Short-term effects of air pollution on hospital admissions for cardiovascular diseases and diabetes mellitus in Sofia, Bulgaria (2009-2018).

Bulgaria has a very high incidence of cardiometabolic diseases and air pollution-related mortality rate. This study investigated the relationship between daily air pollution levels and hospital admissions for ischaemic heart diseases (IHD), cerebral infarction (CI), and type 2 diabetes mellitus (T2DM) in Sofia, Bulgaria. We obtained daily data on hospitals admissions and daily average air pollution levels from 2009 to 2018. Pollutants of interest were particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), sulphur dioxide (SO2), ozone (O3), and carbon monoxide (CO). Negative binomial regressions were fitted to study the effects of air pollution on hospital admission over the course of seven days prior to that event, accounting for autocorrelations and time trend in the data, day of the week, temperature, and relative humidity. Our findings confirm that higher air pollution levels generally increase the risk of hospital admissions for IHD and CI. For T2DM the association is less clear. Admissions often lagged several days behind and were more common in specific demographic subgroups or when pollution crossed a particular threshold. However, we did not expect to find the risk of hospital admissions increased in warmer rather than colder months of the year. Our findings are to be taken with reservation but do provide an idea about how air pollution could trigger acute episodes of related cardiovascular diseases, and our model may serve to investigate similar associations across the country.

Urinary benzene biomarkers and DNA methylation in Bulgarian petrochemical workers: study findings and comparison of linear and beta regression models.

Chronic occupational exposure to benzene is associated with an increased risk of hematological malignancies such as acute myeloid leukemia (AML), but the underlying mechanisms are still unclear. The main objective of this study was to investigate the association between benzene exposure and DNA methylation, both in repeated elements and candidate genes, in a population of 158 Bulgarian petrochemical workers and 50 unexposed office workers. Exposure assessment included personal monitoring of airborne benzene at work and urinary biomarkers of benzene metabolism (S-phenylmercapturic acid [SPMA] and trans,trans-muconic acid [t,t-MA]) at the end of the work-shift. The median levels of airborne benzene, SPMA and t,t-MA in workers were 0.46 ppm, 15.5 µg/L and 711 µg/L respectively, and exposure levels were significantly lower in the controls. Repeated-element DNA methylation was measured in Alu and LINE-1, and gene-specific methylation in MAGE and p15. DNA methylation levels were not significantly different between exposed workers and controls (P>0.05). Both ordinary least squares (OLS) and beta-regression models were used to estimate benzene-methylation associations. Beta-regression showed better model specification, as reflected in improved coefficient of determination (pseudo R(2)) and Akaike's information criterion (AIC). In beta-regression, we found statistically significant reductions in LINE-1 (-0.15%, P<0.01) and p15 (-0.096%, P<0.01) mean methylation levels with each interquartile range (IQR) increase in SPMA. This study showed statistically significant but weak associations of LINE-1 and p15 hypomethylation with SPMA in Bulgarian petrochemical workers. We showed that beta-regression is more appropriate than OLS regression for fitting methylation data.

Specific immune responses in workers exposed to benzene.

UNLABELLED: The aim of this study was to elaborate a method for detection of specific IgG antibodies (Abs) to the haptenes p-benzoquinone (p-BQ) and hydroquinone (HQ) for assessment of specific humoral immune responses. Plasma and urine, collected from petrochemical plant workers have been analyzed. The workers were divided into three professional groups in ascending order of benzene exposure. The concentration of benzene in the air was determined by gas chromatography with mass-spectrometry and trans,trans-muconic acid (biomarker of benzene exposure) in urine-by liquid chromatography with UV-detection. Specific IgG Abs to haptenes p-BQ and HQ in plasma were determined with newly developed ELISA. The relationships "exposure-effect," revealed increased levels of specific IgG to haptens correlating with the benzene exposure. The "exposure-response" relationships demonstrated that workers with value of OD over X+2SD were 62% low exposure group, 68% in group with level of exposure on Threshold Limit Value (TLV) and 91% in the highest exposure group. The data obtained show that there is a good correlation between antibody production and the biomarker of exposure t,t-muconic acid. CONCLUSION: The newly developed method is applicable for assessment of specific humoral immune responses in workers exposed to benzene. There was a good correlation between benzene exposure and formation of antibodies against benzene metabolites.