1
Q
MCS (toxicant-induced loss of tolerance)
A
sensitivity or intolerance to a number of chemicals and other irritants at very low concentrations
2
Q
Sick building syndrome
A
a collection of symptoms reported
by workers in a given building for which no
cause is apparent.
3
Q
Building related Illness
A
symptoms due to being in building with an identifiable cause
4
Q
Natural Gas location and sx
A
- formed when layers of buried plant and animal is exposed to intense heat and pressure over thousands of year
- hydrocarbon mostly methane
- respiratory sx
- lower WBCs, higher RBCs, Hct, Hgb, and platelets
5
Q
What are VOCs
A
any carbon-based compounds that readily enter a gaseous state
6
Q
Benzene found in
A
- volcanoes
- forest fires
- a natural part of crude oil, gasoline, and cigarette smoke
- refinery emissions, motor vehicle exhaust
- glues
- paints
- furniture wax
- detergents
7
Q
Benzene health effects
A
- Drowsiness
- Dizziness
- Rapid or irregular heartbeat
- Headaches
- Tremors
- Confusion
- Unconsciousness
- Death (at very high levels)
- Vomiting
- Irritation of the stomach
- Sleepiness
- Convulsions
Chronic
- bone marrow and immune suppression
- irregular menses and decreased size of ovaries’
- leukemia
8
Q
Toluene
A
methylbenzene
9
Q
Toluene location
A
- plastic soda bottles
- synthetic fragrances
- inks
- cleaning agents
- nylon
- paint thinner
- gasoline
- coatings
- adhesives
- cigarette smoke
10
Q
Toluene health effects
A
- CNS
- fatigue
- sleepiness
- headaches
- nausea
- developmental effect in children of pregnant women
- chronic inhalation
- Irritation of the upper resp. tract and eyes, sore throat, dizziness, and headache
11
Q
Xylene
A
Aromatic hydrocarbon aka dimethylbenzene
12
Q
Xylene health effects
A
- depression of CNS
- Headache
- Dizziness
- Nausea
- Vomiting
- Irritation to the lungs that cause chest pain and SOB
- liver and kidney damage at high levels
- HEENT irritation
- irritation and dermatitis
- can penetrate most clothing
13
Q
Phenol
A
carbolic acid
White volatile crystalline solid
14
Q
Phenol locations
A
- petroleum
- conversion to precursors of plastics
- Bisphenol-A
- Phenolic resins
- Aspirin
- Herbicides
- Chloraseptic and Carmex
15
Q
Phenol health effects
A
- Corrosive to eyes, skin, and resp tract
- dermatitis
- lung edema
- seizure
- coma
16
Q
Formaldehyde
A
- Formalin, Formol, Methyl Aldehyde
- CH2O
- Colorless
- Flammable
- Pungent, irritating odor
17
Q
Formaldehyde location
A
- Adhesives, glues, dyes
- biopsy containers
- Carpet, particle board, plywood
- Paper products
- Germicide, Embalming Fluid
- Fertilizer & food production
- “Wrinkle-free” clothing, Cosmetics
- Petroleum exhaust, tobacco smoke
18
Q
Formaldehyde health effects
A
- Bronchitis, pulmonary edema, asthma (only upper respiratory tract)
- Sinonasal & nasopharyngeal carcinoma
- Leukemia
19
Q
Vinyl chloride
A
Chloroethene
Vinyl Chloride Monomer (VCM)
#3
20
Q
Location of Vinyl chloride
A
new car smell
21
Q
PVC
A
multiple VC
22
Q
What is the route of administration of VOCs?
A
inhalation, ingestion, transdermal absorption
23
Q
MCS risk factors
A
- upper SES
- Caucasian
- middle age female
- males
- fibromyalgia
- chronic fatigue syndrome
- psychiatric/mental health condition
24
Q
MCS diagnosis
A
- Sx are reproducible with repeated chemical exposures.
- Condition has persisted for significant period of time.
- Low levels of exposure result in manifestations of the syndrome (i.e. increased sensitivity).
- Sx improve when the triggering chemicals are removed.
- Responses often occur to multiple chemically unrelated substances.
- Symptoms involve multiple-organ symptoms
25
Sick building syndrome sx
- Fatigue, H/a, Nausea
- EENT irritation
- Chest tightness, Asthma
- Concentration, Memory-loss
26
Xylene location
- histology labs for tissue processing
- petroleum, coal, and wood tar
- solvent
- Occupational (mechanics)
- Leaking underground storage tanks
27
PVC use
- Plastic pipes, Insulation,
- Vinyl siding (Houses)
- window frames
- garden hosing
- medical tubing
- carpeting
- vinyl flooring
combined with phthalates
- Shower curtains
- Packaging – Clear plastic casing (hard) & shrink-wrap (soft)
- Toys (Child & Adult)
- Clothing (Pleather)
28
PVC health effects
- Demyelinating Neuro-toxin: Dizziness, Fatigue, Neurasthenia, Ataxia
- Respiratory & Mucous Membrane irritants
- Highly Hepatotoxic/Carcinogenic
- Hepatic Angiosarcoma
- Portal Hypertension & Cirrhosis
- esophageal variances
- Purpura & Thrombocytopenia
- Synergy (30-700%) w/ co-morbid conditions: Alcohol intake, Hep C, Tobacco Smoking
- Raynaud’s Phenomenon: Vasospasm of distal extremities
- acroosteolysis: Dissolution of terminal phalanges & SI Joint
- Scleroderma-like skin changes
29
Polycyclic Aromatic Hydrocarbons (S-VOC) (PAH)
Multiple conjoined benzene rings
stay in environment for a while
30
What are the two PAHs
naphthalene
benzo(a)pyrene
31
How are PAHs absorbed?
- skin
- lungs via respiratory particles
- GI tract
32
How do you test for PAHs? Dose high levels correlate to harm?
urine hydroxypyrene levels
no
33
Naphthalene
Low Molecular Weight (LMW)
- 2-3 rings (e.g. Naphthalene)
- Aka Tar Camphor
- C10H8
- White solid
- Flammable
- Volatile Aromatic
- Unstable molecule
- Does not linger in the environment
34
naphthalene found in
- Ingredient of Mothballs
- Industrially produced as a by-product of coal processing (coal tar)
- an industrial by-product in manufacturing (e.g. PVC)
- home-based combustion (Wood, Propane)
35
Naphthalene health effects
- hemolytic anemia
- Fatigue, Pallor
- Decreased Hgb & Hct
- Heightened concern for people with known anemia conditions (Sickle cell, G6PD)
- Nausea, vomiting, diarrhea, hematuria, jaundice, renal failure
- Respiratory Irritant
36
Benzo(a)pyrene
higher molecular weight
- 4-7 rings (e.g. Benzo(a)pyrene)
- C20H12
- 5 rings
- can form Heterocyclic Amines (HCA)
37
Benzo(a)pyrene found in
- Fossil Fuels
- Charred/ Grilled Food
- Tobacco Smoke
38
Benzo(a)pyrene health effects
- cancer
- Lungs
- Prostate
- Pancreas
- Stomach
- Colon
- Rectal
39
Benzo(a)pyrene MOA of disease
- Flat, planar structure of HMW PAH molecule
- Slips into Double Helix
- Interference with normal genetic processes (Transcription, etc…)
- Inhibits p52 tumor suppressor gene
40
Benzo(a)pyrene treatment
stop smoking or grilling
brassicas
antioxidants
vit E
marinade foods
41
What are the health effects of smoke?
- lung cancer
- bronchitis
- asthma
- SOB
- CVD
- otitis media
- decreased immune function
42
What factor affect smoke exposure?
- exposure concentration
- size of room
- number of smokers
- air patterns
43
What is continine?
tobacco smoke a metabolite of nicotine
44
how do you test for continine and the purpose of testing?
- urine test
- blood, saliva, hair
- to monitor tobacco cessation
- tracking exposure
45
what are natural plastics?
- lignin
- rubber
- silk
46
what are synthetic plastic/polymers?
very large molecules composed of repeating small monomers
- nylon
- latex
- acrylic
- polyester
47
thermoplastics
- the main type of consumer plastics
- formed by melting the raw material of solid plastic resin and forming it into products
- can be melted again theoretically
48
thermoset plastics
- liquids that are set by the use of a catalyst
- in computer casting, synthetic rubber tires, fiberglass boats, surfboards
- can break into small bits and persist in the environment
49
Derivation of platics
- petroleum
- natural gas feedback
- coal
- corn
- soy
- sugar cane
50
What is #1 plastic?
polyethylene terephthalate
51
What is #2 plastic?
high density polyethylene
52
What is #3 plastic?
polyvinyl chloride
53
What is #4 plastic?
low density polyethylene
54
What is #5 plastic?
polypropylene
55
What is #6 plastic?
polystyrene
56
What is #7 plastic?
other polycarbonate, ABS, fiberglass, nylon
57
which plastic numbers are the safest
2 and 4
58
which plastics have some leeching but are safe?
1 and 5
59
which plastics are unsafe?
3, 6, and 7
60
polyethylene terephthalate found in
soft drink, water, salad dressing bottles
peanut butter
jam jars
61
high density polyethylene found in
water pipes
milk
juice
water bottles
grocery bags
some shampoo and tolitery bottles
62
Polyvinyl chloride found in
no food
pipes
cables
furniture
clothes
toys
63
where is low-density polyethylene found in
frozen food bags
squeezbale bottles
cling films
felxiable container lids
64
polypropylene found in
* reusable microwabale container
* kitchenware
* yogurt containers
* disposable cups and plates
- thermal clothing
- Rubbermaid
- heat-resistance and durable
- can leach into food
65
polystyrene found in
* egg cartons
* packing peanuts
* disposable cups, plates, trays, cutlery, and takeaway containers
- CD cases
- plastic jewelry
- Petri dishes
- plastic models
- razors
- Styrofoam
- burnt plastic smell
* Avoid food storage
66
other (often polycarbonate or ABS) found in
beverage bottles
baby milk bottles
compact discs
unbreakable glazing
lenses
automotive headlamps
riot shields
instrument panels
67
polyethylene health effects
- carcinogen
- relatively safe
68
Phthalates
- a group of chemicals esterified bilaterally around a benzene ring
- plasticizers
- can leech very easily
- dose not bioaccumulate
- ban on these
69
Phthalates health effects
- endocrine disruptors- xenoestrogens
- breast cancer
- endometriosis
- adenomyosis
- leiomyomas
- thyroid disruption
- fetal & infant
- reproductive system development
- undescended testes, shortened anogenital distance, decreased genital size, lower testosterone
70
Polystyrene health effects
- weak toxin
- oral exposure can affect iron absorption
- acute: mucous membranes and respiratory irritation
- chronic
- dizziness
- fatigue
- N/V
- cognitive and perceptual loss
- neural toxicity
- renal/hepatic toxicity
- carcinogen
71
Bisphenol A (BPA)
- Structural components in some polycarbonate beverage bottles
- Also found in metal can coatings
- Been used in food packaging since the 1960s
- FDA did ban BPA use in: baby bottles, sippy cups, and infant formula packaging
72
Bisphenol A (BPA) health effects
xenoestrogen
73
The EPA sets limits for how much pesticide can remain on food. These limits are known as:
MRLs = Maximum Residue Limits
74
The EPA sets limits for how much pesticide can remain on food. These limits are known as:
MRLs = Maximum Residue Limits
75
Fabric softeners are a health concern because they contain:
Quaternary Ammonium Compounds which are a known asthmagen
76
You accidentally break a compact fluorescent light bulb. What are you concerned about being exposed to?
Mercury
77
This group of educators have increased risk of cleft palate in their offspring based on maternal occupation:
Preschool teachers
78
You have some bleach, peroxide, Caviwipes and some other chemicals in your office. You need to know how to properly handle them, dispose of them and what to do should anyone have accidental exposure to them. You have been told to access the MSDS. What does this stand for?
Material Safety Data Sheet
79
VOC stands for
Volatile Organic Compound
80
The water-solubility of this toxic substance prevents its access to the lower respiratory tract:
Formaldehyde
81
The most common VOC that is a potential occupational hazard for persons working in a histology lab and performing tissue processing is:
Xylene
82
One of the most serious health consequences of exposure to this VOC is leukemia as it basically causes cells to not work effectively, especially those of the bone marrow.
benzene and formaldehyde
83
This VOC is a precursor to many medications and is also found as an oral anesthetic ingredient in Chloraseptic and Carmex:
Phenol
84
Those who huff glue are after mostly after this specific VOC that is 25x more reactive than benzene:
Toluene
85
The main systems that are affected by VOCs are:
Hematologic, Nervous and Immune
86
Dry Cleaned clothes that are brought into the home contain elevated levels of this VOC:
Tetrachloroethylene (aka perchloroethylene or PERC)
87
This is the component of non-stick or Teflon cookware that we are concerned about:
Polytetrafluoroethylene (PTFE)
88
Which of the following was the first carcinogen discovered?
Benzo(a)pyrene
89
The main ingredient in mothballs is:
Napthalene
90
This is a major component of tar from charred/grilled foods and tobacco smoke
Benzo(a)pyrene
91
This condition is pathognomonic for asbestos exposure:
Mesothelioma
92
These are used as plasticizers and are of particular concern because they leech very easily
Phthalates
93
This species is considered “black mold”:
Stachybotrys chartarum
94
Vinyl Chloride Disease can be quite serious with this potential outcome:
Acroosteolysis
95
Transvaginal Mesh and Diapers both have this # plastic in them
.#5, polypropylene
96
Vinyl Chloride, in addition to causing vinyl chloride disease, has also been a causative factor in this rare cancer:
Hepatic angiosarcoma
97
What is the main chemical of concern for the salon favorite “Brazilian Blowouts”?
Formaldehyde
98
Polystyrene to-go containers are of a particular health concern because:
Oral exposure to nanoparticles can affect iron absorption
99
IV bags and tubing are often made of this plastic____________ and softened with ___________to make them pliable
Polyvinyl Chloride; DEHP
100
Why is aluminum in vaccines?
Increase antibody response to vaccine
101
What is the Provisional Tolerable Weekly Intake of aluminum for an adult in 2018?
1 mg/kg body weight
102
Hill’s criteria is used to establish causation. Which of the following is NOT one of Hill’s criteria?
103
Which of the following conditions is associated with aluminum in vaccines?
Autoimmune Inflammatory Syndrome Induced by Adjuvants/Gulf War Syndrome
104
Hill’s criteria is used to establish causation. Which of the following is NOT one of Hill’s criteria?
a.Sensitivity
b.Temporality
c.Strength
d.Reproducibility
Sensitivity
105
Thermoplastics
- main type of consumer plastics
- can be recovered and melted again
106
thermoset plastics
- solid forms: computer casings, synthetic rubber tires, fiberglass boats, surfboards (scorch rather than burn)
107
#1: PET or PETE
polyethylene terephthalate
ex: soda bottles
108
#2: HDPE
high density polyethylene
ex: detergent bottles, playground equipment
109
#3: PVC
polyvinyl chloride
ex: pipe, siding
110
#4: LDPE
low density polyethylene
ex: plastic bags, trash bags
111
#5: PP
polypropylene
ex: clothing, tupperware
112
#6: PS
polystyrene
ex: styrofoam, utensils
113
#7: O
other
ex: polycarbonate, fiberglass, nylon
BPA!
114
safest plastics
#2, 4 (no leeching, no detection in humans)
115
safer plastics
#1, 5 (some leeching, no detected health effects)
116
unsafe plastics
#3, 6, some 7 (known leeching + health effects)
117
What is asbestos?
- naturally-occurring (6 different fibrous minerals)
- uses: insulation, friction products, tile
118
What does asbestos cause?
- asbestosis
- mesothelioma
- lung cancer
119
What areas/products is asbestos found in?
Home:
- exterior surfaces
- automobiles
- insulation
- flooring
- boilers, heaters, piping
- interior surfaces
- electrical equipment
- built-in equipment
- appliances
120
mold treatment
- AVOIDANCE
- mold inspector, remediator
- air filters
- mobilize + remove mycotoxins
- antifungals: oral and nasal
- mind/body: limbic system retraining
- support bile production (taurine, glycine, phosphatidylcholine, cholagogues, lipase)
- support emunctories (BMs, enemas, sweat, castor oil pack)
- binders
- natural: activated charcoal, bentonite clay, chlorella, glutathione, NAC, pre/probiotics
- food: insoluble fiber (okra, beets, asparagus, eggplant, turnips, green beans, carrots, cauliflower, kale, cabbage, etc.)
- prescription: cholestyramine, welchol
- supportive therapies: fish oil, curcumin, ALA, CoQ10, quercitin, melatonin, milk thistle, LDN, vit. D3, etc.
121
mold testing
- hx: Crista mold questionnaire
- environmental inspection
- mycotoxin testing
- urine LC/MS, ELISA
- blood: serum ELISA (for mycotoxin IgG & IgE)
- other tests: stool, OAT
122
some examples of mold signs & sxs
fatigue
neurocognitive sxs
H/A
myalgia
insomnia
GI issues
skin issues
palpitations
anxiety/depression/irritability, mood swings
rhinitis, sinusitis
Basically...ANYTHING :D
123
mold antifungals
Rx: azoles, amphotericin b
Herbal: olive leaf, Pau D'arco, oil of oregano, holy basil, thyme, garlic, neem
124
mold spores
- allergy, inflammation, irritation
- stimulate mucociliary clearance
- 1-5 microns
- colonization/biofilm of sinus, resp & GI
125
mycotoxins
- very small (0.1 microns)
- lipophilic + hydrophilic
- avoid mucociliary clearance
- enterohepatic recirculation, some cross BBB
- not destroyed by burning or freezing
126
Which foods is mold found in?
- fermented, processed, contaminated foods
- fruit juices, soft drinks
- baked goods
- nuts
- vitamins/supplements
127
Black mold
- species: Stachybotrys chartarum
- grows on cellulose (particle board, dry wall, lumber)
- common in damp living areas
128
What is aluminum found in:
cans
cookware
foil
window frames
airplanes/spacecraft
electronics
vehicles
vaccine adjuvants
fireworks
consumer products (antacids, deodorants, aspirin, cosmetics)
129
foods high in aluminum
processed cheeses
baking powder
food additives
soy
non-dairy creamer
pickles
130
populations with high aluminum exposures
- occupational
- living near industrial emissions
- chronic kidney failure
- infants fed on formula
- consuming large amounts of: antacids, antiulcerative meds, analgesics, antidiarrheal meds
- elderly
131
examples of some vaccines that contain aluminum
Anthrax
DTaP
Hep A
Hep B
HPV
HIB
Tdap
132
pros and cons of injecting aluminum
- risk of disease vs. risk of adjuvant
- increased # of childhood vaccines = increased level of injected aluminum
133
What happens to aluminum in the bloodstream?
Bound:
- ~90% bound to transferrin
- ~10% bound to citrate
Once bound:
- majority excreted thru kidneys
- small amount thru bile
- small amount retained in tissues
134
health effects of aluminum
osteomalacia
encephalopathy
dementia
Alzheimer's association
ASIA syndrome (Shoenfeld's syndrome)
135
Paper:
"Cumulative and episodic vaccine aluminum exposure in a population-based cohort of young children"
This study examined the extent to which
the Vaccine Safety Datalink (VSD) could be used to study vaccine ingredient safety in children.
Methods: 2 groups - children who were up-to-date and undervaccinated before age 2.
Analyses compared vaccine aluminum exposure across cohorts and determined the
statistical power for studying associations between aluminum exposure and hypothetical vaccine adverse
events.
Results: Up-to-date children were exposed to 11–26% more aluminum from
vaccines than undervaccinated children.
Conclusions: The safety of vaccine aluminum exposure can be feasibly studied in the VSD.
136
Paper:
"Reconsideration of the immunotherapeutic pediatric safe dose levels of
aluminum"
- Estimates a
Pediatric Dose Limit that considers body weight
- When aluminum doses are estimated from Federal
Regulatory Code given body weight, exposure from the current vaccine schedule are found to exceed estimate of a weight-corrected Pediatric Dose Limit
- Levels of aluminum suggested by currently used limits place infants at risk of acute, repeated, and possibly chronic exposures of toxic levels of
aluminum
137
Paper:
"Do aluminum vaccine adjuvants contribute to the rising prevalence of autism?"
- Applied Hill's criteria
for establishing causality between exposure and outcome to find whether exposure to Al from vaccines
could be contributing to the rise in ASD prevalence in the West
- Results:
(i) children from
countries with the highest ASD prevalence appear to have the highest exposure to Al from vaccines
(ii) the increase in exposure to Al adjuvants significantly correlates with the increase in ASD prevalence in the United
States
(iii) a significant correlation exists between the amounts of Al administered to preschool children and the current prevalence of ASD in seven Western countries
- The application of
the Hill's criteria to these data indicates that the correlation between Al in vaccines and ASD may be causal
Environmental Medicine
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