Predictors of elevated blood lead level in Thai children: a pilot study using risk assessment questionnaire.

INTRODUCTION: In the era post leaded-gasoline use, the risk of exposure to environmental lead in Thai children is not well described. This is a pilot study using a risk assessment questionnaire to identify children with elevated blood lead level. MATERIAL AND METHOD: Children from 4 communities, 2 in the Bangkok metropolitan area and 2 in Kanchanaburi province, were recruited during their well child visits. Blood lead levels were obtained in all children and parents are asked to fill out a 25-item risk assessment questionnaire. STATISTICAL ANALYSIS: The relationship between the blood lead level and dependent variables were tested using linear regression and one-way analysis of variance (ANOVA) as appropriate. RESULTS: There were 296 children included in the study; 33 from Klong Toey and 114 from Siriraj community in Bangkok while 149 were from two different communities in Kanchanaburi province. The average blood lead level was 5.65 +/- 3.05 mcg/dL. The overall prevalence of children with blood lead level > 10 mcg/dL was 8.1%, while that of the Klong Toey community was 12.5%. The questionnaire identified 3 independent predictors of elevated blood lead levels; the presence of peeling paint in or outside the house, eating paints chips, and the geographic location of children. CONCLUSION: Using a risk assessment questionnaire, together with obtaining blood lead level has proven effective in identifying key environmental features associated with elevated blood lead level in children from sampled Thai communities. The challenge now is to conduct a larger epidemiological study of a similar type in order to guide the screening and preventive efforts.

Chronic arsenicism and multiple skin cancers.

Abstract : We report a case of skin cancer who presented with an ulcerated nodule at left arm and finger. The patient was previously diagnosed Bowenûs disease at left calf one year ago, skin cancer at hand and foot nine years ago. He also received herbal medicine every month for 1 year since 50 years ago for herpes treatment. Multiple skin cancers were suspected to be induced by chronic arsenicism. High level of arsenic was identified from nails. Bowenûs disease at finger was treated with CO2 laser and squamous cell carcinoma at left arm was removed by surgical excision. Chronic arsenicism was treated by supportive care.

Treatment of paraquat poisoning with cyclophosphamide / dexamethasone combination: The first two years experience at Siriraj Hospital.

While the mortality rate from paraquat is high, a proven treatment for paraquat poisoning is still lacked. In this article, we describe the outcome of the first two years of implementing a treatment protocol containing cyclophosphamide and dexamethasone for paraquat poisoning at Siriraj Hospital. Treatment group was studied by a retrospective review of cases at Siriraj Hospital with significant paraquat poisoning in 2002-2003. Significant ingestion means ingestion of 1gram total or 20 mg/kg or positive urine dithionite test for paraquat. AII patients with significant ingestion received treatments with a regimen consisting of enteral administration of a single dose of Fuller’s earth solution and a 14-day course of intravenous cyclophosphamide plus intravenous dexamethasone plus intravenously vitamin C. Survival rate was compared with historical controls that included searchable cases with significant paraquat poisonings admitted to Siriraj Hospital who were treated only with Fuller’s earth or Bentonite, vitamins B and C and supportive care. From January 2002 to November 2003, there were 6 cases of significant paraquat poisoning presented to Siriraj Hospital. The survival rate of treatment group is 83.3% as judged by presence without life-threatening signs at 4 weeks after the ingestion. Nine cases of significant paraquat poisoning were identified from Siriraj Hospital’s searchable medical records from 1994-1997 and were enrolled as controls. AII control cases died within 12 days, six from fulminant paraquat poisoning and the remaining from moderate to severe poisoning. The use of immunosuppressive agents known for its ability to treat inflammatory lung disease such as cyclophosphamide and dexamethasone presents a viable alternative to an otherwise serious and untreatable poisoning.

Methamphetamine abuse during pregnancy and its health impact on neonates born at Siriraj Hospital, Bangkok, Thailand.

To ascertain the impact of intrauterine methamphetamine exposure on the overall health of newborn infants at Siriraj Hospital, Bangkok, Thailand, birth records of somatic growth parameters and neonatal withdrawal symptoms of 47 infants born to methamphetamine-abusing women during January 2001 to December 2001 were compared to 49 newborns whose mothers did not use methamphetamines during pregnancy. The data on somatic growth was analyzed using linear regression and multiple linear regression. The association between methamphetamine use and withdrawal symptoms was analyzed using the chi-square. Home visitation and maternal interview records were reviewed in order to assess for child-rearing attitude, and psychosocial parameters. Infants of methamphetamine-abusing mothers were found to have a significantly smaller gestational age-adjusted head circumference (regression coefficient = -1.458, p < 0.001) and birth weight (regression coefficient = -217.9, p < or = 0.001) measurements. Methamphetamine exposure was also associated with symptoms of agitation (5/47), vomiting (11/47) and tachypnea (12/47) when compared to the non-exposed group (p < 0r =0.001). Maternal interviews were conducted in 23 cases and showed that: 96% of the cases had inadequate prenatal care (<5 visits), 48% had at least one parent involved in prostitution, 39% of the mothers were unwilling to take their children home, and government or non-government support were provided in only 30% of the cases. In-utero methamphetamine exposure has been shown to adversely effect somatic growth of newborns and cause a variety of withdrawal-like symptoms. These infants are also psychosocially disadvantaged and are at greater risk for abuse and neglect.