Elif ALTUNDAŞ HATMAN, Sebahat Dilek TORUN

Outbreak of lead toxicity during rebar production in a steel mill

Objective: Largely due to the widespread use of unleaded petrol and lead-free dyes, the lead toxicity nowadays is associated with occupational exposure rather than environmental exposure in adults. This study aims to identify the characteristics of lead exposure cases and evaluate working environment based on workers’ statement in a sector where lead monitoring is not routinely performed during health surveillances and to examine the poisoning of lead toxicity. Moreover, we aimed to start a caution on management and treatment of these cases in our country. Methods: This descriptive study conducted in hospital which is authorized to diagnose occupational diseases between April and November 2018. In order to evaluate the sociodemographic characteristics, working life characteristics, workplace environment and risk factors and lead toxicity complaints of 34 cases with the elevated blood lead level (BLL), a 38 item questionnaire form was applied. Physical examination findings, laboratory findings, comorbidities and treatment protocols were obtained from the medical records. Results: 8.3% (n = 34) of the workers applied with a preliminary diagnosis of lead toxicity. Median duration of work was 26 months, average working time was 53.3±7.2 hours/week. The mean BLL was 44.0 ±5.1 μg/dl at the workplace surveillance, 38.4±11.1 μg/dl determined in the hospital and 36.1±8.9 μg/dl during hospital check. The Blood antimony (Sb) level was 5.5±1.4 μg/dl and mean blood manganese (Mn) level were 17.8±5.9 μg/L and 1.5±0.8 μg/L after the 15-day hospitalization. Conclusion: The iron and steel processing sector is among the sectors that should be carefully monitored in terms of lead, Mn, and Sb exposure. The legislations and the exposure limits of toxic metals and the biological limit values should be updated in accordance with scientific data. Chelation treatment of patients with clinical findings should be planned by confirming the accumulation of lead in bone tissue.

İnşaat demiri üreten bir çelik fabrikasında görülen kurşun zehirlenmesi salgını

Amaç: Erişkinlerde kurşun zehirlenmesi, günümüzde kurşunsuz benzin ve kurşun içermeyen boya kullanımının yaygınlaşması nedeniyle artık çevresel etkilenimden çok mesleki etkilenime bağlı olarak görülmektedir. Bu araştırma, sağlık gözetimi sırasında rutin olarak kurşun izleminin yapılmadığı bir sektörde tespit edilen kurşun etkilenimli olguların ve çalışma ortamının özelliklerini tanımlaması ve bu işyerindeki kurşun zehirlenmesinin irdelenmesi amacıyla yapılmıştır. Ayrıca, ülkemizde bu vakaların yönetimine ve tedavisine dikkat çekilmesi hedeflenmiştir. Yöntem: Bu tanımlayıcı araştırma, meslek hastalıkları tanısı koymaya yetkili bir hastanede Nisan- Kasım 2018 tarihleri arasında yürütülmüştür. Kan kurşun düzeyi (KKD) yüksekliği saptanan 34 olguya sosyodemografik özelliklerini, çalışma yaşamına ilişkin özelliklerini, çalışma ortamını ve risk faktörlerini ve kurşun etkilenimine bağlı şikayetlerini değerlendirmek amacıyla oluşturulan 38 maddelik bir soru formu uygulanmıştır. Fiziksel muayene bulguları, laboratuvar bulguları, komorbiditeler ve tedavi protokolleri tıbbi kayıtlardan elde edilmiştir. Bulgular: Çalışanların %8,3’ü (n=34) kurşun toksisitesi ön tanısı ile başvurmuştur. Ortalama çalışma süresinin 26 ay, ortalama haftalık çalışma süresinin ise 53,3±7.2 saat olduğu belirlenmiştir. Ortalama KKD, iş yerinde aralıklı kontrol muayenesi sırasında 44,0±5,1 μg/dl, hastanede alınan ilk örnekte 38,4±11,1 μg/dl ve hastanede kontrol örneğinde 36,1±8,9 μg/dl bulunmuştur. Kan antimon seviyesi 5,5±1,4 μg/dl, ortalama kan mangan seviyesi 17,8±5,9 μg/L ve 15 günlük yatış sonrasında 1,5±0,8 μg/L olarak tespit edilmiştir. Sonuç: Demir çelik sektörü kurşun, mangan ve antimon maruziyeti açısından dikkatle izlenmesi gereken sektörler arasında yer almaktadır. Toksik metallerin mevzuatı ve maruz kalma sınırları ile biyolojik limit değerleri bilimsel verilere uygun olarak güncellenmelidir. Klinik bulguları olan hastaların şelasyon tedavisi, kemik dokusunda kurşun birikimi değerlendirilerek planlanmalıdır.

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