Toxic effects of formalin-treated cadaver on medical students, staff members, and workers in the Alexandria Faculty of Medicine

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 2 January 2017

Figures & data

Table 1 Response of medical students to symptoms of acute exposure to formalin-treated cadavers (n = 454).

Symptoms of acute exposure to formalin-treated cadavers	Grade zero^a		Grade 1^b		Grade 2^c		Grade 3^d
	No.	%	No.	%	No.	%	No.	%
• Unpleasant smell	33	7.3	104	23	228	50.3	81	17.9
• Dry or sore nose	102	22.5	182	40.2	11	26.7	33	7.3
• Running or congested nose	125	27.6	172	38	107	23.6	36	7.9
• Unusual thirst	195	43	156	34.4	70	15.5	18	4
• Itching in the eyes	71	15.7	143	31.6	149	32.9	76	16.8
• Redness of the eyes	110	24.3	162	35.8	116	25.6	50	11
• Excessive lacrimation	94	20.8	146	32.2	136	30	63	13.9
• Disturbance in sight	170	37.5	156	34.4	85	18.8	26	5.7
• Nausea	224	49.4	142	31.3	59	13	15	3.3
• Headache	199	43.9	165	36.4	54	11.9	24	5.3
• Syncope (fainting episode)	306	67.5	100	22.1	25	5.5	7	1.5
• Unusual tiredness/dizziness	231	51	146	32.2	47	10.4	12	2.6
• Dry or sore throat	215	47.5	147	32.5	60	13.2	10	2.2
• GIT disturbances	256	58.5	115	25.4	44	9.7	11	2.4
• Itching of the hands	271	59.8	118	26	38	8.4	10	2.2
• Skin eruptions on the face/neck	292	64.5	108	23.8	31	6.8	6	1.3
• Respiratory distress & disturbed nocturnal sleep	285	62.9	100	22.1	41	9.1	15	3.3

Abbreviations: GIT: gastro-intestinal tract.

a Grade zero: not at all, not recognizable.

b Grade 1: barely recognizable.

c Grade 2: strong, prominent and irritating.

d Grade 3: intolerable.

Table 2 Distribution of medical students according to the duration of relief of symptoms on first exposure to formalin-treated cadavers, bodily adaptations to symptoms, and use of PPD (n = 454).

Duration for relief of symptoms on first exposure to formalin-treated cadaver		No.	%
Duration for relief of eye symptoms	<1 h	384	84.8
	Hours	43	9.5
	6 h to 1 day	3	0.7
	>1 day	7	1.5
Duration for relief of nose symptoms	<1 h	370	81.7
	Hours	44	9.7
	6 h to 1 day	7	1.5
	>1 day	10	2.2
Duration for relief of skin symptoms	<1 h	384	84.8
	Hours	20	4.4
	6 h to 1 day	9	2
	>1 day	11	2.4
Bodily adaptations to symptoms following subsequent exposure to formalin-treated cadaver		No.	%
Bodily adaptations to eye symptoms	Nil	133	29.4
	Mild	205	45.3
	Moderate	82	18.1
	Severe	8	1.8
Bodily adaptations to nose symptoms	Nil	146	32.2
	Mild	185	40.8
	Moderate	88	19.4
	Severe	10	2.2
Bodily adaptations to skin symptoms	Nil	218	48.1
	Mild	149	32.9
	Moderate	47	10.4
	Severe	13	2.9
Use of PPD		No.	%
Use the following PPD
Eye goggles		44	9.7
Hand gloves		334	73.7
Laboratory coat		354	78.1
Frequency of wearing PPD
Always/regularly		143	31.6
Often		102	22.5
Sometimes		101	22.3
Occasionally		24	5.3
Rarely		40	8.8
Never		19	4.2

Abbreviations: PPD: Personal Protective Devices.

Table 3 Personal and occupational characteristics of the studied formalin-exposed and unexposed staff members.

Personal and occupational characteristics		Formalin exposed staff (n = 16)		Unexposed staff (n = 19)
		No.	%	No.	%
Sex
	• Male	7	43.8	3	15.8
	• Female	9	56.2	16	84.2
Current occupation
	• Demonstrator	3	18.8	3	15.8
	• Assistant lecturer	1	6.2	3	15.8
	• Lecturer	2	12.5	1	5.3
	• Assistant professor	0	0.00	2	10.5
	• Professor	2	12.5	7	36.8
	• Worker	6	37.5	2	10.5
	• Secretary	1	6.2	0	5.3
	• Technician	1	6.2	0	0.00
Duration of employment (years)
	• 2 to <4	1	6.2	3	15.8
	• 4 to <6	5	31.2	1	5.3
	• 6 to <8	0	0.00	2	10.5
	• 8 to <10	1	6.2	0	0.00
	• >10	9	56.2	13	68.4

Table 4 Distribution of formalin-exposed and unexposed staff members and workers according to reported systemic disorders.

Systemic disorder	Formalin-exposed staff (n = 16)		Unexposed staff (n = 19)		Test of sign. (p-value)
	No.	%	No.	%
Skin disorder	16	100%	1	5.3%	^FEp = 0.00^b
• White discoloration	2	13.3	1	5.3
• Burning	11	68.8	0.0	0.0
• Drying	12	75	0.0	0.0
• Cracking	9	56.2	0.0	0.0
• Scaling	8	50	0.0	0.0
• Erythema	9	56.2	0.0	0.0
• Edema	5	31.2	0.0	0.0
• Eczema	11	68.8	0.0	0.0
• Allergic contact dermatitis	14	87.5	0.0	0.0
Reproductive disorder^a	8	88.9%	3	18.8%	^FEp = 0.00^b
• Menstrual disorders	3	33.3	0	0.0
• Anemia	4	44.4	1	6.25
• History of spontaneous abortions	4	44.4	2	12.5
• History of LBW babies	2	22.2	0	0.0
• Delivery of a baby with congenital anomalies	2	22.2	1	6.25
Ocular disorder	14	87.5%	1	5.3%	^FEp = 0.00^b
• Discomfort & irritation	11	68.8	1	5.3
• Corneal clouding	2	12.5	0.0	0.0
• Permanent alteration to vision	3	18.8	0.0	0.0
• Blindness	1	6.2	0.0	0.0
Respiratory disorders	16	100%	2	10.6%	^FEp = 0.00^b
• Upper airway irritation	16	100	2	10.5
• Lower respiratory tract irritation	15	93.8	0.0	0.0
• Work-related bronchial asthma	8	53.3	0.0	0.0
• Exacerbation of pre-existing bronchial asthma	7	46.7	0.0	0.0
GIT disorder	6	37.5%	0	0. 0%	^FEp = 0.00^b
• Nausea	3	18.8	0.0	0.0
• Vomiting	1	6.2	0.0	0.0
• Severe abdominal pain	1	6.2	0.0	0.0
• GIT hemorrhage	2	12.5	0.0	0.0
• Gastric outlet obstruction	1	6.2	0.0	0.0
Cancer	1	6.2%	0	0.0%	^FEp = 0.45
• Nasal sinus cancer	0.0	0.0	0.0	0.0
• Leukemia or lymphoma	0.0	0.0	0.0	0.0
• Cancer breast	1	6.2	0.0	0.0

Abbreviations: LBW: low birth weight; GIT: gastro-intestinal tract; FE: Fisher’s Exact test.

a Number of formalin-exposed females = 9, number of unexposed females = 16.

b Statistical test is significant at p < 0.001 (2-tailed).

Table 5 Distribution of the studied formalin-exposed and unexposed staff members according to CBC findings.

CBC parameters		Formalin exposed staff (n = 16)	Unexposed staff (n = 19)	Test of significance (p-value)
Hb (g/dl)%	Min-Max	7.60–16.90	11.40–16.00	Z^Mann-Whitney = −1.32 (0.18)
	Mean ± SD	13.9 ± 2.27	13.4 ± 1.22
	Mean Rank	20.5	15.89
RBCs (×10^6/ul)	Min-Max	2.24–5.00	4.01–5.83	Z^Mann-Whitney = −3.77^b (0.00)
	Mean ± SD	4.08 ± 0.65	4.95 ± 0.50
	Mean Rank	10.88	24.50
Ht (%)	Min-Max	18.8–43.00	34.5–45.8	Z^Mann-Whitney = −2.74^b (0.00)
	Mean ± SD	35.10 ± 5.70	39.40 ± 3.13
	Mean Rank	12.81	22.37
MCV (fl)	Min-Max	74.00–95.00	89.2–89.6	Z^Mann-Whitney = −2.53^a (0.01)
	Mean ± SD	86.5 ± 69	79.9 ± 7.09
	Mean Rank	22.78	13.97
MCH (pg)	Min-Max	28.5–38.60	19.7–30.9	Z^Mann-Whitney = −4.76^b (0.00)
	Mean ± SD	34.16±.72	27.28 ± 2.80
	Mean Rank	27.00	10.42
MCHC (g/dl)	Min-Max	38.60–41.50	32.4–35.6	Z^Mann-Whitney = −5.03 (0.00)^b
	Mean ± SD	39.67 ± 0.71	34.09 ± 0.96
	Mean Rank	27.5	10.00
Platelets (/ul)	Min-Max	127,000–382,000	190,000–363,000	t = 2.01^a (0.05)
	Mean ± SD	237,375 ± 71745.73	280473.68 ± 54456.27
	Mean Rank	13.88	21. 47
WBCs (/ul)	Min-Max	3400–10,900	4170–10,710	t = −0.98 (0.33)
	Mean ± SD	7225 ± 2118.01	6554 ± 1919.5
	Mean Rank	20.25	16.11

Abbreviations: CBC: Complete blood counts; Hb: hemoglobin; RBCs: red blood cells; WBCs: white blood cells; MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin; MCHC: mean corpuscular hemoglobin concentration MCHC (g/dl); SD: standard deviation; t: student t test;

a statistical test is significant at p ⩽ 0.05 (2-tailed);

b statistical test is significant at p ⩽ 0.001 (2-tailed).

Table 6 Distribution of the studied formalin-exposed and unexposed staff members and workers according to their RBCs, WBCs, and Platelets counts.

Blood cells counts		Formalin exposed staff (n = 16)		Unexposed staff (n = 19)		Test of significance (p-value)
		No.	%	No.	%
RBCs count						^MCp = 0.01^a
	• Normal	12	75	16	84.2
	• Abnormal (low)	4	25	0	0.00
	• Abnormal (high)	0	0.00	3	15.8
WBCs count						^MCp = 0.03^a
	• Normal	12	75	19	100
	• Abnormal (low)	1	6.2	0	0.00
	• Abnormal (high)	3	18.8	0	0.00
Platelets count						^FEp = 0.45
	• Normal	15	93.8	19	100
	• Abnormal (low)	1	6.2	0	0.00

Abbreviations: RBCs: red blood cells; WBCs: white blood cells; FE: Fisher’s Exact test; MC: Monte Carlo test.

a statistical test is significant p ⩽ 0.05 (2-tailed).