Cardiovascular Toxicity in Copper Production Workers Exposed to Heavy Metals

Introduction. Cardiovascular diseases (CVD) are a leading cause of morbidity and mortality. The role of occupational hazards in the CVD prevalence remains to be clarified. Material and methods. Here we report the results of the study of risk factors and CVD prevalence in 590 workers at the largest copper production plants in the Sverdlovsk region, exposed to heavy metals in the workplace. The workers' health information was obtained during a regular medical examination in 2018. The lead concentration increase to 1.3-1.8 occupational exposure limits was registered in the working areas of the concentrating mill (for bunkerman) and copper smelting workshops (transporter, smelter, converter, non-ferrous metal spreader, repairman, electrician). Results. We studied the exposure indices (Pb level in blood), the response markers (reticulocyte count, erythrocytes basophilic stippling, coproporphyrin, and aminolevulinic acid in the urine), and their correlation to a working tenure. Based on this analysis, we attributed CVD risk factors and cardiovascular diseases to the occupation, in order to potentially modify some of those risk factors and ultimately inform the risk management. Hypertension occurred in 57% of the examined workers, which is higher than in the general population. We calculated relative risk, confidence intervals and attributable fraction. We developed a predictive mathematical model (stepwise logistic regression) to predict high-stage hypertension and identified the risk factors associated with its development. Conclusions. Correlation analysis revealed direct correlations between stages 2 and 3 hypertension and a working tenure over 20 years. We think it's reasonable to consider the documented CVDs as related to the toxic effects of heavy metals (lead and cadmium). © 2020 Izdatel'stvo Meditsina. All rights reserved.The work of Solodushkin was supported by Act 211 Government of the Russian Federation, contract No 02.A03.21.0006

Non-pharmacological therapy in the treatment of cardiovascular pathology in workers exposed to dust chrysotile–asbestos

Diseases of the heart and blood vessels occupy a leading place (47%) among all comorbidities in persons engaged in the extraction and enrichment of chrysotile asbestos. Based on the analysis of the dynamics of the respiratory and cardiovascular systems developed physiotherapy complexes for the treatment of cardiac arrhythmias in workers exposed to the dust of chrysotile asbestos. The proposed complexes cause improvement of functional parameters of respiratory and cardiovascular systems and can be used for non-drug therapy of patients with combined bronchopulmonary and cardiovascular pathology. The first complex is indicated in patients with chronic obstructive bronchitis in remission phase, having a pronounced electrical instability of the myocardium. The second treatment complex can be assigned to patients with chronic obstructive bronchitis in the acute phase, with signs of chronic pulmonary heart and concomitant cardiac dysrhythmias.Заболевания сердца и сосудов занимают ведущее место (47%) среди всей сопутствующей патологии у лиц, занятых на добыче и обогащении хризотил – асбеста. На основе анализа динамики показателей дыхательной и сердечно-сосудистой систем разработаны физиотерапевтические комплексы для лечения сердечных аритмий у рабочих, экспонированных к пыли хризотил-асбеста. Предложенные комплексы вызывают улучшение функциональных показателей дыхательной и сердечно – сосудистой систем и могут быть использованы для немедикаментозной терапии больных с сочетанной бронхолегочной и кардиоваскулярной патологией. Первый комплекс показан больным хроническим бронхитом в фазе ремиссии, имеющим выраженную электрическую нестабильность миокарда. Второй лечебный комплекс может быть назначен больным хроническим бронхитом в фазе обострения, с признаками хронического легочного сердца и сопутствующими сердечными дисритмиями

The impact of cardiovascular and metabolic disease at the time of development of occupational chronic fluoride intoxication in workers of aluminium production

With the aim of studying the effect of disorders of carbohydrate and lipid exchange and associated cardiovascular disease at the time of development of occupational fluorosis assessed the prevalence of this disease among workers in aluminum production. A significant dissociation of carbohydrate and lipid metabolism indices against the background of high prevalence of overweight, obesity, arterial hypertension in workers in contact with elevated concentrations of inorganic fluorine compounds was established in comparison with patients of the comparison group who are not exposed to toxic substances (р=0,003, t=3,159). The increase in fasting glycemia was revealed already with the work experience of up to 10 years, which can testify to the danger of early development of type 2 diabetes in workers of aluminum production and the need for timely preventive measures in this category of workers. At the same time, patients with occupational fluorosis had significantly higher prevalence of carbohydrate metabolism disorders compared to trained workers without occupational fluorosis (р=0,006). It was revealed that professional fluorosis develops significantly earlier in workers with concomitant cardiovascular dis-ease and metabolic changes.С целью изучения влияния нарушений углеводного и липидного обмена и сопутствующей кардиоваскулярной патологии на сроки развития профессионального флюороза проведена оценка распространенности данной патологии у работников алюминиевого производства. Установлена значимая диссоциация показателей углеводного и липидного обмена на фоне высокой распространенности избыточной массы тела, ожирения, артериальной гипертензии у рабочих, контактирующих с повышенными концентрациями неорганических соединений фтора, по сравнению с пациентами группы сравнения, не подвергающихся воздействию токсических веществ: повышенная гликемия натощак диагностирована у 23% пациентов основной группы и только у 6% рабочих группы сравнения (р=0,003, t=3,159). Выявлено повышение гликемии натощак уже при стаже работы до 10 лет, что может свидетельствовать об опасности раннего развития сахарного диабета 2 типа у рабочих алюминиевых производств и необходимости проведения своевременных профилактических мероприятий у данной категории работников. В то же время у больных профессиональным флюорозом установлена достоверно более высокая распространенность нарушений углеводного обмена по сравнению со стажированными работниками без профессионального флюороза (р=0,006). Выявлено, что профессиональный флюороз достоверно раньше развивается у работников с сопутствующей сердечно-сосудистой патологией и метаболическими изменениями

Variability of diagnostic criteria and treatment of idiopathic nephrotic syndrome across European countries

The aim of the surveys conducted by the Idiopathic Nephrotic Syndrome Working Group of the ESPN was to study the possible variability of treatment in Europe at different stages of the disease by means of questionnaires sent to members of the Working Group. Four surveys have been completed: treatment of the first flare, treatment of the first relapse and the issue of steroid dependency, use of rituximab, and the management of steroid-resistant patients. A uniform treatment of the first flare was applied in only three countries, and ten additional centers have adopted one of the three main protocols. Reported treatment of the first relapse was relatively uniform, whereas the use of additional immunosuppressants in steroid dependency was widely variable. Rituximab had already been used in hundreds of patients, although the formal evidence of efficiency in steroid dependency was relatively recent at the time of the survey. The definition of steroid resistance was variable in the European centers, but strikingly, the first-line treatment was uniform throughout the centers and included the combination of prednisone plus calcineurin antagonists. Conclusion: The variability in the approach of idiopathic nephrotic syndrome is unexpectedly large and affects treatment of the first flare, strategies in the case of steroid dependency, as well as the definitions of steroid resistance.What is Known:• Steroids and immunosuppressants are the universal treatment of idiopathic nephrotic syndrome.What is New:• The variability of treatments and strategy of treatment in European centers of pediatric nephrology

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

PREVALENCE OF BLOOD CIRCULATION DISEASES AMONG WORKERS EXPOSED TO OCCUPATIONAL NOISE IN MINERAL EXTRACTION AND THEIR WORK-RELATEDNESS

The purpose of the study was to assess work-related diseases of blood circulation among workers occupationally exposed to noise in mineral extraction. Material and methods. Working conditions, health status of 1481 workers of leading occupations of oil and ore minerals extraction along with the assessment of cardio-vascular system functional state according to electrocardiography, eye fundus vessels, systemic microhemodynamics and blood microcirculation of bulbar conjunctiva have been studied. Results and discussion. Workers of these occupations are exposed to a complex of work environment and work process factors with occupational noise as a priority one. Blood circulation diseases are detected two times more frequently among workers than in the control group. Arterial hypertension frequency increases with age and work experience; a reliable increase is observed among individuals with work experience of 11-15 years and more than 15 years as compared to the group of workers with 6-10-year work experience and less than 5 years. On electrocardiographic examination, changes in the heart have been revealed in 54.2 % of workers engaged in ore extraction and 42.9 % of workers of oil extraction. Cerebrovascular diseases in most workers have been diagnosed along with arterial hypertension and atherosclerotic processes confirmed by changes in the eye fundus vessels. Thus, the elevated prevalence and an increase in arterial hypertension frequency due to work experience do not exclude potential impact of hazardous working conditions on its formation. The significant role of working conditions for arterial hypertension development has been established among operators of overhaul and underground repair of wells, drift miners, machinists of loading and delivery machines, aggregates and excavators. This is the foundation for the development of measures for creating safe working conditions and prevention of blood circulation diseases