First International Environmental Health Conference,
HEALTH AND THE ENVIRONMENT IN IRAQ:
Status, Needs & Challenges
Amman, Jordan, September 19-22, 2005

Sponsored by Stony Brook University and the Agency for International Development,
Higher Education and Development.
Program Director Prof. Dr. Wajdy Hailoo, Stony Brook University, NY.

Neural tube defects among infants delivered of mothers with tobacco smoke exposure

A. A. Mahmood
Kufa College of Medicine, Kufa, Iraq

Goals and Objectives: Verify the incidence of neural tube defects (Anencephaly /meningomyelocele) among infants delivered of the pregnant mother who had prenatal history of tobacco smoke exposure and to test the association between such variables in Najaf governorate, Iraq.

Design: A cross sectional Study on Pregnant women who were delivered at maternity hospital. The sample was subdivided into exposed and unexposed women to tobacco smoke.

Methods: A systematic random sample of pregnant women who attended the major maternity and children hospital in Najaf city during the period 2002-2004. A sample of 2300 delivered women were selected and interviewed for history of indoor smoking exposure whether they were heavy smokers or passively exposed from their heavily smoking husbands in addition to taking folic acid tablets before and during pregnancy .They were adjusted for dietary folate deficiency and other confounders which may be attributable to congenital anomalies development. The newborns were clinically examined by a pediatrician for presence of any congenital anomalies especially neural tube defects.

Results: The over all newly delivered newborns within the period of study with congenital anomalies were 3.4% (including small defects). The most frequent neural tube defects were spina bifida (1.2% ) and anencephaly ( 1.8% ) among those who were heavily exposed to smoking versus 0.6% and 0.8% respectively among non smokers and passively unexposed women (P<0.05) .

98% of mothers did not have previous delivery of such defect. There was no significant difference in the incidence of congenital anomalies between those who took folic acid tablets and those who did not Neither between those women who live in urban or rural areas or between different age groups for neural tube defects.

Conclusion: There was an increase in the incidence of neural tube defects without previous affected siblings among mothers with heavy exposure to tobacco smoke. Folic acid prescription may not prevent the occurrence of these defects among exposed mothers.

Assessment of pulmonary functions among cotton textile workers in Baghdad

A. Al-Saidi and W. Al-Tawil
National Center of Occupational Health and Safety, Ministry of Labor, Baghdad, Iraq

Goals: Evaluation of health status of Iraqi Textile Workers.

Objectives: To asses the magnitude of respiratory health problems of inhalation cotton dusts by textile workers.

This cross-sectional study covers registered 358 records for the period from Jan.30th 1996 till Jan.30th 2003 for clinical and spirometry assessment done by National Center of Occupational Health and Safety .Spirometry includes FEV1,FVC and FEV1/FVC percent for each worker.

Statistical Analysis includes percentages, chi –square and Z-test.

Results: Out of 358 employees 56 show abnormal lung function tests (15.64%) and all of them are males. The majority of workers with abnormal lung function tests were from the carding room (67.85%) followed by blowing section (25%) then blending room (5.35%). The majority of workers (98.22%) with abnormal lung function tests have duration of employment of (10-24) years.There is statistically significant association between abnormal lung function tests and long duration of work 15 years of exposure or more.

Out of 56 employees with abnormal lung functions tests, 25 employees are smokers (44.64%). Also 51.95% of abnormal lung functions test (29 employees) have clinical signs and symptoms as classified by international classification.The majority of workers with abnormal pulmonary function tests (83.95%) have obstructive type of ventilatory defect while 12.50% have combined type and two employees with restrictive type only.

Conclusion: Duration of exposure is an important factor in pulmonary function abnormality. Carding and blowing rooms are the mostly affected Sites where exposure occurs. Obstructive lung disorder is the prominent type.The middle age groups are the mostly affected. Smoking is an important factor increasing the severity of pulmonary function impairment.

Recommendation: Periodic Medical Examination.The current clinical evaluation reflects the possibility of the high dust exposure although no available data are found. Therefore abiding to the international standards (100µ\m3) is recommended. Workers with atopia should replaced in a relatively dust free areas. Worker's compensation for occupational disability should be available. Technical support to the National Center for Occupational Health and Safety is highly recommended.

A Study of morbidity pattern with special reference to occupational allergic diseases among workers of the State Company of Fertilizers, Basrah

A. Al-Yassen and N. Ajeel
Department of Community Medicine, College of Medicine, University of Basrah, Basrah, Iraq

Goals/Objectives:Examine the general morbidity pattern of workers over a specified period of time. Determine the impact of the exposures to hazardous agents in the workplace with special reference to the development or exacerbation of allergic diseases.

A cross - sectional comparative study was carried out in the state company of fertilizers/southern which is one of the important companies in Iraq. This research was designed to study the relationship between exposure to gases and dust in the workplace and allergic diseases.

Three exposed groups (workers in ammonia & urea, water refinery, and packing departments) were compared to non-exposed control group (workers in administrative departments).The results showed that the prevalence of work-related allergic conditions as reported by workers and diagnosed by the investigator were significantly higher among the exposed groups than the control group. Similarly, the total serum immunoglobulin E (IgE) levels were significantly higher in the exposed groups than in the control group. A clear significant effect of the degree of exposure to hazardous gases and dust on total serum IgE level were observed. These findings suggested that the risk of work-related allergic diseases were higher among workers exposed to irritant gases and dust than among their controls. The overall results of the present study indicate the need for enhancing occupational health measures with a special attention to preventive and promotional aspects.

Levels of pollution by lead in Basrah, Iraq

A. Al-Saboonchi, A. Al-Marashi and A. Ali
Department of Fishery, Basrah University, Basrah, Iraq

Goals: Monitor the levels of lead in environment of the south part of Iraq.

Objectives: Assess the lead level in roadside dust and plant leaves in Basrah and detect the lead level in the blood of traffic police.

Levels of lead in dust of road sides, plant leaves and blood from traffic police-men were measured, during summer season, 2004. Dust of road sides were collected from different stations. Extracted with EDTA and levels of it were measured after dilution by atomic absorption spectrophotometer. Dithizon spectrophotometer techniques were used for extraction of lead in leaves of plants and blood. Study concluded that the levels of lead in dust range between (99-416) mg\kg while in plant leaves the highest value of (5.15) ppm\cm2 near Ashar river and the lowest value (1.09) ppm\cm2 at Abu Al-Kassib. In case of blood the highest value of lead (92) mg\100 ml found in traffic police-men with 15 years serves, while the lowest value (15.1) mg\100 ml is recorded in traffic police-men who serve only 7 months.

Health effects caused by lead absorption among battery manufacturing workers in the private sector in Baghdad in contribution with W.H.O.

E. A-K. Saber
National Center of Occupational Health and Safety, M.L.S.A, Baghdad, Iraq

Goals: Locate and study the impact of such hazardous industries which were created due to the influence of the new situation our country is living under now a day on the environment and human health.

Objectives: 1) Assess the health effects resulting from lead absorption among workers employed in repairing old damaged liquid batteries in Baghdad city. 2) Determine the impact of this phenomenon on the environment and people residing in the vicinity of such work places.

This survey was carried out on the private reinstalling and repairing workers in small industries and work shops, in comparison to a group of workers in big factories not dealing with lead during their usual daily work, in Baghdad city.

A group of researchers at the N.C.O.H.S. conducted this survey

The survey was carried out aiming to assess the health effect resulting from lead absorption among the battery repairing workers and to determine the impact of this phenomenon on the surrounding environment and people residing in the vicinity of such work places. A modified standardized questionnaire was distributed to all the participants. Blood and urine samples were taken from each participant in addition to air samples collected from work places and inspired by the workers.

All these samples were analyzed for lead content and ALA / Cr in the laboratories of the national center of occupational health and safety (N. C. O. H. S.) in Baghdad. Also the survey studied the environmental conditions of the work places as well as the methods of disposing their liquid waste products.The survey revealed a wide, irregular and unorganized spread of these work places in almost all Baghdad industrial, commercial and even the residential areas. This might to a great deal be the cause of pollution of the surrounding environment and affect the health of people living in the vicinity of such work places.This can be due to disposing of the liquid disposals directly to the streets, or due to spreading of polluted air with lead fumes to the surrounding environment. Also we noticed increasing complain of the battery repairing workers of signs and symptoms due to increased exposure to high levels of lead, along with high blood lead levels among them in comparison to the control group of workers. However we noticed that blood lead levels among the control group were still elevated above the accepted levels.

Simple electrometric method for determination of blood and tissue cholinesterase activities in man and animals: Implications for environmental biomonitoring

F. K. Mohammad
College of Veterinary Medicine, University of Mosul, Mosul, Iraq

Goals: Presenting and reviewing a simple modified electrometric method for measurement of blood and tissue cholinesterase in man and animals with possible applications for monitoring exposure to organophosphate and carbamate insecticides.

Objectives:

1. Outlining the electrometric technique for measuring blood and tissue cholinesterase activities.

2. Presenting the specifications and efficiency of the method in measuring cholinesterase activity.

3. Reviewing normal blood or tissue cholinesterase activities determined by the described electrometric method in man and animals.

4. Documented applications of the method for diagnosing organophosphate and carbamate poisoning or exposure.

Measurement of cholinesterase activity is of diagnostic value in cases of organophosphate and carbamate insecticides poisoning. The enzyme is inhibited to various extents with concomitant appearance of signs of cholinergic hyperstimulation. The present report introduces and reviews a simple electrometric technique to measure blood (plasma, erythrocyte and whole blood) or tissue (brain, liver and muscle) cholinesterase activities in animals as well as to measure blood cholinesterase activities in man. Typically, the procedure involves the addition of 0.2 ml of blood sample or tissue homogenate to 3 ml of distilled water followed by 3 ml of barbital-phosphate buffer solution (pH 8.1). The pH (pH1) of the mixture is measured, and then 0.1 ml of 7.1% of acetylcholine iodide or 7.5% acetylthiocholine iodide, as a substrate, is added. The reaction mixture is incubated at 37 °C for 20-40 minutes according to the animal species. The pH (pH2) of the reaction mixture is measured after the end of the incubation period. The enzyme activity is expressed as Δ pH / incubation time= pH1- pH2 - (Δ pH of the blank). The blank is without the enzyme source. Literature are cited regarding the expected normal cholinesterase activities as the method was proved to be efficient, simple, accurate and reproducible for possible monitoring of exposure to organophosphate or carbamate insecticides in man and in several animal species such as mice, rats, sheep, goats, cattle, chickens and wild birds.

Peroxidation of liposomes in the presence of uranyl ion and ascorbic acid

G. D. Lawrence and Y. Chen
Department of Chemistry and Biochemistry, Long Island University, Brooklyn, NY 11201

Goals: Determine whether uranyl ion will induce lipid peroxidation (LPO).

Objectives: Study the conditions that result in uranyl-induced lipid peroxidation and to determine which factors can influence uranyl-induced lipid peroxidation.

Uranium contamination from exposure to fine (submicron) particles of uranium oxides, resulting from the use of depleted uranium munitions in combat, places combat personnel, as well as civilians in areas where uranium munitions have been used, at risk of uranium poisoning. A key feature of uranium poisoning is kidney failure, resulting from destruction of renal tubular epithelial cells. Although malondialdehyde, a marker for lipid peroxidation, may be elevated in plasma after uranyl treatment, studies have failed to show lipid peroxidation in kidney tissue or in kidney cells in culture following uranyl treatment. A study was undertaken to determine whether uranyl ion would catalyze lipid peroxidation in liposomes prepared from lecithin. Initial results indicated that uranyl would not catalyze peroxidation of liposomes at neutral pH, but seemed to catalyze lipid peroxidation under more acidic conditions that might prevail in the renal proximal tubules. The peroxidation reaction was suppressed by addition of citrate to the medium, which suggested a mechanism for the protective of citrate on uranyl-induced kidney failure. However, it was later discovered that traces of iron in the purified water used in these experiments was likely accounting for the catalytic activity observed. This presentation will give an overview of routes for uranium exposure in contaminated areas and current understanding regarding the biochemical processes that might explain uranium toxicity.

Lead blood level among children in Al-Anbar governorate, Iraq

J. K. Al-Diwan, A. M. H. Al-Hamawandi and F. J. Ali
Al-Anbar University, Iraq

Goals: Study the prevalence of lead poisoning in children.

Objectives (minimum 2-3): 1) Assess blood lead levels in children. 2) Assess the effects of lead toxicity in children.

Background: Several cases with lead poisoning were admitted to Al-Anbar maternity and children hospital during the last decades. This study was carried out, therefore, to study lead poisoning among children in Al-Anbar governorate.

Materials and Methods: Two districts (Al-Hatba and Al-Matheeq) were included in the study. 128 blood samples were collected from children and their mothers. 44 samples from water, soil and kuhil were also taken. Lead level was estimated in the samples.

Results: Lead toxicity was noticed in 93.8% and 100% of children from Al-Hathba and Al-Matheeq, respectively. Age of children was significantly associated with lead blood levels. Water lead content was significantly associated with blood lead levels. Pica also, was associated with blood lead levels.

Conclusion: There is a high prevalence of lead toxicity among children in Al-Anbar governorate.

Fluoride ion in drinking water and its effect on oral heath

L. A-K. Alazzawi
College of Dentistry, University of Baghdad, Baghdad, Iraq

Goals: Maintenance of dental health by the use of Fluoride ion.

Objectives: 1) National survey was conducted for the investigation of fluoride ion in drinking water. 2) Relation of fluoride ion to dental caries dental fluorosis among 5 and 15 years old children.

The most feasible way to prevent dental caries is to increase the teeth resistance to decay and the best individual and public health defense against dental decay is the proper use of fluorides

Material and Methods: The sample size of the study included 4695 students at 15 years of age. They were selected from six governorates in Baghdad, Ninevah, Basrah, Anbar, Diyala, and Kerbala. It was decided to take al most equal sample size from urban, periurban and rural areas. In the urban areas 4 sites were chosen, while for 2 sites in each 2 large towns and 4 sites in each 4 villages in different regions (WHO1997) permission was obtained from the ministry of education in Iraq. The school authorities were contacted to ensure full cooperation. Fluorides samples of drinking water were collected from each site using clean polyethylene bottles. 25-30 ml analysis of water was done according to electrodes of water ion (Digital ion activity meter). Plain mouth mirrors were used for examination along with probes. Dental caries was measured using DMFS (WHO 97) The mean decay M missing due to caries F tooth with permanent filling. Dental fluorosis lesions are usually bilaterally symmetrical and tend to show a horizontal striated pattern across the tooth (WHO1997)

Results: Urban students included 933 males and 891 females, periurban 739 males and 785 females and rural 648 Males and 649 Females.

Out of 4695 students, 30.46% were found to be caries free (27.30% urban 31.63% periurban and 33.4% rural) using Z test. There was a statistically significant difference between urban, preiurban students (p< 0.01, Z=2.739)and rural students (p

The DMFS value was 4.328 = 0.068 the highest value was in Baghdad 5.528 while the least was in Karbala 3.300

The prevalence of dental fluorosis was 1.36% in Ninevah .Fluoride ion range from 0.21 in Baghdad to 0.108 in Basra the highest was in Al-Hamdania province in Nenavha 3.38

Conclusions: High prevalence of dental caries was displayed in this national survey. This may be primarily due to the fact that an organized preventive measure has not been initiated and priority being given to diseases with high morbidity and mortality. It is worth mentioning that the natural water fluoride level in different regions of Iraq as presented in this study was far below the optimal level. The absence and\or limited use of fluoridated dentifrices may explain the high prevalence of dental caries and low prevalence of dental fluorosis in our country.

Serum malondialdehyde, total cholesterol and HDL-C in welders

M. L. Al-Naama, J. A. Abdel-Barry, D. Mohammed, A. Talib and S. Salah
Department of Biochemistry, College of Medicine, University of Basrah, Basrah, Iraq

Goals: Assess the effects of exposure upon inhalation of toxic fumes on health related diseases in welders

Objectives (minimum 2-3): 1. Investigate the effects of exposure and duration upon inhalation of toxic fumes on biochemical markers like Serum Malondialdehyde, Total Cholesterol and HDL-C.

2. Observe the effect of smoking habits, as an additional risk factor.

A prospective study from the first of March 2005 to end of April 2005 was designed. The study subjects were 60 male welders who were working in Alnajeebiyaa, South Oil Company and Al-Simaaeyaa of Hamdan within Basrah governorate. For comparison, 60 aged matched healthy male aged 20 -60 years were selected as control who was non welder. The study subjects were classified into 3 groups according to their ages. The welders were also classified according to their working exposure duration in welding. Venous blood samples were collected from all subjects participated in the study. Serum was used for the estimation of malondialdehyde (MDA), total cholesterol (TC) and high density lipoprotein-cholesterol (HDL-C) levels.

The results showed significant increase in the serum levels of MDA, TC, & HDL-C (p< 0.05) with advancing age in welders as compared to control subjects. Furthermore there were gradual increases (p < 0.05) in serum MDA and TC levels with increasing duration of exposure to the toxic fumes.

The effects of fruits & vegetables intake on the above biochemical parameters studied show significant alteration (p<0.05) There were significant decrease in serum MDA & TC and an increase in HDL-C levels with increasing intake of fruits and vegetables.

Smoking habits, as an additional factor revealed significant increase in MDAlevels among welders whether they were smokers or not as compared to their corresponding controls.

Conclusion:Continuous inhalation of welding fume may lead to increased MDA and TC levels so it may increase the risk of incidence of many oxidative stress related diseases such cardiovascular (CHD) and inflammatory diseases as and cancer. However the increase in HDL-C levels which might be due to good physical activity performed by the welders daily may reduce the risks of CHD incidence.

Screening for blood lead levels in Basrah

L. M. Al-Naama, M. K. Hassan and J. Nadum
Department of Biochemistry, College of Medicine, University of Basrah, Basrah, Iraq

Goals: Estimate the blood lead level (BLL) in Basrah and assess the risk factors associated with high BLL.

Objectives: 1.Estimate the blood lead level (BLL) in different age groups and both sexes. 2. Evaluate the risk factors associated with high BLL.

A total of 602 individuals were randomly selected from people attending 17 primary health centers in Basrah for the period from July-December 2002. Their ages ranged from 9 - 79 years. The BLL for all age groups were 11.26 ± 3.46, there was a statistically significant difference among different age groups, being highest in children less than 10 years (16.33 ± 6.5) followed by people in the age group 51 – 60 years (13.26 ± 4.36). The study also reported a statistically higher BLL among males (13.25 ± 3.25) compared to females (10.10 ± 2.96). The p value was less than0.001.

There was also a statistically significant difference in BLL among individuals living in different areas of Basrah ranging from 7.26 ± 2.81, up to 12.75 ± 3.63. In addition the individuals with higher education showed a significantly higher BLL compared to those with lower education (12.10 ± 3.54 & 11.11 ± 3.55) respectively. Exposure to lead & smoking also showed a significant correlation with high BLL.

Lead exposure among Jordanian children (a pilot study)

M. T. A. Jaghbir, M. Saket and S. El-Faury
University of Jordan, Amman, Jordan

Goals: Evaluate degree of lead exposure among children suspected to be at high risk of exposure.

Objectives: 1) Information about Jordanian children regarding blood lead levels. 2) Explore some of possible lead exposure sources in Jordan.

A study was conducted to obtain information on the degree of lead exposure among children suspected to be at high risk of exposure. A questionnaire was designed and aimed to collect information regarding the demographic characteristics of the study population.Three hundred and eighty four children living around high traffic streets were selected for this study. Participation was by invitation and volunteering. A drop of blood was obtained from finger stick and blood lead levels were determined using lead care kit. Blood lead levels were found to be higher among children aged 2 years, using alcohol, living in first floor, consuming home made flour and whose fathers had high-risk job.

Can a treatment plan be developed for children that have been diagnosed with cancer linked to depleted uranium exposure

M. B. Benoist
Info-Mission, Portland, Oregon 97211

Goals: To create a clinic setting to explore treatments for rapid on-set cancer in children.

Objectives: 1) Collect necessary data to develop a study setting. 2) Provide medical equipment and pharmaceutical support for exploring treatment options. 3) Install computer technology and establish a database and global information sharing system for scientists and physicians.

To fully understand the damaging effects of depleted uranium among Iraqi children, studies need to be conducted in a highly functional clinic setting. Peer review studies suggest that depleted uranium is a causal factor in cancer and leukemia among children in Iraq. A report by the Journal of Toxicological Health states “there are few full range studies addressing the toxicological consequences on human health of depleted uranium exposure.” A control study in a known contaminated region would be of great value to the people of Iraq by assisting in solutions to the health crisis.

The aim of this study is to collect and analyze data from Iraqi children with malignant tumors in the region of Basrah and attempt to determine if DU was the primary instigator. The initial data criteria would focus on children diagnosed with cancer from 2000 to the present. The results will be compared with existing data on child cancer rates in Basrah pre-Gulf War and world indicators.

Study implementation plan: A team of medical, scientific and computer technology consultants will be assembled to determine how to provide the appropriate setting for the study.

The preliminary study would be conducted in 3 phases.

Needs Assessment: Team members will travel to Iraq and meet with doctors at Basrah Pediatric hospital. A questionnaire and physician interview will be utilized to collect data on past and current treatments for inpatients diagnosed with cancer at the hospital. It will seek data pertaining to; how many children were admitted with symptoms of cancer, what were the varieties of cancer presented and what were the proposed treatments and outcomes. The information from this on-site assessment will be analyzed and developed into a power point presentation for outreach support.

Medical equipment and Pharmaceutical supplies: The questionnaire would also request data on the equipment and pharmaceutical needs for the hospital to facilitate effective courses of treatment pertaining to the study. Based on that information and interviews with Iraqi physicians, Info-Mission staff in Oregon will develop a report. It will list the various types of equipment and pharmaceuticals to conduct the study.

Database development: Team members will work directly with physicians collecting and documenting all available medical information on pediatric inpatients with cancer. The database will be specially designed and have unique features that facilitate the information for this study. The information from the questionnaire and Iraqi physician interviews will be categorized and entered into the database in the U.S. Our computer specialist will then travel to Basrah and install the database and train Iraqi physicians to use the program.

Results: The results of a successful study can be shared throughout the global science community for comment and suggestion. This should expedite the research that Iraqi physicians have already conducted and significantly accelerate treatment possibilities while addressing the daily medical needs of this public health crisis.

Conclusions: The success of a study addressing depleted uranium related illness could further be developed as a prototype project and imitated in other regions of Iraq. In addition, a published study can be utilized to further educate on the health hazards of depleted uranium and used to promote the immediate need to conduct full scale environmental clean up efforts in Iraq.

Cigarette smoking as an environmental xenobiotic and its effects on certain health parameters

M. M. Al-Shok
College of Medicine, Babylon University, Hilla, Iraq

Objectives: 1-Study the effects of smoking on patients with Diabetes Mellitus, Acute Myocardial Infarction, Lung cancer, Peptic ulcer disease and healthy controls. 2-Study the effects of smoking on certain hemopoietic factors including neutrophil count, and functions, platelets and fibrinogen level.

The study reflects effects of smoking on human health. It included 100 healthy subjects, 240 patients with diabetes mellitus,100 cases of myocardial infarction, 50 patients with lung cancer and 270 patients with peptic ulcer disease It showed smoking affects neutrophils count and function (NBT test) in healthy and diabetic patients in whom it was noticed that 37% of diabetic patients had increased neutrophil counts higher fibrinogen level, increased platelet count & aggregation & markedly defective neutrophil function. Also smokers show significantly higher hemoglobin level (secondary polycythemia), lower PEFR than nonsmokers. Tobacco use through cigarettes and other means is the most avoidable risk factor for CVS diseases, and cancer. We should encourage nonsmokers not to smoke and persons who smoke should be encouraged to stop. We should consider tobacco prevention a teenage issue as 80% of smokers begin smoking before the age of 18.

Determination of chromium concentration in blood and urine of the occupationally exposed workers by flameless atomic absorption spectrometric technique

R. A. Hamza, K. AL- Zubaidi,N. A. Ramadan and R. S. Nief
Ministry of Science and Technology, Baghdad, Iraq

Goals: To compare the Chromium Concentration in Blood and Urine of Iraqi leather workers and assess the effect of its exposure on their health.

Objectives: 1-Study the chromium levels in blood and urine of tannery exposed workers. 2- Evaluate and record the signs / symptoms in occupational persons due to chromium exposure. 3- The maintenance of the health of occupational persons by following the occupational health and safety precautions.

An investigation of chromium concentration from blood and urine samples for twenty workers in leather factory at Baghdad performed using flameless atomic absorption spectrophotometer technique. The samples were directly determined without any chemical treatment to avoid contamination. These results were compared with the chromium levels in blood and urine of twenty subjects as control. The concentration of chromium of occupational persons ranged from 6.5-45 µ g /100 ml in serum and 13-55 µ g/100 ml in urine, while concentration of chromium of twenty control persons ranged from 2-4 µ g/100 ml in serum and 2-5 µ g/100 ml in urine.These results indicated that the concentration of chromium in serum of tannery workers were 3-11 times more than in serum of control subjects. The chromium levels in urine of tannery workers were 5-11 times more than in urine of control subjects. This showed that the amount of chromium absorbed in tannery workers were 11 times more than the amount absorbed by control subjects. The concentrations of chromium in serum of tannery workers were 0.8-2 times less than in urine of tannery workers. The concentration of chromium in serum or urine of tannery workers exposed to chromium for 28 years were 11 times more than the concentration of chromium in tannery workers exposed to chromium for one year only . The mean value of concentration (ìg /100 ml) of chromium for person exposed to it for 1-8 years were 10.67 in serum and 21.5 in urine. These values were less than the value of person exposed to chromium for 11-29 years which are 26.91 in serum and 37.22 in urine, and these values were 3.5-10.7 more than the values of control persons which are 3.0 in serum and 3.48 in urine. Tannery workers were exposed to +3 chromium from inorganic compounds and to +6 chromium from the dust of leather. The amount of chromium in air of leather factory were 1-54 ìg /m 3 and these amount were higher than the amount of chromium in environmental air which are 4-6 ìg / m 3 . Chromium is an essential trace element for the maintenance of normal glucose tolerance. Small amount of chromium combines with DNA and RNA of nuclear proteins. It has been shown that +6 chromium penetrates the skin through the sweat glands and is reduced to +3 chromium in the corium. The +3 chromium react with protein to from stable antigen- antibody complex and this explains the effect of chromium in sweat glands of occupationally exposed workers which causes dermatitis. Due to high concentration of chromium in serum and in urine of tannery workers, many symptoms appeared such as headache, ulcer, allergic reaction, nasal septum ulceration, dermatitis, asthmatic attacks, skin and mucous membrane irritation and corrosion. To decrease the effect of exposure of chromium use of proper designing process including adequate and appropriate exhaust ventilation, suppression of dust or mist containing chromium in the +6 state, supplemented where necessary by built in accessory control measures, and also require the least possible action by either process operations or maintenance staff. The concentration in the working environment must be measured at regular intervals by positional sampling and personal monitoring. This means tannery workers must follow the proper guidelines and protocol of occupational health and safety precautions. To decrease the effect of exposure of chromium the tannery workers should use 10% CaNa 2 EDTA ointment. This reduces +6 chromium to +3 chromium and the EDTA chelates the +3 chromium to form complexes which are not harmful to the health of tannery workers.

Depleted uranium (DU) screening using high precision isotope analysis to assess DU exposure

R. R. Parrish* and A. Gerdes
*University of Leicester & NERC Isotope Geosciences Laboratory, British Geological Survey, UK; J.W. Goethe Universitat, Senkenberganlage 28, Germany

Goals: Provide reliable evidence of exposure to DU internal contamination.

Objectives (minimum 2-3): 1. Assess the extent and impact of exposure to DU in a variety of environments, with particular reference to areas where DU munitions have been used that may have contaminated air, soil, water and food. 2. Discuss the difference in potential health impact of the two main environmental pathways – ingestion and inhalation. 3. Describe the difference interpretations of DU positive tests and how these bear on longevity of exposure and potential health impact.

Reliable evidence of depleted uranium (DU) exposure is essential if any link is to be clearly established between such exposure (especially if via the inhalation pathway) and health, and to elucidate the relationship, if any, between Gulf War Illness and DU. Evidence can consist of confirmed aerosol exposure (for instance from a source of airborne pollution) or it could be confirmed contamination by a test following a short term or chronic exposure. Because DU munitions that are aerosolized during warfare are able to combust and oxidize, fine particles are rendered much less soluble than would otherwise be the case. Inhalation of respirable particles could lead to long term lung contamination, which in due course would lead to a detectable contribution in urine over and above that produced by natural uranium ingestion of uncontaminated food and water. We have developed a very precise method of uranium isotope analysis that uses chemical precipitation separation of uranium from urine followed by multicollector ICP-MS mass spectrometry. This method is able to reliably determine the isotopic composition of uranium extracted from urine more than ± 1% at the 95% confidence interval on total amounts of uranium in urine as low as 0.2 ppt (parts per trillion; e.g. 0.1 nanogram in 500ml urine). In addition we can test for the presence of the rare DU contaminant U-236 in such analyses. This methodology provides a way to measure very small amounts of excreted DU that may be an indicator of larger inhalation exposure many years or even decades prior. We have been involved in the measurement of uranium isotopes in populations/individuals from Afghanistan (2001), Iraq during the Gulf War of 1991, Iraq during the current/recent conflict, and in other areas where DU has been a prominent pollutant, and some of these results will be summarized. The interpretation of DU contamination, in terms of health implications, is complex but very much dependent upon the exposure pathway, chemical and physical form of the uranium, and the quantity of uranium contaminant. We will discuss the interpretation limitations of single DU-positive urine tests, and comment on the usefulness of using teeth, repeat urine tests, and other information in arriving at conclusions on DU exposure and its health impact.

An overview of the toxic effects of inhalational exposure to uranium oxide dust particles derived from depleted uranium munitions

T. M. FASY
Dept. of Pathology, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York

Goals: To review the chemical and physical properties, the bioavailability, biokinetics and toxicology of uranium oxides.

Objectives:

1. Highlight the differences between the uranium naturally present in the environment and the highly concentrated and readily respirable uranium oxide dust derived from D.U. munitions.

2. Describe the organs of uranium uptake, storage and excretion.

3. Discuss the acute early onset toxic effects as well as the long term, delayed onset toxic effects of inhalational exposure to uranium oxide dust.

4. Describe common symptoms induced by uranium oxide inhalation.

5. Review the mortality experience of uranium workers as reported in published epidemiological studies.

6. Emphasize the importance of chemically-mediated toxic effects in addition to the effects mediated by radiation.

7. Briefly mention some endogenous ligands that bind uranyl ions; these include DNA, RNA, hydroxyl apatite, transferrin as well as citrate, bicarbonate and carbonate ions.

When uranium metal undergoes combustion, several different uranium oxides are formed; the most abundant are uranium dioxide UO2, uranium trioxide UO3 and uranium octaoxide U3O8. In contrast to the uranium naturally present in the environment, uranium oxide dust particles derived from DU munitions contain uranium that is 100,000 times more concentrated; this high concentration together with the very small size of most DU dust particles makes DU dust readily respirable and vastly more bioavailability than the uranium naturally present in soil and rocks. Uranium is well documented to be a renal toxin, a neurotoxin, a mutagen, a carcinogen and a teratogen (an inducer of birth defects). Growing evidence indicates that uranium may also damage the immune system and promote allergic and autoimmune responses. Inhalation is by far the most dangerous route of exposure to uranium oxide. Following inhalation,UO3 gradually dissolves and passes into the blood stream as uranyl ions which can enter every organ and tissue though most uranyl ions accumulate in bones and teeth. UO2 particles persist undissolved in lung tissue and are gradually carried by macrophages to tracheo-bronchial lymph nodes where quite high concentrations of UO2 particles may accumulate in chronically exposed individuals. Uranium is excreted as uranyl ions via the kidneys; uranyl ions, however, are toxic to renal tubular epithelial cells. Epidemiological studies of uranium workers consistently show excess mortality from Hodgkin's lymphoma and non-Hodgkin's lymphoma; some studies also report excess deaths from lung cancer, kidney cancer, brain cancer and other malignancies. Uranium induced renal injury may manifest as renal stone formation, occult or gross hematuria, transient oliguria and/or polyuria which may persist for weeks or months. Inhalation of uranium oxides may induce a wide spectrum of neurological signs and symptoms including blurred vision, numbness, paresthesias, memory loss, cognitive dysfunction, migraine headaches and photophobia.

Occupational illness in workers at the largest nuclear and chemical waste site in the U.S.

T. K. Takaro
University of Washington, Occupational & Environmental Medicine Program, Seattle, WA. 98105

Goals: Use assessment characterization of the extent of hazardous exposure and resulting disease burden among former workers at a large nuclear and chemical waste site.

Objectives:

1. Learn about hazardous exposures at the largest nuclear and chemical waste site in the U.S.

2. Learn about the health effects of asbestos, beryllium, and noise as occupational hazards, and about clinical detection of these hazards.

3. Learn about the disease burden in former workers exposed to these hazards and how the surveillance techniques might be applied to prevent disease in other waste clean-up operations.

The U.S. Department of Energy (USDOE) is involved in a massive clean-up of its nuclear weapons production sites. Part of this effort includes medical surveillance of former workers at the sites. The largest of these sites is the Hanford Site in the state of Washington. The University of Washington (UW) provides medical screening for the former Hanford production and non-construction workers. This descriptive study has the primary aim of contributing to further characterization of the extent of hazardous exposure and resulting disease burden among former Hanford workers. Over 2,100 former Hanford workers have been screened by the UW program for asbestos and beryllium disease and noise-induced hearing loss. The decision to screen for these particular health effects was based on a comprehensive needs assessment of hazards at the site, and on whether screening could lead to interventions to alter the course of disease, or could identify substantial impairment and/or health risks and reasonably require worker notification. Of the workers screened by the UW program, 46% had abnormalities on chest radiograph, most of which could be linked to occupational exposures. 38% showed abnormal spirometry and 76% had significant hearing loss. Sensitization to the toxic metal beryllium appeared in nearly 4% of former workers. Repeat screening (at 1 to 3 years) for some former workers exposed to asbestos and/or beryllium picked up additional disease. Of those re-screened, nearly 24% showed new clinical abnormalities, and 8% newly met the criteria for filing a workers compensation claim. Findings from this screening program showed that many former workers were significantly exposed and sustained health effects associated with these hazards. This also demonstrated the importance of ongoing surveillance due to the latency of the lung diseases seen in these workers. We will discuss these results in the context of the need for worker protection in environmental clean-ups.

Environmental impact on public health in Iraq

M. M. Barbooti
Ministry of Environment, Department of Environmental Analysis, Directorate of Baghdad Environment, Baghdad, Iraq

Goals: Restore the water and sanitary systems in Iraq to which is the main vehicle for diseases.

Objectives: 1) Rehabilitate waste disposal systems of industry and adoption of closed cycles to reduce the pollutants introduced to the surface waters.2) Repair the incinerators of the main hospitals to stop the bad situation of their waste disposal.

Public health is greatly affected by the environmental conditions. The deterioration of health status among the people of Iraq is associated with the degradation of the country's infrastructure; the reduced investments on environmental protection projects; the lack of electricity, water purification and sewage treatment have had great impact on public health. Raw sewage dumped into Iraq's rivers every day, finds its way into surface water systems. About 50% of Iraq's population has no access to clean drinking water. Hence conditions are now ripe for an epidemic. The quality of drinking water in terms of pathological and total counts of bacteria over the last two years reflects the extent of the pollution and its effects on the health. Inevitably, it is the children who are most at risk from disease and death through dehydration. UNICEF reported that 300,000 children were facing death. Heavy metals like mercury and lead were introduced to the environment as a result of looting and burning of the stores of insecticides and gasoline additives. In addition, the accumulation of the scrap of the military vehicles which included various metals and depleted uranium (DU), in very large amounts is yet a big environmental problem. The natural oxidation of the metals converts them to powdery materials which can easily be transported by wind and rain water into the soil, air and ground water. There are reports of increased rates of cancers, congenital malformations and renal diseases among the population of Iraq that have been correlated with the exposure to DU. The hazardous wastes of hospitals which must be fed to incinerators are left without treatment because the incinerators of the state and private hospitals are not operational. Some of these wastes are rewashed and illegally sold again especially the disposable syringes.