Petar Bulat

Blood and urine cadmium and bioelements profile in nickel-cadmium battery workers in Serbia

Although cadmium (Cd) is extensively used for nickel-cadmium battery production, few recent reports are available on the effect of this toxic metal on the imbalance of biometals in occupational exposure. The current study was carried out to determine the Cd level and its effect on the content of bioelements: zinc, cooper, magnesium, and iron in blood and urine of workers exposed to Cd during nickel-cadmium battery production. β2-microglobulins (β2-MG), as indicators of kidney damage, were determined in urine. The study group comprised 32 male nickel-cadmium battery workers, and the control group had 15 male construction workers with no history of Cd exposure. Levels of Cd and bioelements were determined in blood and urine by atomic absorption spectrophotometry. Cd concentration in blood of exposed workers was around 10 μg/L and in urine ranged from 1.93 to 8.76 μg/g creatinine (cr). Urine Cd concentration was significantly higher in exposed workers than in the controls, although no statistical difference in β2-MG content was observed in urine between the two groups. Blood Zn and Mg level were significantly reduced and urine Zn level was increased in Cd-exposed group when compared with controls. The mean Cd concentrations in blood and urine did not exceed the recommended reference values of 10 μg/L in blood and 10 μg/g cr in urine. Cd exposure resulted in disturbances of Zn in blood and urine and Mg in blood but had no effect on Cu and Fe content in biological fluids.

Lipid Peroxidation and Antioxidative Enzyme Activity in Erythrocytes of Workers Occupationally Exposed to Aluminium

Lipid Peroxidation and Antioxidative Enzyme Activity in Erythrocytes of Workers Occupationally Exposed to Aluminium Current research indicates that lipid peroxidation could have a role in aluminium toxicity. The aim of this study was to asses lipid peroxidation and antioxidative enzyme activity in erythrocytes of workers occupationally exposed to aluminium. We investigated a group of 59 workers (Al group) exposed to aluminium fumes (contamination factor F=8.07 to 13.47, national maximal allowed concentration value is 2 mg m-3). The control group (C group) consisted of 75 subjects employed in lime production who had not been occupationally exposed to aluminium or any known toxic substance. Erythrocyte aluminium concentrations were significantly higher in the exposed group than controls [Al group (8.41±3.66) μg L-1, C group (5.60±0.86) μg L-1, p<0.001]. In the Al group, erythrocyte malondialdehyde concentration was also significantly higher [Al group (189.59±81.27) μmol L-1, C group (105.21±49.62) μmol L-1, p<0.001] and antioxidative enzyme activity reduced for glucoso-6-phosphate-dehydrogenase [Al group (5.05±1.70) IU g-1 Hb, C group (12.53±4.12) IU g-1 Hb, p<0.001], glutathione reductase [Al group (1.41±0.56) IU g-1 Hb, C group (1.89±0.57) IU g-1 Hb, p<0.001], glutathione peroxidase [Al group (12.37±5.76) IU g-1 Hb, C group (15.54±4.85) IU g-1 Hb, p<0.001], catalase [Al group (116.76±26.60) IU g-1 Hb, C group (158.81±71.85) IU g-1 Hb, p<0.001] and superoxide dismutase [Al group (1175.8±149.9) IU mg-1 Hb, C group (1377.9±207.5) IU mg-1 Hb, p<0.001]. Lipidna peroksidacija i aktivnost antioksidativnih enzima u eritrocitima radnika profesionalno izloženih aluminiju Rezultati suvremenih istraživanja pokazuju da lipidna peroksidacija može imati važnu ulogu u toksičnosti aluminija. Cilj istraživanja bio je da se ispita lipidna peroksidacija i aktivnost antioksidativnih enzima u eritrocitima kod radnika profesionalno izloženih aluminiju. Ispitivanjem je obuhvaćena skupina od 59 radnika (Al skupina) profesionalno izloženih aluminiju (faktor onečišćenja F=8,07 do 13,47, nacionalna maksimalno dopuštena koncentracija je 2 mg m-3). Kontrolna skupina sastojala se od 75 osoba zaposlenih u proizvodnji vapna koje nikada nisu bile profesionalno izložene aluminiju ni drugim toksičnim tvarima. U skupini izloženoj aluminiju utvrđene su statistički signifikantno više koncentracije aluminija u eritrocitima nego u kontrolnoj skupini [Al skupina (8,41±3,66) μg L-1, kontrolna skupina (5,60±0,86) μg L-1, p<0,001]. U Al skupini utvrđene su statistički značajno više koncentracije malondialdehida u eritrocitima [Al skupina (189,59±81,27) μmol L-1, kontrolna skupina (105,21±49,62) μmol L-1, p<0,001]. Također, u Al skupini utvrđene su i statistički značajno niže aktivnosti antioksidativnih enzima u eritrocitima: glukozo-6-fosfatdehidrogenaza [Al skupina (5,05±1,70) IU g-1 Hb, kontrolna skupina (12,53±4,12) IU g-1 Hb, p<0,001], glutationreduktaza [Al skupina (1,41±0,56) IU g-1 Hb, kontrolna skupina (1,89±0,57) IU g-1 Hb, p<0,001], glutationperoksidaza [Al skupina (12,37±5,76) IU g-1 Hb, kontrolna skupina (15,54±4,85) IU g-1 Hb, p<0,001], katalaza [Al skupina (116,76±26,60) IU g-1 Hb, kontrolna skupina (158,81±71,85) IU g-1 Hb, p<0,001] i superoksiddizmutaza [Al skupina (1175,8±149,9) IU mg-1 Hb, kontrolna skupina (1377,9±207,5) IU mg-1 Hb, p<0,001].

Effect of Magnesium Supplementation on the Distribution Patterns of Zinc, Copper, and Magnesium in Rabbits Exposed to Prolonged Cadmium Intoxication

The present study is designed to investigate whether magnesium (Mg) supplementation may prevent Cd-induced alterations in zinc (Zn), copper (Cu), and magnesium (Mg) status in rabbits. For this purpose, the concentrations of Zn, Cu, and Mg were estimated in blood, urine, and organs (brain, heart, lungs, liver, kidney, spleen, pancreas, skeletal muscle, and bone) of rabbits given Cd (10 mg/kg b.w.) and rabbits cotreated with Mg (40 mg/kg b.w.) orally, as aqueous solutions of Cd chloride and Mg acetate every day for 4 weeks. Samples were mineralized with conc. HNO3 and HClO4 (4:1) and metals concentrations were determined by atomic absorption spectrophotometry (AAS). Magnesium supplementation succeeded to overcome Cd-induced disbalance of investigated bioelements. Beneficial effects of Mg were observed on Zn levels in blood and urine, on Cu levels in urine, and on Mg levels in blood. Magnesium pretreatment also managed to counteract or reduce all Cd-induced changes in levels of Cu and Mg in organs, while it did not exert this effect on Zn levels. These findings suggest that enhanced dietary Mg intake during Cd exposure can have at least partly beneficial effect on Cd-induced alterations in homeostasis of zinc, copper, and magnesium.

Biliary function in workers occupationally exposed to aluminium dust and fumes.

Biliary Function in Workers Occupationally Exposed to Aluminium Dust and Fumes This study investigated billiary secretory function in workers occupationally exposed to aluminium dust and fumes. It included a group of 34 male workers aged (44.1±7.8) years and exposed up to 4.6 mg m-3 of aluminium dust and fumes in workplace air for (21.6±2.5) years, and a group of 30 unexposed control male workers. Serum and urine aluminium levels were measured in both groups before and after chelating treatment with 1 g deferoxamine by intramuscular injection. Billiary function was assessed by measuring gamma-glutamyl transpeptidase, alkaline phosphatase, 5-nucleotidase, cholesterol and its fractions, total and indirect bilirubin, and bile acids. We then analysed the relationship between Al exposure and billiary function. In the exposed group mean serum aluminium was significantly higher [(4.91±3.86) μg L-1] than in controls. The same was true for urine Al before [(1.57±1.93) μg L-1] and after deferoxamine [(11.51±14.97) μg L-1]. Total and indirect bilirubin and alkaline phosphatase were significantly higher in the exposed than in control workers, and they correlated with urine Al after the chelating treatment. Our findings suggest that chronic occupational exposure to aluminium dust and fumes leads to a significant body retention of aluminium. The impaired biliary secretion in the exposed workers manifested itself in subclinical signs of cholestasis. Bilijarna funkcija u radnika profesionalno izloženih aluminijskoj prašini i dimu Eksperimentalna istraživanja na životinjama pokazuju da kronična izloženost aluminiju može izazvati smanjen prijenos organskih aniona preko žučnih kanalića, što ima za posljedicu poremećaje sekrecije žuči i kolestazu. Učinci kronične izloženosti aluminiju na bilijarnu funkciju u ljudi do sada nisu istraživani. Procjenjivali smo učinke na bilijarnu funkciju radnika koji su profesionalno izloženi prašini i dimu aluminija. U izloženoj skupini bila su 34 muškarca, životne dobi (44,1±7,8) godina koji su tijekom (21,6±2,5) godina bili izloženi razini do 4,6 mg m-3 prašine i dima aluminija. Kontrolna skupina sastojala se od 30 neizloženih radnika. Vrijednosti aluminija određene su u serumu i mokraći u obje skupine prije i nakon davanja kelatirajućeg spoja (deferoksamin u dozi od 1 g im.). Za procjenu bilijarne funkcije rabljeni su ovi pokazatelji: γ-glutamil transpeptidaza, alkalna fosfataza, 5-nukleozidaza, kolesterol, ukupni i indirektni bilirubin te žučne kiseline. Analizirana je korelacija između izloženosti aluminiju i bilijarne funkcije. Srednja vrijednost Al u serumu izloženih radnika [(4,91±3,86) μg L-1], kao i koncentracije Al u mokraći prije [(1,57±1,93) μg L-1] i nakon primjene kelatirajućeg spoja [(11,5±15,0) μg L-1] bile su statistički značajno više u odnosu na vrijednosti u kontrolnih ispitanika. Vrijednosti ukupnog i indirektnoog bilirubina te alkalne fosfataze bile su statistički značajno više u izloženih radnika i pozitivno su korelirale s ukupnim Al izlučenim mokraćom nakon primjene kelatora. Može se zaključiti da kronična profesionalna izloženost prašini i dimu aluminija dovodi do tjelesnog opterećenja aluminijem i poremećaja bilijarne funkcije, što se odražava supkliničkim znakovima kolestaze.

Work Ability Assessment in a Patient with Wilson's Disease

Work Ability Assessment in a Patient with Wilsons Disease Wilsons disease (WD) is a rare, progressive autosomal recessive disorder characterised by impaired transport and excessive accumulation of copper in the liver, brain, and other tissues. The disease is diagnosed based on clinical manifestations and screening tests results. Work ability assessment of patients with WD is based on the analysis of liver, kidney, neurological, and cognitive impairments, and takes into account patients level of education. This article presents a case with a 48-year-old male patient, who was admitted for work ability assessment due to polymorphic symptoms. The patient had been working as a salesman for 28 years. A detailed interview and examination by occupational health and other medical specialists revealed that the patient had been suffering from Wilsons disease from the age of 13, and had now developed hepatic manifestations (compensated liver cirrhosis with portal hypertension), neurological manifestations (dystonia, dysarthria, muscle weakness, vertigo), and psychiatric manifestations (depression, insomnia, cognitive impairment) of the disease, including problems partially caused by long-lasting treatment with copper chelating agents (neurological and haematological manifestations). There were no ocular manifestations of Wilsons disease (Kayser-Fleischer rings or sunflower cataract). The patient was assessed as having drastically diminished general work ability, dominantly due to neurological and psychiatric impairments caused by Wilsons disease. Ocjena radne sposobnosti pacijenta s wilsonovom bolesti - prikaz bolesnika Wilsonova je bolest rijetka, progresivna autosomno recesivna bolest karakterizirana poremećajem transporta bakra i posljedičnim prekomjernim nakupljanjem bakra u jetri, mozgu i drugim tkivima i organima. Dijagnoza bolesti postavlja se na osnovi kliničkih manifestacija bolesti i nalaza laboratorijskih ispitivanja. Ocjena radne sposobnosti pacijenata s Wilsonovom bolesti zasniva se na analizi postojanja oštećenja i stupnja oštećenja hepatičkih, neuroloških, bubrežnih i kognitivnih funkcija, kao i na analizi stupnja obrazovanja pacijenata. Prikazan je slučaj D. M., 48-godišnjeg pacijenta, koji je primljen zbog polimorfnih tegoba na bolničko ispitivanje radi ocjene radne sposobnosti. Pacijent je radio kao prodavač posljednjih 28 godina. Nakon detaljne anamneze i pregleda koje su obavili specijalisti medicine rada i drugi specijalisti utvrđeno je da pacijent boluje od Wilsonove bolesti od 13. godine života i da u ovom trenutku ima izražene hepatične manifestacije (kompenzirana ciroza jetre s portalnom hipertenzijom), neurološke manifestacije (distonija, dizartrija, mišićna slabost, vrtoglavica) i psihijatrijske manifestacije (depresija, nesanica, kognitivno oštećenje) Wilsonove bolesti, kao i da su prisutne tegobe djelomično uzrokovane dugotrajnom upotrebom kelatne terapije (neurološki i hematološki poremećaji). Nisu uočene karakteristične očne promjene Wilsonove bolesti (Kayser-Fleischerov prsten, katarakta u obliku suncokreta). Ocjenom radne sposobnosti utvrđeno je da pacijent ima drastično smanjenu radnu sposobnost pretežno zbog neuroloških i psihičkih poremećaja u sklopu Wilsonove bolesti.

Can zinc supplementation ameliorate cadmium-induced alterations in the bioelement content in rabbits?

Abstract The study was designed to investigate the influence of zinc (Zn) supplementation on cadmium-induced alterations in zinc, copper (Cu), and magnesium (Mg) status in rabbits. For this purpose, the concentrations of cadmium (Cd), Zn, Cu, and Mg were estimated in the blood, liver, kidney, and bone. The rabbits were divided in a control group, a Cd group-animals intoxicated orally with Cd (10 mg kg-1 bw, as aqueous solution of Cd-chloride), and a Cd+Zn group-animals intoxicated with the same dose of Cd and co-treated with Zn (20 mg kg-1 bw, as aqueous solution of Zn-sulphate). Solutions were administered orally, every day for 28 days. Sample mineralisation was performed with concentrated nitric acid (HNO3) and perchloric acid (HClO4) (4:1) and metal concentrations were determined by atomic absorption spectrophotometry (AAS). Zinc supplementation improved some of Cd-induced disturbances in bioelement levels in the investigated tissues. Beneficial effects of Zn on Zn and Cu levels were observed in blood, as well as on the Cu kidney level. The calculated values for Cu/Zn, Mg/Zn, and Mg/Cu ratios in blood suggest that Zn co-treatment reduces Cd-induced changes in bioelement ratios in blood.

Environmental and take-home lead exposure in children living in the vicinity of a lead battery smelter in Serbia

ABSTRACT Blood lead levels (BLLs) have been falling steadily worldwide due to restricted use of lead (Pb) and its compounds. although they remain above preindustrial Pb levels. Elevated BLL can still be found in children living near secondary Pb smelters that represent around 50% of Pb production. There have been no studies on Pb exposure in children living in Serbia ever since the 1980s. The aim of this study was to evaluate the BLLs in children living in two villages in Serbia (Zajača, the location of a secondary lead smelter, and Paskovac, 5 km away), identify the primary determinants of children’s BLLs, and investigate the impact of BLLs on children’s health symptoms and school achievement. The study was conducted in 2011 on 127 children, aged 1–18 years, whose BLLs were measured using inductively coupled argon plasma mass spectrometry (ICP‐MS). The median BLL in children was 12 &mgr;g/dl, with a significantly higher value of 17.5 &mgr;g/dl in Zajača, compared to 7.6 &mgr;g/dl in Paskovac. Only 1 out of 75 and 12 out of 52 children from Zajača and Paskovac, respectively, had BLLs below the CDC recommended 5 &mgr;g/dl level. Living near the smelter resulted in 19 times, and having a father who works in the plant 4 times higher odds of elevated BLLs. No significant effects of elevated BLLs health symptoms were seen in this study. BLLs of children living near a battery recycling plant in Serbia, an upper‐middle income European country, were in the range and even higher than those of children living in developing countries. For the first time, the contribution of environmental and take‐home lead exposure was quantified using mixed‐effect modeling, and our results indicate a contribution of 25–40% of the take‐home lead exposure to the BLLs of children living in the vicinity of a secondary lead smelter. HighlightsChildren living near a battery recycling plant had elevated blood lead levels (BLLs).Children 0–6 years old living closest to the plant had the highest BLLs.Higher lead exposure was found in children whose fathers worked in the plant.The contribution of take‐home lead exposure was between 25% and 40%.

Occupational exposure to blood and bodily fluids among healthcare workers in Serbian general hospitals

Abstract The risk of occupational bloodborne infections (HBV, HCV, and HIV) among healthcare workers remains a serious issue in developing countries. The aim of this study was to estimate occupational exposure to bloodborne infections among general hospital workers in Serbia. This cross-sectional study was conducted in the spring of 2013 and included 5,247 healthcare workers from 17 general hospitals. The questionnaire was anonymous, self-completed, and included sociodemographic information with details of blood and bodily fluid exposure over the career and in the previous year (2012). Significant predictors of sharps injuries were determined with multiple logistic regressions. The distribution of accidents in 2012 was equal between the genders (39 %), but in entire career it was more prevalent in women (67 %). The most vulnerable group were nurses. Most medical doctors, nurses, and laboratory technicians reported stabs or skin contact with patients’ blood/other bodily fluid/tissue as their last accident. Healthcare workers from the north/west part of the country reported a significantly lower number of accidents over the entire career than the rest of the country (p<0.001). The south of Serbia stood out as the most accident-prone in 2012 (p=0.042).

Assessment of coarse and fine hand motor performance in asymptomatic subjects exposed to hand-arm vibration

Summary A frequently encountered exposure profile for hand-arm vibration in contemporary occupational setting comprises workers with a long history of intermittent exposure but without detectable signs of hand-arm vibration syndrome (HAVS). Yet, most of the published studies deal with developed HAVS cases, rarely discussing the biological processes that may be involved in degradation of manual dexterity and grip strength when it can be most beneficial - during the asymptomatic stage. In the present paper, a group of 31 male asymptomatic vibration-exposed workers (according to the Stockholm Workshop Scale) were compared against 30 male controls. They were tested using dynamometry and dexterimetry (modelling coarse and fine manual performance respectively) and cold provocation was done to detect possible differences in manual performance drop on these tests. The results showed reduced manual dexterity but no significant degradation in hand grip strength in the exposed subjects. This suggests that intermittent exposure profile and small cumulative vibration dose could only lead to a measurable deficit in manual dexterity but not hand grip strength even at non-negligible A(8) levels and long term exposures. Sažetak U suvremenim uvjetima profesionalne izloženosti vibracijama koje se prenose preko ruke i šake, često se mogu vidjeti radnici koji su, i pored dugotrajne povremene izloženosti, i dalje bez uočljivih simptoma vibracijske bolesti. U većini dosadašnjih istraživanja analizirani su ispitanici s razvijenom kliničkom slikom vibracijske bolesti, uz rijetka razmatranja bioloških procesa koji mogu biti uključeni u degradaciju ručne spretnosti i snage stiska šake, osobito u asimptomatskoj fazi, kada bi to bilo od najveće koristi. U ovom su istraživanju uspoređene dvije skupine ispitanika: izložena skupina - 31 radnik izložen lokalnim vibracijama koji prema Stockholmskoj klasifikaciji nema simptome vibracijske bolesti, i kontrolna skupina - 30 radnika koji nisu izloženi lokalnim vibracijama. Svaki je ispitanik bio podvrgnut dinamometrijskom i deksterimetrijskom testiranju (model za grubu i finu motoričku funkciju šake) te testu provokacije hladnoćom radi usporedbe pada motoričkih funkcija šake. U izloženoj skupini zabilježen je pad fine motoričke funkcije, ali ne i snage stiska šake. Rezultati upozoravaju na mjerljiv deficit grube ali ne i fine motoričke funkcije šake kod povremene izloženosti s malim kumulativnim dozama, čak i kada se radi o dugotrajnoj izloženosti nezanemarivim razinama A(8). Vibracijama inducirane lezije živčanih vlakana i/ ili mehanoreceptora, koji osiguravaju senzornu povratnu vezu za signale pokreta - čime kontroliraju zadatke koji iziskuju precizno kretanje prstiju - mogle bi biti odgovorne za uočeno smanjenje ručne spretnosti. Taj mehanizam, međutim, nije potreban za kontrolu grube sile stiska.