Wiktor Wesołowski

Ototoxic effects of occupational exposure to styrene and co-exposure to styrene and noise.

Learning ObjectivesRecall the reported effects of exposure to styrene and noise on the cochlear hair cells and hearing function in rats.Describe which possible confounding factors were and were not controlled for in this study, and what the results indicate about the respective ototoxic effects on humans of exposure to styrene and noise.Characterize the effects in humans of isolated and combined exposure to styrene and noise. Ototoxicity of styrene and the synergistic action of styrene and noise have been shown in rats. The respective data in humans are scarce and equivocal. This study evaluated the effects of occupational exposure to styrene and combined exposures to styrene and noise on hearing. The study group, comprised of 290-yacht yard and plastic factory workers, was exposed to a mixture of organic solvents, having styrene as its main compound. The reference group, totaling 223 subjects, included (1) white-collar workers, exposed neither to solvents nor noise and (2) metal factory workers, exposed exclusively to noise. All subjects were assessed by means of a detailed questionnaire and underwent otorhinolaryngological and audiometric examinations. Multiple logistic regression analysis revealed almost a 4-fold (or 3.9; 95% CI = 2.4–6.2) increase in the odds of developing hearing loss related to styrene exposure. The factors adjusted for were: age, gender, current occupational exposure to noise, and exposure to noise in the past. In cases of the combined exposures to styrene and noise, the odds ratios were two to three times higher than the respective values for styrene-only and noise-only exposed subjects. The mean hearing thresholds—adjusted for age, gender, and exposure to noise—were significantly higher in the solvent-exposed group than in the unexposed reference group at all frequencies tested. A positive linear relationship existed between an averaged working life exposure to styrene concentration and a hearing threshold at the frequencies of 6 and 8 kHz. This study provides the epidemiological evidence that occupational exposure to styrene is related to an increased risk of hearing loss. Combined exposures to noise and styrene seem to be more ototoxic than exposure to noise alone.

Effects of coexposure to noise and mixture of organic solvents on hearing in dockyard workers.

Questionnaire and audiometric data of 701 dockyard workers (517 noise and organic solvent mixture-exposed and 184 noise-only-exposed) were referred to 205 control subjects not exposed to either noise or solvents. The odds ratio (OR) of hearing loss was significantly increased by approximately 3 times in the noise-only group and by almost 5 times in the noise and solvent group. A moderate effect of solvent ototoxicity, in addition to noise, was observed on hearing threshold at a frequency 8 kHz. ORs for hearing loss were 1.12 for each increment of 1 year of age, 1.07 for every decibel of lifetime noise exposure (dB-A), and 1.004 for each increment of the index of lifetime exposure to solvents. The results suggest an additive damaging effect of coexposure to noise and organic solvents to the auditory organ.

Exacerbation of noise-induced hearing loss by co-exposure to workplace chemicals

BACKGROUND : Numerous organic solvents applied in industry, like toluene, styrene, xylene and n-hexane have been demonstrated to impair hearing in animals. However, the effects of exposure to a given organic solvent and the interaction of noise and solvents on hearing in humans are still not fully recognized. STUDY DESIGN : The study was aimed to assess the effects of occupational exposure to solvents alone or in combination with noise on hearing in 1117 employees of yacht, ship, plastic, shoe, and paint and lacquer industry. These persons were exposed either to the mixture of organic solvents with xylene as the main component, or predominantly to styrene, or to the mixture of n-hexane and toluene. Detailed questionnaire data and pure-tone audiometry were compared with data of the reference group that included white collar workers, exposed neither to solvents nor noise and metal factory workers exposed to noise only. In all statistics, the confounding factors were recognized as gender, age, exposure to noise, and other variables occurring at a different rate in study and reference group. RESULTS : Odds ratio (OR) of hearing loss related with the particular exposure to chemicals was 2.4 (95%CI 1.59-3.74) in case of solvent mixture, 3.9 (95%CI 2.4-6.2) in case of styrene and 5.3 (95%CI 2.6-10.9) in case of n-hexane and toluene exposure. The odds of developing hearing loss substantially increased in the case of combined exposure to organic solvents and noise as compared to isolated exposure to each of these hazards. The highest OR (over 20-fold) was demonstrated in subgroups of subjects exposed simultaneously to noise and two ototoxic solvents (i.e. styrene and toluene or n-hexane and toluene). The mean hearing thresholds were significantly higher in the solvent-exposed groups than in the reference group. The differences in thresholds were observed at high frequencies in the solvent mixture- and n-hexane + toluene-exposed groups and at all frequencies in the styrene-exposed group. A positive linear relationship existed between exposure to solvents and hearing thresholds at high frequencies. CONCLUSIONS : The results of the study provide the epidemiological evidence that exposure to organic solvents in humans is associated with an increased risk of hearing loss. The simultaneous exposure to organic solvents and noise seems to enhance the hearing deficit if compared with isolated exposures.

Unmetabolized VOCs in urine as biomarkers of low level occupational exposure

OBJECTIVES To compare the usefulness of determining unchanged forms of volatile organic compounds (VOCs), namely toluene (TOL), ethylbenzene (EB) and xylene (XYL), in urine with the effectiveness of the already used biomarkers of occupational exposure. MATERIALS AND METHODS Surveys were conducted in two workplaces (paint factory and footwear factory). In total, 65 subjects participated in the study. Air samples were collected using individual samplers during work shift. Urine and blood samples were collected at the end of work shift. Urine samples were analyzed for unchanged compounds and selected metabolites, while blood samples were tested for unchanged compounds. VOCs in blood and urine were determined by solid phase microextraction gas chromatography (SPME-GC-MS). RESULTS In the paint factory, the geometric mean (GM) concentrations of VOCs in the air ranged as follows: 0.2-4.7 mg/m(3) for TOL, 0.4-40.9 mg/m(3) for EB and 0.1-122.6 mg/m(3) for XYL. In the footwear factory, the GM concentration of TOL in the air amounted to 105.4 mg/m(3). A significant correlation (p < 0.05) was observed between VOCs in blood, urine and air. The regression analyses performed for paint factory workers showed that TOL-U and TOL-B were better biomarkers of exposure (r = 0.72 and r = 0.81) than benzoic acid (r = 0.12) or o-cresol (r = 0.55). CONCLUSION The findings of the study point out that the concentration of unchanged VOCs in urine can be a reliable biological indicator of low level occupational exposure to these compounds.

Chemical composition of surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy – Assessment of the risk to the patient

ObjectivesThe aim of this study was to assess the exposure of patients to organic substances produced and identified in surgical smoke formed in the abdominal cavity during laparoscopic cholecystectomy.Material and MethodsIdentification of these substances in surgical smoke was performed by the use of gas chromatography-mass spectrometry (GC-MS) with selective ion monitoring (SIM). The selected biomarkers of exposure to surgical smoke included benzene, toluene, ethylbenzene and xylene. Their concentrations in the urine samples collected from each patient before and after the surgery were determined by SPME-GC/MS.ResultsQualitative analysis of the smoke produced during laparoscopic procedures revealed the presence of a wide variety of potentially toxic chemicals such as benzene, toluene, xylene, dioxins and other substances. The average concentrations of benzene and toluene in the urine of the patients who underwent laparoscopic cholecystectomy, in contrast to the other determined compounds, were significantly higher after the surgery than before it, which indicates that they were absorbed.ConclusionsThe source of the compounds produced in the abdominal cavity during the surgery is tissue pyrolysis in the presence of carbon dioxide atmosphere. All patients undergoing laparoscopic procedures are at risk of absorbing and excreting smoke by-products. Exposure of the patient to emerging chemical compounds is usually a one-time and short-term incident, yet concentrations of benzene and toluene found in the urine were significantly higher after the surgery than before it.

Testing of the composition of e-cigarette liquids – Manufacturer-declared vs. true contents in a selected series of products

BACKGROUND Electronic cigarettes are currently in common use. However, in Poland there is no specific legislation governing the sale of these products. At the same time, no information has been made public about the hazards e-cigarettes pose to the users and bystanders - passive smokers. The aim of the study was to determine the qualitative composition of the analyzed liquid, which is an essential element of regulating the distribution of such cigarettes. MATERIAL AND METHODS Under this study the method for determining the composition of e-cigarette liquids was developed. This method employs gas chromatography with mass spectrometry (GC-MS). Levels of nicotine and flavoring components were determined in 50 e-liquid samples. The results were compared with the information provided by the manufacturer on the packaging. RESULTS The applied method of qualitative determination helped to identify the main ingredients, such as nicotine and propylene glycol (PG). Propylene glycol was found to be present in all liquids, because it was used as the solvent for nicotine and flavors. There was a good agreement between the declared and the determined content of nicotine in the analyzed samples. The agreement was considerably poorer for the remaining e-liquid ingredients, mainly flavors. CONCLUSIONS There was no agreement between the flavor substances specified by the manufacturer and aroma identified in the e-cigarette liquid, which may pose a risk to users of e-cigarettes, particularly those susceptible to allergies. Several unsaturated aliphatic alcohols and aldehydes found to be present in the liquids, unstable at elevated temperatures, may be more harmful to the smoker than the original compounds. Therefore, it is essential to implement in Poland the legal provisions regarding e-cigarettes. Med Pr 2016;67(2):239-253.

Application of predictive models for estimation of health care workers exposure to sevoflurane.

Objectives. The aim of this study was to assess the potential use of predictive models to estimate professional exposure to chemicals in the workplace, such as the operating room, by simultaneous determination of the levels of exposure using a model and measurements. Methods. Measurements included determinations of sevoflurane (SEV) in the workplace air of 117 operating rooms of 31 hospitals in one Polish region. Measurements were carried out at the time of various surgical procedures during administration of anaesthetics by endotracheal intubation. The measurement results were compared with the values estimated using two models: ECETOC TRA and Stoffenmanager. Results. In one case the ECETOC TRA estimated the exposure concentration almost equal to the measured concentration but, because of the need to maintain a margin of safety in case of modelling, it can be concluded that the model underestimated the concentration. The Stoffenmanager model provided accurate exposure estimates in the examined case, and it can be used as a screening tool for the assessment of occupational inhalation exposure of medical personnel to anaesthetics. Conclusions. The results are of particular importance to the circumstances in Eastern Europe, where the levels of anaesthetics often exceed the relevant occupational exposure limits.

Health risk to medical personnel of surgical smoke produced during laparoscopic surgery.

OBJECTIVES During laparoscopic cholecystectomy, the removal of the gall bladder, pyrolysis occurs in the peritoneal cavity. Chemical substances which are formed during this process escape into the operating room through trocars in the form of surgical smoke. The aim of this study was to identify and quantitatively measure a number of selected chemical substances found in surgical smoke and to assess the risk they carry to medical personnel. MATERIAL AND METHODS The study was performed at the Maria Skłodowska-Curie Memorial Provincial Specialist Hospital in Zgierz between 2011 and 2013. Air samples were collected in the operating room during laparoscopic cholecystectomy. RESULTS A complete qualitative and quantitative analysis of the air samples showed a number of chemical substances present, such as aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, dioxins and others. CONCLUSIONS The concentrations of these substances were much lower than the hygienic standards allowed by the European Union Maximum Acceptable Concentration (MAC). The calculated risk of developing cancer as a result of exposure to surgical smoke during laparoscopic cholecystectomy is negligible. Yet it should be kept in mind that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Many of these compounds are toxic, and may possibly be carcinogenic, mutagenic or genotoxic. Therefore, it is necessary to remove surgical smoke from the operating room in order to protect medical personnel.

Comparison of chemical composition of selected essential oils used in respiratory diseases

BACKGROUND Essential oils are fragrances extracted from plants. They have a smooth consistency and pleasant smell. Essential oils have been applied in aromatherapy, cosmetics, food and pharmaceutical products. The aim of the study was to analyze the composition of selected essential oils used in respiratory diseases. MATERIAL AND METHODS The qualitative analysis was performed by gas chromatography with mass spectrometry. For the study 6 essential oils available in Polish shops and used in various respiratory diseases were chosen. The results were compared with the information provided by the manufacturer and the literature. RESULTS The method used in the presented work allowed to qualitatively identify the main components in studied essential oils. In the analyzed samples generally occurred: α- i β-pinene, limonene, terpinen-4-ol and caryophyllene. In addition to limonene, the presence of linalool, eugonol and geraniol, potentially allergenic substances, were also detected. CONCLUSIONS The qualitative composition of the studied essential oils comply with the existing literature data. Their main ingredients show antimicrobial and antiviral activities, therefore they are used to eradicate the symptoms of infection. However, the attention should be paid to the composition of the products because they often comprise potential allergens. Information on the presence of such a substance in the preparation should be clearly marked by the manufacturer on the packaging. Fragrances are also found in a number of household products that increase their concentration in the air of living premises, thereby increasing the risk of side effects especially in people with allergies or sensitive. Med Pr 2018;69(2):167-178.