Multiple air pollutant exposure and lung cancer in Tehran, Iran.

Lung cancer is the most rapidly increasing malignancy worldwide with an estimated 2.1 million cancer cases in the latest, 2018 World Health Organization (WHO) report. The objective of this study was to investigate the association of air pollution and lung cancer, in Tehran, Iran. Residential area information of the latest registered lung cancer cases that were diagnosed between 2014 and 2016 (N = 1,850) were inquired from the population-based cancer registry of Tehran. Long-term average exposure to PM10, SO2, NO, NO2, NOX, benzene, toluene, ethylbenzene, m-xylene, p-xylene, o-xylene (BTEX), and BTEX in 22 districts of Tehran were estimated using land use regression models. Latent profile analysis (LPA) was used to generate multi-pollutant exposure profiles. Negative binomial regression analysis was used to examine the association between air pollutants and lung cancer incidence. The districts with higher concentrations for all pollutants were mostly in downtown and around the railway station. Districts with a higher concentration for NOx (IRR = 1.05, for each 10 unit increase in air pollutant), benzene (IRR = 3.86), toluene (IRR = 1.50), ethylbenzene (IRR = 5.16), p-xylene (IRR = 9.41), o-xylene (IRR = 7.93), m-xylene (IRR = 2.63) and TBTEX (IRR = 1.21) were significantly associated with higher lung cancer incidence. Districts with a higher multiple air-pollution profile were also associated with more lung cancer incidence (IRR = 1.01). Our study shows a positive association between air pollution and lung cancer incidence. This association was stronger for, respectively, p-xylene, o-xylene, ethylbenzene, benzene, m-xylene and toluene.

Urine Methyl Hippuric Acid Levels in Acute Pesticide Poisoning: Estimation of Ingested Xylene Volume and Association with Clinical Outcome Parameters.

To determine the relationship between the oral ingestion volume of xylene and methyl hippuric acid (MHA) in urine, we measured MHA in 11 patients whose ingested xylene volume was identified. The best-fit equation between urine MHA and ingested amount of xylene was as follows: y (ingested amount of xylene, mL/kg) = -0.052x² + 0.756x (x = MHA in urine in g/g creatinine). From this equation, we estimated the ingested xylene volume in 194 patients who had ingested pesticide of which the formulation was not available. Our results demonstrated that oxadiazole, dinitroaniline, chloroacetamide, organophosphate, and pyrethroid were xylene-containing pesticide classes, while the paraquat, glyphosate, glufosinate, synthetic auxin, fungicide, neonicotinoid, and carbamate classes were xylene-free pesticides. Sub-group univariate analysis showed a significant association between MHA levels in urine and ventilator necessity in the pyrethroid group. However, this association was not observed in the organophosphate group. Our results suggest that MHA in urine is a surrogate marker for xylene ingestion, and high urine MHA levels may be a risk factor for poor clinical outcome with some pesticide poisoning.

Benzene poisoning, clinical and blood abnormalities in two Brazilian female gas station attendants: two case reports.

BACKGROUND: Brazilian gas station workers are chronically exposed to benzene, toluene, xylene (BTX) during their working time. Describe below two cases of latin female gas station workers with benzene poisoning symptoms and miscarriage history. CASE PRESENTATION: In both cases were identified complex chromosomal rearrangements (CCR) with fluorescence in situ hybridization, applied to whole chromosome paints by chromosomes 1, 2 and 4. The lower natural killer cell (NK) cells have also been observed in cases correspondents, especially the rare type of NK (NKbright) in their peripheral blood cells. CONCLUSIONS: It is known that acquired chromosomal aberrations are positively correlated with cancer and reproductive risk. In concordance, lower NK cytotoxicity increases the risk for cancer, as well. Thus, this is the first study providing hints on a possible causative relation of lower NK cytotoxicity and increase rates of chromosomal rearrangements including CCRs.

Cardiotoxic effect due to accidental ingestion of an organic solvent.

Toxic myocardial injury can be misdiagnosed as a myocardial infarction, resulting in the patient undergoing standard treatment for cardiac rehabilitation. However, such inadequate therapeutic strategies can lead to cardiovascular complications including dilated cardiomyopathy. This study presents a case of a 65-year-old man after accidental ingestion of organic solvents (toluene and xylene), whose condition demonstrated all the criteria for diagnosis of myocardial infarction. The qualitative determinations of the above mentioned volatile organic compounds (VOCs) in whole blood were carried out using a headspace sampling by means of gas chromatography. Cardiac catheterization revealed no specific coronary lesions, only a muscular bridge causing a 30-50% stenosis in the middle of the circumflex branch of the left coronary artery.

Changes in poly(ADP-ribosyl)ation patterns in workers exposed to BTX.

Occupational exposure to (benzene, toluene and xylene, BTX is common in the Chinese workplace. Chronic occupational exposure to benzene is associated with an increased risk of hematological malignancies such as acute myeloid leukemia (AML), but the underlying mechanisms are still unclear. This study investigates changes in poly(ADP-ribosyl)ation and DNA methylation in subjects occupationally exposed to a BTX. Blood DNA samples and exposure data were obtained from subjects with different levels of exposure, including 132 decorators, 129 painters, and 130 unexposed referents in a container-manufacturing factory in Shenzhen, China. Occupational exposure assessment included personal monitoring of airborne benzene, toluene and xylene. Hematological parameters were measured and the cytokinesis-block micronucleus (CBMN) assay was used to detect DNA damage in peripheral lymphocytes. Quantitative real-time PCR was used to detect the mRNA expression of poly(ADP-ribose) polymerase 1 (PARP1) and poly(ADP-ribose) glycohydrolase (PARG), DNA methyltransferases (DNMTs) including DNMT1, DNMT3a and DNMT3b, methyl-CpG-binding domain protein 2(MBD2). PARP1 assay was used to measure PARP activity. Airborne levels of benzene, toluene and xylene in the two exposed groups were significantly higher than those of controls (P<0.001). The two exposed groups (decorators, painters) showed decreased PARP1, DNMTs and MBD2 expression relative to controls (P<0.05), and PARP activity was also decreased (P<0.05). Decreased PARP1, DNMT1, DNMT3a, DNMT3b and MBD2 mRNA expression was correlated with increased airborne BTX (Pearson's r: -0.587, -0.314, -0.636, -0.567 and -0.592 respectively, P<0.001). No significant differences in hematological parameters and CBMN were found among the three groups. Together, these results suggest that decreased DNMTs, MBD2 and PARP1 might be involved in the global hypomethylation associated with BTX exposure, and the imbalance of PARP/PARG might participate in the down-regulation of DNMTs. This is the first human study to link altered poly(ADP-ribosyl)ation patterns, which reproduce the aberrant epigenetic patterns found in benzene-treated cells, to chronic occupational exposure to BTX.

Dettol poisoning and the need for airway intervention.

OBJECTIVES. To (1) characterise the clinical features of Dettol poisoning on a territory-wide basis, (2) assess the need for airway intervention after such poisoning and its time frame after ingestion, and (3) identify predictors for such an intervention. DESIGN. Case series. SETTING. Sixteen accident and emergency departments in Hong Kong. PATIENTS. Patients with Dettol ingestion who presented within 48 hours of ingestion from July 2005 to June 2009, derived from the database of the Hong Kong Poison Information Centre. RESULTS. In all, 213 patient records were identified, of which 36 were excluded based on pre-defined criteria and 177 were analysed. Among the latter, the median age was 32 (range, 2-95) years and the male-to-female ratio was 1:2.7 (48:129). Intentional ingestion constituted the majority (95%) of cases. The most common symptoms were related to the local irritative/corrosive effects on the aero-digestive tract, such as gastro-intestinal upset and localised throat pain. Airway intervention was required in 14 (8%) patients. All interventions were performed within 12 hours of Dettol ingestion and three cases involved re-intubation after extubation. Univariate analysis showed that a Glasgow Coma Scale score of <8, older age, a larger amount ingested, lip swelling, lung crackles, and wheezing were all associated with airway intervention. In the multivariate analysis using forward stepwise logistic regression, only coma (Glasgow Coma Scale score of <8) remained statistically significant. CONCLUSIONS. Delayed airway obstruction (>12 hours after Dettol ingestion) is unlikely. For those who are intubated, careful assessment of airway adequacy before extubation is strongly recommended to avoid extubation failure and subsequent re-intubation. Patients in coma (Glasgow Coma Scale score of <8) should prompt airway intervention.

High concentration of methidathion detected in a fatal case of organophosphate-poisoning.

We report a case of fatal intoxication caused by the ingestion of an organophosphate pesticide, methidathion (DMTP). An 80-year-old male was found dead in his bed. Forensic autopsy revealed no remarkable morphological changes. However, in a toxicological screening test, methidathion was qualitatively detected in extracts of stomach contents. Concentrations of methidathion (µg/g) in body fluids and organ tissues, determined by gas chromatography-mass spectrometry, were as follows; 66.2 in heart blood, 8.33 in peripheral blood, 8.80 in urine, 2000 in the brain (frontal lobe), 4800 in the left lung, 810 in the liver, 150 in the left kidney, and 64,000 in the stomach contents (total 1.9 g). These results strongly suggested that the victim orally ingested methidathion. Additionally, xylene was determined in body fluids and organ tissues. From the toxicological data together with autopsy findings, the cause of his death was diagnosed as acute poisoning by an emulsion of methidathion.

Exposición a solventes y disfunción auditiva central: revisión de la evidencia científica / Solvent exposure and central auditory dysfunction: a literature review on the scientific evidence

Diversos estudios han demostrado que los solventes orgánicos pueden inducir una disfunción auditiva. Los modelos animales han mostrado que los solventes son capaces de dañar las células ciliadas externas. Estudios de campo en trabajadores expuestos a solventes han encontrado por una parte, una mayor prevalencia de hipoacusia sensorioneural en comparación a grupos controles, y por otra, una dis función auditiva central asociada a la exposición a solventes. El presente trabajo tiene como objetivo revisar y discutir la evidencia científica acerca de la disfunción auditiva central asociada a la exposición a solventes como el tolueno, estireno, xileno, bisulfato de carbono, y mezcla de ellos. Se discuten los resultados de las investigaciones llevadas a cabo en humanos expuestos laboralmente a estos agentes. Se discuten además, los mecanismos de ototoxicidady neurotoxidad de los solventes y sus implicancias en la evaluación de la hipoacusia inducida por solventes.

Different studies have demonstrated that solvents may induce an auditory dysfunction. Animal models have shown that solvents can injure the outer hair cells. Studies conducted in workers exposed to solvents have found on one hand, a higher prevalence of sensorineural hearing loss in comparison to non-exposed control group subjects. On the other hand, these studies have found a central auditory dysfunction associated with solvent exposure. The present manuscript aims at revising and discussing the scientific evidence on central auditory dysfunction associated with exposure to solvents such as toluene, styrene, xylene, carbon disulphate, and mixtures. Results from studies conducted in humans occupationally exposed to solvents are discussed. Also, the oto-and neuro-toxicity induced by solvents and the implications for the assessment of solvent-induced hearing loss are addressed.

A fatal case of a paint thinner ingestion: comparison between toxicological and histological findings.

Toluene and xylene are aromatic hydrocarbons commonly used as an industrial solvent for the manufacturing of pharmaceuticals, paints, and chemicals. The Occupational Safety and Health Administration has determined that toluene levels of 2000 parts per million (ppm) are considered dangerous to life and health. Several studies have examined the absorption of toluene and xylene following inhalation and oral ingestion in humans. Volatile organic compounds that are absorbed into the blood are distributed throughout the body; in particular, distribution of absorbed toluene and xylene in humans and rodents is characterized by preferential uptake in well-perfused and lipophil tissues such as the brain, liver, lungs, and body fat and also in central nervous system. The available studies indicate that xylenes are rapidly absorbed independently from the kind of exposition. We illustrate a fatal case of self-poisoning by ingestion of varnishes diluting solvents, reporting the identification and quantification of volatile organic compounds (toluene, o-m-p xylene) from human biologic liquids and viscera samples using the Solid-Phase Microextraction-Headspace-Gas Chromatography/Mass Spectrometry to toxicological analysis, and the histopathological findings evaluated in liver, kidney, and lungs.

Intoxicación por amitraz / Amitraz poisoning

En nuestro medio, la intoxicación por amitraz y su solvente xileno es una patología poco frecuente, pero puede observarse un aumento en zonas rurales, donde se lo emplea como insecticida-ectoparasiticida. Por tal razón, se cuenta con escasa bibliografía que oriente su manejo en niños. Presentamos el caso de un paciente de 2 años de edad, con ingestión accidental de amitraz, internado en nuestra Unidad de Cuidados Intensivos Pediátricos y que requirió ventilación mecánica. Creemos que comunicar este caso puede ser útil para alertar sobre esta intoxicación, poco frecuente en nuestro medio.

Poisoning due to amitraz together with its solvent xilene, is an unusual condition although may be increasing in rural areas where it is used as insecticide-ectoparasiticide. At present, there is scare references to orient physicians concerning its handlingin childhood. We present the case of a 2-year-old boy who suffered an accidental intake of amitraz and was admitted into our Pediatric Intensive Care Unit requiring mechanical ventilation. We consider the usefulness of informing the medical community about this case so as to be aware of this rare kind of poisoning in our community.

Intoxicación por amitraz / Amitraz poisoning

En nuestro medio, la intoxicación por amitraz y su solvente xileno es una patología poco frecuente, pero puede observarse un aumento en zonas rurales, donde se lo emplea como insecticida-ectoparasiticida. Por tal razón, se cuenta con escasa bibliografía que oriente su manejo en niños. Presentamos el caso de un paciente de 2 años de edad, con ingestión accidental de amitraz, internado en nuestra Unidad de Cuidados Intensivos Pediátricos y que requirió ventilación mecánica. Creemos que comunicar este caso puede ser útil para alertar sobre esta intoxicación, poco frecuente en nuestro medio.(AU)

Poisoning due to amitraz together with its solvent xilene, is an unusual condition although may be increasing in rural areas where it is used as insecticide-ectoparasiticide. At present, there is scare references to orient physicians concerning its handlingin childhood. We present the case of a 2-year-old boy who suffered an accidental intake of amitraz and was admitted into our Pediatric Intensive Care Unit requiring mechanical ventilation. We consider the usefulness of informing the medical community about this case so as to be aware of this rare kind of poisoning in our community.(AU)

Audiological findings in individuals exposed to organic solvents: case studies.

Millions of people around the world are exposed to industrial organic solvents such as toluene and xylene in the manufacturing sectors. Solvents are neurotoxic substances that are detrimental to the functioning of the nervous system, including the central auditory nervous system (CANS). This study investigated hearing and auditory processing in seven individuals with a history of exposure to industrial solvents. A battery of audiological tests was administered to all subjects: pure tone, speech, and impedance audiometry, otoacoustic emissions tests, auditory brainstem responses, middle latency responses, as well as the SCAN-A and R-SPIN tests with low predictability sentence lists. All individuals in this study exhibited findings consistent with retrocochlear and/or central abnormality. Two of the seven subjects in this study had normal pure tone thresholds at all frequencies bilaterally, yet showed abnormal retrocochlear/central results on one or more tests. The auditory test battery approach used in this study appears to be valuable in evaluating the pathological conditions of the CANS in solvent-exposed individuals.

Multipronged evaluation of genotoxicity in Indian petrol-pump workers.

Petrol (gasoline) contains a number of toxicants. This study used human biomonitoring to evaluate the genotoxic effects of exposure to benzene in petrol fumes in 100 Indian petrol-pump workers (PPWs) and an equal number of controls. The study was corroborated with in silico assessments of the Comet assay results from the human biomonitoring study. An in vitro study in human lymphocytes was also conducted to understand the genotoxicity of benzene and its metabolites. In a subset of the population studied, higher blood benzene levels were detected in the PPWs (n = 39; P < 0.01) than the controls (n = 18), and 100-250 ppb benzene was also detected in air samples from the petrol pumps. PPWs had higher levels of DNA damage than the controls (P < 0.01). In addition, the micronucleus assay was performed on lymphocytes from a subset of the subjects, and the micronucleus frequency for PPWs was significantly higher (n = 39; 14.79 +/- 3.92 per thousand) than the controls (n = 18; 7.54 +/- 3.00 per thousand). Human lymphocytes were treated in vitro with benzene and several of its metabolites and assayed for DNA damage with the Comet assay. Benzene and its metabolites produced significant (P < 0.05) levels of DNA damage at and above concentrations of 10 microM. The metabolite, p-benzoquinone, produced the greatest amount of DNA damage, followed by hydroquinone > benzene > catechol > 1,2,4,-benzenetriol > muconic acid. This study demonstrates that, using sensitive techniques, it is possible to detect human health risks at an early stage when intervention is possible. possible.

[Oral intoxication with xylene--a case report]. / Doustne zatrucie ksylenem--opis przypadku.

UNLABELLED: A case of a suicidal oral exposure to xylene has been described. A 33 year-old female ingested 300-500 ml of xylene 2.5 hours before admission to the hospital. Hypotonia, metabolic acidosis, diarrhea and moderate, transient dysphagia were observed. Concentrations of xylene, toluene and ethylbenzene in blood at admission were 11.7; 2.9 and 0.18 mg/l respectively and 1.1; 0.33 and 0 mg/l after 24 hours after therapy. CONCLUSIONS: The course of acute xylene intoxication in the described case was relatively uneventful despite high blood concentration of xylene. Further study is necessary to establish the potentially lethal blood concentration of xylene.

A case exercise: outbreak investigation at a Vermont community hospital.

Fifteen employees became ill with headaches, nausea, and vomiting due to chemical poisoning at a Vermont community hospital on January 3, 1980. An epidemiologic and environmental investigation was conducted to determine the source of the illness. The investigation discovered that the vapors of a chemical called xylene, which had previously been disposed of down a drain, were drawn back through the sewer into specific work areas. These vapors were determined to be the most likely cause of the illnesses. This outbreak investigation was used to create an exercise that has been used in a variety of teaching settings.

Intravenous amitraz poisoning.

Amitraz, a derivative of dimethylformamidine, is an acariside and insecticide used to control parasites in animals. Amitraz inhibits monoamine oxidase and prostaglandin synthesis and is an alpha-2 adrenergic agonist. Xylene, a mixture of o-, m-, and p-dimethylbenzene, is widely used in industry. A 22-year-old woman was poisoned by an intravenous injection of 5-6 mL of an amitraz formulation (amitraz 12.5% + xylene 57.5%). Clinical findings were coma (Glasgow coma score 3), respiratory depression, hypotension, bradycardia, hematuria, and edema and hyperemia at the injection site. Although her coma and other symptoms quickly resolved, as has been seen in oral and dermal amitraz poisoning, intoxication with higher doses occurring from intravenous injection may result in more serious problems.

Stridor after ingestion of dettol and domestos.

Dettol (4.8% chloroxylenol, 9% pine oil and 12% isopropyl alcohol) has previously been reported to cause delayed upper airway obstruction when ingested, despite the product being labelled as non-poisonous. Domestos (1-5% sodium hypochlorite) is used as a household and toilet cleaner. This paper reports a rare case in which both agents were consumed together in significant quantities, and caused stridor and impending airway obstruction requiring endotracheal intubation in the emergency department. Patients who have ingested this combination of cleaning agents are at high risk of acute airway compromise, and should have expert upper airway evaluation and control as soon as possible after admission.