Proximity of residence to an old mineral storage site in Chile and blood lead levels in children / Proximidade residencial com um velho depósito mineral no Chile e nível de chumbo no sangue em crianças / Proximidad residencial con un viejo depósito mineral en Chile y el nivel de plomo en sangre de niños

Evidence suggests that an old mineral storage site removed in 1998 due to high lead content, remains as a source of exposure in the city of Antofagasta, Chile. The aim was to determine the association between blood lead levels in children and the residential proximity to the old mineral storage site. A cross sectional study was conducted with 185 children aged 7 to 16 years. The outcome variable was blood lead levels measured in 2005. The exposure variable was the distance between the current residence and the old mineral storage site. The distance was measured in meters by Geographic Information System (GIS). The median blood lead level in 2005 was 3.3μg/dL (interquartile range ‒ IQR: 2.0-4.3). A significant inverse association was found between the residential distance to the old mineral storage site and the blood lead levels in children, after adjusting by confounders (β: -0.04; 95%CI: -0.09; -0.01). This result suggests that the old mineral storage site continues to be a source of lead exposure for the children living nearby.

A evidência sugere que um depósito de minerais removido em 1998 por seu alto teor de chumbo ainda poderia ser uma fonte relevante de exposição a este metal, na cidade de Antofagasta, Chile. O objetivo deste trabalho foi determinar a associação entre a distância da residência até o antigo depósito e a concentração de chumbo no sangue. Estudo transversal com 185 crianças de 7-16 anos. A variável dependente foi a concentração de chumbo no sangue medido em 2005; a exposição foi a distância (metros) entre a residência atual e o antigo depósito de chumbo, obtida por meio do Sistema de Informação Geográfica (SIG). A concentração de chumbo no sangue foi de 3,3μg/dL (intervalo interquartil ‒IQR: 2,0-4.3). Constatou-se uma relação inversa entre a distância da casa para o antigo local de recolha e a concentração de chumbo no sangue (β: -0,04; IC95%: -0,09; -0,01). Esse resultado confirma que o antigo lugar de armazenagem do minério continua a ser uma fonte relevante de exposição ao chumbo.

Evidencia sugiere que un antiguo sitio de acopio de minerales removido en 1998 por el alto contenido de plomo, aún sería una fuente de exposición en la ciudad de Antofagasta, Chile. El objetivo fue determinar la asociación entre la concentración de plomo en sangre y la distancia entre la vivienda actual y el antiguo sitio de acopio. Se realizó un estudio de diseño transversal con 185 niños de 7 a 16 años. La variable dependiente fue la concentración de plomo sanguíneo, medida el 2005. La variable de exposición fue la distancia entre la vivienda actual y el antiguo sitio de acopio. Esta distancia fue medida en metros mediante Sistema de Información Geográfica (SIG). La concentración de plomo en sangre fue de 3,3μg/dL (rango intercuartil ‒ RIC: 2,0-4,3). Se encontró una relación inversa y significativa entre la distancia de la vivienda al antiguo sitio de acopio y la concentración de plomo sanguíneo (β: -0,04; IC95%: -0,09; -0,01). Este resultado sugiere que el antiguo sitio de acopio de minerales sigue siendo una fuente de exposición a plomo.

Lead exposure among five distinct occupational groups: a comparative study

This study was conducted to evaluate blood lead concentration among five selected occupational groups. The five groups were: hospital health workers, shop workers, taxi drivers, automobiles mechanics, and wood workers. The groups did not significantly differ among each other in the average of age and work years. ANOVA test revealed significantly higher mean lead blood concentration in taxi drivers, automechanics, and wood workers compared to other groups. Additionally, workers with lead concentration >0.483 umol/L [10microg/dL] were more likely to have frequent muscle pain compared to those with lower concentrations. No association between other symptoms of lead exposure/toxicity and blood lead concentration was detected. In conclusion, special attention must be directed toward lead blood levels and lead poising symptoms when examining patients from certain occupational groups such as taxi drivers, automechanics, and wood workers. Special safety precautions and educational programs are also needed to limit the lead exposure in these occupational groups.

Exposición a la contaminación con plomo en taller de ensamble de baterías / Exposure to lead contamination in battery assembly workshop

Introducción: Las consecuencias perjudiciales del plomo (Pb) en la salud de las personas, y los trabajadores en particular, han sido suficientemente demostradas desde hace mucho tiempo. No obstante ser un problema de tan larga data, llega hasta la actualidad; y los talleres de baterías constituyen una de las fuentes de contaminación. Objetivo General: Conocer el nivel de exposición al Pb de la totalidad de trabajadores directos de un taller de ensamble de baterías de la localidad de Boulogne, Buenos Aires. Objetivos Específicos: -Evaluar los registros sobre el nivel de Pb en sangre de los trabajadores entre 2007 y 2013. -Describir las condiciones de trabajo y las prácticas higiénicas de los empleados. -Medir la cantidad de Pb existente en el aire del establecimiento. Material y métodos: Es un estudio observacional descriptivo. El relevamiento general de riesgos se realizó mediante observación directa. Se analizaron las plombemias de los trabajadores. Las prácticas higiénico-laborales se estudiaron mediante un cuestionario semi-estructurado. Se llevó a cabo un estudio del aire. Resultados: El cumplimiento de las normas de seguridad e higiene laboral es parcial. Es una planta pequeña y mal ventilada, sin un adecuado sistema de extracción ni ventilación. No utiliza proceso húmedo o con aspiradores para la limpieza. No es sistemático el recambio de filtros de la campana de extracción ni de los respiradores personales. Las plombemias realizadas entre diciembre de 2007 y marzo de 2013 muestran valores superiores a los límites aceptables, alcanzando el promedio 19,23 ug/100ml (rango: 3 ug/100ml - 48,8 ug/100ml). Existen debilidades en cuanto a la utilización de la máscara de protección con filtros, a su higienización y a la forma en que esto se realiza. Resultados de las muestras del aire: en crisol: concentración de plomo (resultado analítico): 0,06 mg/m³; en intercelda: 0,92 mg/m3; en el sector de etiquetado: 0,03 mg/m³. Conclusiones principales: Se requiere el mejoramiento de las normas de seguridad e higiene laborales.

Introduction: The harmful effects of lead (Pb) on the health of people and workers in particular have long been sufficiently demonstrated. However being a problem as longstanding, arrives to present workshops and batteries are one of the sources of pollution. General Objective: To determine the level of exposure to Pb of all direct workers of a battery assembly workshop in the town of Boulogne, Buenos Aires. Specific Objectives: -Evaluate the records on the level of Pb in blood of workers between 2007 and 2013. -Describe the working conditions and hygiene practices of employees. -Measure the amount of Pb in the air existing in the establishment. Material and Methods: It is an observational descriptive study. The general risk survey-stage was conducted by direct observation. The lead levels of workers were analyzed. Hygiene and work practices were studied using a semi-structured questionnaire. It was made an air study. Results: Compliance with safety and hygiene is partial. It is a small and stuffy plant without adequate ventilation or exhaust system. It does not use wet or vacuum for cleaning process. No systematic replacement filters range hood or personal respirators. The lead levels between December 2007 and March 2013 show above acceptable limits values, reaching 19,23 ug/100ml average (range: 3 ug/100ml - 48,8 ug/100ml). There are weaknesses with regard to the use of the protective mask filters, to sanitize and the way this is done. Results of air samples: in pot: lead concentration (analytical result): 0,06 mg/ m3, in intercell 0,92 mg/m3; labeling sector: 0,03 mg/m3. Main conclusions: improving the safety and health at work is required.

Effect of chronic lead intoxication on the distribution and elimination of amoxicillin in goats

A study of amoxicillin pharmacokinetics was conducted in healthy goats and goats with chronic lead intoxication. The intoxicated goats had increased serum concentrations of liver enzymes (alanine aminotransferase and gamma-glutamyl transferase), blood urea nitrogen, and reactivated delta-aminolevulinic acid dehydratase compared to the controls. Following intravenous amoxicillin (10 mg/kg bw) in control and lead-intoxicated goats, elimination half-lives were 4.14 and 1.26 h, respectively. The volumes of distribution based on the terminal phase were 1.19 and 0.38 L/kg, respectively, and those at steady-state were 0.54 and 0.18 L/kg, respectively. After intramuscular (IM) amoxicillin (10 mg/kg bw) in lead-intoxicated goats and control animals, the absorption, distribution, and elimination of the drug were more rapid in lead-intoxicated goats than the controls. Peak serum concentrations of 21.89 and 12.19 microg/mL were achieved at 1 h and 2 h, respectively, in lead-intoxicated and control goats. Amoxicillin bioavailability in the lead-intoxicated goats decreased 20% compared to the controls. After amoxicillin, more of the drug was excreted in the urine from lead-intoxicated goats than the controls. Our results suggested that lead intoxication in goats increases the rate of amoxicillin absorption after IM administration and distribution and elimination. Thus, lead intoxication may impair the therapeutic effectiveness of amoxicillin.

Anestesia em paciente com saturnismo: relato de caso / Anesthesia in patient with lead poisoning: case report / Anestesia en paciente con saturnismo: relato de caso

JUSTICATIVA E OBJETIVOS: O saturnismo decorre da intoxicação crônica pelo chumbo, comum após exposição ocupacional. Projéteis retidos no corpo podem resultar em elevados níveis plasmáticos de chumbo com inúmeras repercussões clínicas, principalmente neurológicas. Apresentamos um caso de paciente sintomático, sem diagnóstico, que foi detectado durante visita pré-anestésica. RELATO DO CASO: Paciente apresentado para retirada de projétil alojado em joelho esquerdo há 14 anos, com polineuropatia sem investigação. Durante visita pré-anestésica foi levantada a hipótese de saturnismo, confirmada pelos altos níveis plasmáticos de chumbo (129 µg.dL-1). A cirurgia foi realizada sob anestesia geral antes do início da quelação do chumbo. Durante indução anestésica, o paciente evoluiu com apneia, sem rigidez torácica após 50 µg de fentanil. CONCLUSÃO: A intoxicação por chumbo interfere com a função de diversos órgãos e sistemas, altera o metabolismo oxidativo e os mecanismos intracelulares de sinalização. O acometimento neurológico, com redução da condução neural merece especial atenção do anestesiologista.

BACKGROUND AND OBJECTIVES: Lead poisoning, also Saturnism, results from chronic lead poisoning, common after occupational exposure. Projectiles retained in the body may result in increased levels of plasma lead with numerous clinical implications, particularly neurological. We report a case of a symptomatic patient, undiagnosed, whose diagnosis was made during the preanesthesia evaluation. CASE REPORT: The patient was attended at our hospital to remove a bullet lodged in his left knee 14 years ago, presenting with polyneuropathy without investigation. During the preanesthetic visit, saturnism was hypothesized and confirmed by high plasma lead levels (129 µg.dL-1). Surgery was performed under general anesthesia before starting lead chelation. During anesthesia, the patient developed apnea, without chest-wall rigidity after administration of fentanyl (50 mg). CONCLUSION: Lead poisoning interferes with the function of various organs and systems, alters oxidative metabolism and intracellular signaling mechanisms. Neurological involvement, with reduced neural conduction, deserves special attention from anesthesiologists.

JUSTIFICATIVA Y OBJETIVOS: El saturnismo proviene de la intoxicación crónica por el plomo común después de la exposición ocupacional. Los proyectiles que el cuerpo retiene pueden traer como resultado elevados niveles plasmáticos de plomo con innumerables repercusiones clínicas, principalmente neurológicas. Presentamos aquí un caso de paciente sintomático, sin diagnóstico, y que fue detectado durante la visita preanestésica. RELATO DEL CASO: Paciente que se presentó para la retirada de una bala que se había alojado en la rodilla izquierda hacía 14 años, con polineuropatía sin investigación. Durante la visita preanestésica se pensó en saturnismo, lo que fue confirmado por los altos niveles plasmáticos de plomo (129 µg.dL-1). La cirugía fue realizada bajo anestesia general antes del inicio de la quelación del plomo. Durante la inducción anestésica, el paciente evolucionó con apnea sin rigidez torácica después de 50 µg de fentanilo. CONCLUSIONES: La intoxicación por plomo interfiere con la función de diversos órganos y sistemas, altera el metabolismo oxidativo y los mecanismos intracelulares de señalización. El compromiso neurológico, con la reducción de la conducción neural, merece una especial atención por parte del anestesiólogo.

Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report / Intoxicação por chumbo devida a projétil de arma de fogo em contato com o líquido cefalorraquidiano: relato de caso

CONTEXT: Lead poisoning due to retained gunshot bullets is a well-known clinical problem that is fairly frequently described in the literature. The risk factors for this occurrence relate mainly to whether the lead bullet is in contact with the joint fluid or cerebrospinal fluid (CSF). The treatment for these cases entails chelation therapy while symptoms are shown and definitive surgical removal of the bullet as a potential source of lead. The aim of this paper is to describe a clinical case of lead poisoning due to a retained gunshot bullet in contact with CSF. CASE REPORT: A 42-year-old male was hit by gunshot bullets during a holdup, and one of them was retained in the spinal cord. Six years later, he developed intense low back pain and underwent laminectomy. Nine years later, he then underwent arthrodesis on L5-S1, but he developed intense abdominal pain after the surgical procedure. For five years, he was treated with calcium versenate in five-day cycles, with a good response. The chelation therapy cycles showed great efficacy during symptomatic periods, thus reducing the symptoms and signs of poisoning and promoting great amounts of lead excretion, thereby reducing the total lead burden responsible for the symptoms. Fortunately, over the last four years, the symptoms have improved and the urine levels of aminolevulinic acid (ALA) have declined, to reach complete normalization. This shows that a healing process is probably taking place on the spinal wound, thereby isolating the bullet fragments from CSF contact.

CONTEXTO: A intoxicação por chumbo devida a projétil retido em ferimento por arma de fogo é uma complicação já conhecida e descrita na literatura. O risco de intoxicação endógena por chumbo está associado ao contato do projétil com o líquido sinovial ou líquido o cefalorraquidiano. O tratamento requer terapia de quelação e retirada cirúrgica do projétil como tratamento definitivo. Este artigo descreve caso clínico de paciente que desenvolveu intoxicação por chumbo devida a projétil retido em contato com líquido cefalorraquidiano. RELATO DE CASO: Paciente masculino, 42 anos, foi baleado durante assalto e teve projéteis que se alojaram no abdômen, perna direita e coluna lombo-sacra. Seis anos depois, desenvolveu intensa lombociatalgia e foi submetido a laminectomia. Nove anos após o acidente, foi submetido a artrodese de L5-S1, quando foi tentada a retirada do projétil, sem sucesso, desenvolvendo no pós-operatório intensa dor abdominal. Foi então feito diagnóstico de intoxicação por chumbo, que foi tratada com gluconato de cálcio, com boa resposta. Durante os cinco anos seguintes, fez ciclos de quelação com ácido etilenodiaminotetracético (EDTA) cálcico, com boa evolução. Os ciclos de quelação mostraram grande eficácia na redução dos sinais e sintomas da intoxicação, promovendo um grande aumento da excreção de chumbo e reduzindo a carga corpórea total de chumbo responsável pelos sintomas. Nos últimos quatro anos, apresentou melhora dos sintomas de intoxicação, com diminuição dos níveis de ALA urinário até a normalização, mostrando que provavelmente houve um processo de cicatrização da lesão, isolando os fragmentos de chumbo do contato com o líquor.

[Serious lead poisoning in oral and inhaled opium abuser]

A 25 year old man who referred with abdominal pain, nausea and progressive vomiting since 2 months ago and 7kg weight loss from this time. Also he was complaining from generalized bone pain especially back pain and jaundice. The patient has a long time history of addiction with oral and inhalation form of narcotics. In physical exam pallorness and icter of mucosa was observed. In mouth examination bluish pigmentation seen at the gum-tooth line. Hepatosplenomegaly and lymphadenopathy was not detected. Upper GI endoscopy was normal. And in lab tests hepatic aminotransferases were increased but alkalin phosphatase was in normal range also indirect billirubin was increased too. CBC test non auto immune hemolytic anemia was deteded, and direct and indirect combs test was negative. BMB and BMA evaluation hyperplasia of erythroid was shown. The patient had a history of smoking and oral narcotics use from 6 years ago. According to all symptoms with clinical doubt of lead poisoning the very high level of lead in narcotic sample was reported and in blood analysis very high level of lead [350mg/dl] was detected. The patient was treated with Ca.EDTA and BAL with decreasing lead level and the symptoms were recovered. There are some reports Similar this case [due to oral narcotics contain Lead] in Iran

Lead hepatotoxicity & potential health effects.

Occupational and environmental exposures to lead (Pb), one of the toxic metal pollutants, is of global concern. Health risks are increasingly associated with environmental exposures to Pb emissions from, for example, the widespread use of leaded gasoline in developing countries. Exposure occurs mainly through the respiratory and gastrointestinal systems, and the ingested and absorbed Pb is stored primarily in soft tissues and bone. Autopsy studies of Pb-exposed patients have shown a large amount (approximately 33%) of the absorbed Pb in soft tissue stored in liver. In addition to neuronal encephalopathy observed in persons after exposure to very high concentrations of Pb, gastrointestinal colic (abdominal pain, constipation, intestinal paralysis) is a consistent early symptom of Pb poisoning in humans. Such severe gastrointestinal effects are consistently observed in patients with a blood Pb range of 30 to 80 microg/dl. Ingestion of Pb is one of the primary causes of its hepatotoxic effects. Hepatocarcinogenic effects of Pb reported in animal toxicology studies have led to new research into the biochemical and molecular aspects of Pb toxicology. Gains in the molecular understanding of Pb effects on hepatic drug metabolizing enzymes, cholesterol metabolism, oxidative stress, and hepatic hyperplasia suggest a potential role for Pb in damaging extrahepatic systems, including the cardiovascular system. This review also discusses the therapeutic potential of chelation therapy in treating Pb-induced hepatotoxicity in animals.

Determining lead sources in Mexico using the lead isotope ratio

OBJECTIVE: Lead poisoning can, in some cases, be traced to a specific route or source of exposure on the basis of the individual's blood lead isotope ratio. To assess the major source of lead exposure among women residing in Mexico City, we compared blood, ceramic, and gasoline lead isotope ratios. MATERIAL AND METHODS: The study population, randomly selected from participants of a large trial, (1/1996-12/1996) comprised of 16 women whose lead levels exceeded 10 æg/dl and who reported using lead-glazed ceramics. Lead isotope ratios were performed on a Perkin Elmer 5000 Inductively Coupled Plasma Mass Spectrometer (ICP-MS) interfaced with a Perkin Elmer HGA-600MS Electrothermal Vaporization System (ETV). RESULTS: The isotope ratios (206Pb/204Pb, 207Pb/204Pb, and 208Pb/204Pb) of both the blood specimens and their corresponding ceramic specimens were highly correlated, with r=0.9979, r²=0.9958, r=0.9957, r²=0.9915 and r=0.9945, r²=0.9890 values for the three isotope ratios, respectively, suggesting that the lead exposure most likely resulted from the use of these ceramic. Measurements of lead isotope ratios from leaded gasoline in use at the time of blood sampling, differed from those in blood and ceramics. CONCLUSIONS: Determining lead isotope ratios can be an efficient tool to identify a major source of lead exposure and to support the implementation of public health prevention and control measures.

Lead poisoning after gunshot wound

CONTEXT: Despite the absence of symptoms in the majority of patients carrying lead bullet fragments in their bodies, there needs to be an awareness of the possible signs and symptoms of lead intoxication when bullets are lodged in large joints like knees, hips and shoulders. Such patients merit closer follow-up, and even surgical procedure for removing the fragments. OBJECTIVE: To describe a patient who developed clinical lead intoxication several years after a gunshot wound. DESIGN: Case report. CASE REPORT: A single white 23-year-old male, regular job as a bricklayer, with a history of chronic alcohol abuse, showed up at the emergency department complaining of abdominal pain with colic, weakness, vomiting and diarrhea with black feces. All the symptoms had a duration of two to three weeks, and had been recurrent for the last two years, with calming during interval periods of two to three weeks. Abdominal radiograms showed a bullet lodged in the left hip, with a neat bursogram of the whole synovial capsule. A course of chelating treatment using calcium versenate (EDTACaNa2) intravenously was started. After the chelation therapy the patient had recurrence of his symptoms and a radical solution for the chronic mobilization of lead was considered. A hip arthroplasty procedure was performed, leading to complete substitution of the left hip.

Saturnismo causado por projétil de arma de fogo no quadril: relato de três casos / Lead poisoning from retained bullets in the hip: report of 3 cases

Säo descritos três casos de saturnismo causado por projétil de arma de fogo alojado na cabeça femoral. Säo feitas consideraçöes sobre a intoxicaçäo pelo chumbo de forma geral e abordada especificamente a intoxicaçäo que ocorre por projéteis alojados no organismo.

Saturnismo causado por projetil de arma de fogo no quadril: relato de dois casos / Saturnism caused by lead poisoning in the hip region: report of two cases

Sao descritos dois casos de saturnismo causado por projetil de arma de fogo alojado na cabeca femoral. Sao feitas consideracoes sobre a intoxicacao pelo chumbo de forma geral e abordada especificamente a intoxicacao que ocorre por projeteis alojados no organismo.

Localizacao intra-articular de um projetil de arma de fogo / Intra-articular localization of armfire bullet

A permanencia de uma projetil de arma de fogo no corpo humano raramente causa problemas significativos. A maioria dos fragmentos localizados em tecidos moles sao rapidamenente encapsulados e nao necessitam ser removidos. A remocao e necessaria quando o projetil se localiza no tecido subcutaneo, sob uma proeminencia ossea. Os fragmentos ou projeteis de chumbo que penetram e permanecem nas grandes articulacoes podem causar nao somente artrite, mas tambem a absorcao sistemica de chumbo com sinais e sintomas de intoxicacao. Isto ocorre principalmente quando o fragmento de chumbo esta localizado no interior ou proximo de uma articulacao ou bursa. O caso relatado e o de uma crianca na qual foi indicado tratamento cirurgico precoce, devido a localizacao intra-articular do projetil