Association between Musculoskeletal Pain and Bone Turnover Markers in Long-Term Pb-Exposed Workers.

BACKGROUND: On chronic exposure, Lead (Pb) deposits in the skeletal system, replaces calcium ions, and alters the normal physiological processes, which in turn, lead to stunting, delayed fracture healing, and high resorption of collagen molecules. The present study aimed to assess the association of musculoskeletal pain and discomfort with bone turnover markers (BTMs) among long-term Pb-exposed workers. STUDY DESIGN: A cross-sectional study. METHODS: The study recruited 176 male Pb-exposed workers and 80 control subjects who were matched for age, gender, and socio-economic status. Blood lead levels (BLLs), bone growth markers, such as serum osteocalcin (OC), alkaline phosphatase (ALP), bone alkaline phosphatase (BAP), and bone resorption markers: serum pyridinoline (Pry), deoxypyridinoline (DPry), tartrate-resistant acid phosphatase-5b(TRACP-5b), and hydroxyproline in urine (HyP-U) of participants were investigated. Pain and discomfort in the musculoskeletal system were assessed using Nordic Musculoskeletal Questionnaire. RESULTS: Pb-exposure was significantly associated with musculoskeletal discomfort of the lower back (P<0.001), upper back (P<0.001), and ankle/foot (P=0.011). Among bone formation markers, serum OC was significantly lower in musculoskeletal discomfort of elbows (P=0.033) and ankle/foot (P=0.042). Among bone resorption markers, serum DPry was significantly lower in musculoskeletal discomfort of the neck (P=0.049) and shoulders (P=0.023). HyP-U was significantly higher in musculoskeletal discomfort of shoulders (P=0.035) and lower back (P=0.036). CONCLUSION: As evidenced by the obtained results, Pb-exposure was associated with musculoskeletal discomfort of the lower back, upper back, and ankle/foot. Lower bone formation (serum OC) marker was noted with musculoskeletal discomfort of elbows and ankle/foot. Furthermore, bone resorption markers were associated with musculoskeletal discomfort of the neck, shoulders, and lower back. The findings of the present study suggested that long-term Pb-exposure and BTMs were associated with musculoskeletal discomfort.

Assessment of Bone Turnover Biomarkers in Lead-Battery Workers with Long-Term Exposure to Lead.

BACKGROUND: The major portion of lead in the body resides in skeletal system. The bone turnover affects the release of lead into the circulation from bones. The bone turnover biomarkers (BTM) in lead-battery workers with long-term exposure to lead have not been explored yet. OBJECTIVE: To evaluate the BTM (formation and resorption) in lead-battery workers with long-term exposure to lead in lead-battery manufacturing plant. METHODS: 176 male lead-exposed workers and 80 matched comparison group were studied. All participants were examined for blood lead levels (BLLs), bone formation biomarkers- serum osteocalcin (OC), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP)-and bone resorption biomarkers-serum pyridinoline (PYD), deoxypyridinoline (DPYD), tartarate-resistant acid phosphatase-5b (TRACP-5b), and urinary hydroxyproline (UHYP). RESULTS: We found a significantly higher bone formation biomarkers such as BALP (p=0.007) and bone resorption biomarkers, eg, PYD (p=0.048), TRCAP-5b (p=0.001), and UHYP (p=0.001) in lead-exposed workers. A significant (p=0.041) negative correlation (ρ ­0.128) was noted between BLLs and OC. A significant positive correlation was noted between BLLs and TRACP-5b (ρ 0.176, p=0.005) and UHYP (ρ 0.258, p=0.004). Serum OC (p=0.040) and UHYP (p=0.015) levels changed significantly with BLL level. Bone resorption biomarkers levels- PYD, TRACP-5b, and BALP-were higher among those with higher BLLs levels. The duration of exposure was significantly associated with BALP (p=0.037), DPYD (p=0.016), TRACP-5b (p=0.001), and UHYP (p=0.002) levels. CONCLUSION: Long-term lead exposure affects the bone turnover.

Association of Musculoskeletal Disorders and Inflammation Markers in Workers Exposed to Lead (Pb) from Pb-battery Manufacturing plant.

BACKGROUND: Lead (Pb) deposits in the skeletal system on chronic exposure and releases to circulation over a period. The musculoskeletal disorders (MSDs) are associated with enhanced expression of inflammation. The combination of Pb-exposure and MSDs induced inflammation was not attempted. OBJECTIVE: This study was conducted to examine the association between MSDs and inflammatory markers in workers exposed to Pb from Pb-battery plant. MATERIAL AND METHODS: In a case-control study design, the study enrolled 176 male Pb-exposed workers as study subjects and 80 healthy workers with no occupational exposure to Pb as control subjects. The Nordic musculoskeletal questionnaire was used to assess the MSDs. From the blood sample, blood lead level (BLL) and High Sensitivity C-reactive protein (Hs-CRP) were estimated as markers of Pb-exposure and Inflammatory marker respectively. The BLL was estimated by flame atomic absorption spectrometric method and the Hs-CRP by using a diagnostic kit method. RESULTS: Significantly high proportions of MSDs were noted in study subjects as compared to controls. The MSDs identified in the study subjects were at low back (33%) followed by knee (26%), shoulders (16%), neck (14%), ankle/foot (11%), wrist/hand (10%), elbows (8%), upper back (7%), and hips/thighs (5%). The significant association between Pb-exposure and MSDs among study subjects was mainly noted in low back and ankle/foot. Also, significantly high serum Hs-CRP levels were noted among study subjects with ankle/foot MSDs. CONCLUSION: Pb-exposure and inflammatory markers were significantly associated with lower limbs of MSDs.

Assessment of Lead Exposure and Urinary-δ-aminolevulinic Acid Levels in Male Lead Acid Battery Workers in Tamil Nadu, India.

BACKGROUND: Exposure to lead (Pb) affects multiple health outcomes and physiological systems. In adults, even small increases in blood Pb levels have been associated with decreased glomerular filtration rate, increased risk of hypertension and increased incidence of essential tremor. To date, there have been few Pb-exposure assessments using the United States Occupational Health and Safety Administration (OSHA) regulations. OBJECTIVE: The aim of the present study was to assess Pb-exposure in terms of elevated blood lead levels (BLL) and urinary-δ-aminolevulinic acid (U-δ-ALA) levels of workers exposed to Pb in the lead acid battery industry in Tamil Nadu, India based on Pb exposure regulations set by the American Conference of Governmental Industrial Hygienists (ACGIH) and OSHA. MATERIALS AND METHODS: BLLs and U-δ-ALA were estimated in 449 male workers exposed to Pb across ten different job categories in a lead acid battery factory. Worker BLLs were estimated using atomic absorption spectrophotometry and U-δ-ALA was estimated using spectrophotometry. RESULTS: The Biological Exposure Index of the American Conference of Governmental Industrial Hygienists (BEI-ACGIH) were used to assess Pb exposure. BLLs <30 µg/dL were found in 63.5% of workers, and 36.5% of workers had BLLs>30 µg/dL. The present study also assessed Pb exposure using OSHA regulations and found that 83.3% of workers had BLLs <40 µg/dL and 16.7% of workers had BLLs>40 µg/dL. Among these workers, 0.7% of workers had BLLs >60 µg/dL. An excessive excretion of U-δ-ALA (20-40 mg/L) was noted in pasting area workers (2.6%) followed by executives (2.2%) and assembly workers (0.9%). CONCLUSIONS: Workers in the job categories of pasting and assembly, as well as executives, are at high risk of Pb exposure compared to other job categories. We recommend placing humidifiers on the roof and keeping a water bath closer the to plate cutting area to reduce fugitive Pb dust emissions. We recommended workers with BLLs >60 µg/dL be removed from jobs involving Pb exposure and return to work only when their BLLs are <40 µg/dL. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the ethics committee of the Regional Occupational Health Centre (Southern) Bengaluru, part of the National Institute of Occupational Health of India. COMPETING INTERESTS: The authors declare no competing financial interests.

Effect of Lead Exposure on the Status of Reticulocyte Count Indices among Workers from Lead Battery Manufacturing Plant.

Earlier studies conducted on lead-exposed workers have determined the reticulocyte count (RC) (%), but the parameters of Absolute Reticulocyte Count (ARC), Reticulocyte Index (RI), and Reticulocyte Production Index (RPI) were not reported. This study assessed the effect of lead (Pb) exposure on the status of reticulocyte count indices in workers occupied in lead battery plants. The present cross-sectional study was carried out on 391 male lead battery workers. The blood lead levels (BLL) were determined by using an Atomic Absorption Spectrophotometer. The RC (%) was estimated by using the supravital staining method. The parameters, such as ARC, RI, and RPI, were calculated by using the RC (%) with the red cell indices (RBC count and hematocrit). The levels of RBC count and hematocrit were determined by using an ABX Micros ES-60 hematology analyzer. The levels of reticulocyte count indices - RC (%), ARC, RI, and RPI significantly increased with elevated BLL. The association between BLL and reticulocyte count indices was positive and significant. The results of linear multiple regression analysis showed that the reticulocyte count (ß = 0.212, P < 0.001), ARC (ß = 0.217, P < 0.001), RI (ß = 0.194, P < 0.001), and RPI (ß = 0.208, P < 0.001) were positively associated with BLL. The variable, smoking habits, showed a significant positive association with reticulocyte count indices: RC (%) (ß = 0.188, P < 0.001), ARC (ß = 0.174, P < 0.001), RI (ß = 0.200, P < 0.001), and RPI (ß = 0.151, P < 0.005). The study results revealed that lead exposure may cause reticulocytosis with an increase of reticulocyte count indices.

Effects of lead exposure on the status of platelet indices in workers involved in a lead-acid battery manufacturing plant.

This study was carried out to determine the effect of Pb exposure on the status of platelet indices in workers exposed to Pb during lead-acid battery plant process. Platelet indices and blood lead levels (BLLs) were determined in 429 male workers. BLLs were determined by using an atomic absorption spectrophotometer. Platelet indices in the samples were quantified by using the Sysmex KX-21 hematology analyzer. The levels of platelet count (PLT), plateletcrit (PCT) and mean platelet mass (MPM) were significantly decreased and platelet distribution width (PDW), platelet large cell ratio (P-LCR) and mean platelet volume were increased with an increase in BLLs. The results of linear multiple regression analysis showed that the platelet count (ß -0.143, P=0.005), PCT (ß -0.115, P=0.023) and MPM (ß -0.110, P=0.030) were negatively associated with BLLs and P-LCR (ß 0.122, P=0.016) was positively associated with BLLs. The variable of body mass index showed a positive association with PCT (ß 0.105, P=0.032) and MPM (ß 0.101, P=0.039). The results of the study may indicate that lead exposure may impair coagulation function through endothelial tissue injury and reduction of nitric oxide.

The relationship between blood lead levels and morbidities among workers employed in a factory manufacturing lead-acid storage battery.

The present study was carried out to find the relationship between blood lead levels (BLLs) and morbidities among 391 male workers employed in a factory manufacturing lead-acid storage batteries. A predesigned questionnaire was used to collect information on subjective health complaints and clinical observation made during a clinical examination. In addition to monitoring of BLL, other laboratory parameters investigated included hematological and urine-δ-aminolevulinic acid levels. Logistic regression method was used to evaluate the relationship between BLL and morbidities. The BLL among workers was associated with an odd ratio of respiratory, gastrointestinal (GI), and musculoskeletal (MSD) morbidities. Mean corpuscular hemoglobin and packed cell volume variables were associated with respiratory problems. The variables of alcohol consumption and hematological parameters were associated with GI complaints. Systolic blood pressure was related to MSD in workers exposed to Pb during the manufacturing process.

Estimation of capsaicin through scanning densitometry and evaluation of different varieties of capsicum in India.

Capsicum annuum L. (family: Solanaceae) possesses therapeutic benefits for the treatment of rheumatism, neuropathy, psoriasis, flatulence and so on. In this study fruits of four different varieties of C. annuum from four different geographical regions in India were evaluated based on their total content of capsaicin. Ethanol extracts of the fruits were used. HPTLC plates were developed in a mobile phase containing benzene, ethyl acetate and methanol (75:20:5). Densitometric scanning was performed at a wavelength of 283 nm in the absorbance mode. The calibration curve was described by the equation Y=393.587+3.836*X with a correlation coefficient (r) of 0.99890. The content of capsaicin in Nagaland, Manipur, West Bengal and Shimla varieties was found to be 3.71%, 1.78%, 0.54% and 0.06%, respectively. The developed densitometric method was found to be specific, accurate and precise. A recovery study and precision showed low levels of %RSD values. The linearity range of the curve for capsaicin was found to be 300-900 ng per spot. The limit of detection and the limit of quantification values were determined to be 31 and 94 ng, respectively, proving the sensitivity of the method. Thus the method can be used to control the total content of capsaicin on an industrial scale.