June 2019 additions to NERDB

June 2019 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Obvibase.

More information on this database on the NERDB page

On the website we will publish from this month on regular updates on new disease – exposure combinations we added to the database. Currently, we have 202 entries. Ordered by year in which the abstract is published

20093unknown year6

Last new entries

Napoli PE, Nioi M, Iovino C, Sanna R, d’Aloja E, Fossarello M. Ocular surface and respiratory tract damages from occupational, sub-chronic exposure to fluorspar: case report and other considerations. Int Ophthalmol. 2019 May;39(5):1175-1178. doi: 10.1007/s10792-018-0915-1. Epub 2018 Mar 28.

A 50-year-old man was referred to our clinic with bilateral conjunctival injection, ocular foreign body sensation, and symptoms of ocular discomfort. He reported having 3 days before urgent hospital admission for dyspnoea with odynophagia, hyposmia, nausea, vomiting, headache, and asthenia. Otorhinolaryngological examination revealed a severe hypertrophic rhinopharyngitis and a significant decrease in overall sensitivity to olfactory stimuli. General anamnesis was negative for previous diseases or medication use. Ocular examination revealed a diffuse injection of the ocular surface with some areas of conjunctival and limbal ischemia, a best-corrected visual acuity of 20/25 in both eyes, an intraocular pressure of 23 and 21 mmHg, respectively, in the right and in the left eyes, and normal fundus oculi. Assessment of the tear film and ocular surface showed the presence of dry eye disease. Based on medical history and clinical tests, the initial diagnostic hypothesis was ocular surface burn due to chemical exposure, i.e. to fluorspar. Therefore, anterior segment fluorescein angiography was performed to confirm the extension of conjunctival and limbal ischemia. Thus, ocular ischemia was detected in approximately 10 clock hours of the limbus and in 50% of the conjunctiva. The present work remarks on the importance of using protective equipment for preventing ocular and respiratory tract damages in workers occupationally exposed to the ‘acid-grade fluorite’.

Spinder N, Prins JR, Bergman JEH, Smidt N, Kromhout H, Boezen HM, de Walle HEK. Congenital anomalies in the offspring of occupationally exposed mothers: a systematic review and meta-analysis of studies using expert assessment for occupational exposures. Hum Reprod. 2019 May 1;34(5):903-919. doi: 10.1093/humrep/dez033

Research question: Is there an association between maternal occupational exposure to solvents, pesticides, and metals as assessed by expert-based assessment and congenital anomalies in the offspring?
SUMMARY ANSWER: There is an association between maternal occupational exposure to solvents and congenital anomalies in the offspring, including neural tube defects, congenital heart defects, and orofacial clefts.
WHAT IS KNOWN ALREADY: One important environmental risk factor for the development of congenital anomalies is maternal occupational exposure to chemicals in the workplace prior to and during pregnancy. A number of studies have assessed the association with often conflicting results, possibly due to different occupational exposure assessing methods.
MAIN RESULTS AND THE ROLE OF CHANCE: In total, 2806 titles and abstracts and 176 full-text papers were screened. Finally, 28 studies met the selection criteria, and 27 studies could be included in the meta-analysis. Our meta-analysis showed that maternal occupational exposure to solvents was associated with neural tube defects (OR: 1.51, 95%CI: 1.09-2.09) and congenital heart defects (OR: 1.31, 95%CI:1.06-1.63) in the offspring. Also, maternal occupational exposure to glycol ethers, a subgroup of solvents, was associated with neural tube defects (OR: 1.93, 95%CI: 1.17-3.18) and orofacial clefts (OR: 1.95, 95%CI: 1.38-2.75) in the offspring. Only one study investigated the association between maternal occupational exposure to solvents and hypospadias and found an association (OR: 3.63, 95%CI: 1.94-7.17). Results of the included studies were consistent. In our meta-analysis, we found no associations between occupational exposure to pesticides or metals and congenital anomalies in the offspring.
LIMITATIONS, REASONS FOR CAUTION: A limited number of studies was included, which made it impossible to calculate pooled estimates for all congenital anomalies, analyze individual chemicals or calculate exposure-response relations. Bias could have been introduced because not all included studies corrected for potentially confounding factors.
WIDER IMPLICATIONS OF THE FINDINGS: Employers and female employees should be aware of the possible teratogenic effects of solvent exposure at the workplace. Therefore, is it important that clinicians and occupational health specialist provide women with preconception advice on occupational solvent exposure, to reduce the congenital anomaly risk.

Chen KH, Chung KM, Chung JH, Chen KT. Asthma associated with denatonium benzoate in a healthcare worker in Taiwan: A case report. Medicine (Baltimore). 2019 May;98(21):e15818. doi: 10.1097/MD.0000000000015818.

RATIONALE: Denatonium benzoate is a useful indicator to ensure that the respirator being used by an individual, forms a tight enough seal to adequately protect against unwanted airborne exposure. Although the relative risk for adverse effects of fit testing using denatonium benzoate is low, the absolute number of workers with adverse reactions may nevertheless be sizeable.
PATIENT CONCERNS: A 34-year-old female nurse rapidly developed shortness of breath, cough, and agitation after denatonium benzoate fit testing. She had a history of allergy to shrimp, crab, mite, and disinfecting products (containing quaternary ammonium).
DIAGNOSES: Due to typical symptoms of asthma after exposure to denatonium benzoate aerosol without any other apparent cause, serial pulmonary function tests indicating obstructive lung function and a higher concentration of immunoglobulin antibody E, she was diagnosed with allergic asthma.
LESSONS: There may be potentially important health risks when healthcare workers are exposed to denatonium benzoate. Individuals who have a history of allergy to disinfecting products (containing quaternary ammonium) should avoid exposure of denatonium benzoate. More advanced research is needed in the future.



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