Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions.

BACKGROUND: Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions. AIM: To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-ß), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions. METHODS: This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs. RESULTS: The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively (P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance (P < 0.0001). In contrast, IL-1ß, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions. CONCLUSION: EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

Association of heat shock protein70-2 genotypes with hypertension among textile workers occupationally exposed to noise.

Noise exposure is a primary cause of hearing loss with a broad range of auditory and non-auditory effects. It is one of the occupational health risks in both developed and industrialized countries. Heat shock proteins (HSPs) are induced after severe noise exposure. Those proteins protect the ear from damage following excessive noise exposure. This protection showed high variability between individuals. The aim of the study was to investigate the variation in hearing loss and blood pressure in textile workers and its association with genetic predisposition related to HSP70 genes. Also, the role of smoking was studied. We genotyped HSP-70 (hsp70-1, hsp70-2, and hsp70-hom) genes in 109 textile workers working in a noisy environment. Diastolic and systolic blood pressure was measured for workers. Hearing was assessed using an audiogram. We reported significant variation in HSP70-homo genotypes among smoker workers and nonsmoker ones. Only HSP70-2 genotypes were associated with high significant variations in both systolic and diastolic blood pressure among textile workers. Positive correlation between duration of exposure and both systolic (P < 0.047) and diastolic blood pressure (P < 0.033) was observed among workers. Our study recorded that HSP70-2 genotypes were associated with hypertension among textile workers with absence of that association with either HSP70-1 or HSP70-homo genotypes. We also confirmed the relationship between noise exposure and blood pressure (both systolic and diastolic blood pressure). Furthermore, significant variation was shown in HSP70-hom genotypes among smoker and nonsmoker workers.

Early prediction of liver carcinogenicity due to occupational exposure to pesticides.

Several studies linked between pesticides exposure and development of liver cancer, through several mechanisms inform of genotoxicity, cytotoxicity, tumor promotion, immunotoxicity and hormonal actions. This study aimed to estimate novel biomarkers for early prediction of liver malignancy due to occupational exposure to pesticides in two groups of workers with different socioeconomic standard (highly educated urban researchers and low educated rural pesticides sprayers). This study included 50 urban researchers and 50 rural pesticides sprayers occupationally exposed to pesticides. They were compared with 50 non-exposed urban researchers and 50 non-exposed rural subjects. Several tumor biomarkers were estimated; P53 protein, Alfa fetoprotein (AFP), and Alpha-L-fucosidase (AFU). Additionally, telomerase enzyme activity, Relative telomere length (RTL), and DNA damage using comet assay were measured. Furthermore, the glutathione-S-Transferase (GST) gene polymorphisms were identified for both exposed groups. Statistical analysis revealed elevated level of tumor biomarkers among exposed subjects relative to control groups in spite of being within the normal range. Increase in the DNA damage was detected, with shortening of telomere length and decrease in telomerase enzyme activity in pesticides-exposed subjects compared to their controls. Most of these changes were related to the levels of butyrylcholinesterase. Subjects with GSTT1 genotype were suggested to be more susceptible to hepatic carcinogenicity. Telomere relative length and comets assay together with GST genes polymorphisms could be used as early predictors for liver cancer susceptibility among pesticides exposed workers.

Antimicrobial Activity of Terpenoids Extracted from Annona muricata Seeds and its Endophytic Aspergillus niger Strain SH3 Either Singly or in Combination.

BACKGROUND: Annona muricata (Soursop) has an antimicrobial activity toward various pathogenic microorganisms which support its ethnomedicinal for the treatment of many infectious diseases. AIM: Aim of the present study to evaluate the relation between antimicrobial activities of terpenoids extracted from different soursop parts with the isolated endophytic fungi. METHODS: Endophytic fungal species of pulp and peel of Annona fruit along with those of seeds were isolated. Salkowski test was used for qualitative screening of terpenoids in plant and the isolated endophytic Aspergillus niger strain SH3. RESULTS: Endophytic A. niger strain SH3 and Annona seed extract showed high terpenoid content indicated by the high intensity of reddish-brown colour. GC/Mass analysis revealed six compounds of terpenoids from endophytic A. niger strain SH3 extract and four compounds from seed extract with different retention times. The antimicrobial assay was performed using A. niger strain SH3 extract and Annona seed extract singly or in combinations against S. aureus, P. aeruginosa, E. coli and C. albicans. CONCLUSION: The results revealed the significant antimicrobial activity of both extracts. However, the combined extract showed some reduction in antimicrobial activity which could be attributed to the antagonistic effect exhibited by their constituents.

Effect of Occupational Cadmium Exposure on Parathyroid Gland.

BACKGROUND: Cadmium (Cd) is used in many industries. High-level exposure is associated with severe kidney and bone damage. AIM: This study investigates the possible effect of occupational cadmium exposure on parathyroid gland and some minerals in workers. METHODS: Environmental air monitoring of cadmium was done. Serum and urine cadmium levels, kidney function, some minerals, and plasma parathormone were estimated in the studied groups. RESULTS: The exposed workers had significantly higher Cd concentration in serum and urine than controls. The mean levels of plasma parathyroid hormone, serum phosphorus and magnesium were significantly lower among the exposed group. However, the mean levels of serum creatinine and calcium were significantly higher in the same group when compared to referents. There was a significant positive correlation between Cd concentration in the serum and urine for the exposed group. The biological Cd exposure indices correlated positively with serum calcium and negatively with plasma PTH level. The prevalence of musculoskeletal complaints, bone ache, joint pain and muscle spasm were more prevalent among the exposed workers compared with the controls with odds ratio 4.316, 3.053 and 3.103 respectively. CONCLUSIONS: Occupational cadmium exposure has an adverse effect on PTH level and serum human minerals.

Hormonal Perturbations in Occupationally Exposed Nickel Workers.

BACKGROUND: Nickel exposure is recognized as an endocrine disruptor because of its adverse effects on reproduction. AIM: This study was designed to investigate the possible testiculo-hormonal perturbations on workers occupationally exposed to nickel and to assess its effects on human male sexual function. METHODS: Cross-sectional comparative study, comprising 105 electroplating male non-smoker, non-alcoholic workers exposed to soluble nickel and 60 controls was done. Serum luteinizing hormone, follicle stimulating hormone, testosterone levels and urinary nickel concentrations were determined for the studied groups. RESULTS: Serum luteinizing hormone, follicle stimulating hormone, urinary nickel and the simultaneous incidence of more than one sexual disorder were significantly higher in the exposed workers compared to controls. The occurrence of various types of sexual disorders (decreased libido, impotence and premature ejaculation) in the exposed workers was 9.5, 5.1 and 4.4 folds respectively than the controls. CONCLUSIONS: Exposure to nickel produces possible testiculo-hormonal perturbations in those exposed workers.

Serum autoantibodies in silicosis and non-silicosis cement workers.

AIM: To study serum autoantibodies and immunoglobulin levels in cement workers. METHODS: Blood samples for numerous antibodies were collected from 30 silicosis and 42 non-silicosis cement workers. Spirometry of the silicosis workers was also studied. RESULTS: Serum IgA mean level showed a significant increase in the silicosis group compared to the non-silicosis group. Elevated titers of serum anti-smooth muscle antibodies (ASMA) and anti-glomerular basement membrane (anti-GBM) were detected only in the silicosis group. The duration of exposure showed a significant positive correlation with serum IgA, ASMA and anti-GBM, and a significant negative correlation with serum IgG. Serum anti-GBM showed a significant positive correlation with IgG while the inverse titer (1/titer) of anti-GBM showed highly significant positive correlations with serum IgA and ASMA. The percent predicted FVC was the ventilatory function most closely associated with immunological parameters in silicosis group. CONCLUSION: Serum IgA, ASMA, and anti-GBM are the principal immunologic parameters associated with silicosis.

Impact of aluminum exposure on lung.

Aluminum (Al) metal is considered one of the most benign industrial metals. Although the harmful effects of Al on respiratory health have been denied by some studies, others reported its noxious effect on the lung through spirometric measurements. This work aimed at studying the effect of Al fumes on pulmonary functions of occupationally exposed workers. It investigated the possible relationship between inhalation exposure to Al fumes and levels of C-reactive protein (CRP) and alpha-1-antitrypsin (A1AT). The study participants comprised a group of 56 male Al workers with a mean duration of occupational exposure of 10.1 ± 9.5 years and 52 male participants who were not exposed to Al fumes as the control group. All participants filled a questionnaire, underwent full clinical examination and their spirometric pulmonary functions were measured. Blood samples were collected for the determination of serum CRP and A1AT and urine samples for measuring Al. Results revealed that urinary Al (UAl) was significantly higher in Al workers compared with controls (p < 0.05). However, spirometric measures showed no significant difference between the exposed group and the controls. A1AT was significantly lowered in Al workers compared with the controls (p < 0.000). Serum CRP was positive in only two (3.6%) of the exposed workers. Smokers of both groups (exposed and controls) showed significantly higher UAl and lower A1AT compared with nonsmokers. There was only significant negative correlation between the duration of exposure and A1AT (p < 0.05). There was a positive significant correlation between smoking index (SI) and UAl. There was also significant negative correlation between SI and some of the pulmonary function tests namely the percentage of predicted forced vital capacity, forced expiratory volume in the first second and peak expiratory flow in the exposed group. Those correlations point to the importance of the combined effect of smoking and Al exposure on the impairment of lung functions. The study recommends the determination of CRP and A1AT in Al-exposed workers. It is expected that those parameters may undergo changes before reduction in pulmonary functions takes place.

Serum Levels of Copper, Ceruloplasmin and Angiotensin Converting Enzyme among Silicotic and Non-Silicotic Workers.

BACKGROUND: Silicosis is the most frequently occurring pneumoconiosis. AIM: Measurement of serum levels of Angiotensin converting enzyme (ACE), Copper (Cu) and Ceruloplasmin (Cp) in cement workers occupationally exposed to silica dust as biomarkers of exposure rather than biomarkers of effect for silicosis. METHODS: Plain chest X-ray & pulmonary functions were done for 30 silicotic and 42 non-silicotic workers and 42 controls. CT scan was done for the exposed groups. Serum levels of Cu, Cp and ACE were estimated. RESULTS: The results showed a higher significant difference between the exposed groups and controls, and between the two exposed groups regarding the mean levels of all measured biochemical parameters. The pulmonary functions were significantly lower among silicotic workers than controls and non-silicotic groups. There was a significant positive correlation between duration of employment and serum ACE and Cu. CONCLUSION: Since respirable dust exposure-linked lung fibrosis disease is non-curable, the biochemical parameters (Cu, ACE and Cp) can be used as exposure biomarkers to silica dust, providing a better way for early diagnosis of this deadly disease. Down regulating the inflammatory responses could potentially reduce the adverse clinical pulmonary effects of air pollution.

Carcinogenic effects of aflatoxin B1 among wheat handlers.

BACKGROUND: Epidemiological studies have demonstrated that serum aflatoxin B1 (AFB1) is a hepatocarcinogenic mycotoxin and contributor to the high rate of hepatocellular carcinoma (HCC). The prevalence of liver cancer in Egypt is particularly worrisome. In a registry-based analysis of occupational risk for HCC, significant excesses were observed especially for grain mill workers. OBJECTIVE: The aim of this study was to assess the hepatic carcinogenicity of AFB1 in wheat handlers. METHODS: Serum AFB1/albumin (AFB1/Alb), alpha-fetoprotein (AFP), alpha-l-fucosidase (AFU), and arginase were estimated in exposed wheat handlers including millers and bakers. The control group was composed of non-occupationally exposed workers. RESULTS: AFB1/Alb and AFU were significantly higher among workers employed as bakers compared to mill workers and controls. Mill workers had higher levels of AFB1/Alb than the controls. AFB1/Alb, AFP, and AFU were all significantly higher and arginase was significantly lower among HCC cases compared to the other groups. There was a significant correlation between AFU and AFB1/Alb in bakers and between AFP and AFB1/Alb in HCC cases. Arginase was inversely correlated with AFB1/Alb in HCC cases. AFB1/Alb was significantly correlated with the duration of exposure in bakers. CONCLUSION: Wheat handlers exposed to Aspergillus flavus have a high risk of elevated serum AFB1/Alb levels and AFU.

Effect of occupational exposure to aflatoxins on some liver tumor markers in textile workers.

BACKGROUND: In a study of textile workers, the effects of occupational exposure to cotton dust-with possible exposure to aflatoxin-on levels of some liver tumor biomarkers were explored. METHODS: The study included 58 textile workers and 64 controls. Skin prick tests, urinary Aflatoxin M1 (AFM1) and the tumor biomarkers (alpha-fetoprotein (AFP), alpha-L-fucosidase (AFU), insulin-like growth factors (IGF-1) were measured. RESULTS: Positive reactants to Aspergillus niger, Aspergillus flavus, and cotton dust were significantly higher in pre-spinning (14.3%, 28.6%, and 28.6%, respectively) and spinning workers (25.0%, 33.3%, and 25.0%, respectively) compared to controls (4.7%, 7.8%, and 3.1%, respectively). Urinary AFM1 was significantly higher in the pre-spinning, spinning, and weaving groups compared to controls (554.2 ± 346.2 pg/ml, 459.1 ± 781.6 pg/ml, 296.5 ± 336.5 pg/ml and 68.5 ± 136.8 pg/ml, respectively). We found a highly significant increase in levels of serum AFU in textile workers, compared to the control group. CONCLUSION: Exposure to fungi had a significant effect on AFM1 measurements and tumor biomarkers, especially in allergic textile workers (with the exception of the arginase biomarker), though results were generally within normal limits.

Organochlorine pesticide residues in biological compartments of healthy mothers.

The present study was conducted to detect placental and breast milk (BM) transfer of organochlorine pesticides (OCPs) between biological compartments in healthy lactating mothers. The study explores the effect of parity, breast-feeding and urban/rural residence on body burden of OCP residues. The study included 38 healthy participants submitted to cesarean delivery. Sociodemographic data and specimens of maternal and umbilical sera, adipose tissue (Adp T) and BM were collected. Specimens were analyzed to detect OCP residues. The lindane in BM, o,p'-dichlorodiphenyldichloroethane (DDD) in maternal serum (MS) and total dichlorodiphenyltrichloroethane (DDT) and o,p'-dichlorodiphenyldichloroethylene in umbilical serum were the only detected residues in significantly higher frequencies and/or means in the primigravidae than multigravidae. There was a high risk of detecting o,p'-DDD (odds ratio = 8.3) in umbilical serum of the mothers with o,p'-DDD detected in the MS. Total DDT was detected in about 65% of specimens of BM, MS and Adp T and in about 40% of the umbilical serum specimens. There was only a significant positive correlation between total DDT residues in the BM and Adp T. Total DDT residues in umbilical serum and Adp T were significantly higher in the urban than in the rural mothers. The detection of some OCPs in maternal biological compartments suggests their potential placental and BM transfer to her child during pregnancy and lactation, respectively. Furthermore, it might reflect the persistence or recent use of these pesticides in the environment.

Ventilatory functions in cotton textile workers and the role of some inflammatory cytokines.

Exposure to cotton dust in industrial environments causes inflammation in the airways of the exposed workers. This may manifest as respiratory complaints and changes in the respiratory functions after work shift and in the baseline of their ventilatory functions. The study aimed to investigate the effect of occupational exposure to cotton dust on respiratory symptoms, ventilatory functions and pro-inflammatory cytokine levels (tumor necrosis factor α, interleukin 6 and interleukin 1ß). The study was conducted on 63 textile workers and 65 nonexposed subjects. Both groups were matched for age, socioeconomic status and smoking habit. The respirable dust measured in the workplace did not exceed the permissible values of the Egyptian law 1994. The bacterial counts detected were within the occupational exposure limits of the industrial settings. The results revealed that the percentage of respiratory symptoms was higher in textile workers. Respiratory complaints were chronic cough (33.2%), chronic bronchitis (39.7%) and dyspnea (23.8%) in textile workers compared to (6.2%, 6.2% and 1.5%), respectively, in controls. There was a marked reduction in the ventilatory functions (forced vital capacity and forced expiratory volume in 1 s) in the textile workers compared to the controls. The additive effect of smoking on the ventilatory functions was not apparent. The ventilatory functions of the workers were significantly positively correlated with the duration of exposure. The cytokines were insignificantly higher in the textile workers compared to their controls. The textile workers with respiratory complaints showed significant decline in ventilatory functions and elevation in the cytokine levels compared to the nonsymtomatizing workers with significant difference in interleukin 1ß and interleukin 6. In conclusion, the results supported the fact that exposure to cotton dust deteriorates ventilatory functions and elevates proinflammatory cytokine levels. Analysis of the release of cytokines can be used to evaluate the immune responses to organic dust-induced airway inflammation.