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Case Report
A case of syncope in a villager with hypertrophic cardiomyopathy after hydrogen sulfide exposure by an unauthorized discharge of wastewater
Hyeonjun Kim, Seunghyeon Cho, Inho Jung, Sunjin Jung, Won-Ju Park
Ann Occup Environ Med 2023;35:e34.   Published online August 21, 2023
DOI: https://doi.org/10.35371/aoem.2023.35.e34
AbstractAbstract AbstractAbstract in Korean PDFPubReaderePub
Background

Hydrogen sulfide is a toxic substance that humans can be exposed to occupationally, and cases of hydrogen sulfide poisoning of workers in industrial sites are commonly reported. However, there have been no cases of poisoning of the public due to an unauthorized discharge of wastewater, so it is important to describe this incident.

Case presentation

In a small village in Jeollanam-do, Republic of Korea, accounts of a terrible stench had been reported. A 26-year-old man who lived and worked in a foul-smelling area was taken to the emergency room with a headache, dizziness, nausea, and repeated syncope. A subsequent police and Ministry of Environment investigation determined that the cause of the stench was the unauthorized discharge of 9 tons of wastewater containing hydrogen sulfide through a stormwater pipe while the villagers were sleeping. The patient had no previous medical history or experience of symptoms. Leukocytes and cardiac markers were elevated, an electrocardiogram indicated biatrial enlargement, left ventricular hypertrophy, and corrected QT interval prolongation. Myocardial hypertrophy was detected on a chest computed tomography scan, and hypertrophic cardiomyopathy was confirmed on echocardiography. After hospitalization, cardiac marker concentrations declined, symptoms improved, and the patient was discharged after 7 days of hospitalization. There was no recurrence of symptoms after discharge.

Conclusions

We suspect that previously unrecognized heart disease manifested or was aggravated in this patient due to exposure to hydrogen sulfide. Attention should be paid to the possibility of unauthorized discharge of hydrogen sulfide, etc., in occasional local incidents and damage to public health. In the event of such an accident, it is necessary to have government guidelines in place to investigate health impact and follow-up clinical management of exposed residents.

무단 방류된 황화수소 노출에 의해 비후성심근증이 악화되어 실신한 마을 주민 사례
배경
황화수소 중독은 산업현장, 하수처리시설 또는 관리되지 않는 화장실 등에서 흔하게 보고된다. 다만 폐수 무단 방류로 인해 일반 주민에게 건강 영향이 발생한 사례는 보고된 바 없어 이를 보고한다.
증례
전라남도 한 지역에서 새벽부터 심한 악취가 난다는 주민 신고가 다수 발생하였다. 경찰과 환경청의 조사 결과 악취의 원인은 새벽에 주민들이 잠든 사이 폐수처리업체에서 황화수소가 포함된 폐수 9톤을 우수관을 통해 무단으로 방류한 것으로 밝혀졌다. 심한 악취가 나는 지역에서 장시간 활동했던 26살 남성이 두통, 어지럼증, 메스꺼움과 짧은 실신을 반복하여 119를 통해 응급실로 내원하였다. 환자는 과거에 특별한 병력이나 증상 경험은 없었다. 검사상 환자의 백혈구와 심장 표지자 수치가 상승되어 있었다. 심전도에서 양측 심방 확장, 좌심실 비대 및 QTc 연장이 관찰되었다. 흉부 컴퓨터 단층 촬영 상 심근비대 소견과 심장 초음파 검사 상 비후성심근증이 확인되었다. 입원하여 대증치료 후 심장 표지자 수치는 감소하였고, 증상은 호전되어 입원 7일 만에 퇴원하였다. 퇴원 이후 추적관찰 동안 특별한 증상은 재발하지 않았다.
결과
본 사례는 환자가 이전에 인지하지 못하고 증상도 없었던 비후성심근증이 황화수소 노출로 인해 급성 악화된 것으로 판단된다. 종종 발생하는 지역의 악취 사건에 황화수소가 무단 방류되었을 가능성을 고려해야 할 것이며, 향후 이러한 화학사고 발생 시 화학물질관리법에 따른 주민 건강영향조사를 실시하여 주민 건강을 관리해야 할 것이다.
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Research Article
Drinking and recreational water-related diseases: a bibliometric analysis (1980–2015)
Waleed M. Sweileh, Sa’ed H. Zyoud, Samah W. Al-Jabi, Ansam F. Sawalha, Naser Y. Shraim
Ann Occup Environ Med 2016;28:40.   Published online September 6, 2016
DOI: https://doi.org/10.1186/s40557-016-0128-x
AbstractAbstract PDFPubReaderePub
Background

Water – related diseases are worldwide health concern. Microbial contamination and contaminant products in water are a source of disease outbreaks and development of cumulative toxic effects. Ensuring safe water is one of the goals to be achieved at the global level. The aim of this study was to assess publications on drinking and recreational water from a health point of view to understand current problems and future research trends in this field.

Methods

Scopus, the largest scientific electronic database, was used to retrieve related articles and present the results as bibliometric tables and maps. Search query was modified manually using related terms to maximize accuracy.

Results

A total of 2267 publications were retrieved with an average of 16.82 citations per article. The h-index of retrieved articles was 88. Visual mapping showed that E. coli, diarrhea, cryptosporidiosis, fluoride, arsenic, cancer, chlorine, trihalomethane, and H. pylori were most frequently encountered terms in title and abstract of retrieved articles. The number of articles on water microbiology was a significant (P < 0.01) predictor of worldwide productivity of water – related disease publications. Journal of Water and Health ranked first in number of publications with 136 (6.00 %) articles. The United States of America ranked first in productivity with a total of 623 (27.48 %) articles. Germany (15.44 %), India (16.00 %) and China (20.66 %) had the least international collaboration in water-related disease research. Environmental Protection Agency and Centers for Disease Prevention and Control were among top ten productive institutions. In the top ten cited articles, there were three articles about arsenic, one about aluminum, one about trihalomethane, one about nitrate, one about toxoplasmosis, one about gastroenteritis, and the remaining two articles were general ones.

Conclusions

There was a linear increase in the number of publications on water – related diseases in the last decade. Arsenic, in drinking water is a serious concern. Cryptosporidiosis and other infectious gastroenteritis remain a major health risk of exposure to contaminated water. Increased number of publications from Asian countries was not associated with a high percentage of international collaboration.


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    Waleed M. Sweileh
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    Waleed M. Sweileh, Samah W. Al-Jabi, Ansam F. Sawalha, Adham S. AbuTaha, Sa’ed H. Zyoud
    Malaria Research and Treatment.2017; 2017: 1.     CrossRef
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    Waleed M. Sweileh
    Globalization and Health.2017;[Epub]     CrossRef
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    Waleed M. Sweileh
    Orphanet Journal of Rare Diseases.2017;[Epub]     CrossRef
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Review
Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries
Shehani A. Wimalawansa, Sunil J. Wimalawansa
Ann Occup Environ Med 2016;28:33.   Published online August 5, 2016
DOI: https://doi.org/10.1186/s40557-016-0119-y
AbstractAbstract PDFPubReaderePub
Background

Environmentally induced, occupational diseases are increasing worldwide, especially in rural agricultural communities. Poverty-associated malnutrition, environmental hazards and pollution, and lack of access to clean water, safe sanitation, and modern healthcare facilities are often associated with these chronic illnesses.

Method

The authors systematically reviewed occupational public health issues that have been related to the environment. General interpretations of results were included as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Pertinent publications from research databases were reviewed on (A) the risk–benefits, (B) the prevalence of risk factors for various diseases, (C) the benefits of not ignoring the risk factors (i.e., broader evidence), and (D) the risks, effects, and outcomes of different types of interventions. The authors used chronic kidney disease of multifactorial origin (CKDmfo) as an example to explore the theme. Emphasis was given to the regions with emerging economies and developing countries located in the vicinity of the equator.

Findings

Geographical, socio-economic and aetiological similarities exist for many chronic non-communicable diseases that are affecting tropical countries around the equator. The authors identified manufacturing, mining, and agriculture as the biggest polluters of the environment. In addition, deforestation and associated soil erosion, overuse of agrochemicals, and irresponsible factory discharge (e.g., chemicals and paint, from rubber and textile factories, etc.), all contribute to pollution. To decrease the escalating incidences of environmentally induced diseases, governments should work proactively to protect the environment, especially watersheds, and take steps to minimise harmful occupational exposures and strictly enforce environmental regulations.

Conclusion

Creating public awareness of environmental issues and their relationship to public health is essential. This includes regular monitoring and periodic publication of the quality of water, air and soil; preventing deforestation and man-made soil erosion, increasing forest and ground cover, preventing occupational injuries, judicious and safe use of agrochemicals, sustainable agriculture and development programs, and implementing legislation to protect and conserve water heriage and the environment. These actions are essential both for a healthier environment and for the health of the people who live in that environment. Such measures would also decrease public health threats from such, including global-warming-related erratic environmental changes and the occurrence and the spread of non-communicable diseases, such as CKDmfo.


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Research Article
Contribution of Arab countries to pharmaceutical wastewater literature: a bibliometric and comparative analysis of research output
Sa’ed H. Zyoud, Shaher H. Zyoud, Samah W. Al-Jabi, Waleed M. Sweileh, Rahmat Awang
Ann Occup Environ Med 2016;28:28.   Published online July 3, 2016
DOI: https://doi.org/10.1186/s40557-016-0117-0
AbstractAbstract PDFPubReaderePub
Background

Recently, the pharmaceutical manufacturing industry has been growing rapidly in many countries in the world, including in Arab countries. Pharmaceuticals reach aquatic environments and are prevalent at small concentrations in wastewater from the drug manufacturing industry and hospitals. Such presence also occurs in domestic wastewater and results from the disposal of unused and expired medicines. Therefore, the objective of this study was to analyze and compare the quantity and quality of publications made by researchers in Arab countries on pharmaceutical wastewater.

Methods

To retrieve documents related to pharmaceutical wastewater, we used the Scopus database on November 21, 2015. All documents with terms related to pharmaceutical wastewater in the title or abstract were analysed. Results obtained from Arab countries were compared with those obtained from Turkey, Iran and Israel.

Results

Globally, a total of 6360 publications were retrieved while those from Arab countries, Iran, Turkey and Israel, were 179, 113, 96 and 54 publications respectively. The highest share of publications belonged to Kingdom of Saudi Arabia (KSA) with a total of 47 (26.2 %) publications, followed by Egypt (38; 21.2 %), Tunisia (17; 9.5 %) and Morocco (16; 8.9 %). The total number of citations was 1635, with a mean of 9.13 and a median (inter quartile range) of 3 (1.0–10.0). The study identified 87 (48.6 %) documents with 32 countries of international collaboration with Arab countries. It was noted that Arab researchers collaborated mainly with authors in Western Europe (54; 30.2 %), followed by authors from the Asiatic region (29; 16.2 %) and Northern America (15; 8.4 %). The most productive institution was King Saud University, KSA (13; 7.3 %), followed by the National Research Centre, Egypt (10; 7.3 %).

Conclusions

This study showed that KSA has the largest share of productivity on pharmaceutical wastewater research. Bibliometric analysis demonstrated that research productivity, mainly from Arab countries in pharmaceutical wastewater research, was relatively lagging behind. More research effort is required for Arab countries to catch up with those of non-Arab Middle Easter countries on pharmaceutical wastewater research.


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Review
Underwater and Hyperbaric Medicine as a Branch of Occupational and Environmental Medicine
Young Il Lee, Byeong Jin Ye
Ann Occup Environ Med 2013;25:39-39.   Published online December 19, 2013
DOI: https://doi.org/10.1186/2052-4374-25-39
AbstractAbstract PDFPubReaderePub

Exposure to the underwater environment for occupational or recreational purposes is increasing. As estimated, there are around 7 million divers active worldwide and 300,000 more divers in Korea. The underwater and hyperbaric environment presents a number of risks to the diver. Injuries from these hazards include barotrauma, decompression sickness, toxic effects of hyperbaric gases, drowning, hypothermia, and dangerous marine animals. For these reasons, primary care physicians should understand diving related injuries and assessment of fitness to dive. However, most Korean physicians are unfamiliar with underwater and hyperbaric medicine (UHM) in spite of scientific and practical values.

From occupational and environmental medicine (OEM) specialist’s perspective, we believe that UHM should be a branch of OEM because OEM is an area of medicine that deals with injuries caused by physical and biological hazards, clinical toxicology, occupational diseases, and assessment of fitness to work. To extend our knowledge about UHM, this article will review and update on UHM including barotrauma, decompression illness, toxicity of diving gases and fitness for diving.


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