Biomarker of exposure
Biomarker responses
Biomarkers of suspectbility
38
Scopus Publications
Scopus Publications
Association between Occupational Cadmium Exposure and Markers of Kidney Injury: A Systematic Review and Meta-Analysis Ravibabu Kalahasthi, Raju Nagaraju, Rakesh Balachandar, Kuldip Upadhyay, Bhavani Shankara Bagepally Chemical Research in Toxicology, 2025 Cadmium (Cd)-induced nephrotoxicity is a well-known phenomenon; however, several observational studies have used various biomarkers to monitor kidney injury in occupationally exposed populations. The markers used in these studies are found to be varied in sensitivity and are site-specific, and experts have the opinion that a single marker cannot predict the degree of kidney injury in human biomonitoring studies. Therefore, the current systematic review consolidates existing evidence to identify the association between Cd exposure and markers of potential sites of renal dysfunction/damage. Thirty (30) studies with 1980 chronic Cd exposure by occupations and 1292 unexposed were included in the review. The pooled mean difference of Cd exposure was as follows: blood Cd, 6.45 (5.18 to 7.71) μg/L; urine Cd, 4.52 (3.54 to 5.5) μg/g creatinine. Cd exposure was associated with impaired glomerular function (higher serum creatinine, serum β2 microglobulin, and lower creatinine clearance rate), tubular reabsorption (higher urinary β2 microglobulin and retinol binding protein), and injury (higher urinary N-acetyl-β-d-glucosaminidase and kidney injury molecule-1). However, the included studies exhibited high levels of heterogeneity. From the data, it is highly evident that biomarkers such as urinary N-acetyl-β-d-glucosaminidase, and retinol binding protein are found to be more sensitive than conventional clinical renal functional markers such as serum creatinine, urinary albumin, and protein levels, which are found to be within acceptable limits among the Cd-exposed group. Considering the rising disease burden of chronic kidney disease of unknown origin, Cd exposure-associated renal dysfunction and damage is a public health concern. Therefore, the review also discussed emerging biomarkers with higher sensitivity for early detection that can be adopted in occupational biomonitoring studies as early markers to prevent/delay the progression of kidney disease among the working population. Prospero Registration ID: CRD42022380923
Estimation of the pooled mean blood lead levels of Indian children: Evidence from systematic review and meta-analysis Kuldip Upadhyay, Rakesh Balachandar, Bhavani Shankara Bagepally, Kalahasthi Ravibabu, Venugopal Dhananjayan, Nagaraju Raju, Geetika Yadav, Beerappa Ravichandran, Santasabuj Das Toxicology Reports, 2025 A recent systematic review reported very high pooled estimates of blood lead levels (BLLs) for Indian children. Current study aimed at systematically pooling the BLLs of Indian children (aged ≤ 14 years). Further, explore the time trend of BLLs with respect to implementing the ban on the use of Pb-petrol (i.e.2000) and a decade later (2010). Observational studies documenting the BLL in Indian children (aged ≤ 14 years) from PubMed-Medline, Scopus, and Embase digital databases from inception to August 2024 were systematically reviewed. Detailed protocol is available at PROSPERO (ID: CRD42022382835). Pooled mean BLL was estimated using the random-effects model and conventional- I 2 statistics to assess the heterogeneity, while the Newcastle Ottawa Scale for bias assessment. Sub-group, sensitivity, and meta-regression analyses were performed where data permitted. Observations from 65 reports (51 original studies) revealed pooled BLL of 10.4 (95 % CI: 9.55–11.2) µg/dL with a trend of gradual reduction during the last 3 decades. Subgroup analysis revealed the high risk (with known Pb exposure) children had BLL of 14.3 (12.3–16.2) µg/dL, while that of the low risk (no known Pb exposure) is 8.71 (7.71–9.71) µg/dL. Only the low risk group exhibited a time trend of a gradual reduction in BLL. Notably, the review observed high heterogeneity. A progressive decline in Pb burden with respect to the national ban on leaded petrol was observed. However, present observations emphasize remedial actions toward non-occupational Pb exposure particularly among high risk Pb group, such as periodic BLL surveys. • Pooled data indicates Indian children's mean BLL is above the reference level. • BLLs have gradually declined following the ban on leaded petrol in India. • Higher BLLs observed in children with known/high Pb exposure risk versus low risk. • Currently available evidences are predominantly low quality and carried high heterogeneity. • National programs are effective and required on long run to reduce Pb pollution
Global DNA methylation and its association with lead exposure, B vitamin deficiency and lifestyle variables among lead-recycling workers in India Ravibabu Kalahasthi, Vinay Kumar Adepu, Raju Nagaraju Public Health and Toxicology, 2024 Introduction Lead (Pb) exposure affects the methylation of DNA. However, the relationship between global DNA methylation (5 methylcytosine) and Pb-exposure outcomes among occupationally exposed recycling workers needs to be ascertained. The current study aimed to evaluate the association of Pb-exposure and global DNA methylation by considering lifestyle variables and B vitamin deficiency among Pb-exposed recycling workers. Methods This cross-sectional study assessed Pb exposure, B-vitamin status, lifestyle variables, and 5-methylcytosine (5 mC) levels in 164 male workers exposed to Pb from the leadrecycling process in India, in 2022. The lead concentration in the blood sample was determined using the inductively coupled plasma emission spectrometer (ICP-OES) method. Serum levels of B vitamins and 5mC were assessed with enzyme-linked immunosorbent assay (ELISA) protocols. A pre-structured questionnaire was used to obtain information about demographic and lifestyle factors. SPSS version 23 was used for the statistical analysis of the data. Results The findings of the univariate model demonstrated that global DNA methylation was significantly decreased by experience (≥5 years), vitamin B9 deficiency, and blood lead levels (BLLs) of 30–50 and >50 μg/dL. In the stepwise multiple linear regression analysis, experience (β= -0.283; p=0.001), increased BLLs (β= -0.195; p=0.010), tobacco chewing (β= -0.184; p=0.014), and vitamin B9 deficiency (β= -0.157; p=0.037) were negatively and significantly associated with methylation of DNA. Conclusions The results indicated that the Pb exposure consequences (a range of doses and times), vitamin B9 deficiency, and chewing of tobacco products contributed to reduced methylation of DNA, which could be attributed to epigenetic deregulation and overexpression within the study population.
Assessing Health Seeking Behaviors and Economic Consequences of Morbidity in Indian Construction Workers: A Multicenter Study Soundarya Soundararajan, Ankit Viramgami, Ankit Sheth, Ravichandran Beerappa, Ravibabu Kalahasthi, Raghavan Sampathraju, Dhananjayan Venugopal, Kamalesh Sarkar, Rakesh Balachandar Indian Journal of Occupational and Environmental Medicine, 2024 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.
Association between non-high density lipoprotein-cholesterol fractions and presence of allostatic load among industrial workers Ravibabu Kalahasthi, Vinaykumar Adepu, Rakesh Balachandar, Raju Nagaraju Indian Journal of Physiology and Pharmacology, 2022 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.
Association between occupational lead exposure and immunotoxicity markers: A systematic review and meta-analysis Ravibabu Kalahasthi, Raju Nagaraju, Rakesh Balachandar, Bhavani Shankara Bagepally Toxicology, 2022 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.
Association of risk factors with insulin resistance/sensitivity biomarkers among manufacturing industry workers Journal of Krishna Institute of Medical Sciences University, 2020
Evaluation of the relationship between pro-inflammatory cytokines and health hazards in workers involved in hazardous waste sites at Karnataka, India Journal of Research in Health Sciences, 2010
Asessing dust exposure in an integrated iron and steel manufacturing plant in South India Work, 2008
Effect of nickel exposure on urinary enzymes in nickel-plating workers Journal of Occupational Health and Safety Australia and New Zealand, 2008
