silicosis in india- overview of diseases

silicosis is a major problem in india

1. Silicosis in India - An overview Dr Pawan Kumar Singh, DM Assoc. Prof. Pulm . & Crit. Care Med., Pt BDS PGIMS, Rohtak

2. Disclosure No conflict of Interest Definitely not an expert Always have to revise the ILO classification before a board meeting

3. Source of Silica Crystalline silica is found in materials such as soil, sand, concrete, mortar, granite, and other minerals Industries such as construction, mining, oil and gas extraction, stone countertop and foundries. Cement production is one of the industries where workers are exposed to silica dust. Other form of silica is Amorphous https://www.lung.org/lung-health-diseases/lung-disease-lookup/silicosis/learn-about-silicos .

4. New sources of silicosis

5. Market of Silica Hindustan Zinc Ltd., Ambuja Cements Ltd., UltraTech Cement Ltd., ACC Limited India is a major exporter for sandstone The sandstone mining industry in Rajasthan, India is largely unregulated Sandstone industry is growing at 6-7% CAGR No established formal relationship between employer and employee No accountability https://www.regattaexports.com/indian-sandstone-economic-analysis/

6. Estimated workers in India and Burden In India According to a report, in FY 2017-18, there were 229,522 persons in employment in the quarries in Rajasthan It excludes workers from MSMEs, traders, exporters or transport Sandstone mining industry in India employs nearly 1.3 million people on a seasonal basis. 8.5 million more work in construction related activities Silicosis and silicotuberculosis in India, WHO bulletin, Sharma N et al.

7. 343 sites in Mahendergarh and 117 registered. Each having nearly 30-40 workers My State https://timesofindia.indiatimes.com/city/gurgaon/in-mahendergarh-crushers-`s

8. Source of Indian Data 2009 SC Judgement directing NHRC work on silicosis No Prospective registry All workers should come under ESIC cover however data is not maintained No routine screening Compensations and rehabilitation assist schemes making the source of data SC has asked all states to fix compensation to all silicosis cases. https://iris.who.int/bitstream/handle/10665/271977/PMC5043201.pdf

9. Awareness about silicosis among workers Indian J Occup Environ Med. 2018 May-Aug; 22(2): 97–100.

10. Awareness among regulators Wind breaking wall with height should be 3-ft more than the highest node of the crusher. Rotating water sprinkling system/fogger/Anti-smog gun. 2-3 rows of tall trees around the periphery of crusher. Regular wetting of roads Health survey of workers should be carried out by the stone crusher on half-yearly basis

11. NIOSH recommendations Know the dangers of breathing in crystalline silica dust. Remember: Even if you cannot see dust, you may still be at risk. Use water spray systems and proper ventilation in confined spaces. If water systems and ventilation are not enough, your employer must provide respirators specifically designed to protect against crystalline silica. Take advantage of health and lung screenings offered by your employer. Thoroughly wash your hands before eating or drinking in dusty areas. Shower and change into clean clothes before leaving work to help prevent contamination of your car or home. https://www.cdc.gov/niosh/docs/96-120/default.html#:~:text=NIOSH%20recommen

12. Severity at the time of presentation Occup Med (Lond). 2022 Aug 16;72(6):366-371. J Family Med Prim Care. 2021 Feb;10(2):686-691.

13. Co- exisiting factors in silicosis 76% Smokers In other studies- 56-89% Tuberculosis (one survey found 12% to be positive for active tb) Nonsmoking tobacco use NTM Misdiagnosis Other occupations hazard like fall, skin, eye Occup Med (Lond). 2022 Aug 16;72(6):366-371. J Family Med Prim Care. 2021 Feb;10(2):686-691.

14. Limitations in silicosis management No treatment Lack of symptom correlation No standardization for follow up investigations Vaccination Family support Rehabilitations

15. Challenges and the way forward Lack of disease Burden information: Forming Registries Low awareness among workers: Training sessions and screening camps Low use of Protective measures: Revision of regulations and applications Lack of funding for research: Need to have more information about physiological pathological changes No drugs in silicosis: Antifibrotics, PGD2 modulators in Silicosis

16. A way forward… PGIMS Rohtak is collaborating with centres managing cases with silicosis. The purpose is to study PG metabolites in serum and urine The follow up of this investigation will be a drug trial Minimum three years durations commitment. [email protected] Thank You