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1.
Methoxyflurane toxicity: historical determination and lessons for modern patient and occupational exposure.
Allison, SJ, Docherty, PD, Pons, D, Chase, JG
The New Zealand medical journal. 2021;(1534):76-90
Abstract
AIM: Historically methoxyflurane was used for anaesthesia. Evidence of nephrotoxicity led to abandonment of this application. Subsequently, methoxyflurane, in lower doses, has re-emerged as an analgesic agent, typically used via the Penthrox inhaler in the ambulance setting. We review the literature to consider patient and occupational risks for methoxyflurane. METHOD Articles were located via PubMed, ScienceDirect, Google Scholar, Anesthesiology journal and the Cochrane Library. RESULTS Early studies investigated pharmacokinetics and considered the resulting effects to pose minimal risk. Pre-clinical rodent studies utilised a species not vulnerable to the nephrotoxic fluoride metabolite of methoxyflurane, so nephrotoxicity was not identified until almost a decade after its introduction, and was initially met with scepticism. Further evidence of nephrotoxicity led to abandonment of methoxyflurane use for anaesthesia. Subsequent research suggested there are additional risks potentially relevant to recurrent patient or occupational exposure. Specifically, greater than expected fluoride production after repeated low-dose exposure, increased fluoride production due to medication-caused hepatic enzyme induction, fluoride deposition in bone potentially acting as a slow-release fluoride compartment, which suggests a risk of skeletal fluorosis, and hepatotoxicity. Gestational risk is unclear. CONCLUSIONS Methoxyflurane poses a potentially substantial health risk in high (anaesthetic) doses, and there are a number of pathways whereby repeated exposure to methoxyflurane in lower doses may pose a risk. Single analgesic doses in modern use generally appear safe for patients. However, the safety of recurrent patient or occupational healthcare-worker exposure has not been confirmed, and merits further investigation.
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A clandestine culprit with critical consequences: Benzene and acute myeloid leukemia.
Shallis, RM, Weiss, JJ, Deziel, NC, Gore, SD
Blood reviews. 2021;:100736
Abstract
While most clinicians recognize adult therapy-related leukemias following cytotoxic chemotherapy and radiation, environmental regulatory agencies evaluate exposure to "safe levels" of leukemogenic compounds. Benzene represents the most notorious leukemogenic chemical. Used in the production of ubiquitous items such as plastics, lubricants, rubbers, dyes, and pesticides, benzene may be responsible for the higher risk of acute myeloid leukemia (AML) among automobile, janitorial, construction, and agricultural workers. It is possible that ambient benzene may contribute to many cases of "de novo" AML not arising out of germline predispositions. In this appraisal of the available literature, we evaluate and discuss the association between chronic, low-dose and ambient exposure to environmental benzene and the development of adult AML.
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Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States.
Chapman, CL, Hess, HW, Lucas, RAI, Glaser, J, Saran, R, Bragg-Gresham, J, Wegman, DH, Hansson, E, Minson, CT, Schlader, ZJ
American journal of physiology. Regulatory, integrative and comparative physiology. 2021;(2):R141-R151
Abstract
Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.
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4.
Potential ocular and systemic COVID-19 prophylaxis approaches for healthcare professionals.
Shetty, R, Lalgudi, VG, Khamar, P, Gupta, K, Sethu, S, Nair, A, Honavar, SG, Ghosh, A, D'Souza, S
Indian journal of ophthalmology. 2020;(7):1349-1356
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Abstract
The COVID-19 pandemic has brought with it, innumerable challenges in healthcare, both through the direct burden of morbidity and mortality of the disease, and also by the curtailing of other essential albeit less emergency medical services to reduce the risk of community spread. Reports from around the world are showing mounting number of cases even in healthcare professionals spite of usage of adequate personal protective equipment. There are a number of factors which could account for this, be it the affinity of the virus to the respiratory and other mucosa or to patient risk factors for developing severe forms of the disease. In view of the growing need for resuming other medical services, it is essential to find newer ways to protect ourselves better, whether by systemic or topical mucosal prophylaxis with various medications or lifestyle changes promoting wellbeing and immunity. This article discusses additional prophylactic measures including drug repurposing or new indication paradigms to render protection. Certain medications such as chloroquine, trehalose, antihistaminics, and interferons used topically for various ocular conditions with reasonably good safety records are known to have anti-viral properties. Hence, can be harnessed in preventing SARS-CoV-2 attachment, entry, and/or replication in host cells. Similarly, use of hypertonic saline for nasal and oral mucosa and dietary changes are possible methods of improving our resistance. These additional prophylactic measures can be cautiously explored by healthcare professionals to protect themselves and their patients.
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Donning and doffing of personal protective equipment protocol and key points of nursing care for patients with COVID-19 in ICU.
Yuan, L, Chen, S, Xu, Y
Stroke and vascular neurology. 2020;(3):302-307
Abstract
Coronavirus pandemic is the most important public health event in the world currently. Patients with coronavirus disease 2019 (COVID-19) in a critical state are at risk of progressing rapidly into many serve complications; they require a high level of care from ICU nurses. How to avoid the virus to infect health care worker is also a critical issue. Based on the summarized experience of Chinese health workers, literature review and clinical practice, this article introduced donning and doffing of personal protective equipment (PPE) protocol and some keypoints of nursing critical care in patients with coronavirus disease 2019 (COVID-19): caring of patients requiring intubation and ventilation, venous thromboembolism (VTE) prevention, caring of patients on ECMO, caring for patients requiring enteral nutrition, psychological support and nursing management of COVID-19 ICU. This article introduced a useful protocol of donning and doffing personal protective equipment to protect health care workers, and provided key points for the ICU nurses how to take care of COVID-19 patients.
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Glyphosate's Synergistic Toxicity in Combination with Other Factors as a Cause of Chronic Kidney Disease of Unknown Origin.
Gunatilake, S, Seneff, S, Orlando, L
International journal of environmental research and public health. 2019;(15)
Abstract
Chronic kidney disease of unknown etiology (CKDu) is a global epidemic. Sri Lanka has experienced a doubling of the disease every 4 or 5 years since it was first identified in the North Central province in the mid-1990s. The disease primarily affects people in agricultural regions who are missing the commonly known risk factors for CKD. Sri Lanka is not alone: health workers have reported prevalence of CKDu in Mexico, Nicaragua, El Salvador, and the state of Andhra Pradesh in India. A global search for the cause of CKDu has not identified a single factor, but rather many factors that may contribute to the etiology of the disease. Some of these factors include heat stroke leading to dehydration, toxic metals such as cadmium and arsenic, fluoride, low selenium, toxigenic cyanobacteria, nutritionally deficient diet and mycotoxins from mold exposure. Furthermore, exposure to agrichemicals, particularly glyphosate and paraquat, are likely compounding factors, and may be the primary factors. Here, we argue that glyphosate in particular is working synergistically with most of the other factors to increase toxic effects. We propose, further, that glyphosate causes insidious harm through its action as an amino acid analogue of glycine, and that this interferes with natural protective mechanisms against other exposures. Glyphosate's synergistic health effects in combination with exposure to other pollutants, in particular paraquat, and physical labor in the ubiquitous high temperatures of lowland tropical regions, could result in renal damage consistent with CKDu in Sri Lanka.
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Neurotoxic effects of mercury exposure in dental personnel.
Bjørklund, G, Hilt, B, Dadar, M, Lindh, U, Aaseth, J
Basic & clinical pharmacology & toxicology. 2019;(5):568-574
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Abstract
Numerous studies have reported neurobehavioural effects in dental personnel occupationally exposed to chronic low levels of mercury (Hg). Hg exposure from dental work may also induce various chronic conditions such as elevation of amyloid protein expression, deterioration of microtubules and increase or inhibition of transmitter release at motor nerve terminal endings. Therefore, clinical studies of Hg toxicity in dentistry may provide new knowledge about disturbed metal homeostasis in neurodegenerative diseases such as Alzheimer's disease, multiple sclerosis and mood disorders. The purpose of this MiniReview is to evaluate the evidence of possible relevance between Hg exposure in dentistry and idiopathic disturbances in motor functions, cognitive skills and affective reactions, as well as dose-response relationships.
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Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos.
Maisonneuve, P, Rampinelli, C, Bertolotti, R, Misotti, A, Lococo, F, Casiraghi, M, Spaggiari, L, Bellomi, M, Novellis, P, Solinas, M, et al
Lung cancer (Amsterdam, Netherlands). 2019;:23-30
Abstract
OBJECTIVES Smoking is the main risk factor for lung cancer, but environmental and occupational exposure to carcinogens also increase lung cancer risk. We assessed whether extending low-dose computed tomography (LDCT) screening to persons with occupational exposure to asbestos may be an effective way reducing lung cancer mortality. MATERIALS AND METHODS We conducted a nested case-control study within the COSMOS screening program, assessing past asbestos exposure with a questionnaire. LDCT scans of asbestos-exposed participants were reviewed to assess the presence of pulmonary, interstitial and pleural alterations in comparison to matched unexposed controls. We also performed an exhaustive review, with meta-analysis, of the literature on LDCT screening in asbestos-exposed persons. RESULTS Exposure to asbestos, initially self-reported by 9.8% of COSMOS participants, was confirmed in 216 of 544 assessable cases, corresponding to 2.6% of the screened population. LDCT of asbestos-exposed persons had significantly more pleural plaques, diaphragmatic pleural thickening and pleural calcifications, but similar frequency of parenchymal and interstitial alterations to unexposed persons. From 16 papers, including this study, overall lung cancer detection rates at baseline were 0.81% (95% CI 0.50-1.19) in asbestos-exposed persons, 0.94% (95% CI 0.47-1.53) in asbestos-exposed smokers (12 studies), and 0.11% (95% CI 0.00-0.43) in asbestos-exposed non-smokers (9 studies). CONCLUSION Persons occupationally exposed to asbestos should be monitored to gather more information about risks. Although LDCT screening is effective in the early detection lung cancer in asbestos-exposed smokers, our data suggest that screening of asbestos-exposed persons with no additional risk factors for cancer does is not viable due to the low detection rate.
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Spacecraft Maximum Allowable Concentrations for Manganese Compounds in Mars Dust.
Romoser, AA, Ryder, VE, McCoy, JT
Aerospace medicine and human performance. 2019;(8):709-719
Abstract
INTRODUCTION Exposure to excess manganese (Mn) can cause multiple toxicological outcomes in humans, most notably neurotoxicity. Ample epidemiological evidence suggests that chronic, low-level exposure causes subclinical cognitive effects. Because NASA astronauts will be exposed to Mars regolith, Spacecraft Maximum Allowable Concentrations (SMACs) were developed following an extensive literature review.METHODS Multiple databases were searched for information relevant to derivation of Mn SMAC values. An additional search for Mars dust data was performed. Risk assessment approaches were applied, including adjustments for space-relevant susceptibility to Mn effects, to develop limits for 1-h to 1000-d exposures. Rover data informed the assessment and enabled calculation of allowable total dust exposure based on Mn content.RESULTS Over 400 relevant sources were identified. Applicability of exposure characteristics and data collection methods influenced key study choice. SMACs ranging from 3 mg · m-3 (1 h) - 0.0079 mg · m-3 (1000 d) were set to protect primarily against neurocognitive and respiratory effects. Considering 0.38 wt% total Mn presence in the dust, maximum recommended total dust exposure should not exceed 790 mg · m-3 (1 h) - 2 mg · m-3 (1000 d).DISCUSSION This literature review allowed for identification of relevant studies to inform SMAC development. Manganese is one of several components to consider when developing an appropriate total dust limit for Martian dust; other dust elements may alter Mn bioavailability. Mission-specific activities may require alteration of assumptions regarding Mn dust concentration and exposure duration. However, based on expected toxicity of particulate matter itself, the acute SMACs are protective, even with transient exposure during activities that could produce higher concentrations.Romoser AA, Ryder VE, McCoy JT. Spacecraft maximum allowable concentrations for manganese compounds in Mars dust. Aerosp Med Hum Perform. 2019; 90(8):709-719.
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Acute Respiratory Failure from Cement Exposure: A Case Report and Review of the Literature.
Ali, S, Wightman, R, Hack, J
Rhode Island medical journal (2013). 2019;(1):55-57
Abstract
Cement is widely used in construction. Acute exposures with immediate sequelae have been infrequently described. This case report describes a man who developed multifocal pneumonitis with acute respiratory distress syndrome (ARDs) and respiratory failure one day after cement dust exposure. Chromium, cobalt, and nickel components in cement may cause pulmonary tissue irritation. Sand and gravel in cement may cause direct abrasive injury. Inhalation may cause direct thermal injury through an exothermic reaction. The silicon dioxide component has been shown to cause pulmonary injury through cytokine-mediated inflammation. Cement batches for smaller-scale construction jobs are often mixed onsite increasing exposure risk. Implementation of personal protective equipment has been shown to reduce respiratory symptoms among cement workers, underscoring the need for occupational health standards and further research. [Full article available at http://rimed.org/rimedicaljournal-2019-02.asp].