Research Article

Integrative Analysis of DNA Damage, Oxidative Stress, and Serum Mineral Composition in Pesticide-Exposed Agricultural Workers from South Punjab, Pakistan

Abdul Ghaffar1*, Kashfa Akram1, Habiba Jamil1, Riaz Hussain2, Ghulam Abbas3, Fozia Afzal4, Ahrar Khan5,6, Rabia Tahir7, Muhammad Ahmad Chishti1 and Shahnaz Rashid3

1Department of Zoology, The Islamia University of Bahawalpur, 63100, Pakistan; 2Department of Pathology, University College of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur-63100, Pakistan; 3Centre of Excellence in Marine Biology University of Karachi, 75270, Pakistan; 4Department of Zoology, The Islamia University of Bahawalpur, Rahim Yar Khan Campus, 64100, Pakistan; 5Shandong Vocational Animal Science and Veterinary College, Weifang, 261061, China; 6Faculty of Veterinary Science, University of Agriculture, Faisalabad, Pakistan; 7College of Animal Science and Technology, Sichuan Agricultural University, Chengdu, China.

Received | April 02, 2024; Accepted | May 17, 2024; Published | July 13, 2024

*Correspondence | Abdul Ghaffar, Department of Zoology, The Islamia University of Bahawalpur, 63100, Pakistan; Email: dr.abdul.ghaffar@iub.edu.pk

Citation | Ghaffar, A., K. Akram, H. Jamil, R. Hussain, G. Abbas, F. Afzal, A. Khan, R. Tahir, M.A. Chishti and S. Rashid. 2024. Integrative analysis of DNA damage, oxidative stress, and serum mineral composition in pesticide-exposed agricultural workers from South Punjab, Pakistan. Sarhad Journal of Agriculture, 40(3): 785-798.

DOI | https://dx.doi.org/10.17582/journal.sja/2024/40.3.785.798

Keywords | Pesticides, Oxidative stress, Hematological abnormalities, Genetic abnormalities

Copyright: 2024 by the authors. Licensee ResearchersLinks Ltd, England, UK.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

Introduction

Extensive use of pesticides, herbicides, insecticides has increased the contamination level of our ecosystem leading to adverse impacts over living organisms. Two million tons of pesticide constituents are applied annually to destroy or stop pests, fungi, herbs, insects, rodents and ticks for improvement in the production of crops (Marrs and Ballantyne, 2004; De et al., 2014). Pesticides are complex mixtures containing active component and other constituent like additives, emulsifying agents and solvents. Furthermore, many agricultural implementations of insecticide having various formulations and combinations applied on the time of the growing season (Mostafalou and Abdollahi, 2013). Exposure to pesticides increase the risk of health ailments in human beings, different type of cancer, oxidative stress by greater construction of free radicals and damage to DNA, RNA, DNA repair proteins (Abdollahi et al., 2004; Mostafalou and Abdollahi, 2013; Kim et al., 2017) including detoxification and scavenger enzymes or change antioxidant defense mechanisms (Possamai et al., 2007; Hernandez et al., 2013). These chemicals can accumulate within the body of human by ingestion, inhalation and through skin contact and bioaccumulation at various trophic levels (Damalas and Koutroubas, 2016).

Genotoxic biomonitoring of population showed that chemical mutagens are warning system for genetic ailments. Occupational submission to pesticides concerned with increased risk of carcinomas like Alzheimer’s disease, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, multiple lymphoma, colon and bladder cancer, gall bladder sarcoma, Leukemia, lung cancer, pancreatic cancer, Parkinson’s ailment and reproductive abnormalities (Gauthier et al., 2001; Shukla et al., 2001; Baris et al., 2004; Beane-Freeman et al., 2005; Orsi et al., 2009; Andreotti et al., 2009; Koutros et al., 2009; Bonner et al., 2010; Bertrand et al., 2010).

Pakistan has wide climatic diversity, which offers great opportunities for growing a variety of vegetable crops in regional markets to meet demand across the country throughout the year. Vegetable production in the country is well-diversified in terms of a range of species grown as more than thirty-five types of vegetables are grown in Pakistan from low to high elevation areas in rain fed to irrigated land and low to high input systems. Different vegetables like tomato, chili, eggplant, potato, cucumber, gourds and okra are grown in large quantities by using different technologies in different zones in different season (Ahmad et al., 2005; Maalik et al., 2013; Tahir and Altaf, 2013). In Pakistan, control of pesticide residues in the food chain is not meticulous because there is no relative legislation for the management of pesticides and other harmful chemicals for monitoring their residues. Farm workers involved in spraying activities ignoring basic preventive measures when handling pesticides, which trigger numerous health concerns. In addition, Pakistan has no official training on safety measures for insecticide use due to lack of effective legislation and knowledge of potential risks (Latif et al., 2011; Yawar et al., 2012; Arafa et al., 2013; Khan and Damalas, 2015; Damalas and Koutroubas, 2016).

In recent years the demand of crop yield in Pakistan increased quickly due to native feeding. Different types of pesticides are used for the better growth and protection of crops throughout the country mainly insecticides. There are five types of acaricides, 39 types of herbicides, 108 types of insecticides, 30 types of fungicides and six types of rodenticides are registered in Pakistan (Zia et al., 2009; Anwar et al., 2011). Agricultural employers also exposed to insecticide when they are working in the field, which is not related to pesticide application (Bradman et al., 2009; Coronado et al., 2004; Quandt et al., 2004). Epidemiological studies suggested that larger submission to insecticides have harmful impacts such as endocrine, cancer at different sites, neurologic, nephrotoxic, respiratory and reproductive disorders an understandable linkage have to be accepted (Ntzani et al., 2013; McCauley et al., 2006). Epidemiological studies have suggested that there is association between the insecticides submitted workers and respiratory ailments like airway inflammation, coughing, wheezing, asthma, chronic obstructive pulmonary disease and lung cancer (Hoppin et al., 2007, 2009). Therefore, current study was planned to determine the genotoxicity, hematological-serological alterations and oxidative stress induced by pesticides in workers exposed to it (Widowati et al., 2022).

Materials and Methods

Study area and sampling

Survey conducted to collect blood samples of 100 exposed and 100 unexposed workers by using disposable syringes from district Bahawalpur (Saddar and Ahmedpur), Lodhran and Rahim Yar Khan. For hematology, serum biochemistry and to measure DNA damage, 5ml blood taken, 2.5ml in CBC vials containing EDTA as anticoagulant and 2.5 ml in plain CBC vials. Sampling of the pesticide-exposed workers done in the morning when they were spraying in the cotton fields. The ages of the pesticide occupational workers were approximately 18 to 59 years, all the workers were male, and their exposure period was 3 to 35 years. After taking the blood of the farmers, the samples were carefully transported to the laboratory in iced cooler. Study conducted from July 2018 to October 2018 at the Aquaculture, Genetic Toxicity and Molecular Biology Laboratory in the Department of Zoology, The Islamia University of Bahawalpur Punjab, Pakistan. This survey was done in the month of July to October when pesticides use is on peak in cotton and sugarcane fields. Following parameters were focused during study: Age, marital status, children, smoking and economic status and clinical abnormalities were cough, throat infection, sneezing, nasal allergy, skin allergy, eye irritation, hepatitis, economic status, flu, kidney problem, diabetes, blood pressure, muscle problem, fever, uric acid, stomach problem, respiratory problem, restlessness, vomiting, dizziness, nervousness, heart problem, chest tightness and backbone tightness i.e., lumbago.

Hematological assay

Collected blood samples inspected using an automatic analyzer (Bk-5000vet; Biobase Biodustry Co. Ltd, Shandong, China) for haematological assay. Haematological parameters were calculated are listed as: white blood cells (WBC), Red blood cells, haemoglobin (Hb), hematocrit (HCT), platelet count (PLT), lymphocytes (LYM), neutrophils (NEUT), monocytes, eosinophils, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC). Biochemical Analysis of blood samples was carried out by using spectrophotometer with the use of commercially available kits of different parameters. First, collected blood samples were centrifuged by centrifugation machine (EBA-20, Hettich Zentrifugen Co. Ltd, Germany). at 1500 rpm for 15 min. Then serum got was separated from plasma through pipetting in Eppendorf tubes. Serum enzyme tests were carried out in from the laboratory. Parameters which were taken for biochemical analysis are Glucose, Urea, creatinine, Bilirubin, alanine aminotransferase (ALT), Alkaline Phosphatase (ALP), Aspartate aminotransferase (AST), lactate dehydrogenase (LDH), Lipid Profile (total cholesterol, triglycerides, HDL-C, LDC-C), serum minerals (sodium and potassium, calcium and phosphorous) Cardiac Enzymes (CPK and AST).

Comet assay

Blood samples were collected and processed for the assay according to the protocol outlined by Singh et al. (1988) with modifications. Thin smears of both 1% normal melting point agarose and 1% low melting point agarose were applied to frosted glass slides. Subsequently, these prepared slides, containing cells suspended in low melting agarose, were solidified and promptly immersed in freshly prepared lysing buffer solution. Following this, the slides were placed in a horizontal electrophoresis tank and subjected to electrophoresis in darkness for 25 minutes at 25 V. Following electrophoresis, the slides were neutralized and stained with ethidium bromide. Subsequent examination of all slides was conducted under a fluorescent microscope, with DNA damage assessed by measuring the tail length of 50 cells in each tissue sample (Ghaffar et al., 2021).

Statistical analysis

The data collected in this study underwent statistical analysis using MS Excel and SPSS 15 software. Results are presented as mean±SD for hematological and serum analyses, comparing exposed and unexposed workers through multiple comparisons. The grades of DNA damage in exposed and unexposed workers were compared using Duncan’s multiple tests, accounting for variations in age.

Results and Discussion

Clinical abnormalities

Survey indicated that diseases were more common in pesticides exposed group as compared to unexposed workers. The percentages of clinical abnormalities of the pesticide exposed workers and unexposed workers are shown in Table 1. A notably high prevalence of various health issues was observed among pesticide-exposed workers compared to their unexposed counterparts. These included throat infection, cough, nasal allergy, skin allergy, eye irritation, hepatitis, kidney problems, fever, elevated uric acid levels, respiratory infection, restlessness, vomiting, nervousness, and tightness in the backbone. Additionally, farmers frequently reported experiencing headaches, burning or watery eyes, and neurological symptoms such as forgetfulness, lack of concentration, and increased tiredness reported by Monger et al. (2023).

 

Table 1: Percentage of clinical abnormalities in the pesticide exposed and unexposed workers.

Clinical abnormalities	Unexposed % (N=100)	Exposed % (N=100)
Throat infection	17%	37%
Cough	18%	22%
Sneezing	81%	37%
Nasal Allergy	40%	76%
Skin Allergy	32%	58%
Eye irritation	17%	47%
Hepatitis	04%	05%
Kidney problem	02%	03%
Diabetes	5%	3%
Blood Pressure	10%	05%
Fever	03%	05%
Uric acid	21%	29%
Stomach problem	18%	11%
Respiratory infection	03%	07%
Restlessness and vomiting	16%	35%
Nervousness	15%	39%
Cardiac problem	05%	02%
Chest, backbone tightness	18%	48%

 

Similar patterns of pesticide poisoning conditions have been documented in prior studies by del-Prado (2007); Khan et al. (2010), and Mwabulambo et al. (2018). The reported clinical symptoms align closely with those documented among the exposed farmers in this study, corroborating the reality of the general health effects associated with pesticide exposure within farming communities. These clinical abnormalities are indicated by the pesticide-exposed workers may be due to the exposure of pesticide within their immune system (Henneberger et al., 2013).

Demographic characteristic of pesticide exposed workers

Table 2 provides in-depth demographic profiles of pesticide-exposed workers, including age distribution, education, marital status, agricultural background, pesticide training history, monthly household income, economic standing, and no. of sibling. Additionally, Table 3 furnishes a comprehensive depiction of observed clinical abnormalities among both pesticide-exposed and unexposed workers, elucidating the behavioral and demographic factors influencing health outcomes within this cohort. In previous studies have revealed that pesticide exposure is greater in Pakistan agricultural workers (Srivirojana et al., 2005). There are large numbers of pesticide exposed workers who were affected from the harm impacts of pesticides. Therefore, we decided to examine this problem and adopted possible safety measures to deal with pesticides exposure (Aroonvilairat et al., 2015). The age of workers that use pesticides were from 18 to 59 years and exposure time of pesticides workers was 3 to 35 years (Chuisseu et al., 2015) reported similar examinations. Additionally, the study results align closely with those of previous research, including studies by Staudacher et al. (2020); Afata et al. (2022), and Lelamo et al. (2023).

 

Table 2: Demographic characteristic of pesticide Exposed workers in and around the district Bahawalpur.

Age (years)
15-25	22%
26-35	38%
36-45	21%
46-55	16%
≥ 56	3%
Education level
None	59%
1-5th grade	27%
6-8th grade	14%
Marital status
Married	89%
Unmarried	11%
Agricultural experience
2-10	45%
≥15	55%
Received training about pesticides
Yes	13%
No	87%
Monthly household income
5000 ≤ less	23%
6000-8000	66%
9000-11000	11%
Economic status
Poor	87%
Middle	13%
Number of siblings
None	14%
1-5	64%
5-10	22%

 

Table 3: Detailed behavioral and demographic characteristic of pesticide-exposed (n=100) and unexposed (n=100) workers for observed clinical abnormalities.

 

Hematological analysis

Results of blood parameters expressed in Table 4 as mean and Standard Deviation. Hemoglobin level, WBCs, RBCs, HCT, MCV, MCH, MCHC, lymphocytes, neutrophils, and eosinophils showed a notable decrease in pesticide-exposed workers compared to their unexposed workers. Moreover, these parameters exhibited significant decreases in exposed workers with clinical abnormalities. Conversely, mixed cell count (MXD) and monocytes in pesticide-exposed individuals significantly increased in comparison to the unexposed group, particularly among those with clinical abnormalities such as blood pressure issues, skin allergies, cardiac problems, and diabetes.

The observed slight decrease in neutrophils, eosinophils, and lymphocytes can be attributed to the presence of clinical abnormalities, which weaken the immune system. Conversely, the increase in mixed cell count and monocytes in pesticide-exposed workers may be linked to clinical abnormalities. This finding is consistent with the study by Garg et al. (2004). Furthermore, monocyte levels were significantly elevated in pesticide-exposed workers above 36 years of age, albeit within the reference range, when compared with unexposed workers. This increase in monocyte count could be attributed to the phagocytic activity of eosinophils and the activity of neutrophils. These results closely resemble those reported by Al-Sararet al. (2009). It’s worth noting that similar findings have been documented in previous studies, such as the one conducted by Aroonvilair et al. (2015).

 

Table 4: Mean ± S.D values of hematological parameters in different diseases of pesticide exposed and unexposed individuals.

Serum analysis

Results of different serological parameters expressed in (Tables 5, 6) as mean and Standard Deviation. Glucose, Alkaline Phosphatase level, HDL-C, LDL-C, sodium level, calcium level, potassium level and phosphorus level in pesticide-exposed workers remarkably decreased as compared to the unexposed individuals. These parameters significantly decreased in exposed workers with clinical abnormalities kidney problem, uric acid, stomach problem and hepatitis as compared to unexposed individuals with same clinical abnormalities. While urea level, cholesterol, triglyceride, VLDL, CK-MB, lactate dehydrogenase, creatinine phosphokinase, creatinine, bilirubin, ALT in pesticide exposed workers significantly increased as compared to the unexposed individuals. These parameters significantly increased in exposed workers with clinical abnormalities blood pressure, skin allergy, cardiac problem and diabetes as compared to unexposed individuals with

 

Table 5: Mean ± S.D values of serum parameters in different diseases of pesticide exposed and unexposed individuals.

same clinical abnormalities. Liver enzymes Aspartate aminotransferase AST and Alanine aminotransferase ALT were remarkably increased in pesticide exposed worker as compared to non-exposed workers but within reference range. This study is similar to previous study of (Chuisseu et al., 2015) reported similar alterations in activity of liver enzymes. Pesticides disrupt the liver function because liver absorbed most of the pesticides and metabolized Kazmi et al. (2023). Our research is also similar with the previous study (Al-Sarar et al., 2009). In serum profile, glucose level was remarkably decreased in exposed workers. Urea, Creatinine, Cholesterol, Bilirubin, (ALT), Very low-density lipoprotein (VLDL), Lactate Dehydrogenase (LDH) and Triglycerides were notably greater in exposed workers in comparison with unexposed individuals. Creatinine Phosphokinase (CPK) and Serum minerals were significantly decreased in pesticide-exposed workers as compared to unexposed workers (García-García et al., 2016).

Genotoxicity

Genotoxic changes were represented in (Table 7 and Figures 1, 2, 3, 4, 5, 6, 7, 8, 9) showed the number and percentage of undamaged, slightly damaged, damaged and highly damaged cells according to age groups of

 

 

Table 6: Mean ± S.D values of serum parameters in different diseases of pesticide exposed and unexposed individuals.

 

exposed and unexposed workers. In microscopic field total (100×5×15) 7500 cells were observed. These tables indicated the comparison of DNA damage in pesticide exposed and unexposed workers according to their age groups. Rate of percentage of DNA damage highly increased in 35-46 age groups. The percentage of overall DNA damage was significantly increased with the increase in the age of pesticide exposed workers because of the increase of exposure time. The current study suggested that a longer exposure to

 

Table 7: Grades of damaged DNA of exposed and unexposed workers according to their ages.

Age groups (years)	Grades of DNA damages
	Undamaged		Slightly damaged		Damaged		Highly Damaged
	No.	%	No.	%	No.	%	No.	%
15-25
Exposed	2776	87.5	207	6.5	105	3.3	82	2.5
Unexposed	2522	90.1	106	3.7	69	2.4	40	1.4
26-35
Exposed	2487	82.4	240	7.9	168	5.5	121	4.0
Unexposed	2360	87.7	210	7.8	82	3.0	36	1.3
36-45
Exposed	2270	76.0	301	10.0	256	8.5	159	5.3
Unexposed	2440	88.2	135	4.8	87	3.1	52	1.8
46-55
Exposed	2654	79.5	287	8.7	258	7.7	138	4.1
Unexposed	2491	88.0	158	5.5	135	4.7	45	1.5
≥ 56
Exposed	2372	78.0	268	8.8	255	8.3	143	4.7
Unexposed	2462	89.8	133	4.8	107	3.9	39	1.4

 

 

 

 

 

 

 

 

insecticide has harmful impacts on health and cause oxidative stress (Aziz et al., 2022). Various pesticides cause oxidative stress due to the creation of free radicals and alteration in antioxidant defense enzymes. This study is like the previous research (Lozano-Paniagua et al., 2018). In this study, analysis of DNA damage was done by the procedure of comet assay. All the solutions were freshly prepared in the laboratory and fresh blood of pesticide exposed and unexposed individuals were taken to make slides (Al-Saeed et al., 2023). The samples were promptly observed after preparation. Cells were categorized based on the degree of damage, ranging from undamaged to highly damaged cells. Significantly greater DNA alterations were observed in exposed individuals compared to those who were unexposed. This study shares similarities with previous research (Collins, 2004).

Conclusions and Recommendations

Pakistan has wide climatic diversity, which offers great opportunities for growing throughout the year. Variety of hazardous pesticide remain exposed in environment to beat pest control. Pesticide exposure may acute and chronic effects on exposed individual’s mild toxicity to severe. Pesticides have been associated with neurological, endocrine, psychological, immunological, respiratory, hematological, dermatological, nephritic, hepatic issues. It has been concluded that pesticides cause clinical and hematological abnormalities, parameters like serum biochemical alterations, oxidative stress and genotoxic effects in pesticides exposed workers. In future, there is a need to form training institutes that teach the farmers about safety measures. The pesticides are toxic chemicals that induce harmful effects in exposed workers. Must underscore the need for intervention to improve workplace and safety. Worker’s health surveillance participates to enhance interdisciplinary strategies providing quality of life at work. Engineering measures should be taken to get rid of these chemicals and aware train the occupational workers about the hazardous impact of these pesticides. There is also need to start a medical program to treat the pesticide exposed workers who indicate clinical abnormalities in their bodies. For treatment natural herbs and artificially made supplements also vitamins C and E are recommended.

Acknowledgements

We are grateful to NRPU Project No. 3392 entitled Monitoring of Adverse Effects of Pesticide Exposure on Health of Agriculture and Industrial Workers and their amelioration with vitamin C and E for providing the funds to conduct this research, and thankful to the staff of Aquaculture, Genetic Toxicity, and Molecular Biology Laboratory, Department of Zoology, IUB.

Novelty Statement

This research presents a pioneering comprehensive investigation into the effects of pesticides in a structured and systematic manner, providing valuable insights to the workers exposed to pesticide.

Author’s Contribution

Abdul Ghaffar: Supervision, conceptualization, formal analysis.

Kashfa Akram: Executed sampling and data collection and laboratory work.

Riaz Hussain: Formal analysis, data curation.

Habiba Jamil: Writing review and editing.

Ghulam Abbas: Data curation.

Fozia Afzal, Ahrar Khan and Rabia Tahir: Helped in review and editing.

Muhammad Ahmad Chishti and Shahnaz Rashid: Helped in data curation and format setting of the MS.

Conflict of interest

The authors have declared no conflict of interest.

References

Abdollahi, M., A. Ranjbar, S. Shadnia, S. Nikfar and A. Rezaie. 2004. Pesticides and oxidative stress: A review. Med. Sci. Monit., 10(6): 141-147.

Afata, T.N., S. Mekonen, M. Shekelifa and G.T. Tucho. 2022. Prevalence of pesticide use and occupational exposure among small-scale farmers in Western Ethiopia. Environ. Health Insights, 16: 11786302211072950. https://doi.org/10.1177/11786302211072950

Ahmad, B., S. Hassan and K. Bakhsh. 2005. Factors affecting yield and profitability of carrot in two districts of Punjab. Int. J. Agric. Biol., 7(5): 794-798.

Al-Saeed, F.A., S. Naz, M.H. Saeed, R. Hussain, S. Iqbal, A.M.M. Chatha and R. Akram. 2023. Oxidative stress, antioxidant enzymes, genotoxicity and histopathological profile in Oreochromis niloticus exposed to lufenuron. Pak. Vet. J., 43(1). https://doi.org/10.29261/pakvetj/2023.012

Al-Sarar, A.S., Y. Abo-Bakr, G.S. Al-Erimah, H.I. Hussein and A.E. Bayoumi. 2009. Hematological and biochemical alterations in occupationally pesticides-exposed workers of Riyadh municipality, Kingdom of Saudi Arabia. Res. J. Environ. Toxicol., 3(4): 179-185. https://doi.org/10.3923/rjet.2009.179.185

Andreotti, G., L.E.B. Freeman, L. Hou, J. Coble, J. Rusiecki, J.A. Hoppin and M.C. Alavanja. 2009. Agricultural pesticide use and pancreatic cancer risk in the agricultural health study cohort. Int. J. Cancer, 124(10): 2495-2500. https://doi.org/10.1002/ijc.24185

Anwar, T., I. Ahmad and S. Tahir. 2011. Determination of pesticide residues in fruits of Nawabshah district, Sindh, Pakistan. Pak. J. Bot., 43(2): 1133-1139.

Arafa, A., M. Afify and N. Samy. 2013. Evaluation of adverse health effects of pesticides exposure (biochemical and hormonal) among Egyptian farmers.

Aroonvilairat, S., W. Kespichayawattana, T. Sornprachum, P. Chaisuriya, T. Siwadune and K. Ratanabanangkoon. 2015. Effect of pesticide exposure on immunological, hematological and biochemical parameters in Thai orchid farmers. A cross-sectional study. Int. J. Environ. Res. Publ. Health, 12(6): 5846-5861. https://doi.org/10.3390/ijerph120605846

Aziz, S., S. Abdullah, H. Anwar and F. Latif. 2022. DNA damage and oxidative stress in economically important fish, Bighead carp (Hypophthalmichthys nobilis) exposed to engineered copper oxide nanoparticles. Pak. Vet. J., 42(1).

Baris, D., D.T. Silverman, L.M. Brown, G.M. Swanson, R.B. Hayes, A.G. Schwartz and P.A. Stewart. 2004. Occupation, pesticide exposure and risk of multiple myeloma. Scand. J. Work Environ. Health, pp. 215-222. https://doi.org/10.5271/sjweh.782

Beane-Freeman, L.E., M.R. Bonner, A. Blair, J.A. Hoppin, D.P. Sandler, J.H. Lubin and M.C. Alavanja. 2005. Cancer incidence among male pesticide applicators in the Agricultural Health Study cohort exposed to diazinon. Am. J. Epidemiol., 162(11): 1070-1079. https://doi.org/10.1093/aje/kwi321

Bertrand, K.A., D. Spiegelman, J.C. Aster, L.M. Altshul, S.A. Korrick, S.J. Rodig and F. Laden. 2010. Plasma organochlorine levels and risk of non-Hodgkin lymphoma in a cohort of men. Epidemiology, 21(2): 172-180. https://doi.org/10.1097/EDE.0b013e3181cb610b

Bonner, M.R., B.A. Williams, J.A. Rusiecki, A. Blair, L.E. Beane Freeman, J.A. Hoppin and M.C. Alavanja. 2010. Occupational exposure to terbufos and the incidence of cancer in the agricultural health study. Cancer Causes and Contr., 21: 871-877. https://doi.org/10.1007/s10552-010-9514-9

Bradman, A.S.A., A.L. Salvatore, M. Boeniger, R. Castorina, J. Snyder, D.B. Barr and B. Eskenazi. 2009. Community-based intervention to reduce pesticide exposure to farmworkers and potential take-home exposure to their families. J. Exposure Sci. Environ. Epidemiol., 19(1): 79-89. https://doi.org/10.1038/jes.2008.18

Chuisseu, P.D., S.N. Fewou, G. Moudjo, F.P. Manfo, J.L. Simo and J. Ngogang. 2015. Effect of chronic pesticides exposure in farm workers health of a Camerounian community. In: 7th Int. Toxicol. Symp. Afr., pp. 79.

Collins, A.R., 2004. The comet assay for DNA damage and repair: Principles, applications, and limitations. Mol. Biotechnol., 26(3): 249-261. https://doi.org/10.1385/MB:26:3:249

Coronado, G.D., B. Thompson, L. Strong, W.C. Griffith and I. Islas. 2004. Agricultural task and exposure to organophosphate pesticides among farmworkers. Environ. Health Perspect., 112(2): 142-147. https://doi.org/10.1289/ehp.6412

Damalas, C.A. and S.D. Koutroubas. 2016. Farmers’ exposure to pesticides: Toxicity types and ways of prevention. Toxics, 4(1): 1. https://doi.org/10.3390/toxics4010001

De, A., R. Bose, A. Kumar and S. Mozumdar. 2014. Targeted delivery of pesticides using biodegradable polymeric nanoparticles. New Delhi: Springer India. 10: 978-981. https://doi.org/10.1007/978-81-322-1689-6

Del Prado-Lu, J.L., 2007. Pesticide exposure, risk factors and health problems among cut flower farmers: A cross sectional study. J. Occup. Med. Toxicol., 2: 1-8. https://doi.org/10.1186/1745-6673-2-9

García-García, C.R., T. Parrón, M. Requena, R. Alarcón, A.M. Tsatsakis and A.F. Hernández. 2016. Occupational pesticide exposure and adverse health effects at the clinical, hematological and biochemical level. Life Sci., 145: 274-283. https://doi.org/10.1016/j.lfs.2015.10.013

Garg, U.K., A.K. Pal, G.J. Jha and S.B. Jadhao. 2004. Haemato-biochemical and immuno-pathophysiological effects of chronic toxicity with synthetic pyrethroid, organophosphate and chlorinated pesticides in broiler chicks. Int. Immunopharmacol., 4(13): 1709-1722. https://doi.org/10.1016/j.intimp.2004.08.002

Gauthier, E., I. Fortier, F. Courchesne, P. Pepin, J. Mortimer and D. Gauvreau. 2001. Environmental pesticide exposure as a risk factor for Alzheimer’s disease: A case-control study. Environ. Res., 86(1): 37-45. https://doi.org/10.1006/enrs.2001.4254

Ghaffar, A., R. Hussain, N. Ahmad, R. Ghafoor, M.W. Akram, I. Khan and A. Khan. 2021. Evaluation of hemato-biochemical, antioxidant enzymes as biochemical biomarkers and genotoxic potential of glyphosate in freshwater fish (Labeo rohita). Chem. Ecol., 37(7): 646-667. https://doi.org/10.1080/02757540.2021.1937141

Hernández, A.F., M. Lacasaña, F. Gil, M. Rodríguez-Barranco, A. Pla and O. López-Guarnido. 2013. Evaluation of pesticide-induced oxidative stress from a gene–environment interaction perspective. Toxicology, 307: 95-102. https://doi.org/10.1016/j.tox.2012.09.007

Hoppin, J.A., D.M. Umbach, S.J. London, P.K. Henneberger, G.J. Kullman, J. Coble and D.P. Sandler. 2009. Pesticide use and adult-onset asthma among male farmers in the agricultural health study. Eur. Respirat. J., 34(6): 1296-1303. https://doi.org/10.1183/09031936.00005509

Hoppin, J.A., M. Valcin, P.K. Henneberger, G.J. Kullman, D.M. Umbach, S.J. London and D.P. Sandler. 2007. Pesticide use and chronic bronchitis among farmers in the agricultural health study. Am. J. Ind. Med., 50(12): 969-979. https://doi.org/10.1002/ajim.20523

Kazmi, S.A.H., R. Iqbal, A.A. Al-Doaiss, M. Ali, R. Hussain, F. Latif and G.A. Raza. 2023. Azoxystrobin-induced oxidative stress in gills, hematological biomarkers and histopathological ailments in fresh water fish. Pak. Vet. J., 43(2). https://doi.org/10.29261/pakvetj/2023.025

Khan, D.A., S. Shabbir, M. Majid, T.A. Naqvi and F.A. Khan. 2010. Risk assessment of pesticide exposure on health of Pakistani tobacco farmers. J. Exposure Sci. Environ. Epidemiol., 20(2): 196-204. https://doi.org/10.1038/jes.2009.13

Khan, M. and C.A. Damalas. 2015. Factors preventing the adoption of alternatives to chemical pest control among Pakistani cotton farmers. Int. J. Pest Manage., 61(1): 9-16. https://doi.org/10.1080/09670874.2014.984257

Kim, K.H., E. Kabir and S.A. Jahan. 2017. Exposure to pesticides and the associated human health effects. Sci. Total Environ., 575: 525-535. https://doi.org/10.1016/j.scitotenv.2016.09.009

Koutros, S., C.F. Lynch, X. Ma, W.J. Lee, J.A. Hoppin, C.H. Christensen and M.C. Alavanja. 2009. Heterocyclic aromatic amine pesticide use and human cancer risk: Results from the US agricultural health study. Int. J. Cancer, 124(5): 1206-1212. https://doi.org/10.1002/ijc.24020

Latif, Y., S.T.H. Sherazi and M.I. Bhanger. 2011. Assessment of pesticide residues in commonly used vegetables in Hyderabad, Pakistan. Ecotoxicol. Environ. Saf., 74(8): 2299-2303. https://doi.org/10.1016/j.ecoenv.2011.07.030

Lelamo, S., T. Ashenafi, A. Ejeso, N.E. Soboksa, B. Negassa and M.B. Aregu. 2023. Pesticide use practice and associated factors among rural community of Malga District, Sidama Regional State, South Ethiopia. Environ. Health Insights, 17: 11786302231157226. https://doi.org/10.1177/11786302231157226

Lozano-Paniagua, D., T. Parrón, R. Alarcón, M. Requena, F. Gil, O. López-Guarnido and A.F. Hernández. 2018. Biomarkers of oxidative stress in blood of workers exposed to non-cholinesterase inhibiting pesticides. Ecotoxicol. Environ. Saf., 162: 121-128. https://doi.org/10.1016/j.ecoenv.2018.06.074

Maalik, S., S.A. Rana, H.A. Khan and M. Ashfaq. 2013. Diversity and abundance of lepidopteran populations from selected crops of district Faisalabad, Pakistan. Pak. J. Agric. Sci., 50: 95-101.

Marrs, T.T. and B. Ballantyne. 2004. Pesticide toxicology and international regulation: John Wiley and Sons. https://doi.org/10.1002/0470091673

McCauley, L.A., W.K. Anger, M. Keifer, R. Langley, M.G. Robson and D. Rohlman. 2006. Studying health outcomes in farmworker populations exposed to pesticides. Environ. Health Persp., 114(6): 953. https://doi.org/10.1289/ehp.8526

Monger, A., K. Mahat, Dorjee, N. Om, P. Mongar, T. Dorji and V. Chettri. 2023. Assessment of exposure to pesticides and the knowledge, attitude and practice among farmers of western Bhutan. PLoS One, 18(5): e0286348. https://doi.org/10.1371/journal.pone.0286348

Mostafalou, S. and M. Abdollahi. 2013. Pesticides and human chronic diseases: Evidences, mechanisms, and perspectives. Toxicol. Appl. Pharmacol., 268(2): 157-177. https://doi.org/10.1016/j.taap.2013.01.025

Mwabulambo, S.G., Mrema, E.J., Ngowi, A.V. and S. Mamuya. 2018. Health symptoms associated with pesticides exposure among flower and onion pesticide applicators in Arusha region. Ann. Glob. Health, 84(3): 369. https://doi.org/10.29024/aogh.2303

Ntzani, E.E., Ntritsos, G., Chondrogiorgi, M., Evangelou, E. and Tzoulaki, I., 2013. Literature review on epidemiological studies linking exposure to pesticides and health effects. EFSA Support. Publ., 10(10). https://doi.org/10.2903/sp.efsa.2013.EN-497

Orsi, L., L. Delabre, A. Monnereau, P. Delval, C. Berthou, P. Fenaux and J. Clavel. 2009. Occupational exposure to pesticides and lymphoid neoplasms among men: Results of a French case-control study. Occup. Environ. Med., 66(5): 291-298. https://doi.org/10.1136/oem.2008.040972

Possamai, F.P., J.J. Fortunato, G. Feier, F.R. Agostinho, J. Quevedo, D.W. Filho and F. Dal-Pizzol. 2007. Oxidative stress after acute and sub-chronic malathion intoxication in Wistar rats. Environ. Toxicol. Pharmacol., 23(2): 198-204. https://doi.org/10.1016/j.etap.2006.09.003

Quandt, S.A., T.A. Arcury, P. Rao, B.M. Snively, D.E. Camann, A.M. Doran and D.S. Jackson. 2004. Agricultural and residential pesticides in wipe samples from farmworker family residences in North Carolina and Virginia. Environ. Health Persp., 112(3): 382. https://doi.org/10.1289/ehp.6554

Shukla, V.K., A.N. Rastogi, T.K. Adukia, R.B. Raizada, D.C.S. Reddy and S. Singh. 2001. Organochlorine pesticides in carcinoma of the gallbladder: A case–control study. Eur. J. Cancer Prevent., 10(2): 153-156. https://doi.org/10.1097/00008469-200104000-00006

Singh, N.P., M.T. McCoy, R.R. Tice and E.L. Schneider. 1988. A simple technique for quantitation of low levels of DNA damage in individual cells. Exp. Cell Res., 175(1): 184-191. https://doi.org/10.1016/0014-4827(88)90265-0

Srivirojana, N., T. Theptepa, S. Punpuing, P. Guest, K. Tun, O. Chankham and A. Suvansrual. 2005. Population pressure, utilization of chemicals in agriculture, health outcomes and solid waste management. In: Proceedings of the international conference on integrated solid waste management in Southeast Asian Cities, Siem Reap, Cambodia. pp. 5-7.

Staudacher, P., S. Fuhrimann, A. Farnham, A.M. Mora, A. Atuhaire, C. Niwagaba and M.S. Winkler. 2020. Comparative analysis of pesticide use determinants among smallholder farmers from Costa Rica and Uganda. Environ. Health Insights, 14: 1178630220972417. https://doi.org/10.1177/1178630220972417

Tahir, A. and Z. Altaf. 2013. Determinants of income from vegetables production: A comparative study of normal and off-season vegetables in Abbottabad. Pak. J. Agric. Res., 26(1).

Widowati, W., S. Prahastuti, M. Hidayat, S.T. Hasiana, R. Wahyudianingsih, E. Afifah and M. Subangkit. 2022. Protective effect of ethanolic extract of Jati Belanda (Guazuma ulmifolia L.) by inhibiting oxidative stress and inflammatory processes in cisplatin-induced nephrotoxicity in rats. Pak. Vet. J., 42(3).

Yawar, L., S.T. Hussain, M.B. Iqbal and N. Shafi. 2012. Evaluation of pesticide residues in human blood samples of agro professionals and non-agro professionals. Am. J. Anal. Chem., 3: 587-595. https://doi.org/10.4236/ajac.2012.38077

Zia, M.S., M.J. Khan, M. Qasim and A. Rehman. 2009. Pesticide residue in the food chain and human body inside Pakistan. J. Chem. Soc. Pak., 31(2): 284-291.