research article cement dust exposure and perturbations in...

Research ArticleCement Dust Exposure and Perturbations in Some Elements andLung and Liver Functions of Cement Factory Workers

Egbe Edmund Richard Nsonwu-Anyanwu Augusta Chinyere Offor Sunday JeremaiahUsoro Chinyere Adanna Opara Etukudo Maise Henrieta and Egbe Deborah Ifunanya

Department of Medical Laboratory Science Faculty of Allied Medical Sciences College of Medical SciencesUniversity of Calabar Calabar 543000 Nigeria

Correspondence should be addressed to Nsonwu-Anyanwu Augusta Chinyere austadechicyahoocom

Received 18 October 2015 Revised 4 January 2016 Accepted 5 January 2016

Academic Editor Steven J Bursian

Copyright copy 2016 Egbe Edmund Richard et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Background Cement dust inhalation is associated with deleterious health effects The impact of cement dust exposure on the peakexpiratory flow rate (PEFR) liver function and some serum elements in workers and residents near cement factory were assessedMethods Two hundred and ten subjects (50 workers 60 residents and 100 controls) aged 18ndash60 years were studied PEFR liverfunction aspartate and alanine transaminases (AST andALT) and total and conjugated bilirubin (TB andCB) and serumelementslead (Pb) copper (Cu) manganese (Mn) iron (Fe) cadmium (Cd) selenium (Se) chromium (Cr) zinc (Zn) and arsenic (As)were determined using peak flow meter colorimetry and atomic absorption spectrometry respectively Data were analysed usingANOVA and correlation at 119901 = 005 Results The ALT TB CB Pb As Cd Cr Se Mn and Cu were significantly higher and PEFRFe and Zn lower in workers and residents compared to controls (119901 lt 005) Higher levels of ALT AST and Fe and lower levelsof Pb Cd Cr Se Mn and Cu were seen in cement workers compared to residents (119901 lt 005) Negative correlation was observedbetween duration of exposure and PEFR (119903 = minus0416 119901 = 0016) in cement workers Conclusions Cement dust inhalation may beassociated with alterations in serum elements levels and lung and liver functions while long term exposure lowers peak expiratoryflow rate

1 Introduction

Deleterious effects of exposure to constituents of cementdust on organ system in humans have been describedMolecules of primary importance in cement dust in termsof content and potential health effects basically include 60ndash67 calcium oxide 17ndash25 silicon oxide (SiO

2) and 3ndash5

aluminium (Al) oxide with some amount of iron oxidechromium (Cr) potassium sodium sulphur andmagnesiumoxide [1 2] Occupational exposures to aluminum (Al) iron(Fe) calcium (Ca) and silicon (Si) have been associated withdecreased lung function indicators in exposed workers [3 4]Hepatosplenic silicosis and hepatic porphyria with associ-ated changes in liver function parameters have also beendescribed as some of the systemic effects of silica Lipid per-oxidation oxidative damage and immunologic mechanismshave been described as pathologic mechanisms of cement

dust induced toxicities [5 6] Some essential elements nec-essary for normal physiologic functions are also constituentsof cement dust Toxicity from these essential trace elementsoccurs only when the exposure is above the range which canbe accommodated by homeostatic mechanisms [7]

Studies on effects of cement dust exposure on lung andliver functions in occupationally exposed individuals inNigeria have been documented [2 8 9] however informa-tion on the levels of some essential and nonessential elementsand their relative or absolute contribution to lung and livertoxicities among individuals occupationally exposed tocement dust is still uncertain This study therefore estimatesthe lung and liver functions and levels of some essential andnonessential elements in residents and workers in cementfactory sites to determine their possible contribution toimpairment of lung and liver functions in these individuals

Hindawi Publishing CorporationJournal of ToxicologyVolume 2016 Article ID 6104719 7 pageshttpdxdoiorg10115520166104719

2 Journal of Toxicology

2 Materials and Methods

21 Study Design This study was conducted at the UnitedCement Company (UNICEM) atMfamosing Akamkpa localgovernment area Cross River State Nigeria The Mfamosinglimestone deposit serves as the major source of raw materialsused by UNICEM for the production of ordinary Portlandcement (OPC) Since July 2009 the Mfamosing cement plantproduces approximately 25 million metric tons of cementper annum and currently employs about 350 permanentworkersThe factory has fourmajor departments Production(Crusher RawMill Kiln CementMill and Packing Section)Engineering and Maintenance (Mechanical and ElectricalSection) Mining and Administration (Cashier Administra-tive Officer Security andMarketing Section)The site is closeto 200m west to Mbebui village at coordinates 0504493∘N008298995∘E 500m south to Abifan community at coordi-nates 0507591∘N 00852192∘E and 200m east to Mfamosingcommunity and 100m east to main quarry site at coordinates0506993∘N 00853908∘E [10]

22 Selection of Subjects Two hundred and ten male subjectsaged 18ndash60 years who fulfilled the inclusion criteria wererandomly selected for this study This study populationcomprised fifty regular cement factory workers sixty resi-dents of the communities surrounding the UNICEM factoryand one hundred apparently healthy individuals residing inCalabarmetropolis 45 km away from the factory not exposedto cement dust who served as control subjects Informedconsent was obtained from them and ethical approval wasobtained from The Center of Clinical Governance Researchand Training Ministry of Health Cross River State Thisstudy was carried out in accordance with the Ethical Prin-ciples for Medical Research Involving Human Subjects asoutlined in the Helsinki Declaration in 1975 (revised in2000) Test subjects of the study were selected from theproduction section of the cement factory This comprisespermanent employees of the factory who are occupationallyexposed to cement dust daily for not less than 2 years in thecourse of their work Host community resident subjects werealso individuals that had been resident in the communitiesproximal to the cement factory for not less than 2 yearswhile control subjects were individuals who had never beenoccupationally exposed to cement dust and are resident inCalabar metropolis

Participants were notified several days before the com-mencement of the study and were given appropriate instruc-tions The physical characteristics of the subjects includedweight and height measured with the use of weighing scaleand stadiometer respectively Systolic and diastolic bloodpressure were taken using sphygmomanometer All subjectsof the study were interviewed to establish their level ofliteracy and were assisted in filling the questionnaire tominimize errors Sociodemographic datawere collected by aninterviewer-administered structured questionnaire aimingto determine age educational levels socioeconomic statusyears of exposure as deduced from date of employment siteor position at the workplace and use and nonuse of safetygadgets such as dust masks Information on general health

and history of past disease(s) and habits such as smokingconsumption of alcoholic beverages and addictions werecollected according to the British Medical Research Councilquestionnaire (BMRC 1960) Individuals with a history ofcigarette smoking tobacco sniffing or chewing liver diseaseor pulmonary disorders chronic organ or systemic illnessand long term medication were excluded from the study

23 Sample Collection Blood samples were collected frommidmorning to noon for both subjects and controls Sevenmilliliters of blood was collected by venipuncture underaseptic conditions into a dry clean plain sample containerThe blood was allowed to clot and was centrifuged at 3500revolutions per minute for 5 minutes After centrifuging theserum was separated with the aid of a Pasture pipette anddispensed into dry chemically clean serum container afterwhich the samples were analysed immediately or stored atminus20∘C for subsequent analysis

24 Laboratory Methods

241 Estimation of Alanine Aminotransferase (ALT) [11]Consider

alpha-oxogutarate + L-alanine

ALT997888997888997888rarr L-glutarate + pyruvate

(1)

Alanine aminotransferase catalyzes the transfer of ami-no group from L-alanine to 120572-ketoglutarate forming pyru-vate and L-glutamate Pyruvate reacts with 24-dinitro-phenylhydrazine to form 24-dinitrophenylhydrazone whoseconcentration is proportional to the ALT activity

242 Estimation of Aspartate Aminotransferase (AST) Reit-man and Frankel [11] Consider

alpha-oxoglutarate + L-aspartate

AST997888997888997888rarr glutamate + oxaloacetate

(2)

Aspartate aminotransferase (AST) catalyses the transfer ofamino acid group from aspartate to ketoglutarate formingoxaloacetate and glutamateThe oxaloacetate reacts with 24-dinitrophenylhydrazine to form 24-dinitrophenylhydrazonewhich in alkaline pH is reddish brown and whose concentra-tion is proportional to the AST activity

243 Estimation of Bilirubin by Modified Valleyrsquos Method[12] Serum bilirubin is present in two forms conjugatedwhich is mostly with glucuronic acid and unconjugatedwhich is known as free bilirubin Both react with diazotizedsulphanilic acid to give a rose-purple azobilirubin Conju-gated bilirubin reacts in aqueous solution (direct reaction)whereas the unconjugated bilirubin requires an accelerator orsolubilizer such as benzoate urea as in this method or alcoholwhich is used in other methods (indirect reaction)

Journal of Toxicology 3

Table 1 Mean age anthropometric indices (weight height and BMI) systolic BP diastolic BP some liver function tests peak expiratory flowrate and serum elements levels in cement workers residents near cement factory and controls

Parameter Cement workers119899 = 50

Residents119899 = 60

Controls119899 = 100

119865-value 119901 value

Age (years) 3998 plusmn 556 3832 plusmn 403 3767 plusmn 532 0453 0636Weight (kg) 6104 plusmn 1353 6204 plusmn 1255 6190 plusmn 1335 0204 0816Height (meters) 167 plusmn 010 168 plusmn 009 172 plusmn 006 0055 0747BMI (kgm2) 2335 plusmn 256 2395 plusmn 232 2310 plusmn 211 2574 0079Sys BP (mmHg) 12880 plusmn 880 12780 plusmn 883 12880 plusmn 786 0166 0847Diast BP (mmHg) 8420 plusmn 1310 8233 plusmn 1014 8250 plusmn 1076 0476 0622ALT (IU) 2978 plusmn 258 1125 plusmn 096 872 plusmn 041 7653 0000lowast

AST (IU) 3700 plusmn 261 1741 plusmn 170 946 plusmn 064 8429 0000lowast

TB (120583molL) 1826 plusmn 091 1818 plusmn 081 1382 plusmn 062 1280 0000lowast

CB (120583molL) 757 plusmn 058 733 plusmn 052 584 plusmn 027 566 0004lowast

PEFR (Lmin) 32496 plusmn 1040 34025 plusmn 1038 40017 plusmn 910 1697 0000lowast

Fe (120583gdL) 10208 plusmn 178 9613 plusmn 143 15099 plusmn 135 44799 0000lowast

Zn (120583gdL) 8094 plusmn 201 7825 plusmn 186 10652 plusmn 070 14764 0000lowast

Pb (120583gdL) 1593 plusmn 042 2009 plusmn 064 1033 plusmn 060 7032 0000lowast

As (120583gdL) 0011 plusmn 0002 0011 plusmn 0005 0003 plusmn 0002 18345 0000lowast

Cd (120583gdL) 0042 plusmn 0008 1950 plusmn 0212 0022 plusmn 0001 10220 0000lowast

Cr (120583gdL) 0033 plusmn 0003 160 plusmn 0125 0012 plusmn 0000 20039 0000lowast

Se (120583gdL) 0022 plusmn 0004 175 plusmn 0127 0044 plusmn 0015 217479 0000lowast

Mn (120583gL) 2970 plusmn 0074 3346 plusmn 0062 2579 plusmn 0038 56101 0000lowast

Cu (120583gdL) 21664 plusmn 693 23462 plusmn 716 17306 plusmn 3662 3783 0000lowastlowastSignificant at 119901 lt 005 Sys BP = systolic blood pressure Diast BP = diastolic blood pressure

244 Estimation of Trace Element by Atomic Absorption Spec-trophotometer [13] An extract of the physiological sample isdeproteinized and the filtrate is treated as lanthanum Thisis aspirated in AAS which measures the absorbance of tracemetals at various wavelengths corresponding to its band-width The absorbance is proportional to the concentrationof trace element in the sample

245 Estimation of Peak Expiratory Flow Rate by PeakExpiratory Flow Meter The PEFR test is done with a peakexpiratory flowmeter Spiroflow by Spirometrics USA (orig-inally described by Wright and McKerrow [14]) This is asimple handheld instrument with a mouthpiece on one endand a scale on the other A small plastic arrowmoves when airis blown into the mouthpiece measuring the airflow speedThe subject breathes in deeply to full lung saturation andthen blows into the mouthpiece as quickly and as hard aspossibleThe reading is taken and the procedure repeated twoadditional times The highest record of the three is notedIf the subject coughs or sneezes while breathing out theprocedure will be repeated again The PEFR readings weretaken during break hour of 12 noon to 1 pm for the cementworkers and for other subjects of the study

25 Statistical Analysis Data analysis was done using thestatistical package for social sciences (SPSS version 200) Stu-dentrsquos 119905-test analysis was used to determine mean differences

between variables Analysis of variance (ANOVA)was used totest significance of variations within and among groupmeansand Fisherrsquos least significant difference (LSD) post hoc testwas used for comparism of multiple group means Pearsoncorrelation analysis was employed to determine relationshipbetween variables A two-sided probability value 119901 lt 005was considered statistically significant

3 Results

Mean age anthropometric indices (weight height and bodymass index) systolic and diastolic blood pressure some liverfunction tests (ALT AST TB and CB) peak expiratoryflow (PEFR) and serum elements levels (Fe Zn Pb AsCd Cr Se Mn and Cu) in cement workers residents nearthe cement factory and controls were shown in Table 1Significant variations (119901 lt 005) were observed in liverfunction test peak expiratory flow and serum elements levelsin cement workers residents living near the cement factoryand controls No variations were observed in the levels ofother indices studied (119901 gt 005)

Table 2 shows comparison of some liver function testand PEFR of cement workers residents near cement factoryand controls using post hoc analysis The ALT AST TBand CB were significantly higher and PEFR was lower incement workers and residents near cement factory comparedto controls (119901 lt 005) The ALT and AST levels were


Table 2 Comparison of some liver function tests and peak expiratory flow in cement workers residents near cement factory and controlsusing post hoc analysis

ParameterGroups

Mean diff 119901 valueCem workers Controls119899 = 50 119899 = 100

ALT (IU) 2978 plusmn 257 872 plusmn 041 2106 plusmn 175 0000lowast

AST (IU) 3700 plusmn 261 946 plusmn 064 27540 plusmn 212 0000lowast

TB (120583molL) 1826 plusmn 091 1382 plusmn 062 444 plusmn 109 0000lowast

CB (120583molL) 757 plusmn 058 584 plusmn 027 173 plusmn 060 0004lowast

PEFR (Lmin) 32496 plusmn 1040 40017 plusmn 910 minus7521 plusmn 1458 0000lowast

Residents Controls119899 = 60 119899 = 100






Cem workers Residents119899 = 50 119899 = 60



TB (120583molL) 18264 plusmn 091 1818 plusmn 081 081 plusmn 1204 0947CB (120583molL) 757 plusmn 058 733 plusmn 052 24 plusmn 067 0723PEFR (Lmin) 32496 plusmn 1040 34025 plusmn 1038 minus1529 plusmn 1612 0344lowastSignificant at 119901 lt 005

significantly higher in cement workers compared to residents(119901 lt 005) No significant differences were observed in TBCB and PEF levels in cement workers and residents (119901 gt005)

Comparison of serum elements levels in cement workersresidents near the cement factory and controls using post hocanalysis was shown in Table 3 Cement workers and residentshave significantly higher levels of Pb As Cd Cr Se Mn andCu and lower levels of Fe and Zn compared to the controls(119901 lt 005) Higher levels of Fe and lower levels of Pb Cd CrSe Mn and Cu were seen in cement workers compared toresidents (119901 gt 005) No significant differences were seen inZn and As levels of cement workers and residents (119901 gt 005)

Figure 1 shows the correlation plot of duration of expo-sure to cement dust against peak expiratory flow rate incement workers A significant negative correlation (119903 =minus0416 119901 = 0001) was observed between duration of expo-sure and peak expiratory flow rate in cement workers

4 Discussion

The lung and liver function and some serum elements levelsin occupationally exposed cement workers and residentsnear cement factories were studied Decreased peak expi-ratory flow rate (PEFR) was observed in cement workersand residents living near cement factory when comparedto unexposed controls Similar findings have also beenreported in cement workers in other developing countries[4 15 16] Association of cement dust exposure with chronic

0

5

10

15

20

25

30

Dur

atio

n of

expo

sure

(yea

rs)

100 200 300 400 5000PEFR (Lmin)

R2= 01727

r = minus0416

p = 0016

y = minus00268x + 19102

Figure 1 Correlation plot of duration of exposure to cement dustagainst peak expiratory flow rate in cement workers

impairment of lung function and respiratory symptoms suchas cough phlegm and chest tightness and lung functionindices has been described [17] Accumulation of cement


Table 3 Comparison of serum elements level in cement workers residents near cement factory and controls using post hoc analysis

ParameterGroups


Fe (120583gdL) 10208 plusmn 178 15099 plusmn 135 minus4892 plusmn 219 0000lowast

Zn (120583gdL) 8095 plusmn 201 10652 plusmn 070 minus2558 plusmn 197 0000lowast

Pb (120583gdL) 1593 plusmn 042 1033 plusmn 060 560 plusmn 089 0000lowast

As (120583gdL) 0011 plusmn 0002 0003 plusmn 0002 0008 plusmn 0001 0000lowast

Cd (120583gdL) 0042 plusmn 0008 0022 plusmn 0001 0035 plusmn 0005 0000lowast

Cr (120583gdL) 0033 plusmn 0013 0012 plusmn 0000 0021 plusmn 0002 0000lowast

Se (120583gdL) 0023 plusmn 0004 0044 plusmn 0015 minus0010 plusmn 0002 0000lowast

Mn (120583gL) 297 plusmn 0074 258 plusmn 0038 039 plusmn 0078 0000lowast

Cu (120583gdL) 21665 plusmn 693 17307 plusmn 366 4358 plusmn 7917 0000lowast








Se (120583gdL) 175 plusmn 013 0044 plusmn 0015 171 plusmn 009 0000lowast




Fe (120583gdL) 10208 plusmn 178 9613 plusmn 143 5945 plusmn 2422 0015lowast

Zn (120583gdL) 8095 plusmn 2007 7825 plusmn 186 269 plusmn 219 0219Pb (120583gdL) 1593 plusmn 042 2009 plusmn 064 minus416 plusmn 098 0000lowast

As (120583gdL) 0011 plusmn 0002 0011 plusmn 0005 0002 plusmn 00005 0693Cd (120583gdL) 0042 plusmn 0008 195 plusmn 0212 minus191 plusmn 0168 0000lowast

Cr (120583gdL) 0033 plusmn 0013 160 plusmn 0125 minus157 plusmn 010 0000lowast


Mn (120583gL) 297 plusmn 0074 335 plusmn 0062 minus38 plusmn 009 0000lowast

Cu (120583gdL) 21665 plusmn 693 23462 plusmn 717 minus1797 plusmn 875 0041lowastlowastSignificant at 119901 lt 005

dust particles on upper and lower airways of the trachea-bronchial region of the lungs results in shortness of breathchest tightness sneezing and coughing Interaction betweencement dust particles and the mast cell or basophil surfaceresults in their degranulation and release of a variety of phar-macological active agents including histamine and serotoninthe effect of these amines on tissues such as bronchial smoothmuscles and vascular endothelium produces many of thesymptoms of atopic conditions observed [18]

Prolonged duration of exposure to cement dust was asso-ciated with decreased peak expiratory flow Similar obser-vations have been reported by other studies [15 16 19 20]Bioaccumulation of some specific components as chromiumand silica present in the cement dust in the respiratory tractmay lead to delayed hypersensitivity reaction and chronicinflammation and hence impaired respiratory function Con-trary to our findings a study by Fell et al [1] reported no

association between duration of cement dust exposure anddecreased peak expiratory flow

Increased levels of serum alanine aminotransferaseaspartate aminotransferase and total and conjugated biliru-bin were observed in cement workers compared to controlsThe higher levels of aminotransferase observed in the cementworkers are still within normal range for the liver enzyme incirculation and hence are not indicative of liver impairmentThe liver has a high functional reserve capacity and onlyshows dysfunction when about 50 of the hepatocytes areaffected However this increase may be an indication ofpotential for future development of hepatotoxic complica-tions in occupationally exposed individuals Our findingsare in agreement with reports from other studies [8 21]Contrary to our findings elevated serum levels of alanineaminotransferase aspartate aminotransferase and alkalinephosphatase above the normal ranges have been reported in


cement workers by Al Salhen [22] Cement dust inclusionparticles diffuse swelling proliferation of hepatic sinusoidallining cells sarcoid granulomas and perisinusoidal andportal fibrosis have been described in the hepatocytes ofcement mill workers These changes have been associatedwith hepatic lesions produced by inhaled cement dust [23]

Increased serum lead arsenic cadmium chromium sele-nium manganese and copper levels and lower iron and zinclevels were observed in cement workers and residents livingnear cement factory when compared to unexposed controlsIncreased levels of chromium copper manganese and sele-niumhave also been demonstrated in cement factoryworkersand had been attributed to their exposure to cement dust [624] The toxic effect of most elements depends principally onthe absorption concentration and persistence of the elementat its site of actionThese elements react with the endogenoustarget molecule such as receptors enzymes DNA proteinsand lipids and critically alter their biologic functions pro-ducing structural and functional changes that result in toxicdamage [25] Zinc and copper are components of antioxidantenzyme copper-zinc superoxide dismutase (Cu-Zn SOD)The increased demand on the antioxidant system to bufferthe deleterious effects of heavy metal accumulation mayaccount for lower zinc levels and a compensatory increasein copper levels seen in cement factory workers comparedto unexposed controls The body tends to retain copper tocombat heavy antioxidant demands [6] Decreased iron levelsseen in cement workers may be associated with increasedcopper levels Copper is a component of ceruloplasminwhich catalyzes the oxidation of iron to ferric forms forbinding to its transport protein transferrin and subsequentstorage in tissues and synthesis of haemoglobin Thereforeincreased copper implies increased conversion and removalof circulating iron and hence decreased serum levels seen incement factory workers [6]

Cement workers had higher levels of ALT AST and Feand lower levels of Pb Cd Cr Se Mn and Cu comparedto residents of communities near the cement factory Theobservation of higher serum levels of ALT AST and Feand lower Cu seen has been discussed above Contraryto our findings no significant difference was reported inserum blood lead levels of cement workers and residentsof neighboring community in a cement factory [26] Lowerlevels of Pb Cd Cr Se and Mn in cement workers com-pared to residents may be attributed to the observationthat cement factory workers are mandated to observe thelaid down protective and safety precaution of the use ofdust masks at factory site Residents on the other hand donot observe such precautionary measures Higher elementslevels in residents compared to cement workers may also beattributed to duration of exposurewhich is also a determiningfactor in serum elements concentration Cement workersare mere employees of the cement factory whose exposureto cement dust is dependent on duration of employmentResidents on the other hand spend almost all their life timein their community and are therefore exposed to cementdust on daily basis The continuous inhalation or ingestionmakes even the smallest concentration of such toxic elementsa concern to their health This is because the effects of

exposure to any hazardous substance depend on the routeof the exposure concentration of substance and duration ofexposure The level of toxicity found in short term exposuremay be remedied but the long term toxicity is associated withundesirable health consequences

The findings of this study have shown that occupationalexposure to cement dust may be associated with changesin the homeostasis of some essential and toxic elementsresulting in higher levels of Pb As Cd Cr Se Mn andCu and lower levels of Fe and Zn which may be implicatedin impaired peak expiratory flow rate with potentials forfuture development of hepatotoxicity These observationsemphasize the need for adequate safety and precautionarymeasures among cement factory workers

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper

References

[1] A K M Fell T R Thomassen P Kristensen T Egeland and JKongerud ldquoRespiratory symptoms and ventilatory function inworkers exposed to Portland cement dustrdquo Journal of Occupa-tional and EnvironmentalMedicine vol 45 no 9 pp 1008ndash10142003

[2] AM Gbadebo andO D Bankole ldquoAnalysis of potentially toxicmetals in airborne cement dust around Sagamu SouthwesternNigeriardquo Journal of Applied Sciences vol 7 no 1 pp 35ndash40 2007

[3] A A Baccarelli Y Zheng X Zhang et al ldquoAir pollution expo-sure and lung function in highly exposed subjects in BeijingChina repeated-measure studyrdquo Particle and Fibre Toxicologyvol 11 pp 51ndash60 2014

[4] Z K Zeleke B E Moen and M Bratveit ldquoCement dust expo-sure and acute lung function a cross shift studyrdquo BMC Pul-monary Medicine vol 10 article 19 2010

[5] N Zawilla F Taha and Y Ibrahim ldquoLiver functions in silica-exposed workers in Egypt possible role of matrix remodelingand immunological factorsrdquo International Journal of Occupa-tional and Environmental Health vol 20 no 2 pp 146ndash1562014

[6] J O Ogunbileje and O M Akinosun ldquoBiochemical and hae-matological profile in nigerian cement factory workersrdquo Re-search Journal of Environmental Toxicology vol 5 no 2 pp 133ndash140 2011

[7] Health Risk Assessment Guidiance for Metals (HERAG)ldquoAssessment of occupational dermal exposure and dermalabsorption for metals and inorganic compoundsrdquo HERAG factsheet 12007 2007

[8] J O Ogunbileje O M Akinosun O G Arinola and PAkinduti ldquoImmunological classes (IgG IgA IgM and IgE)and liver function tests in Nigerian cement factory workersrdquoResearcher vol 2 no 4 pp 55ndash58 2010

[9] W Alakija V I Iyawe L N Jarikre and J C ChiwuzieldquoVentilatory function of workers at Okpella cement factory inNigeriardquoWest African Journal of Medicine vol 9 no 3 pp 187ndash192 1990

[10] G A Lameed ldquoEnvironmental impact assessment of cementfactory production on biodiversity a case study of UNICEM


Calabar NigeriardquoWorld Journal of Biological Research vol 1 pp1ndash7 2008

[11] S Reitman and S Frankel ldquoA colorimetricmethod for the deter-mination of serum glutamic oxalacetic and glutamic pyruvictransaminasesrdquo American Journal of Clinical Pathology vol 28no 1 pp 56ndash63 1957

[12] D Watson ldquoAnalytic methods for bilirubin in blood plasmardquoClinical Chemistry vol 7 pp 603ndash625 1961

[13] M E Everson ldquoSpectrophotometric techniquesrdquo in Tietz Text-book of Clinical Chemistry C A Burtis andE R Ashwood Edspp 75ndash93 W B Saunders Philadelphia Pa USA 3rd edition1999

[14] BMWright andC BMcKerrow ldquoMaximum forced expiratoryflow rate as ameasure of ventilatory capacity with a descriptionof a new portable instrument for measuring itrdquo British MedicalJournal vol 2 no 5159 pp 1041ndash1046 1959

[15] S Shaikh A A Nafees V Khetpal A A Jamali A M Arainand A Yousuf ldquoRespiratory symptoms and illnesses amongbrick kiln workers a cross sectional study from rural districtsof Pakistanrdquo BMC Public Health vol 12 article 999 2012

[16] A Mandal (Majee) and R Majumder ldquoAssessment of pul-monary function of cement industry workers fromrdquo Progress inHealth Sciences vol 3 no 1 pp 65ndash71 2013

[17] H Noor C L Yap O Zolkepli andM Faridah ldquoEffect of expo-sure to dust on lung function of cement factory workersrdquoMedical Journal of Malaysia vol 55 no 1 pp 51ndash58 2000

[18] J G Ayres ldquoThe effects of inhaled materials on the lung andother target organsrdquo in Occupational Hygiene K Gardiner andJ M Harrington Eds vol 2 pp 7ndash13 Wiley-Blackwell 3rdedition 2005

[19] O G Akanbi O Ismaila W Olaoniye K T Oriolowo and AOdusote ldquoAssessment of post-work peak expiratory flow rate ofworkers in cement companyrdquo Sigurnost vol 56 no 4 pp 315ndash322 2014

[20] S A Meo A M Al-Drees A A Al Masri F Al Rouq andM A Azeem ldquoEffect of duration of exposure to cement duston respiratory function of non-smoking cement mill workersrdquoInternational Journal of Environmental Research and PublicHealth vol 10 no 1 pp 390ndash398 2013

[21] F B Mojiminiyi I A Merenu M T Ibrahim and C H NjokuldquoThe effect of cement dust exposure on haematological andliver function parameters of cement factory workers in SokotoNigeriardquo Nigerian Journal of Physiological Sciences vol 23 no1-2 pp 111ndash114 2008

[22] K S Al Salhen ldquoAssessment of oxidative stress haematologicalkidney and liver function parameters of Libyan cement factoryworkersrdquo Journal of American Science vol 10 no 5 pp 58ndash652014

[23] J C Pimentel and A P Menezes ldquoPulmonary and hepaticgranulomatous disorders due to the inhalation of cement andmica dustsrdquoThorax vol 33 no 2 pp 219ndash227 1978

[24] J O Ogunbilege OM Akinosun P A Akinduti L A Nwaobiand O A Ejilude ldquoSerum levels of some trace metals andleucocyte differential count in Nigeria cement factory workersPossible toxicityimplicationsrdquo Florida Int J vol 2 pp 55ndash582010

[25] L J Langman and B M Kapur ldquoToxicology then and nowrdquoClinical Biochemistry vol 39 no 5 pp 498ndash510 2006

[26] O O Babalola and S O Babajide ldquoSelected heavy metals andelectrolyte levels in blood of workers and residents of industrialcommunitiesrdquo African Journal of Biochemistry Research vol 3no 3 pp 37ndash40 2009

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MEDIATORSINFLAMMATION

of


2 Materials and Methods

21 Study Design This study was conducted at the UnitedCement Company (UNICEM) atMfamosing Akamkpa localgovernment area Cross River State Nigeria The Mfamosinglimestone deposit serves as the major source of raw materialsused by UNICEM for the production of ordinary Portlandcement (OPC) Since July 2009 the Mfamosing cement plantproduces approximately 25 million metric tons of cementper annum and currently employs about 350 permanentworkersThe factory has fourmajor departments Production(Crusher RawMill Kiln CementMill and Packing Section)Engineering and Maintenance (Mechanical and ElectricalSection) Mining and Administration (Cashier Administra-tive Officer Security andMarketing Section)The site is closeto 200m west to Mbebui village at coordinates 0504493∘N008298995∘E 500m south to Abifan community at coordi-nates 0507591∘N 00852192∘E and 200m east to Mfamosingcommunity and 100m east to main quarry site at coordinates0506993∘N 00853908∘E [10]

22 Selection of Subjects Two hundred and ten male subjectsaged 18ndash60 years who fulfilled the inclusion criteria wererandomly selected for this study This study populationcomprised fifty regular cement factory workers sixty resi-dents of the communities surrounding the UNICEM factoryand one hundred apparently healthy individuals residing inCalabarmetropolis 45 km away from the factory not exposedto cement dust who served as control subjects Informedconsent was obtained from them and ethical approval wasobtained from The Center of Clinical Governance Researchand Training Ministry of Health Cross River State Thisstudy was carried out in accordance with the Ethical Prin-ciples for Medical Research Involving Human Subjects asoutlined in the Helsinki Declaration in 1975 (revised in2000) Test subjects of the study were selected from theproduction section of the cement factory This comprisespermanent employees of the factory who are occupationallyexposed to cement dust daily for not less than 2 years in thecourse of their work Host community resident subjects werealso individuals that had been resident in the communitiesproximal to the cement factory for not less than 2 yearswhile control subjects were individuals who had never beenoccupationally exposed to cement dust and are resident inCalabar metropolis

Participants were notified several days before the com-mencement of the study and were given appropriate instruc-tions The physical characteristics of the subjects includedweight and height measured with the use of weighing scaleand stadiometer respectively Systolic and diastolic bloodpressure were taken using sphygmomanometer All subjectsof the study were interviewed to establish their level ofliteracy and were assisted in filling the questionnaire tominimize errors Sociodemographic datawere collected by aninterviewer-administered structured questionnaire aimingto determine age educational levels socioeconomic statusyears of exposure as deduced from date of employment siteor position at the workplace and use and nonuse of safetygadgets such as dust masks Information on general health

and history of past disease(s) and habits such as smokingconsumption of alcoholic beverages and addictions werecollected according to the British Medical Research Councilquestionnaire (BMRC 1960) Individuals with a history ofcigarette smoking tobacco sniffing or chewing liver diseaseor pulmonary disorders chronic organ or systemic illnessand long term medication were excluded from the study

23 Sample Collection Blood samples were collected frommidmorning to noon for both subjects and controls Sevenmilliliters of blood was collected by venipuncture underaseptic conditions into a dry clean plain sample containerThe blood was allowed to clot and was centrifuged at 3500revolutions per minute for 5 minutes After centrifuging theserum was separated with the aid of a Pasture pipette anddispensed into dry chemically clean serum container afterwhich the samples were analysed immediately or stored atminus20∘C for subsequent analysis

24 Laboratory Methods

241 Estimation of Alanine Aminotransferase (ALT) [11]Consider

alpha-oxogutarate + L-alanine

ALT997888997888997888rarr L-glutarate + pyruvate

(1)

Alanine aminotransferase catalyzes the transfer of ami-no group from L-alanine to 120572-ketoglutarate forming pyru-vate and L-glutamate Pyruvate reacts with 24-dinitro-phenylhydrazine to form 24-dinitrophenylhydrazone whoseconcentration is proportional to the ALT activity

242 Estimation of Aspartate Aminotransferase (AST) Reit-man and Frankel [11] Consider

alpha-oxoglutarate + L-aspartate

AST997888997888997888rarr glutamate + oxaloacetate

(2)

Aspartate aminotransferase (AST) catalyses the transfer ofamino acid group from aspartate to ketoglutarate formingoxaloacetate and glutamateThe oxaloacetate reacts with 24-dinitrophenylhydrazine to form 24-dinitrophenylhydrazonewhich in alkaline pH is reddish brown and whose concentra-tion is proportional to the AST activity

243 Estimation of Bilirubin by Modified Valleyrsquos Method[12] Serum bilirubin is present in two forms conjugatedwhich is mostly with glucuronic acid and unconjugatedwhich is known as free bilirubin Both react with diazotizedsulphanilic acid to give a rose-purple azobilirubin Conju-gated bilirubin reacts in aqueous solution (direct reaction)whereas the unconjugated bilirubin requires an accelerator orsolubilizer such as benzoate urea as in this method or alcoholwhich is used in other methods (indirect reaction)

























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research article cement dust exposure and perturbations in...

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