quality levels was evaluated using standard methods. RESULTS All the indoor air pollutants were within the recommended guidelines except CO, TVOC and PAH emission in the kitchen. Incremental life time cancer risk (ICLR) based on indoor air PAH measurements indicates potential for carcinogenic risk. Significant lung function decline was observed among kitchen workers as compared to controls after adjusting for smoking habits. Urinary PAH metabolites were detected in kitchen workers and measured concentrations were comparatively higher than control subjects. CONCLUSION The decline in lung functions after adjustment for confounders and detection of urinary PAH metabolites in kitchen workers can be associated with higher concentrations of PAHs, CO and TVOCs in kitchen indoor air.

Hair selenium as a monitoring tool for occupational exposures in relation to clinical profile.

Nineteen workers exposed to low levels of selenium (0.047-0.202 mg/m3 air) along with 15 control subjects were studied for clinical, hematological, radiological, and neurobehavioral variables in relation to selenium concentration in hair. The levels of selenium in the hair of exposed subjects (1.44 +/- 0.37 micrograms/g) were significantly higher than those of control subjects (0.78 +/- 0.18 microgram/g). The levels of selenium in the hair of 22 nonvegetarian subjects were found to be significantly higher as compared to 12 vegetarian subjects. Complaints of weakness and/or fatigue were found to be more prevalent in the exposed subjects. The study holds promise that hair selenium may be used as a monitoring tool for low-level occupational exposure to selenium.

Visual disturbances with cholinesterase depletion due to exposure of agricultural pesticides among farm workers

In this study, risk assessment for visual disturbances among farm workers spraying agricultural pesticides in farms have been assessed. A cross-sectional study for the assessment of visual disturbances was undertaken using questionnaire survey and clinical examination among agricultural workers exposed to pesticides. Two hundred and thirty nine pesticide sprayers participated in the study. The study was compared to 110 controls not occupationally exposed to pesticides with similar socio-economic status. The prevalence of ocular morbidity was found to be 40% among pesticide sprayers which was significantly higher (p < 0.01) as compared to controls. The symptoms among morbid subjects were found to be blurred vision, lacrimation, pain in eyes, red swollen eyes, and irritation of eyes. Exposure wise assessment of ocular symptoms among pesticide sprayers illustrates that exposure time elevates the ocular problems among sprayers. The cholinesterase activity was found to be significantly depleted (p < 0.01) among pesticide sprayers as compared to controls which show the exposure of organophosphate pesticides among them. The visual disturbances observed among pesticide sprayers clearly exhibit that eyes get exposed by pesticides during spraying operations in agriculture and eventually get affected leading to ocular illness.

Mathematically derived body volume and risk of musculoskeletal pain among housewives in North India.

Background Global Burden of Disease Study 2010 demonstrates the impact of musculoskeletal diseases as the second greatest cause of disability globally in all regions of the world. The study was conducted to determine the role of mathematically derived body volume (BV), body volume index (BVI), body mass index (BMI), body surface area (BSA) and body fat % (BF %) on musculoskeletal pain (MSP) among housewives in National Capital Region (NCR). Methods A cross sectional study was undertaken among 495 housewives from Gurgaon and New Okhla Industrial Development Area (NOIDA) in National Capital Region (NCR), New Delhi, India. The study includes questionnaire survey, clinical examination and body composition monitoring among housewives. Results A significantly higher BMI, BVI, BV and BSA were observed in subjects with MSP as compared to those who had no MSP. This was also true for subjects with pain in knee for BMI category for overweight. Subjects with pain in limbs had significantly high BMI and BVI as compared to subjects with no MSP. A significant positive correlation of age with BMI, BVI, BV and BSA was observed among subjects having no MSP denoting a direct relationship of age and these body factors. Conclusions The prevalence of MSP among housewives is associated with increasing age, BMI and BVI. This can possibly be used for formulating a strategy for prevention of MSP.

Gender Disparity in Lung Function Abnormalities among a Population Exposed to Particulate Matter Concentration in Ambient Air in the National Capital Region, India

Background The World Health Organization (WHO) global air quality study shows that 27 Indian cities, including New Delhi, are among the one hundred cities with the worst air quality globally. The scope of airway obstruction cases among residents in locations with critical air pollution levels like particulate matter (PM) pollutants PM2.5 and PM1 has not been addressed in the National Capital region, India. Objectives The present cross-sectional study was undertaken to assess the forced expiratory volume in one second (FEV1) % predicted abnormalities among residents living in the National Capital Region, India with respect to their exposure to particulate matter pollutants (PM1, PM2.5) in ambient air. Methods Eight hundred and fifty-four residents, including 433 men and 421 women ranging in age from 18-70 years, living in the National Capital Region (NCR) of India participated in the study. Particulate matter concentrations in ambient air (PM2.5 and PM1) were monitored at 10 residential locations in the National Capital Region, India (New Okhla Industrial Development Authority (NOIDA) and Gurgaon). The lung function test (FEV1) was conducted using a spirometer. Results The Indian Air Quality Index showed either very poor or severe levels for PM2.5 at all study locations. A significant negative linear relationship was found between higher concentrations of PM1 and reduced FEV1% predicted values (r = -0.8, p < 0.05). The prevalence of airway obstruction cases (79.6%, odds ratio 1.96, confidence interval 1.42-2.71) was higher (p<0.001) among female subjects compared to their male counterparts. Even though there was a significant decline in FEV1% predicted among 80% of cases in women, only 19.24% cases were in the moderate category and 6.18% cases in the severe category. The severe category of FEV1% predicted cases showed greater respiratory symptoms than the other two categories, which denotes higher risk among those in the severe category. The present study shows that obstruction cases increased from 1.97 to 7.40% and 2.73 to 14.93% in women, with a corresponding increase in PM1 and PM2.5 from the minimum to maximum concentration. Conclusions Since the women in this study were non-smokers, the PM in ambient air can be considered to be the major reason for the decline in lung function. The sources of PM pollutants in the study locations are large scale infrastructural development activities such as building and road construction activities. Narrowed lung airways can alter the airway caliber or resistance and flow rates proportional to the airway radius, especially in smaller airways. The present study suggests the need for policy makers and stake holders to take the necessary steps to identify PM sources and reduce the emissions of PM concentrations in ambient air.

Meta-analysis approach to study the prevalence of chronic obstructive pulmonary disease among current, former and non-smokers

Comparative risk assessment for Chronic Obstructive Pulmonary Disease (COPD) among current, former and non-smokers categories remains controversial and not studied in detail. We conducted a meta-analysis to summarize all the relevant published studies on this topic and to update the association between smoking and prevalence of COPD in current, former and non-smokers. Identification, screening, eligibility and inclusion of articles for the study were conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Quality assessment of included studies was undertaken using a scoring sheet. Meta-analysis after the final synthesis of the selected studies was performed using the STATA and Comprehensive Meta-Analysis (CMA) software. Estimates from forty two independent studies reporting 547,391 individuals were identified. Twenty two studies were conducted in Europe, nine in America and ten in Asia and one from New Zealand. The meta-analysis showed that the prevalence of COPD was significantly higher in current smokers compared with former and non-smokers. However, owing to large heterogeneity among the estimates obtained from the studies, stratification was done with respect to continent, diagnostic criteria of COPD and study design which also showed similar results. The stratified analysis also revealed similar trend of results with prevalence of COPD being higher in current smokers as compared to former and non-smokers. The present meta-analysis highlights the positive association between smoking and COPD prevalence. There is an urgent need to implement more effective policies towards the restriction of tobacco use, to reduce the burden of COPD.