Occupational lead exposure health risk assessment and heme biosynthesis: A study on batik artisans in yogyakarta, Indonesia

This study aims to assess dermal and inhalation lead exposure levels among batik industry workers and evaluate noncarcinogenic and carcinogenic health risks associated with lead exposure. We investigate potential relationships between lead exposure (dermal average daily dose and inhalation exposure concentration) and the workers' blood hemoglobin levels (Hb), as well as their urinary ALA (u-ALA) concentrations. Additionally, we explore any possible associations between Hb and u-ALA levels among the workers and identify various factors influencing lead exposure levels. A total of 30 workers were recruited for the study. Interviews and exposure sampling were conducted to measure dermal and inhaled lead exposure. Sample analysis methods include XRF for exposure samples, spectrophotometry for u-ALA, and HiCN colorimetric for Hb. Carcinogenic and noncarcinogenic risk assessments, correlation analysis, as well as ANOVA for factors analysis, were performed. The average dermal exposure dose and inhalation exposure concentration of lead were 6.53 ± 3.2 ng/kg/day and 0.021 ± 0.015 μg/m3, respectively. Hazard Index (HI) values for all workers were below 1 (average: 0.372 ± 0.155), indicating no expected noncarcinogenic health effects due to lead exposure. The average Excess Lifetime Cancer Risk (ELCR) was (5.18 ± 3.84) × 10-8, significantly below acceptable limits. Correlation analysis revealed a significant negative correlation between Hb and u-ALA (r = -0.519, p = 0.058 for male workers and r = -0.531, p = 0.034 for female workers), supporting their use as lead exposure biomarkers. The factors analysis demonstrated a significant impact of working conditions on inhalation exposure (p = 0.018), with outdoor workers experiencing lower lead inhalation. This research provides crucial insights into potential dangers faced by batik workers due to lead exposure, emphasizing the importance of targeted interventions. The strong correlation between Hb and u-ALA indicates their combined effectiveness in detecting lead exposure, even at low levels. The study underscores the significance of outdoor work as a protective measure against inhaling heavy metals, such as lead, present in the air. The assessment of health risks associated with lead exposure in the batik industry lays the groundwork for informed decision-making and interventions to protect workers' well-being, particularly in informal sectors workplaces where health risks are often overlooked.

Glove-Induced Hand Dermatitis: A Study in Healthcare Workers during COVID-19 Pandemic in Indonesia

Skin damage among healthcare workers has been reported by many centers around the world. Occupational hand dermatitis is one of the most commonly known occupational skin diseases and a socially significant health issue. The use of gloves is one of the risk factors for the occurrence and/or aggravation of hand dermatitis. This cross-sectional study involved healthcare workers in 14 referral hospitals for COVID-19 throughout Indonesia. Questionnaires were distributed to the participants, which consisted of the subject's characteristics, glove-related skin problems, history of glove use, and clinical history. This study involved a total of 845 healthcare workers. Approximately 156 healthcare workers (18.46%) had glove-induced hand dermatitis during the pandemic. Itchy skin was the most common symptom (44.23%), and the palm was the most frequently complained area (48.72%). There was a significant association between glove use and glove-induced hand dermatitis among healthcare workers. In particular, equal to or more than 2 hours per day of glove use was significantly associated with hand dermatitis. Glove-induced hand dermatitis also had a significant association with the subject's history of atopic dermatitis and previous history of hand dermatitis. The use of gloves by healthcare workers should be considered carefully, especially in individuals at increased risk, including those who use gloves for 2 hours or more per day and those who have a history of atopic or hand dermatitis, in order to prevent the incidence of glove-induced hand dermatitis among healthcare workers, as well as to provide a safe working environment.

Combination of cyclosporine A and methylprednisolone to treat pediatric Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome

The treatment of epidermal necrolysis in pediatric patients remains a major challenge. Cyclosporine A has emerged as a promising therapy for epidermal necrolysis in adults; however, its efficacy in children is unclear. We present the case of a boy with Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome who was initially resistant to methylprednisolone monotherapy but improved after receiving the combination of cyclosporine A and methylprednisolone. Published reports on the use of cyclosporine A for pediatric epidermal necrolysis are also briefly reviewed.

Hazard identification and the prevalence of occupational skin disease in Indonesian Batik workers

Batik, a resist-dyeing technique to decorate a special cotton fabric, has been practiced for centuries in Indonesia. Unfortunately, as an informal enterprise, batik industry activities lack work safety and health regulations. This study aimed to identify potential health hazards, including inventorying the chemicals to which the workers are exposed, the PPE profile, and investigating the prevalence of occupational skin diseases (OSD) in the batik industry. A cross-sectional study and an inventory of exposure to the chemicals were done in traditional batik workplaces in 5 districts in Yogyakarta province, Indonesia. The chemicals were classified as potential sensitizers/irritants, and the workers were examined and interviewed using the Nordic Occupational Skin Questionnaire-2002/LONG. Of 222 traditional batik workers, OSD were diagnosed in 61 (27.5%) workers, with occupational contact dermatitis was the most common OSD encountered (n = 23/61; 37.7%) (allergic contact dermatitis n = 7/23; irritant contact dermatitis n = 16/23). A smaller portion of other OSD was also encountered including callus, miliaria, and nail disorder (9%, 6.3%, and 5.9%, respectively). During each step of the traditional batik manufacturing process, the workers are exposed to substances that act as irritants and/or as potential contact allergens. However, only one-fourth of the workers used PPE regularly, particularly during the coloring process and wax removal (wet processes). Traditional batik manufacturing process exposes the worker to various physical and chemical hazards, resulting in a high prevalence of occupational skin diseases, especially contact dermatitis among the employees.

Cutaneous Manifestation in COVID-19: A Lesson Over 2 Years Into the Pandemic

Cutaneous manifestations related to Coronavirus Disease-19 (COVID-19) have been reported over 2 years since the pandemic began. This research aimed to review articles published in English that describe cutaneous manifestations related to COVID-19/SARS-CoV-2. A data search for case reports, original studies, and review articles from the onset of the current COVID-19 pandemic to December 31, 2022, was performed using PUBMED, Cochrane Library, ResearchGate, and Google search engines. Keywords were "coronavirus", "novel coronavirus 2019", "COVID-19", "SARS-CoV-2", and "2019-nCoV" in combination with "cutaneous", "skin" and "dermatology" The extracted data included authors, region, sex, age, number of participants with skin signs, cutaneous signs, its location, symptoms, extracutaneous/associated symptoms, suspected or confirmed status for COVID-19, timeline, and healing duration. Six authors independently reviewed the abstracts and full-texts to identify publications providing these details concerning cutaneous manifestations related to COVID-19. A total of 139 publications with full text (122 case reports, 10 case series, and 7 review articles) that reported cutaneous manifestations were identified, and reviewed from 5 continents. The most common cutaneous manifestations of COVID-19 were maculopapular, followed by chilblain-like lesion, urticarial, livedoid/necrotic, vesicular, and other/non-descript rashes/skin lesions. After 2 years into the COVID-19 pandemic, we can conclude that there is no pathognomonic cutaneous manifestation of COVID-19, since it can be also found in other viral infections.

Risk factors of occupational skin diseases among traditional batik manufacturing workers in Yogyakarta, Indonesia

OBJECTIVE

Batik is one of the Indonesian traditional arts made by decorating fabric using the resist dyeing technique. Currently, batik manufacturing serves as an important source of livelihood in Indonesia. However, the production process of traditional batik involves a range of chemicals and some repetitive physical movements, making batik production inseparable from physical and chemical hazards which increase the risk of developing occupational skin diseases (OSD). This study aimed to identify the risk factors related to OSD, including occupational contact dermatitis (OCD), among traditional batik manufacturing workers in Yogyakarta, Indonesia.

RESULTS

The study demonstrated that working duration (≥ 8 h daily) and type of work (wet process only) were statistically significant as risk factors for developing OSD. While for OCD, our results found that gender (male), history of atopy, and type of work (all and wet phase only) were risk factors for OCD development among traditional batik manufacturing workers.

Prevalence of pesticide related occupational diseases among Indonesian vegetable farmers - A collaborative work

Objective

This study was done to understand the prevalence of various occupational diseases including dry eyes, nail dystrophy, and neuropathy related to pesticide exposure in Indonesian local vegetable farmers.

Methods

The data were collected through questionnaires and physical examination involving dermatology, neurology, and ophthalmology domains at Ngablak District, Magelang, Central Java directed to local vegetable farmers. Ocular Surface Disease Index (OSDI) questionnaire and the Schirmer test were used. Analysis was done using descriptive statistics using the Statistical Package for the Social Sciences (SPSS 21.0) and presented in tables.

Results

Inadequate spraying equipment and improper storage of pesticides were found. Out of 105 farmers, 41.9 % experienced occupational skin diseases (OSD). Definite cognitive impairments were found in 3.4 % of subjects but probable in 28.3 % of subjects. Neuropathies were found in 61.7 % of subjects, and dry-eyes syndrome were found in 28.78 % of subjects.

Conclusion

There was a high prevalence of peripheral neuropathy and tremor, dry eyes syndrome in one-third of the population, and the most common skin problem was nail discoloration, with a low incidence of contact dermatitis.

Metabolomic Assay, Computational Screening, and Pharmacological Evaluation of Caulerpa racemosa as an Anti-obesity With Anti-aging by Altering Lipid Profile and Peroxisome Proliferator-Activated Receptor-γ Coactivator 1-α Levels

Obesity is associated with an accelerated aging process, which prevents healthy aging. Both obesity and aging were manifested in the peroxisome proliferator-activated receptor-γ coactivator α (PGC-1α) level. These studies fulfill the scientific gap in assembled pharmacological activity assay of Caulerpa racemosa done in a previous preclinical trial. Six major compounds from sea grape (C. racemosa) extract were evaluated using an in silico approach against human pancreatic lipase, a-glucosidase, and a-amylase to predict prospective anti-obesity candidates. The lipase inhibitory activity of the extract reached 90.30 ± 0.40%, 1.75% lower than orlistat. The a-amylase inhibitory assay of the extract was 84.07 ± 5.28%, while the inhibitory activity against a-glucosidase was 81.67 ± 1.54%; both were lower than acarbose. We observe the effect of C. racemosa extract as anti-obesity with anti-aging by evaluating the obesity parameters in the human body for a 4-week period. There was a significant decrease in blood glucose, total cholesterol, low-density lipoprotein (LDL), triglycerides (TG), waist circumference, waist-hip ratio, and body weight (p < 0.05); PGC-1α and high-density lipoprotein (HDL) increased significantly (p = 0.000), in Group B when compared with Group A. Our study revealed that sea grape extract is a potent anti-obesity with an anti-aging reagent that does not produce any significant adverse effects.

Allopurinol-Induced Stevens–Johnson Syndrome in Javanese Men With Positive HLA‐B*58:01

Background: Allopurinol is the most commonly used drug for the treatment of gout arthritis. However, the use of allopurinol is associated with severe cutaneous adverse reactions (SCARs) and life-threatening immune-mediated reactions that include Stevens–Johnson syndrome (SJS). SJS induced by allopurinol is strongly linked with the presence of HLA-B*58:01 in the Asian population. Such a study has not been conducted in Indonesia. We present two cases with clinical diagnosis of SJS. These patients had Javanese ethnicity, for which evidence on the genetic predisposition of allopurinol-induced SJS/TEN had not been established. Testing for the presence of the HLA-B∗58:01 allele was positive in both cases. Our case report confirms findings from studies in Asian countries that link HLA-B*58:01 and allopurinol-induced SJS/TEN. A larger study is needed to elicit evidence that the HLA-B*58:01 allele can potentially be used as a genetic marker for allopurinol-induced SCARs among different ethnicities in Indonesia.

Occupational skin dermatoses among health care workers: A review of adverse skin reactions to personal protective equipment

Occupational skin-related problems include dermatoses caused by agents in the working environment. For health care workers, these occupational dermatoses could be due to usage of personal protective equipment (PPE), such as gloves, masks, goggles, and other protective equipment. These PPE contribute to both allergic and irritant contact dermatitis. This review summarized the skin damage after PPE usage and hand hygiene protocol. Recommendations should be established to prevent these occupational dermatoses from PPE usage.

Urinary hippuric acid level as a biological indicator of toluene exposure on batik workers

Urinary hippuric acid (uHA) is one of the biomonitoring parameters of toxic organic exposure, such as toluene. Repeated exposure to a low concentration of toluene may lead to chronic effects such as central nervous system damage. In the preliminary study, toluene was found in the batik industry's working area in Yogyakarta, Indonesia. This study aims to assess the health condition of batik workers to toluene exposure based on the concentration of uHA. There were 52 respondents divided into 2 groups: the batik workers as the exposed group (30 respondents) and the non-batik workers as the control group (22 respondents). The urine sample was taken from batik workers at the end of the shift, and uHA was measured using spectrophotometry. The uHA value was corrected with urinary creatinine. The results showed that the average uHA concentration of batik workers was higher than that of the control group. The result also showed that workers with more than 2 years working period, writing workers, and stamping workers give an Odds Ratio (OR) of 6.43, 6.75, and 9.00 respectively on having a higher concentration of uHA. Workers with toluene exposure symptoms were also having a higher concentration of uHA than workers without any symptoms.

Quality of Life of Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) and Stevens-Johnson Syndrome (SJS) and/or Toxic Epidermal Necrolysis (TEN) Patients

PURPOSE

Drug Reaction With Eosinophilia and Systemic Symptom (DRESS), Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) are acute hypersensitivity reactions with the potential to reduce the quality of life of exposed individuals. This study aims to determine the quality of life of patients suffering from DRESS, SJS, SJS/TEN.

PATIENTS AND METHODS

A cross-sectional approach was used to get the quality of life data from DRESS, SJS, and/or TEN patients at Dr. Sardjito general hospital, Yogyakarta. The utility index and VAS score differences of EQ-5D-5L were analyzed based on the diagnosis.

RESULTS

We recruited 58 patients. Most of the patients were female (63%). The mean value of utility index was 0.61, 0.08 and 0.03 for DRESS, SJS and SJS/TEN patients, respectively (p value <0.01). Furthermore, the mean of VAS score was 73.36, 57.93 and 50.00 for DRESS, SJS and SJS/TEN patients, respectively (p value <0.01).

CONCLUSION

In general, the quality of life of DRESS patients is better than the quality of life of SJS and/or TEN patients.

Blood Cholinesterase Level is Associated with Cognitive Function in Indonesian School-age Children Exposed to Pesticides

BACKGROUND: Pesticides are known as depressors of acetylcholinesterase (AChE) activity, resulting in the nervous system toxicity. The previous studies have described associations between AChE, a stable marker of pesticide poisoning, and cognitive performance in children. AIM: This study aimed to identify the association between blood AChE level and cognitive function in children exposed to pesticides in the Magelang Regency, Indonesia. METHODS: A cross-sectional study involving school-age children with a history of pesticide exposure in Ngablak, Magelang Regency, Central Java, Indonesia, was conducted. Blood AChE level was evaluated, and the Modified Mini–Mental State Examination for Children (MMMSEC) was used to analyze the cognitive function of the children. RESULTS: In total, 56 subjects aged between 9 and 11 years were included in this study. Median blood AChE level was 9.64 kIU/L, and 24 subjects (42.9%) had low blood AChE levels. Median MMMSEC score was 33. Eleven subjects (19.6%) were found to have abnormal cognitive function. Bivariate analysis showed that blood AChE level was associated with MMMSEC score (r = 0.343, p = 0.010). Multiple linear regression showed that blood AChE level had a positive association with cognitive function in children, assessed using the MMMSEC score (β = 0.360; p = 0.006). Further analysis showed that the attention and orientation (memory function) domains of the MMMSEC were significantly associated with blood AChE level (β: 0.371 and 0.297, respectively, p < 0.05). CONCLUSIONS: Blood AChE level, a stable marker of pesticide poisoning, was positively associated with cognitive function in children, as assessed using the MMMSEC score. In particular, the orientation and attention domains of the MMMSEC were associated with blood AChE level.