Scientific journal
European Journal of Natural History
ISSN 2073-4972

THE DYNAMICS OF CLINICAL HEALTH OF THE COHORT GROUP

Basharova G.R, Karamova L.M.
Abstract: The data on the dynamic clinical 40-year observation of health promotion of workers with chloracne who were involved in the production of 2,4,5 T are presented in the paper. The clinical picture of intoxication was characterized by moderate cytopenia, hypercholesterinemia, vegeto-vascular dystonia with background chloracne signs. Postcontact follow-up data on a closed cohort aged 23-63 years showed the disappearance of chloracne manifestations, but there were signs of pigmentation, proliferative formations. Mono-lymphocytosis was found in blood samples. There is evidence of an increase in the number of lipids, enzyme activity, blood coagulation, biological age. Functional disorders of the neuro-vegetative and cardio-vascular systems are transformed into clinically marked destructive diseases such as IHD, infarcts, insults, tumours that shorten the life span.

Introduction: During the past decades, studies involving experimental, environmental and epidemiological surveys of many scientists as well as our own data on clinico-functional manifestations and medico-biological consequences of dioxins have shown these supertoxicants to be hazardous in their impact on health of exposed individuals and their offspring. The toxic substances originate the development of numerous geno-, phono- and locally specific effects.

Most investigators (1-4) believe that due to their cumulative characteristics dioxins produce a long term hormone-like impact on the development and functioning of the body systems. Even though the contact has ceased, the formation of a broad spectrum of clinically manifested and subclinically multilevel health disorders is in progress.

Materials and Methods: Enrolled in our study is a group of individuals who were involved in the production of 2, 4, 5 T between 1965 and 1967. All 128 workers developed chloracne. We have been following these occupationally exposed subjects with chloracne manifestations since 1990.

Results and Discussion: Retrospective analysis showed the absence of dioxin content measurements during technological processes of 2, 4, 5 T production. According to calculations by L.A. Fedorov (1993), dioxin content in the end product was no less than 30-40 mg/kg (5). The singular clinically-based medical examination revealed chloracne in 85,3 % of workers. Long term treatment resulted in the disappearance of this disease signs. So, the first complex clinico-functional examination of exposed workers was conducted with background chloracne clinical signs.

The majority of male patients were at the age of 20-26 years. The mean age of the whole cohort was 23±2,5 years. The examination detected typical chloracne in all of them. Moderate neutropenia, lympho and monocytopenia were found in peripheral blood of 32-37,7 % of workers. Hypercholesterinemia was detected in 43,8 %. Every other subject (46,0±4,3) had vegeto-vascular disorders of sympathico-adrenal origin. Clinically marked diagnoses are mainly associated with vegeto-vascular dystonia, chronic gastritis, cholecystitis, bronchitis.

The subjects whose mean age was 38 years were re-examined in 1984/1985. There was no evidence of chloracne. However, numerous pigment spots of various intensity, hyperkeratic and papilo-like formations were found on their back and hips. The number of cardiovascular pathology cases with clinical formation of hypertensive and ischemic diseases increased significantly. Two cases of myocardial infarction and diabetes mellitus were detected. The blood sample was characterized by a moderate elevation of white blood cells. The level of activity of enzymes, autoimmune processes tended to be high. There was a distinct trend towards immunity suppress.

Ten years later, between 1990 and 1995, further investigations were carried out.  Alongside with the studies conducted between 1996 and 2006, they confirmed an elevation in the incidence of atherogenic pathologies including lipidemia, enzymopathy, hypercoagulation, atherosclerotic processes in the brain and heart vessels. Every fourth individual aged 46-53 years was found to have CBS, myocardial infarction and brain insult. The increased rate of cancer was observed. There was evidence of an increase in diseases in every subject.


Table 1. Presented is the dynamics of the cohort clinical health (in %)

Years

1966-67

1984-85

1990-95

2004-2006

         Age

Clinical signs

20-26(M=23± 2,5)

38-43(M=38± 3,3)

47-53(M=51±1,4)

63-70(M=63±2,5)

Cardiovascular: ECG- Arterial

Hypertension

52,6±3,4

AH-40,0(20)

78,8±7,1

58,8(15,4)

100,1±0,5

56,5(31,3)

100,0±0,3

40(82,2)

Cerebral circulation disorders

Ischemic heart disease

-

IHD   - 13,0

IHD  - 25,4

MI, CCD

CCD, IHD, MI

CNS: VVD

          NCD

46,3±4,3

16,6±2,0

56,0±5,6

encephalopathy

NCD

encephalopathy

NCD

encephalopathy

Respiration:

Ch. bronchitis

5,4±1,1

8,3±1,2

12,5±1,6

19,2±2,1

Alimentary tract: ch.gastritis

ch.cholecystitis

21±2,4

14,4±4,1

36,6±6,0

16,8±4,0

38,7±4,5

16,7±2,3

37,2±2,4

19,1±2,8

Skin:chloracne,

eczema, dermatitis

100,0

6,0

2,0

7,0

-

3,0

-

2,6

Endocrinology:

diabetes, thyroid gland

-

 

1 case

 

 

2 cases

2 cases

 

2 cases

2 cases

 

2 cases

2 cases

Others:  dental

             cancer

-

-

38,4

1,4

88,

4,7

100,0

19,2

Blood:

leukocytes

eosinophils

lymphocytes

monocytes

hypercoagulation

 

reduced    19,5

higher       28,9

lower   37,7  lower         32,1

no evidence

 

increased   11,0

higher       18,1

higher       11,0

higher       25,0

42,7±1,7

 

Normal

normal

higner         18,6

higner         33,8

53,4±3,7

 

Normal

normal

higner          20,0

higner          35,7

83,4±4,3

Biochemistry

 

Glucose

Cholesterin

b Lipoprotein

BLOI

Mean molecule

No evidence

No evidence

Normal

43,8

no evidence

no evidence

no evidence

increased    18,7

increased    14,4

normal

no evidence

no evidence

no evidence

no evidence

increased     25,7

increased     18,9

increased     10,0

increased      49,6

increased      10,2

reduced       -14,0

increased      77,4

increased   22,3

increased   24,4

increased    12,6

increased    56,6

increased    18,8

reduced       21,2

increased   81,25

Immunol.lymph.

B lymph.

Olyph.

Im.A

CIC

No evidence

No evidence

No evidence

No evidence

No evidence

No evidence

Reduced      50,0

Reduced      51,0

Increased     60,0

increased     13

increased     12

increased     14,0

reduced        64,3

reduced        34,3

increased      51,4

increased      17,4

increased      16,4

increased      17.0

reduced       77,0

reduced       34,6

no evidence

increased     20,0

increased     22,8

increased     19,5

Number of diseases per person

1,0

1,4

3,7

8,0


Now that the mean age of the cohort studied is 63 (from 63 to 70 years), it is obvious that marked atherogenic processes and disorders have increased with age. However, comparative health studies of the cohort and controls matched in age show the rate of disorders in subjects exposed to dioxins to be significantly elevated over controls.

Special calculations of the cohort biological age showed that individuals with a history of chloracne were 18-20 years older than their calendar age. There was a 1,5 fold rise in mortality rate compared with the general city population. The mean age of dead people was 52,3±4,3 years.

Thus, the dynamic health follow-up of workers exposed to dioxins in the cohort group aged 23 - 63 years has shown that skin disorders like chloracne disappear but pigmentation and proliferative processes occur. Cytopenic reaction is associated with a trend toward a decrease and replacement by mono- and lymphocytosis. Levels of lipids, enzyme activity, blood coagulability, and biological age increase gradually. Functional disorders of the neuro-vegetative and cardiovascular systems are gradually transformed into clinically marked destructive diseases such as IHD, infarcts, insults, tumours that shorten the life span.

References:

  1. Roumak V.S., Poznyakov S.P., Umnova N.V. The baseline of biological assessment of dioxin hazards // Dioxins are supertoxicants of the XXI century. Medico-biological problems. - M., 1998, P. 111 p.
  2. Poznyakov S.P., Roumak V.S., Umnova N.V. 2,3,7,8,- tetrachlorbenzo-p-dioxin - hormone-like dezantogenic superecotoxicant // Jour. of Ecol. Chemistry - 1993. N 3. P. 189-212.
  3. Roumak V.S. Medico-biological assessment bases for remote consequences of phytotoxicants containing 2,3,7,8 T used in military purposes (Agent Orange in Ranch Hand as an example) // Doctorate thesis. St. Petersburg, 1993. - 50 p.
  4. Basharova G.R. Medico-biological dioxin consequences // Candidate thesis. 1996. 20 p.
  5. Fedorov L.A. Dioxins as ecological danger: retrospectives and perspectives // edit. by V.V. Onaprienko/ - M., Science, 1993. - 265 p.
    The article is admitted to the International Scientific Conference "Prospects of development of a high school science", Sochi (Dagomys), September, 20-23th 2007, came to the editorial office on 14.06.07