|Year : 2021 | Volume
| Issue : 3 | Page : 281-284
Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh
Rahnuma Ahmed1, Qazi Shamima Akhter2, Mainul Haque3
1 Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh
2 Department of Physiology, Dhaka Medical College, Dhaka, Bangladesh
3 Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
|Date of Submission||05-Apr-2021|
|Date of Decision||07-May-2021|
|Date of Acceptance||15-May-2021|
|Date of Web Publication||14-Jun-2021|
The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ahmed R, Akhter QS, Haque M. Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh. Adv Hum Biol 2021;11:281-4
|How to cite this URL:|
Ahmed R, Akhter QS, Haque M. Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh. Adv Hum Biol [serial online] 2021 [cited 2021 Oct 26];11:281-4. Available from: https://www.aihbonline.com/text.asp?2021/11/3/281/318441
An industry that has witnessed fast-paced growth worldwide is the cement industry, with a 4% increase in cement demand per year., Cement production in 2019 globally was 4.2 billion metric tons. In Bangladesh, the cement industry plays a vital role in developing the country's infrastructure. The cement industry sees a 12%–15% growth year to year with a current production capacity of 68 million tons and has 37 active cement manufacturing companies in the country. There has been a 12.67% annual growth rate in the previous 5 years. The demand for cement continues to grow as the country embraces seven mega infrastructure projects such as metro rail, power plants, bridges and rail line development in real estate and commercial projects.
Cement is composed of clay and lime. The clay consists of alumina, oxide of iron and silica, while lime contains calcium oxide. The significant oxides found in cement are oxides of aluminium, iron, calcium and silicon. Cement also contains trace elements such as chromium, copper, nickel, zinc, cobalt, lead and arsenic. The manufacturing process of cement results in the emission of metal dust that is non-volatile. The raw materials are mixed and grinded into a homogenous mixture processed in the rotary kiln at 900°C. This is followed by the process of clinkering where calcium oxide, silica, ferrous oxide and alumina react with each other at 1400°C–1500°C. The clinker is cooled and combined with limestone and gypsum, forming Portland cement, stored in bags or silos., Dust emission occurs from these kilns and during the steps of grinding, crushing, clinker cooling and handling materials.
Crystalline silica or quartz, a component of cement dust, is smaller in size than pollen. This silica dust releases into the air during various high-energy processes of cement production. Crystalline silica can pass through the respiratory tract when its diameter is <5 μm and is referred to as respirable crystalline silica. The respirable crystalline silica is non-irritating and has no colour or odour with no immediate toxic effect on the human body, and therefore, may remain undetected in the workplace. The silicon oxide radicals resulting from silica crushing react with water forming hydroxyl ions, which causes tissue damage. Crystals of silica, having the piezoelectricity property, gain electrical charge when pressure is applied to them. The charged crystalline silica then reacts with cells and causes cell membrane lipid peroxidation. Silicosis, emphysema, pulmonary tuberculosis, rheumatoid arthritis, scleroderma, lung carcinoma and kidney damage are some of the damaging health effects of silica dust exposure.,,
Silicosis is one of the harmful occupational diseases that result from exposure to crystalline silica. Workers suffering from silicosis develop nodules and pulmonary fibrosis with inflammatory change and scarring of the alveolar sac. Even when the exposure ceases, the disease continues to progress. Acute, chronic and lightning stroke are the three forms of the disease. When there is exposure to the substantial amount of silica dust, the person develops fever, shortness of breath, cough and loss of weight that eventually leads to respiratory failure that does not improve upon corticosteroid administration.
A study carried out in Sweden to observe an association between silica dust exposure and risk of developing sarcoidosis found a strong correlation between exposure to dust-containing silica and the prevalence of sarcoidosis in men. Sarcoidosis is a systemic inflammatory disease in which granuloma formation occurs in different organs, commonly lungs and lymph nodes of the thorax. A cohort study carried out in Denmark found an association between exposure to respirable crystalline silica and the development of autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and small-vessel vasculitis) in susceptible individuals. The study suggested that due to the retention of silica in the lung, chronic inflammation, disturbance in the mechanism of control and tolerance break cause auto-antibodies production in susceptible individuals.
Chromium, in its hexavalent form, is found in cement dust., Hexavalent chromium is toxic as well as carcinogenic. Inhaling, ingesting and skin contact with hexavalent chromium can result in chromosomal anomalies and damage to DNA., Hematological, gastrointestinal abnormalities may occur upon repeated exposure to hexavalent chromium.,, When exposed to chromium dust concentration of more than 0.002 mg m–3, there is reduced pulmonary function, which results in bronchitis, pulmonary oedema and bronchopneumonia. Workers in the cement industry commonly suffer from dermatitis as they are exposed to heavy metals found in cement-like chromium, cobalt and nickel. Systemic contact dermatitis occurs upon exposure to aluminium, cobalt, nickel and chromium. Individuals with nickel exposure on skin and mucosa suffer from the formation of vesicles, erythema, pruritis and scaling. Contact of skin with cement may also cause cobalt allergy and chronic skin diseases such as psoriasis due to mercury exposure.,
Aluminium, another toxic constituent of cement dust, has a toxic effect on the nervous system upon long-term exposure. Exposure to this chemical causes oxidative stress and alters the signalling pathway of calcium in the hippocampus. Neurons synthesizing acetylcholine are particularly affected in neurotoxicity due to aluminium.
Exposure to the cement dust and its toxic components leads to pathological conditions in the human body, including asthma, chronic bronchitis, lung cancer, tuberculosis, pneumonia, inflammation of oral mucosa and skin., Cement dust can enter the human body utilising inhalation and swallowing. The cement dust particle size ranges from 0.05 to 20 mμ quickly passing through and depositing within the respiratory tract.
Upon breathing in the high levels of toxic dust, there are non-specific immune responses such as sneezing, coughing, mucociliary dysfunction and airway constriction due to smooth muscle contraction around the airway [Figure 1]. The computed tomography scan findings of a study have demonstrated that cement dust brings about structural changes. The cement-factory workers with chronic exposure to cement-dust often develop narrowing of the airway, alveolar wall thickening, and loss of airway wall elasticity, particularly in lower lobes than the control group (unexposed) of research participants were observed, detected through common spirometer findings.
|Figure 1: Immune response of human body upon repeated cement dust exposure.|
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In Ethiopia, an association was found between chronic respiratory disease and cement dust exposure. Another study done in Pakistan on non-smoking cement mill workers observed reduced lung function in subjects exposed for a longer duration. In Yemen in 2013, a study was done to observe the respiratory epithelial change in cement dust-exposed subjects and found dysplasia, squamous metaplasia and inflammation in cement dust-exposed workers.
Following repeated inhalation of the cement dust containing heavy metals such as silica, chronic inflammation occurs within the respiratory system. The body's innate immune system is activated by forming inflammatory cytokines and the accumulation of white blood cells. White blood cells (neutrophils, basophils, eosinophils, monocyte, macrophage and lymphocytes) are an integral part of the immune system. During inflammation, the released cytokines, lipid mediators result in leucocyte recruitment.
Macrophages take up crystalline silica and alumina in the alveoli with the eventual release of species of reactive oxygen and lipid peroxidation of the phagolysosomal membrane. Cathepsin protease from the phagolysosomal membrane and the species of reactive oxygen causes the formation of inflammasomes. These inflammasomes, in turn, cause cathepsin 1 to activate interleukins 1 and 18, which further facilitate the inflammatory process. Transcription factor nuclear factor kappa B activation during inflammation causes activation of cytokines, inflammatory mediators and tumour necrosis factor-α., Adaptive immune response that occurs upon silica exposure results in inflammation in the respiratory system utilising T-lymphocytes, including helper T-cells and regulatory T-cells [Figure 1]. There is also induction of immunoglobulin (Ig) G1 and IgE as part of the immune response to dust containing toxic chemicals such as an oxide of aluminium and Damage-associated molecular pattern (DAMPs),,, thus, resulting in an allergic reaction in the human body [Figure 1].
Cement dust is a cloud of toxic chemical dust that, following repeated exposure, brings about inflammatory changes in the body. Heavy metal components of cement dust such as quartz, chromium, alumina, nickel and cadmium contribute to these harmful effects. There are 42 cement mills and 35 cement companies that are active in Bangladesh. There is a labour force of about 60.8 million aged 15 years and above. About 14.4% of this labour force are employed in the industry involved in manufacturing. About 8% of the manufacturing sector consists of the non-metallic and gas industry, including the cement industry. The workers performing their daily tasks in this toxic dust environment often lack the proper understanding of the health risk. They may also show non-compliance to using personal protective gear such as gloves, masks and helmets.
Several initiatives have been undertaken and developed policies programs around the globe for safeguarding and promoting the health of cement-industry workers and advocated to execute in the cement industry. The health management policies implemented by the Cement Sustainability Initiative and European Industry Representative (CEMBUREAU), ensure toxic agent exposure monitoring and control. They also implement proper health care and enforce usage of personal protective equipment.,, Programs to promote awareness and education on the appropriate use of personal protective equipment should be undertaken for the cement workers. Medical examination, including lung function tests and blood tests measuring inflammatory markers of those employed in the cement factories, should be done periodically as a preventive measure to protect these workers' health.
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| References|| |
Bonnet C, Hache E, Jabberi A, Seck GS, Simoen M, Carcanague S. The Impact of Future Generation on Cement Demand: An Assessment Based on Climate Scenarios Working Paper 2019-2 (INIS-FR--19-0338). IFP Energies Nouvelles, 1 et 4 Avenue de Bois-Preau, 92852 Rueil-Malmaison Cedex (France); Institut de Relations Internationales et Strategiques-IRIS, 2 Bis rue Mercoeur, 75011 Paris, France; 2019. Available from: file:///C:/Users/MEH/Downloads/Working-PAPER-GENERATE-THE-IMPACT-OF-FUTURE-GENERATION-ON-CEMENT-DEMAND-janvier2019%20 (1).pdf. [Last accessed on 2021 Mar 27].
Biernacki J, Bullard JW, Sant G, Banthia N, Brown K, Glasser FP, et al
. Cements in the 21st
century: Challenges, perspectives, and opportunities. J Am Ceram Soc 2017;100:2746-73.
Dunuweera SP, Rajapakse MG. Cement types, composition, uses and advantages of nano-cement, environmental impact on cement production, and possible solutions. Hindawi Adv Mater Sci Eng 2018;2018:4158682.
Bediako M, Amankwah EO. Analysis of chemical composition of Portland cement in Ghana: A key to understand the behavior of cement. Hindawi Publ Corp Adv Mater Sci Eng2015;2015:349401.
Bae S, Hikaru F, Kanematsu M, Yoshizawa C, Noguchi T, Yu Y, et al
. Removal of hexavalent chromium in Portland cement using ground granulated blast-furnace slag powder. Materials (Basel) 2017;11:11.
Cipurkovic A, Trumic I, Hodžic Z, Selimbašic V, Djozic A. Distribution of heavy metals in Portland cement production process. Adv Appl Sci Res 2014;5:252-9.
Gaharwar AS, Gaurav N, Singh AP, Gariya HS, Bhoora. A review article on manufacturing process of cement, environmental attributes, topography and climatological data station: IMD, Sidhi M.P. J Med Plants Stud 2016;4:47-53.
Mishra S, Siddiqui NA. A review on environmental and health impacts of cement manufacturing emissions. Int J Geol Agri Environ Sci 2014;2:26-31.
Hoy RF, Chambers DC. Silica-related diseases in the modern world. Allergy 2020;75:2805-17.
Soin N, Anand SC, Shah TH. Handbook of Technical Textiles, Energy Harvesting and Storage Textiles. 2nd
ed. Cambridge, United Kingdom.: Woodhead Publishing; 2016. p. 357-96.
Murugadoss S, Lison D, Godderis L, Van Den Brule S, Mast J, Brassinne F, et al
. Toxicology of silica nanoparticles: An update. Arch Toxicol 2017;91:2967-3010.
Mayeux JM, Escalante GM, Christy JM, Pawar RD, Kono DH, Pollard KM. Silicosis and silica-induced autoimmunity in the diversity outbred mouse. Front Immunol 2018;9:874.
Sato T, Shimosato T, Klinman DM. Silicosis and lung cancer: Current perspectives. Lung Cancer (Auckl) 2018;9:91-101.
Shamim M, Alharbi WD, Pasha TS, Nour MO. Silicosis, a monumental occupational health crisis in Rajadthan. An epidemiological survey. Int J Res Granthalayah 2017;5:554-5.
Keramydas D, Bakakos P, Alchanatis M, Papalexis P, Konstantakopoulos I, Tavernaraki K, et al
. Investigation of the health effects on workers exposed to respirable crystalline silica during outdoor and underground construction projects. Exp Ther Med 2020;20:882-9.
Graff P, Larsson J, Bryngelsson IL, Wiebert P, Vihlborg P. Sarcoidosis and silica dust exposure among men in Sweden: A case-control study. BMJ Open 2020;10:e038926.
Ungprasert P, Ryu JH, Matteson EL. Clinical manifestations, diagnosis, and treatment of sarcoidosis. Mayo Clin Proc Innov Qual Outcomes 2019;3:358-75.
Boudigaard SH, Schlünssen V, Vestergaard JM, Søndergaard K, Torén K, Peters S, et al
. Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: A nationwide cohort study. Int J Epidemiol 2021; DOI: 10.1093/ije/dyaa287.
Estokova A, Palascakova L, Kanuchova M. Study on Cr (VI) leaching from cement and cement composites. Int J Environ Res Public Health 2018;15:824.
Costa M, Klein CB. Toxicity and carcinogenicity of chromium compounds in humans. Crit Rev Toxicol 2006;36:155-63.
Sun H, Brocato J, Costa M. Oral chromium exposure and toxicity. Curr Environ Health Rep 2015;2:295-303.
Yaman B. Health effects of chromium and its concentrations in cereal foods together with sulfur. Expo Health 2020;12:153-61.
Sazakli E, Villanueva CM, Kogevinas M, Maltezis K, Mouzaki A, Leotsinidis M. Chromium in drinking water: Association with biomarkers of exposure and effect. Int J Environ Res Public Health 2014;11:10125-45.
Ahmad R, Akhter QS, Haque M. Occupational Cement Dust Exposure and Inflammatory Nemesis:Bangladesh Relevance. J Inflamm Res 2021;14: 2425-44.
Ahmad R, Akhter Q. Effects of exposure to cement dust on hemoglobin concentration and total count of RBC in cement factory1050 workers. J Bang Society Physiol 2018;13:6872.
Wilbur S, Abadin H, Fay M, Yu D, Tencza B, Ingerman L, et al
. Toxicological Profile for Chromium. Atlanta (GA): Agency for Toxic Substances and Disease Registry (US); 2012.
Thomas B, Kulichova D, Wolf R, Summer B, Mahler V, Thomas P. High frequency of contact allergy to implant and bone cement components, in particular gentamicin, in cemented arthroplasty with complications: Usefulness of late patch test reading. Contact Dermatitis 2015;73:343-9.
Thyssen JP, Ahlström MG, Bruze M, Rustemeyer T, Lidén C. Contact Allergy to Metals. Contact Dermatitis. 6th
ed. Cham: Springer; 2021. p. 757-802.
Yoshihisa Y, Shimizu T. Metal allergy and systemic contact dermatitis: An overview. Dermatol Res Pract 2012;2012:749561.
Uter W, Werfel T, White IR, Johansen JD. Contact Allergy: A Review of Current Problems from a Clinical Perspective. Int J Environ Res Public Health. 2018;15:1108.
Wang BJ, Wu JD, Sheu SC, Shih TS, Chang HY, Guo YL, et al
. Occupational hand dermatitis among cement workers in Taiwan. J Formos Med Assoc 2011;110:775-9.
Klotz K, Weistenhöfer W, Neff F, Hartwig A, van Thriel C, Drexler H. The health effects of aluminum exposure. Dtsch Arztebl Int 2017;114:653-9.
Rahmani AH, Almatroudi A, Babiker AY, Khan AA, Alsahly MA. Effect of exposure to cement dust among the workers: An evaluation of health related complications. Open Access Maced J Med Sci 2018;6:1159-62.
Saji KG, Zubair M, Nair SB, Varghese PR. An epidemiological study on effect of occupational exposure of cement. Int J Community Med Public Health 2018;5:5105-9.
Manjula R, Praveena R, Clevin RR, Ghattargi CH, Dorle AS, Lalitha DH. Effects of occupational dust exposure on the health status of Portland cement factory workers. Int J Med Public Health 2013;3:192-96. [Full text]
Rumselly KU, Suhartono S, Sulistiyani S .Factors that are related to bronchitis in employees in the cement warehouse Unit Ambon City. Int J Health Educ Soc 2020;3:27–36.
Kim T, Cho HB, Kim WJ, Lee CH, Chae KJ, Choi SH, et al
. Quantitative CT-based structural alterations of segmental airways in cement dust-exposed subjects. Respir Res 2020;21:133.
Gizaw Z, Yifred B, Tadesse T. Chronic respiratory symptoms and associated factors among cement factory workers in Dejen town, Amhara regional state, Ethiopia, 2015. Multidiscip Respir Med 2016;11:13.
Meo SA, Al-Drees AM, Al Masri AA, Al Rouq F, Azeem MA. Effect of duration of exposure to cement dust on respiratory function of non-smoking cement mill workers. Int J Environ Res Public Health 2013;10:390-8.
Hommi BS, Abdelaziz MS, Ahmed HG. Effect of occupational cement dust pollution on the respiratory epithelium in Amran Cement Factory-Yemen. J Sci Tech 2013;15:25-32.
Pollard KM. Silica, silicosis, and autoimmunity. Front Immunol 2016;7:97.
Dai W, Liu F, Li C, Lu Y, Lu X, Du S, et al
. Blockade of Wnt/β-Catenin Pathway Aggravated Silica-Induced Lung Inflammation through Tregs Regulation on Th Immune Responses. Mediators Inflamm. 2016;2016:6235614.
Fox P, Hudson M, Brown C, Lord S, Gebski V, De Souza P, et al
. Markers of systemic inflammation predict survival in patients with advanced renal cell cancer. Br J Cancer 2013;109:147-53.
Villeneuve DL, Landesmann B, Allavena P, Ashley N, Bal-Price A, Corsini E, et al
. Representing the process of inflammation as key events in adverse outcome pathways. Toxicol Sci 2018;163:346-52.
Mischler SE, Cauda EG, Giuseppe MD, McWilliam LJ, Croix CS, Sun M, et al
. Differential activation of RAW 264.7 macrophages by size-segregated crystalline silica. J Occup Med Toxicol 2016;11:57.
Rathinam VA, Vanaja SK, Fitzgerald KA. Regulation of inflammasome signaling. Nat Immunol 2012;13:333-42.
Peeters PM, Eurlings IM, Perkins TN, Wouters EF, Schins RP, Borm PJ, et al
. Silica-induced NLRP3 inflammasome activation in vitro
and in rat lungs. Part Fibre Toxicol 2014;11:58.
Tsui JC, Law PT, So WK, Chan DY, Leung P, Sham MM, et al
. Short research communication regulation of TLR4 in silica-induced inflammation: An underlying mechanism of silicosis. Int J Med Sci 2018;15:986-91.
Tolinggi S, Nakoe MR, Gobel IA, Sengke J, Keman S, Sudiana IK, et al
. Effect inhaling of limestone dust exposure on increased level of IL-8 serum and pulmonary function decline to workers of limestone mining industry. Int Ref J Eng Sci 2014;3:66-72.
Matsuzaki H, Hayashi H, Lee S, Takeri NK, Yamamoto S, Ikeda M, et al
. Alteration of immune cells in silicos
is: Roles in development of autoimmunity and lung fibrosis. Ann Mens Health Wellness 2017;1:1002.
Kurado E, Ozasa K, Temizoz B, Ohata K, Koo CX, Kanuma T, et al
. Inhaled fine particles induce alveolar macrophage death and interleukin-1a release to promote inducible bronchus-associated lymphoid tissue formation. Immunity 2016;45:1299-310.
Jacobson LS, Lima H Jr., Goldberg MF, Gocheva V, Tsiperson V, Sutterwala FS, et al
. Cathepsin-mediated necrosis controls the adaptive immune response by Th2 (T helper type 2)-associated adjuvants. J Biol Chem 2013;288:7481-91.
Paul U, Hasan M, Labib L, Roy N. Optimal Design of Hybrid Microgrids for Readymade Garments Industry of Bangladesh: A Case Study. 3rd
International Conference on Electrical Information and Communication Technology (EICT). Institution of Electrical and Electronic Engineering (IEEE), Fulbarigate, Khulna 9203 Bangladesh: 2017. p. 1. [doi: 10.1109/EICT.2017.8275208].
Cement Sustainability Initiative (CSI). Health Management Handbook: Addressing Occupational Exposures in the Cement Industry. World Business Council for Sustainable Development Maison de la Paix, Chemin Eugène-Rigot 2, CP 246, 1211 Geneve 21, Switzerland; 2015. p. 5-11. Available from: https://docs.wbcsd.org/2015/10/CSI_Health_Management_Handbook_Eng.pdf
. [Last accessed on 2021 Mar 09].
Cement Sustainability Initiative (CSI). Safety in the Cement Industry: Guidelines for Measuring and Reporting. World Business Council for Sustainable Development Maison de la Paix, Chemin Eugène-Rigot 2, CP 246, 1211 Geneve 21, Switzerland; 2013. p. 2-4. Available from: file:///C:/Users/MEH/Downloads/CSI%20health%20and%20safety%20reporting%20guidelines_ v4%20 (1).pdf. [Last accessed on 2021 Mar 09].
[Figure 1], [Figure 1]