Ravibabu kalahasthi
@nioh.org
Scientist-D and Bicchemistry
National Institute of Occupational Health
RESEARCH INTERESTS
Biomarker of exposure
Biomarker responses
Biomarkers of suspectbility
Scopus Publications
Scopus Publications
Soundarya Soundararajan, Ankit Viramgami, Ankit Sheth, Ravichandran Beerappa, Ravibabu Kalahasthi, Raghavan Sampathraju, Dhananjayan Venugopal, Kamalesh Sarkar, and Rakesh Balachandar
Medknow
Abstract Background: Construction laborers succumb to poor health due to the inherent workplace health hazards and poor socio-economic living conditions. With rising healthcare expenses, the increased risk of poor health may aggravate their economic status, pushing them deeper into poverty. Settings and Design: The current cross-sectional multicenter study comprehensively investigated the determinants of health, health-seeking behavior, and poor economic impact regarding catastrophic health expenditure (CHE) among construction laborers. Methods and Material: We collected details on illnesses among self and family members of the construction laborers that required healthcare visits during the previous year and their approximate expenses. Among the 1110 participants with complete data, 37% reported illness requiring a healthcare visit either for self or a family member. Results: Regression models to ascertain demographic and living condition determinants of perceived illness revealed an increased risk of illness when the kitchen is shared with the living space (OR = 1.87) and use unhygienic smoky cooking fuels (OR = 1.87). More than 25% of those who reported illness incurred CHE. Conclusion: We conclude that the frequency of perceived illness and the economic impact, i.e., CHE is relatively higher among the construction laborers. Our results demonstrate that poor living conditions add to the burden of morbidity in construction workers and families. Providing healthcare coverage for this population and engaging and educating them about affordable healthcare are necessary future steps to prevent the worsening of the economic situation.
Ravibabu Kalahasthi, Vinay Kumar Adepu, and Raju Nagaraju
Springer Science and Business Media LLC
Raju Nagaraju, Ravibabu Kalahasthi, Rakesh Balachandar, and Bhavani Shankara Bagepally
Springer Science and Business Media LLC
Ravibabu Kalahasthi, Vinaykumar Adepu, Rakesh Balachandar, and Raju Nagaraju
Scientific Scholar
Objectives: Non-high density lipoprotein-cholesterol (non-HDL-C) fraction is the total cholesterol (TC) minus HDL-C. It is not a routinely reported component of lipid profile and is used in lipoprotein lowering therapy and prediction of coronary artery disease, target organ damage and atherosclerosis. Allostatic load (AL) is an imbalance between repetitive chronic exposure to stress and adaptive response. The present study investigates the association between non-HDL-C and its fractions (non-HDL-C/HDL-C, non-HDL-C/TC, non-HDL-C/ triglyceride [TG] and non-HDL-C/low-density lipoprotein-cholesterol [LDL-C]) and the presence of AL to determine, which fractions of non-HDL-C predict the diagnostic accuracy and optimal cut points. Materials and Methods: The study design is cross-sectional and data were collected from 169 male industrial workers. AL was measured using neuroendocrine (cortisol and dehydroepiandrosterone sulphate), cardiovascular (systolic blood pressure, diastolic blood pressure and heart rate), metabolic (TC, TG, HDL-C and LDL-C) and anthropometric (waist-hip ratio and body mass index) factors. The fractions of non-HDL-C/HDL-C, nonHDL-C/TC, non-HDL-C/TG and non-HDL-C/LDL-C were calculated using non-HDL-C, HDL-C, TC, TG and LDL-C values. Results: About 43.2% and 56.8% of workers had low and high AL, respectively. The non-HDL-C and its fractions such as non-HDL-C/HDL-C, non-HDL-C/TC and non-HDL-C/LDL-C were significantly increased in the high AL group. Stepwise regression analysis was used to examine the association between non-HDL-C fractions and AL. The fractions of non-HDL-C (b = 0.785, P = 0.001), non-HDL-C/TC (b = −0.336, P = 0.001) and nonHDL-C/LDL-C (b = 0.295, P = 0.001) influenced AL by 38.6%. The AUC with 95% CI in the high AL group was as follows: non-HDL-C 0.766 (0.696–0.837, P = 0.001); non-HDL-C/HDL-C 0.638 (0.555–0.721, P = 0.002); nonHDL-C/TC 0.635 (0.552–0.712, P = 0.003) and non-HDL-C/LDL-C 0.520 (0.433–0.607, P = 0.657). Non-HDL-C and its fractions were more precisely predicted in the high AL category of workers than in the low AL category. Non-HDL-C predicted the most precisely, followed by non-HDL-C/HDL-C, non-HDL-C/TC, non-HDL-C/ LDL-C and non-HDL-C/TG. Conclusion: According to the present study, non-HDL-C and its fractions such as non-HDL-C/HDL-C, nonHDL-C/TC and non-HDL-C/LDL-C should be considered regular lipid profiles and could be used as biomarkers to reduce the risk of AL.
Ravibabu Kalahasthi, Raju Nagaraju, Rakesh Balachandar, and Bhavani Shankara Bagepally
Elsevier BV
Recent evidences suggest the role of chronic lead (Pb) exposure in altering immunological parameters. Present study aimed to systematically review existing literature and synthesize quantitative evidence on the association between chronic Pb exposure and changes in immunological markers. Observational studies reporting immunological markers such as leukocyte derivative counts (CD3+, CD4+, CD8+, CD45+, CD56+, lymphocyte, and total leukocyte), cytokine, Immunoglobulin (Igs), C-reactive protein (CRP) among Pb-exposed and unexposed controls were systematically searched from PubMed, Scopus and Embase digital databases from inception to January 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered during systematic review. Mean differences in the immunological markers between Pb-exposed and control groups were pooled using random-effects model. The heterogeneity was assessed using Cochran-Q test and I2 statistic. The review included forty studies reporting immunological markers in Pb-exposed and unexposed control groups. The occupational Pb-exposed group exhibited significantly higher BLL, impaired immunological markers, characterized by a marginal lowering in lymphocyte count, lymphocyte subsets (CD3+, CD4+, CD4+/CD8+ ratio), INF-γ and IgG levels, while CD8+, IgM, IgA, IgE, and cytokines (IL-4, IL-6, IL-10, and TNF-α) exhibited a trend of higher values in comparison to the control group. Further, inflammatory marker viz., total leukocyte count was significantly higher among Pb-exposed. The included studies exhibited high levels of heterogeneity. In conclusion, Occupational Pb exposure alters the immunological markers such as the circulating cytokines and leukocyte counts. However, high-quality, multicentered studies are required to strengthen present observations and further understand the Pb's role on the immune system. Prospero Registration ID: CRD42021228252.
Raju Nagaraju, Ravibabu Kalahasthi, Rakesh Balachandar, and Bhavani Shankara Bagepally
Informa UK Limited
Existing literature suggests an association between chronic cadmium (Cd) exposure and the induction of DNA damage and genotoxicity. However, observations from individual studies are inconsistent and conflicting. Therefore current systematic review aimed to pool evidence from existing literature to synthesize quantitative and qualitative corroboration on the association between markers of genotoxicity and occupational Cd exposed population. Studies that evaluated markers of DNA damage among occupationally Cd-exposed and unexposed workers were selected after a systematic literature search. The DNA damage markers included were chromosomal aberrations (chromosomal, chromatid, sister chromatid exchange), Micronucleus (MN) frequency in mono and binucleated cells (MN with condensed chromatin, lobed nucleus, nuclear buds, mitotic index, nucleoplasmatic bridges, pyknosis, and karyorrhexis), comet assay (tail intensity, tail length, tail moment, and olive tail moment), and oxidative DNA damage (8-hydroxy-deoxyguanosine). Mean differences or standardized mean differences were pooled using a random-effects model. The Cochran-Q test and I2 statistic were used to monitor heterogeneity among included studies. Twenty-nine studies with 3080 occupationally Cd-exposed and 1807 unexposed workers were included in the review. Cd among the exposed group was higher in blood [4.77 μg/L (-4.94-14.48)] and urine samples [standardized mean difference 0.47 (0.10-0.85)] than in the exposed group. The Cd exposure is positively associated with higher levels of DNA damage characterized by increased frequency of MN [7.35 (-0.32-15.02)], sister chromatid exchange [20.30 (4.34-36.26)], chromosomal aberrations, and oxidative DNA damage (comet assay and 8OHdG [0.41 (0.20-0.63)]) compared to the unexposed. However, with considerable between-study heterogeneity. Chronic Cd exposure is associated with augmented DNA damage. However, more extensive longitudinal studies with adequate sample sizes are necessary to assist the current observations and promote comprehension of the Cd's role in inducing DNA damage.Prospero Registration ID: CRD42022348874.
Bhavani Shankara Bagepally, Rakesh Balachandar, Ravibabu Kalahasthi, Ravikesh Tripathi, and Madhumita Haridoss
Elsevier BV
INTRODUCTION
Chronic Aluminium (Al) exposure is reported to be linked with neuro-cognitive impairment. However, there is limited synthesized information on the role of chronic Al exposure on individual cognitive domains. This knowledge gap is explored here by systematic review and meta-analysis of the published literature.
METHODS
Observational studies that reported the association between Al exposure and cognitive functions were systematically searched in PubMed, Scopus and Embase databases since inception to June 2019 and updated on September 2020. PRISMA guidelines were adhered in this study. Meta-analysis was performed using a random-effect model if the included studies exhibited heterogeneity, in the absence of heterogeneity fixed effect model was used. Heterogeneity was assessed using Cochran-Q test and I2 statistic. Risk of bias was assessed using the risk of bias in non-randomized studies of exposures. Sub-group analysis and meta regression analysis were explored.
RESULTS
Twenty-three studies including 1781 Al exposed and 1186 unexposed were part of the final results. The pooled standardized mean difference of global cognitive scores (-0.65, 95%CI: 1.09 to -0.22, I2 = 91.09%), memory (-0.45, 95% CI: 0.69 to -0.21, I2 = 81.67%), working memory (-0.3, 95%CI: 0.45 to -0.15, I2 = 0%) and processing speed domains were significantly inferior among Al exposed as compared to unexposed. The other evaluated cognitive domains, such as cognitive flexibility, visuospatial abilities and psychomotor functions did not significantly differ between the two groups. We observed a serious risk of bias in most of the included studies.
CONCLUSION
Current pieces of evidence suggest an association between chronic Al exposure and impaired cognitive function in majority of domains including memory, processing speed and working memory while no significant influence in other cognitive domains. However, considering high heterogeneity and low quality of primary evidence, further high-quality studies are necessary for conclusive evidence in this regard.
Ravibabu Kalahasthi, Bhavani Shankara Bagepally, and Tapu Barman
Maad Rayan Publishing Company
Background: On chronic exposure, Lead (Pb) deposits in the skeletal system, replaces calcium ions, and alters the normal physiological processes, which in turn, lead to stunting, delayed fracture healing, and high resorption of collagen molecules. The present study aimed to assess the association of musculoskeletal pain and discomfort with bone turnover markers (BTMs) among long-term Pb-exposed workers. Study design: A cross-sectional study. Methods: The study recruited 176 male Pb-exposed workers and 80 control subjects who were matched for age, gender, and socio-economic status. Blood lead levels (BLLs), bone growth markers, such as serum osteocalcin (OC), alkaline phosphatase (ALP), bone alkaline phosphatase (BAP), and bone resorption markers: serum pyridinoline (Pry), deoxypyridinoline (DPry), tartrate-resistant acid phosphatase-5b(TRACP-5b), and hydroxyproline in urine (HyP-U) of participants were investigated. Pain and discomfort in the musculoskeletal system were assessed using Nordic Musculoskeletal Questionnaire. Results: Pb-exposure was significantly associated with musculoskeletal discomfort of the lower back (P<0.001), upper back (P<0.001), and ankle/foot (P=0.011). Among bone formation markers, serum OC was significantly lower in musculoskeletal discomfort of elbows (P=0.033) and ankle/foot (P=0.042). Among bone resorption markers, serum DPry was significantly lower in musculoskeletal discomfort of the neck (P=0.049) and shoulders (P=0.023). HyP-U was significantly higher in musculoskeletal discomfort of shoulders (P=0.035) and lower back (P=0.036). Conclusion: As evidenced by the obtained results, Pb-exposure was associated with musculoskeletal discomfort of the lower back, upper back, and ankle/foot. Lower bone formation (serum OC) marker was noted with musculoskeletal discomfort of elbows and ankle/foot. Furthermore, bone resorption markers were associated with musculoskeletal discomfort of the neck, shoulders, and lower back. The findings of the present study suggested that long-term Pb-exposure and BTMs were associated with musculoskeletal discomfort.
Rakesh Balachandar, Bhavani Shankara Bagepally, Ravibabu Kalahasthi, and Madhumitha Haridoss
Elsevier BV
Present study aimed to systematically review and synthesise quantitative evidence on association between occupational Lead (Pb) exposure and male reproductive hormones (MRH) and sperm quality from the existing literature. Observational studies investigating the effects of Pb exposure on MRH, sperm-count and sperm motility are systematically searched in PubMed, Scopus and EMBASE databases since inception to May 2019. The PRISMA guidelines are adhered during the entire study procedure and details such as participant characteristics, occupational Pb exposure, MRH, sperm-count and sperm motility from individual articles are extracted to the perform meta-analysis. Sub-group analysis and sensitivity analysis are additionally explored. Further, meta-regression is executed to investigate the influence of participant's age, duration of workplace Pb exposure on the individual outcome parameters. We observed that otherwise normal (fertile) male participants from all studies were within the age range of 25 - 45 years. Male employees occupationally exposed to Pb exhibited significantly higher blood Pb, lower sperm-count, poor sperm motility and higher serum prolactin levels as compared to the Pb unexposed males. The testosterone, follicle stimulating hormone and luteinising hormone levels of the occupationally Pb exposed participants are comparable to that of unexposed comparators. Studies included for synthesising quantitative evidence had unacceptable levels of heterogeneity. Explorative subgroup or meta-regression analysis had no additional results to the study. Lastly, included studies were driven by publication bias (positive results) and low powered (small sample size) studies. Thus, Pb exposure at workplaces is detrimental to male reproductive function, with lower sperm-count and higher prolactin levels. However, to enumerate the precise quantity of Pb exposure detrimental on male reproductive functions, high quality longitudinal studies with large cohorts are needed.
Ravi Babu Kalahasthi, Tapu Barman, and Bhavani Shankara Bagepally
Informa UK Limited
Abstract The aim of present study was to assess the systemic inflammatory response markers (SIR) in male lead-exposed workers with the contemplation of lifestyle factors. The SIR markers and blood lead levels (BLLs) were assessed in two groups of Pb-exposed workers. The first group consists of 250 workers with their BLLs is ≤32 µg/dl and consider them as low-exposure. The second group consists of 229 workers with their BLL is >32 µg/dl and consider them as high exposure. White blood cell count (p = .05), neutrophils (p = .03) and systemic immune-inflammatory index (SII) (p = .03) parameters were significantly increased in high-exposure group. A significant correlation was noted between BLLs and C-reactive protein (CRP) and CRP/albumin ratio in the high-exposure group. The results of linear regression analysis presented that the CRP, CRP/albumin ratio, white blood cell count, neutrophils, lymphocyte, prognostic index and Glasgow prognostic score were positively associated with body mass index (BMI). The extent of alcohol consumption presented the negative association with lymphocyte and positive association with the platelet-lymphocyte ratio (PLR). The experience presented a negative association with prognostic nutritional index. The smoking habit was presented the positive association with lymphocyte and negative association with the platelet-lymphocyte ratio. The results of the study indicated that the Pb-exposure and lifestyle factors significantly influenced the systemic inflammatory response markers.
Ravibabu Kalahasthi and Tapu Barman
Environmental Health Perspectives
Background. Exposure to lead (Pb) affects multiple health outcomes and physiological systems. In adults, even small increases in blood Pb levels have been associated with decreased glomerular filtration rate, increased risk of hypertension and increased incidence of essential tremor. To date, there have been few Pb-exposure assessments using the United States Occupational Health and Safety Administration (OSHA) regulations. Objective. The aim of the present study was to assess Pb-exposure in terms of elevated blood lead levels (BLL) and urinary-δ-aminolevulinic acid (U-δ-ALA) levels of workers exposed to Pb in the lead acid battery industry in Tamil Nadu, India based on Pb exposure regulations set by the American Conference of Governmental Industrial Hygienists (ACGIH) and OSHA. Materials and Methods. BLLs and U-δ-ALA were estimated in 449 male workers exposed to Pb across ten different job categories in a lead acid battery factory. Worker BLLs were estimated using atomic absorption spectrophotometry and U-δ-ALA was estimated using spectrophotometry. Results. The Biological Exposure Index of the American Conference of Governmental Industrial Hygienists (BEI-ACGIH) were used to assess Pb exposure. BLLs <30 μg/dL were found in 63.5% of workers, and 36.5% of workers had BLLs>30 μg/dL. The present study also assessed Pb exposure using OSHA regulations and found that 83.3% of workers had BLLs <40 μg/dL and 16.7% of workers had BLLs>40 μg/dL. Among these workers, 0.7% of workers had BLLs >60 μg/dL. An excessive excretion of U-δ-ALA (20–40 mg/L) was noted in pasting area workers (2.6%) followed by executives (2.2%) and assembly workers (0.9%). Conclusions. Workers in the job categories of pasting and assembly, as well as executives, are at high risk of Pb exposure compared to other job categories. We recommend placing humidifiers on the roof and keeping a water bath closer the to plate cutting area to reduce fugitive Pb dust emissions. We recommended workers with BLLs >60 μg/dL be removed from jobs involving Pb exposure and return to work only when their BLLs are <40 μg/dL. Participant consent. Obtained Ethics Approval. The study was approved by the ethics committee of the Regional Occupational Health Centre (Southern) Bengaluru, part of the National Institute of Occupational Health of India. Competing Interests. The authors declare no competing financial interests.
Ravibabu Kalahasthi and Tapu Barman
The Korean Society of Toxicology
Earlier studies conducted on lead-exposed workers have determined the reticulocyte count (RC) (%), but the parameters of Absolute Reticulocyte Count (ARC), Reticulocyte Index (RI), and Reticulocyte Production Index (RPI) were not reported. This study assessed the effect of lead (Pb) exposure on the status of reticulocyte count indices in workers occupied in lead battery plants. The present cross-sectional study was carried out on 391 male lead battery workers. The blood lead levels (BLL) were determined by using an Atomic Absorption Spectrophotometer. The RC (%) was estimated by using the supravital staining method. The parameters, such as ARC, RI, and RPI, were calculated by using the RC (%) with the red cell indices (RBC count and hematocrit). The levels of RBC count and hematocrit were determined by using an ABX Micros ES-60 hematology analyzer. The levels of reticulocyte count indices - RC (%), ARC, RI, and RPI significantly increased with elevated BLL. The association between BLL and reticulocyte count indices was positive and significant. The results of linear multiple regression analysis showed that the reticulocyte count (β = 0.212, P < 0.001), ARC (β = 0.217, P < 0.001), RI (β = 0.194, P < 0.001), and RPI (β = 0.208, P < 0.001) were positively associated with BLL. The variable, smoking habits, showed a significant positive association with reticulocyte count indices: RC (%) (β = 0.188, P < 0.001), ARC (β = 0.174, P < 0.001), RI (β = 0.200, P < 0.001), and RPI (β = 0.151, P < 0.005). The study results revealed that lead exposure may cause reticulocytosis with an increase of reticulocyte count indices.
K Ravibabu, T Barman, and HR Rajmohan
Maad Rayan Publishing Company
Background: The interaction between serum neuron-specific enolase (NSE), biogenic amino-acids and neurobehavioral function with blood lead levels in workers exposed to lead form lead-acid battery manufacturing process was not studied. Objective: To evaluate serum NSE and biogenic amino-acids (dopamine and serotonin) levels, and neurobehavioral performance among workers exposed to lead from lead-acid storage battery plant, and its relation with blood lead levels (BLLs). Methods: In a cross-sectional study, we performed biochemical and neurobehavioral function tests on 146 workers exposed to lead from lead-acid battery manufacturing process. BLLs were assessed by an atomic absorption spectrophotometer. Serum NSE, dopamine and serotonin were measured by ELISA. Neurobehavioral functions were assessed by CDC-recommended tests—simple reaction time (SRT), symbol digit substitution test (SDST), and serial digit learning test (SDLT). Results: There was a significant correlation (r 0.199, p<0.05) between SDST and BLL. SDLT and SRT had also a significant positive correlation (r 0.238, p<0.01). NSE had a negative correlation (r –0.194, p<0.05) with serotonin level. Multiple linear regression analysis revealed that both SRT and SDST had positive significant associations with BLL. SRT also had a positive significant association with age. Conclusion: Serum NSE cannot be used as a marker for BLL. The only domain of neurobehavioral function tests that is affected by increased BLL in workers of lead-acid battery manufacturing process is that of the "attention and perception" (SDST).
Tapu Barman, Ravibabu Kalahasthi, and H R Rajmohan
Springer Science and Business Media LLC
Ravi Babu Kalahasthi, Tapu Barman, and H.R. Rajmohan
Informa UK Limited
The present study was carried out to find the relationship between blood lead levels (BLLs) and morbidities among 391 male workers employed in a factory manufacturing lead–acid storage batteries. A predesigned questionnaire was used to collect information on subjective health complaints and clinical observation made during a clinical examination. In addition to monitoring of BLL, other laboratory parameters investigated included hematological and urine-δ-aminolevulinic acid levels. Logistic regression method was used to evaluate the relationship between BLL and morbidities. The BLL among workers was associated with an odd ratio of respiratory, gastrointestinal (GI), and musculoskeletal (MSD) morbidities. Mean corpuscular hemoglobin and packed cell volume variables were associated with respiratory problems. The variables of alcohol consumption and hematological parameters were associated with GI complaints. Systolic blood pressure was related to MSD in workers exposed to Pb during the manufacturing process.
RaviBabu Kalahasthi, HR Rajmohan, Pavitra Narendranan, and Adithya Pradyumna
Medknow
Background: The exposures of bio-aerosols have reported higher occupational health hazards, the association between serum total IgE levels and job categories and occupational health hazards of waste disposal area was limited. The present study was undertaken to assess the relationship between occupational health hazards and Serum total IgE in waste disposal area. Materials and Methods: One hundred eighty subjects working in waste disposal areas in different parts of Bangalore at Karnataka, India were enrolled into the study in 2009. Using questionnaire the respiratory morbidity and other work related problems in HWW was carried. The levels of serum total IgE in study subjects were determined by using Enzyme–linked –immunosorbent assay kits (DRG International Inc, USA). The differences of serum total IgE levels between the groups were computed by using non-parametric Mann-Whitney U test. SPSS 10.0 for windows version of statistical software was used in the analysis. Results: The levels of serum total IgE was significantly increased in landfill area (P=0.027) compose plant workers (P=0.020). The morbidity conditions such as respiratory and musculoskeletal found significantly higher in waste disposal workers as compared to controls. Conclusion: The levels of serum total IgE was significantly increased in land fill area and compose plant workers but no significant relationship was found between the levels of serum total IgE and occurrence of health related symptoms or past respiratory disease.
Ravi Babu Kalahasthi, Rajmohan Hirehal Raghavendra Rao, Rajan Bagalur Krishna Murthy, and M. Karuna Kumar
Informa UK Limited
The objective of this study was to determine the effect of nickel (Ni) exposure on serum amylase activity in nickel-plating workers in Bangalore (India). Sixty-nine subjects using Ni during the electroplating process formed the exposed group. An equal number of age- and sex-matched subjects working in the administration section formed the control group. Urine Ni levels were determined using a flameless atomic absorption spectrophotometer. Serum amylase activity was determined using spectrophotometric method with 2-chloro-4-nitrophenyl-α-D-maltotrioside as substrate. A significant increase in urine Ni and serum amylase activity was noted in nickel platers as compared with the control group. The level of serum amylase activity was positively and significantly associated with Ni content in urine of nickel platers. Stepwise multiple regression analysis was used to assess the effects of Ni exposure, life style confounding factors and presence of gastrointestinal problems on serum amylase activity. The analysis showed that the subjects who had urine Ni levels beyond 10 µg g−1 of creatinine, nickel platers category, smoking and body mass index variables were significantly associated with serum amylase activity. The results of this study suggest that the increased serum amylase activity observed in nickel-exposed subjects could be used as a biomarker for investigating pancreatic function in Ni exposure.
Ravi Babu Kalahasthi, HR Rajmohan, BK Rajan, and Karuna Kumar M
Springer Science and Business Media LLC
Ravi Babu Kalahasthi, Rajmohan Hirehal Raghavendra Rao, Rajan Bagalur Krishna Murthy, and M. Karuna Kumar
Elsevier BV