Health Risk Assessment in Children Occupationally and Para-Occupationally Exposed to Benzene Using a Reverse-Translation PBPK Model

Benzene is a known human carcinogen and one of the ten chemicals of major public health concern identified by the World Health Organization. Our objective was to evaluate benzene's carcinogenic and non-carcinogenic health risks (current and projected) in highly exposed children in Yucatan, Mexico. Benzene exposure was estimated through a reverse-translation, four-compartment, physiologically based pharmacokinetic model (PBPK) based on previously performed urine trans, trans-muconic acid (benzene metabolite) determinations. Using a risk assessment methodology, the carcinogenic and non-carcinogenic risks of benzene were estimated for 6-12-year-old children from a family of shoemakers. The children's hazard quotients for decreased lymphocyte count were 27 and 53 for 4 and 8 h/day exposure, respectively, and 37 for the projected 8 h/day exposure in adults. The risks of developing leukemia were 2-6 cases in 1000 children exposed 4 h/day; 4-10 cases in 1000 children exposed 8 h/day, and 2-9 cases in 1000 adults with an 8 h/day lifetime exposure. Children in Yucatan working in shoe-manufacturing workshops, or living next to them, are exposed to benzene concentrations above the reference concentration and have unacceptably high risks of presenting with non-carcinogenic and carcinogenic hematologic symptoms, now and in the future. Interventions to prevent further exposure and mitigate health risks are necessary.

Prenatal Co-Exposure to Manganese, Mercury, and Lead, and Neurodevelopment in Children during the First Year of Life

Lead (Pb), mercury (Hg), and manganese (Mn) are neurotoxic, but little is known about the neurodevelopmental effects associated with simultaneous prenatal exposure to these metals. We aimed to study the associations of Pb, Hg, and Mn prenatal levels (jointly and separately) with neurodevelopment in the first year of life. Methods: Pb, Hg, and Mn blood lead levels were measured in 253 pregnant women. Their offspring's neurodevelopment was assessed through the Bayley Scale of Infant Development III^® at one, three, six, and twelve months. The metals' mean blood levels (µg/L) were Pb = 11.2, Hg = 2.1, and Mn = 10.2. Mean language, cognitive, and motor development scores of the infants at each age were between low-average and average. Multilevel models' results showed that language development coefficients of the offspring decreased by 1.5 points per 1 µg/dL increase in maternal blood lead levels (p = 0.002); the magnitude of the aforementioned association increased in children with maternal blood Mn < 9.6 µg/L (ß = -1.9, p = 0.003) or Hg > 1.9 µg/L (ß = -1.6, p = 0.013). Cognitive and motor development had negative associations with maternal blood Pb levels; the latter was statistically significant when the interaction term between Pb, Mn, and Hg was included (ß = -0.037, p = 0.03). Prenatal exposure to low Pb levels may impair infants' neurodevelopment in the first year of life, even more so if they are exposed to Hg or deficient in Mn.

Fluoride Exposure through Different Drinking Water Sources in a Contaminated Basin in Guanajuato, Mexico: A Deterministic Human Health Risk Assessment

Water fluoride levels above the World Health Organization’s guideline (1.5 mg/L), common in overexploited aquifers, represent a health hazard. Our objective was to assess the health risks posed by exposure to fluoride in different drinking water sources in a contaminated basin in Mexico. Fluoride was measured in mutual drinking water sources and in the urine of 39 children and women. Risks were estimated through hazard quotient (HQ) by drinking water source. Dental fluorosis was assessed in the children. Mean fluoride water concentrations (mg/L) were: well, 4.2; waterhole, 2.7; bottled, 2.1; rainwater, 0.4. The mean urinary fluoride concentrations (specific gravity adjusted) were 2.1 mg/L and 3.2 mg/L in children and women, respectively. Our multiple linear regression model showed children’s urinary fluoride concentrations increased 0.96 mg/L for every 1 mg/L increase in water fluoride (p < 0.001). Dental fluorosis was diagnosed in 82% of the children, and their HQ according to drinking water source was: well, 1.5; waterhole, 1.1; bottled, 0.8; harvested rainwater, 0.3. The pervasive dental fluorosis indicates a toxic past fluoride exposure; urinary fluoride levels and HQs indicate high exposure and current health risks for most children. Drinking harvested rainwater will likely prevent most of the local fluoride exposure.

Environmental Health Promotion of a Contaminated Site in Mexico

Entangled in complex ecological, sociocultural, and economic systems, current environmental health problems require integrated participatory approaches. Alpuyeca, a semi-urban, highly marginalized community in South-Central Mexico burdened by lead and polychlorinated biphenyl (PCB) contamination, dengue fever, and intestinal diseases, illustrates this. Its residents are distinctive, however, for their concerted actions in the face of environmental problems and the presence of defenders of a prehispanic worldview based on the protection of nature. This article addresses the health impacts of an integrated environmental health promotion strategy implemented through a participatory action research intervention based on qualitative and quantitative methods. Different actors, sectors, dimensions, and knowledge types were harmonized in a collaborative space created specifically for our interdisciplinary research team, community residents and local authorities. Reflections, plans and actions were developed collectively in this space with the view of finding solutions anchored in the local culture. Results included sharp reductions in blood-lead concentrations among children, in entomological indices, and in PCB contamination, as well as capacity strengthening. Medium-level community participation was achieved. This work contributes evidence that participatory environmental health research can be effective in analyzing and reducing problems in communities with multiple environmental health concerns. It complements ecohealth and environmental health literacy approaches.

Prenatal exposure to persistent organic compounds and their association with anogenital distance in infants

RESEARCH QUESTION

What is the association between prenatal exposure to persistent organic pollutants, separately and combined, and anogenital distance (in-utero endocrine disruption marker).

DESIGN

A cohort study conducted in Sonora, Mexico. Blood concentrations of polychlorobiphenyls (PCB) 28, 74, 118, 138/158, 153, 170, 180 and the isomers of dichlorodiphenyltrichloroethane (DDT) and its metabolites were determined in women in the third trimester of pregnancy; three variants of anogenital distance were measured on five occasions during the first year of life of their infants: 82 girls (402 observations) and 74 boys (356 observations).

RESULTS

Boys had negative and significant associations between anogenital distance/height and the concentrations of PCB 28 (beta = - 0.005;P = 0.006), PCB 74 (beta = - 0.003;P = 0.013), and PCB 170 (beta = - 0.005;P = 0.001) when analysed individually. Negative and significant associations were also found using statistical models applied to mixtures of compounds. The latter associations were sometimes larger in magnitude and significance, suggesting a possible potentiation of the compounds. No associations were observed between anogenital distance and DDT in either sex or with PCB in girls.

CONCLUSIONS

The decreased anogenital distance associated with prenatal exposure to the persistent organic pollutants, observed consistently in different analyses, suggests an under-masculinizing effect of these environmental pollutants in boys.

Alterations in male reproductive hormones in relation to environmental DDT exposure

DDT [1, 1, 1-trichloro-2,2-bis (p-chlorophenyl)-ethane] compounds are used for indoor residual spraying (IRS) to control malaria mosquitoes. DDT is an endocrine disruptor chemical in experimental conditions, but little is known of adverse effects related to living conditions with continual uptake across a time span by all possible means of exposure. Based on estrogenic and/or anti-androgenic effects found in animal studies, we hypothesized that chronic DDT/DDE exposures in men may be associated with changes in male reproductive hormones. We tested this hypothesis by compared the magnitude and direction of associations between DDT and DDE (1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene) concentrations and male reproductive hormones in samples collected from IRS and non-IRS areas. We sampled a cross-section of 535 men (aged 18-40 years). Men living in IRS villages had significantly higher DDT and DDE concentrations compared with men from non-IRS villages. Men with DDT or DDE uptake (as reflected in detectable plasma concentrations) had significantly higher total-, free and bio-available testosterone (T), and lower follicle stimulating hormone (FSH) concentrations; lower luteinizing hormone (LH) concentrations were only evident with DDT uptake. To establish a dose-dependent effect, four sub-categories were defined. Men with the highest DDT (74-519 μg/g) and DDE (173-997 μg/g) concentrations had significantly higher total-, free and bio-available T, and lower FSH concentrations compared with subjects with non-detectable isomer concentrations. Estradiol concentrations were significantly higher in men with DDT and DDE concentrations in both the third (DDE: 27-172 μg/g; DDT: 5-73 μg/g) and fourth (DDE: 173-997 μg/g; DDT: 74-519 μg/g) categories. Men from IRS villages were significantly more likely to have higher total and bioavailable T as well as higher estradiol concentrations OR = 2.5 (95% CI 1.2, 3.2); OR 2.5 (95% CI 1.6, 4.0) and OR = 2.3 (95% CI 1.3, 4.1) compared to men from non-IRS villages, after controlling for age, BMI, personal use of pesticides, and smoking. Men living in IRS villages with life-long exposure (17.6 (±6) years) at the current residence with multiple exposure modalities incurred the highest degree of physiological imbalance over and above circulating isomer concentrations. Further studies are needed to elucidate the health implications of these findings.

Lead in school children from Morelos, Mexico: levels, sources and feasible interventions

Background: Lead is a pervasive pollutant, associated at low levels to many adverse health effects. Objective: To investigate lead levels, exposure pathways and intervention possibilities in school children from Alpuyeca, in Morelos, Mexico. Methods: Blood lead concentrations (BPb) were measured in 226 children in 2011. Exposure pathways were assessed through a questionnaire, lead measurements in different environmental matrices and spatial aggregation analysis of lead concentrations. Results: BPb ranged from 1.5 to 36.5 µg/dL, with a mean (SD) of 7.23 (4.9) µg/dL. Sixty-four and 18% of the children had BPb > 5 µg/dL and > 10 µg/dL, respectively. The use of lead glazed ceramics was reported in almost half of the households; it was the main BPb determinant and it was associated with an increased risk of having BPb > 5 g/dL by 2.7 times (p = 0.001). Environmental samples were within US EPA’s lead recommended limits, and blood lead levels were randomly distributed in the community. Conclusions: Lead remains a public health problem in Alpuyeca, Mexico. Unlike other local pollutants, lead exposure prevention can be achieved inexpensively and in a short term. Interventions should make mothers aware of lead’s health effects and empower them to safeguard their children’s health by avoiding the culturally ingrained use of lead glazed pottery.

Arousal and differential Fos expression in histaminergic neurons of the ascending arousal system during a feeding-related motivated behaviour

Arousal depends on the concerted activity of the ascending arousal system (AAS) but specific stimuli may primarily activate some nuclei of this system. Motivated behaviours are characterized by behavioural arousal, although it is not known which AAS nuclei are active during a motivated behaviour. To address this issue, rats were rendered motivated for food by fasting them for 1 day and then were enticed with food that they could not obtain for varying periods of time. We studied the level of arousal by polysomnography or radiotelemetry, and Fos-ir in the AAS, during food enticing. We found a strong arousal and an early increase in Fos-ir in the histaminergic neurons from the tuberomammillary nucleus, after 30 min of enticing, followed by increased Fos-ir in the whole AAS if food enticing was prolonged to 1 or 2 hours. In contrast, food presentation to non-motivated rats did not increase arousal or Fos-ir in the tuberomammillary nucleus. As opposed to the active arousal of the motivated rats, passive arousal induced by sensory stimulation was associated with increased Fos-ir in the locus coeruleus and the orexin neurons, but not with increased Fos-ir in the tuberomammillary nucleus or in the other nuclei of the AAS. We conclude that the arousal during feeding-related motivated behaviour is associated primarily with the activation of the tuberomammillary nucleus, while the other arousal-related nuclei become active later on.

Differential effects of infralimbic cortical lesions on temperature and locomotor activity responses to feeding in rats

The time of food availability induces important behavioral and metabolic adaptations. Animals subjected to feeding restricted to a few daytime hours show increased locomotor activity and body temperature in anticipation of mealtime. In addition, animals under ad libitum feeding show a marked postprandial raise in body temperature and in thermogenesis. The areas of the brain commanding these responses to food are partially known. We investigated in the rat the role of the infralimbic area, located in the medial prefrontal cortex, and considered a visceral-autonomic motor area, in the responses to ad libitum or restricted feeding schedule. We performed infralimbic cortex excitotoxic lesions using injections of ibotenic acid, and measured body temperature and locomotor activity by telemetry in rats under ad libitum and restricted feeding conditions. We found that bilateral infralimbic area lesions prevented both the anticipatory and the postprandial increases in core temperature, decreased mean temperature by nearly 0.3 degrees C during both light/dark phases, and increased daily temperature variability. In contrast, the lesion caused a rapid induction of the anticipatory locomotor activity. These results show that behavioral and metabolic responses to the time of food availability are commanded separately and that the infralimbic area is a key structure to adjust the body temperature to an upcoming meal.

Nonoccupational Determinants of Plasma DDT and p,p'-DDE in Men from Chiapas, Mexico

A cross-sectional study was conducted to evaluate nonoccupational biological exposure to 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT) compounds and to identify the main factors associated with such exposure in a malaria endemic region in Mexico. Capillary gas column chromatography was used to determine levels of p,p'-DDT and its metabolites in plasma. The mean age of the 144 male participants was 28 yr. Mean p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene) and p,p'-DDT levels were 203.5 microg/l and 67.4 microg/l, respectively. Those whose houses had been sprayed for malaria control had much higher p,p'-DDE levels (p < 0.001). High levels of chlorinated pesticides were found despite being banned in Mexico for agricultural and public health use. Findings demonstrate the role of antimalarial campaigns as a major contributing factor for high DDT plasma levels.

[DDT/DDE concentrations and risk of hypospadias. Pilot case-control study]

OBJECTIVE

To evaluate the association between maternal serum DDT/DDE levels and risk of hypospadias.

MATERIAL AND METHODS

A case-control study in Mexico City was conducted during 1997-1999 among 41 subjects with hypospadias and 28 controls. Blood samples were obtained from study subjects. Information was obtained using a standardized questionnaire. Data were analyzed using multivariate logistic regression models.

RESULTS

Maternal DDT and DDE levels showed no association with hypospadias (OR 1.13; 95% CI 0.24-5.29 and OR = 0.48; 95% CI 0.15-1.60, respectively). Associated factors were older age of mothers (OR 8.69; 95% CI 1.69-44.9), and working during pregnancy (OR 4.68; 95% CI 1.15-18.9).

CONCLUSIONS

Information about the endocrine effects of different levels of DDT/DDE in human subjects is scarce; dosage may be a determinant factor of the type of effect. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

[Study of anti-loxosceles serum action on hemolytic and ulcero-necrotic cutaneous effects of Loxosceles laeta venom]

The action of an anti-loxosceles serum on in vitro human red blood cell hemolysis and on the development of ulcero-necrotic lesions in rabbit skin, induced by loxosceles laeta venom, was studied. An 81 +/- 3% hemolysis was obtained after 72 h incubation of a 2.5% Rh+ red blood cell solution with the equivalent of one Loxosceles laeta venom gland. This parameter was not modified adding anti-loxosceles serum before, along with or after the venom (79.7 +/- 0.8, 77.3 +/- 2.1 and 80.7 +/- 0.7% respectively). After the intradermic injection of a minimal necrotizing venom dose in rabbits, a skin necrotic lesion appeared. This lesion did not appear if anti-loxosceles serum was injected together with the venom; if the serum was injected one hour after the venom, the resulting skin lesion was inflammatory but not necrotic. It is concluded that anti-loxosceles serum does not inhibit loxosceles venom induced hemolysis and causes a time dependent inhibition on skin necrotic lesions.

[Typhoid fever in children: association with blood phenotypes ABO, Rh and MNSs]

The hypothesis that blood phenotype B is associated to typhoid fever either directly or interacting with other phenotypes of the Rh or MNSs blood systems was tested. 256 children from the Northern Area of Santiago (Chile) with bacteriologically confirmed typhoid fever and 329 afebrile controls matched by age and gender from the same population, were studied. Association was found between phenotype RH3 and protection against disease for the whole group (OR = 0.67; p < 0.042) and for males (OR = 0.05; p = 0.014) although the gender-RH3 interaction was at the limit of significance. RH8 and Ss phenotypes were associated to increased susceptibility (OR = 1.83; p < 0.034 and OR = 1.56; p = 0.01, respectively). Controlling RH3 and Ss phenotypes by B, increased their effects (OR = 0.26; p = 0.04 and OR = 3.42; p = 0.026, respectively), but interactions did not reach statistical significance. These results show a susceptibility cline whose implications and applicability deserve further studies. A high proportion of S. paratyphi B (23.8%) appeared in this series, which may imply sample heterogeneity. The meaning of these findings need further epidemiological and genetic studies.

[Etiology of lower respiratory infections in hospitalized infants]

As a contribution to knowledge about the etiology of lower respiratory tract infections (LRI) in infants, 235 patients aged one year or less admitted to a children's hospital at northern metropolitan area of Santiago, Chile along years 1987 throughout 1989 with radiologically confirmed diagnosis were studied. Infants were eligible only if their symptoms lasted for not more than five days and their hospital stay was less than two days. Controls consisted on 74 healthy infants. A search for presumptive etiology was done by means of usual bacteriological procedures (pharyngeal swabs and blood cultures), plus latex test for type b Haemophilus influenzae (Hib) and Streptococcus pneumoniae (SP) in concentrated urine specimens; indirect immunofluorescence (IF) for specific Chlamydia trachomatis (CT) IgM; serological tests, isolation and IF in pharyngeal aspirates for syncytial respiratory virus (SRV), influenza, parainfluenzae and adenoviruses were also used. Evidence of viral infection was detected from 135/235 (57.5%) of cases and 21/74 (28.3%) controls, SRV being the most common. From 18/119 and 2/119 studied patients Hib and SP antigens were respectively detected, but urinary antigens were also present in 6/24 controls, raising questions about this test's specificity. IF titers of 1:32 or higher for CT were found in 5/80 patients, all younger than 5 months. It was possible to perform the whole set of available methods in 80 patients, in 70% of which some evidence of a known etiologic agent was found. Serology alone gave etiological clues in only 30% of these cases and usual microbiological cultures of throat swabs and blood from none of them. No combinations of age, fever, respiratory rate, apnea, bronchial obstructive syndrome, white blood cell counts over 15,000 or of band forms over 500 per cu mm, erythrocyte sedimentation rates, reactive C protein and x-ray findings allowed differential diagnosis between presumptive bacterial or viral etiology, except in one case of an infant presenting with pleural effusion and positive antigenuria for Hib.

[Etiology of lower acute respiratory infections in hospitalized infants. 3. Investigation of Chlamydia trachomatis]

Five infants with Chlamydia trachomatis associated pneumonia are analyzed. They were diagnosed out of 80 infants admitted to the hospital with pneumonia whose etiology was studied for virus, bacteria and Chlamydia trachomatis. Serum IgM antibodies to Chlamydia tr. were measured by indirect immunofluorescence (IIF), which is considered to be specific in high titers (1 greater than or equal to 32). The five cases represented 10.4% of infants studied younger than six months. One child was born by cesarean section suggesting the possibility of other non oculogenital still undefined mechanism of transmission. Clinical symptoms and laboratory findings were characteristics of those described in Chlamydia tr. pneumonia. Chlamydia trachomatis must be considered an etiologic agent in infantile pneumonia specially in the first six months of life. The high specificity and sensitivity of the IFF makes this serologic test the best non-invasive method for diagnosis of Chlamydia tr. pneumonia currently available.

[Etiology of acute infections of the lower respiratory tract in hospitalized infants: bacterial antigens]

Demonstration of bacterial antigens in biological fluids has been used for early detection of bacterial infections. Recent evidence suggests that higher detection rates of these antigens can be obtained from concentrated urine than from serum samples of patients. Evidence of bacterial infection by antigen detection was looked for from 50 fold concentrated urine samples by means of an ultrafilter system (Minicom) and latex agglutination for Haemophilus influenzae B (HiB) and Streptococcus pneumoniae (Sp) in three groups of patients. Group A (Positive controls), included 7 patients whose blood culture were positive for HiB (n = 5) and Sp (n = 2). Group B (Healthy controls) involved 16 children without clinical and laboratory signs of infection, coming from ambulatory well baby clinics and surgical wards, and group C was formed by 77 patients with negative blood cultures but with clinical and X ray evidence of lower respiratory tract infection. The corresponding antigen was demonstrated in urine samples from all group A patients. Three group B subjects gave positive results for HiB antigen. HiB antigen was detected from 10 and Sp antigen from 2 group C patients. These results suggest that the search for bacterial antigens in urine would be useful for etiological diagnosis and management of patients with bacterial pneumoniae. There is no definite explanation for the finding of HiB antigen in urine from apparently healthy children but the possibility of previous or actual asymptomatic infections must be taken into account.

[Intestinal cryptosporidiosis: a case of hospital infection]

A hospital acquired case of human cryptosporidiosis is reported in a pediatric patient with prolonged diarrhea, whose previous investigation was negative for the agent. Cryptosporidium was isolated from feces in coincidence with admission, to the same hospital room, of an additional patient with acute diarrhea in whom infection by the same agent had been demonstrated. Infant to infant transmission in hospital wards is thus a possibility.