Ameliorative effects of nutritional minerals on lead-induced hematological alterations in male Wistar albino rats.

The deficiency of essential minerals increases lead absorption and thus aggravates the lead-induced toxic effects. This study was aimed at understanding the ameliorative effect of essential minerals on lead-induced alterations in hematological parameters in rats. To achieve this objective, the study was conducted in 320 male Wistar albino rats, grouped into two, with equal numbers. One of the groups of rats was fed on a mineral-supplemented food referred to as a 'well-nourished group' and another group 'undernourished group' on food without mineral supplements. Each group of rats was further subdivided into 'Subjects' and 'Controls.' Subjects of both the groups of rats were exposed to 500 ppm lead acetate up to a period of 300 days (10 months) in drinking water and the role of minerals on lead-induced alterations in hematological parameters was evaluated. A significant decrease (p < 0.001) in hemoglobin (Hb) and δ-aminolevulinic acid dehydratase (δ-ALAD) levels and a significant increase (p < 0.001) in urinary δ-aminolevulinic acid (δ-ALAU) levels were seen in subjects without mineral supplementation compared to those fed on a mineral-enriched diet. A positive correlation was observed between blood lead levels (PbB) and δ-ALAU (r = 0.792) and a negative correlation with Hb (r = -0.926) and δ-ALAD (r = -0.836) in the subjects. These changes were very prominent in the undernourished subjects when compared to the well-nourished subjects. Observations of the present study indicate that mineral supplementation with ongoing lead exposure may help in minimizing the absorption of lead and reduce lead-induced toxic effects.

The 1 µg cosyntropin test in normal individuals: A reappraisal.

BACKGROUND: The 1µg cosyntropin test has some advantages over the 250µg test as a test of adrenal function. One of the concerns regarding the 1 µg test includes stability of the cosyntropin when reconstituted and stored. Classically the 5(th) percentile responses to cosyntropin in normal individuals have been used to define a normal response. Recent studies have shown that these normative values should be determined for individual assays. MATERIALS AND METHODS: We performed a 1µg cosyntropin test using reconstituted and refrigerated (4-8(°) C) cosyntropin in saline solution in 49 non pregnant adults who were apparently healthy and had no exposure to exogenous glucocorticoids. The cosyntropin solution was stored for up to 60 days following reconstitution. We analysed the data for any association between duration of cosyntropin solution storage and the cortisol responses to cosyntropin administration. RESULTS: The mean ± SD cortisol level at baseline, 30 and 60 min were-12.19 ± 3 µg/dl, 20.72 ± 2.63 µg/dl, 16.86 ± 3.33 µg/dl. The 5(th) percentile cortisol response at 30 min was 16.5 µg/dl (16.33 µg/dl rounded off). The correlation coefficients between number of days of cosyntropin solution storage and the cortisol responses at 30 and 60 min were (Spear mans rho = 0.06,-0.24 respectively) (P = 0.69 and 0.41). There were no differences in cortisol values whether the storage was for less than 30 days or more than 30 days (mean difference 0.25 µg/dl P = 0.44). CONCLUSION: The 5(th) percentile normative values determined for our assay is lower than what is currently being used clinically and in research publications. Prolonged refrigerated storage of cosyntropin solution does not affect the validity of the 1 µg cosyntropin test.

Diagnosis, evaluation, and treatment of lead poisoning in general population.

Among the heavy metals, lead still remains the major toxic pollutant of the environment. Human exposure to lead can occur through numerous pathways including air, food, dust, soil, and water. In the present study 14 lead poisoned patients with non-occupational lead exposure were evaluated. They were followed up and compared against the controls with no history of lead exposure. The patients had high blood lead levels and symptoms of weakness, dizziness, abdominal pain, generalized body ache, loss of appetite, and anxiety. Repeated course of chelation therapy helped to bring down their body burden of lead. Alternative sources for lead exposure can cause severe lead poisoning in general population. Screening and medical management of such individuals is very important to identify and eliminate sources of lead. The treatment and management requires a thorough medical evaluation and environmental intervention.

Evaluation and treatment of wrist drop in a patient due to lead poisoning: case report.

Lead (Pb) is widely used because of its useful properties and it is ubiquitous in human environment. There are various lead based industries and several workers who are working in these industries without the knowledge of the ill effects of lead and hence not taking proper precautions while handling lead. Many a times, these workers who have accumulated lead in their blood and body organs, are not properly diagnosed and might receive only symptomatic treatment. We describe a thirty-two-year old male, who was working in an unorganized lead based industry for 3 yr, developed severe lead poisoning leading to wrist drop. Since one year the patient received only symptomatic treatment for abdominal pain. His laboratory investigation showed elevated blood lead levels. The chelation therapy using D-Penicillamine brought down his blood lead levels and is on follow up presently. It is required to take proper history about the occupation of the patient, exposed to potentially hazardous levels of lead in the workplace and medically evaluate them.

Lead toxicity in a family as a result of occupational exposure.

This article describes an entire family manufacturing lead acid batteries who all suffered from lead poisoning. The family of five lived in a house, part of which had been used for various stages of battery production for 14 years. Open space was used for drying batteries. They all drank water from a well located on the premises. Evaluation of biomarkers of lead exposure and/or effect revealed alarming blood lead levels [(3.92+/-0.94) micromol L-1], 50 % reduction in the activity of delta-aminolevulinic acid dehydratase [(24.67+/-5.12) U L-1] and an increase in zinc protoporphyrin [(1228+/-480) microg L-1]. Liver function tests showed an increase in serum alkaline phosphatase [(170.41+/-41.82) U L-1]. All other liver function test parameters were normal. Renal function tests showed an increase in serum uric acid [(515.81+/-86.29) micromol L-1] while urea and creatinine were normal. Serum calcium was low [(1.90+/-0.42) mmol L-1 in women and (2.09+/-0.12) mmol L-1 in men], while blood pressure was high in the head of the family and his wife and normal in children. Lead concentration in well water was estimated to 180 microg L-1. The family was referred to the National Referral Centre for Lead Poisoning in India, were they were received treatment and were informed about the hazards of lead poisoning. A follow up three months later showed a slight decrease in blood lead levels and a significant increase in haemoglobin. These findings can be attributed to behavioural changes adopted by the family, even though they continued producing lead batteries.

Lead toxicity as a result of herbal medication.

Awareness about the toxic effects of non-essential metals is still lacking in developing countries. Lead is one among them, which ranks second in the Agency for Toxic Substances and Disease Registry' s top 20 lists of toxic metals. Some of the herbal medicines prepared from certain roots and leaves are known to contain this toxic metal at alarming levels. We have a case of a person who suffered from the toxic effects of lead such as vomiting and colicky abdominal pain after consuming a herbal remedy for Jaundice treatment. This went unrecognized initially because of the presence of multiple problems like Malaria and Renal calculi. Lead poisoning as causative factor for anemia, vomiting and colic were confirmed only when blood lead concentration was estimated. A combination of chelation therapy and nutritional supplementation was found to be useful in reducing the body lead burden.

Role of essential trace minerals on the absorption of heavy metals with special reference to lead.

Heavy metals are important toxicants known to exert adverse effects in humans and animals, given sufficient exposure and accumulation in the body. This has a great concern both at personal and public health risk. Heavy metals are also known to interact with the essential trace minerals at the level of absorption and also during the metabolism. The adverse effects of the absorbed and accumulated heavy metals include neurological, reproductive, renal and hematological systems. Children are more sensitive than adults to the effects of lead. Efforts are made to understand the mechanism of the interactions of heavy metals with essential trace minerals at the level of absorption. With available sensitive and specific methodologies like Anodic Stripping Voltammetry for the evaluation of the levels of toxic heavy metals such as lead, cadmium, mercury etc., better understanding of heavy metal absorption is made possible.Due to the poor nutritional standards, risk of heavy metal exposure is still a major concern in developing countries. Studies carried out by the author have provided evidence towards the understanding of the prevailing mechanisms of metal-metal interaction at the intestinal level. During growth and development the demand for the essential minerals being at higher level, differentiation of various essential metals and heavy metals pose an inherent problem due to certain common properties shared by them. With this approach to the problem of heavy metal toxicity, it is preventable not only with environmental intervention but also by the nutritional management.

Screening for lead poisoning in urban school children of southern India using capillary and venous blood samples.

Our study aimed at comparing lead and zinc protoporphyrin (ZPP) levels in capillary and venous blood samples in a small population and to employ an easier method of sample collection for a major screening program in school children in major Indian cities. An awareness program on lead and its effects was conducted in two different schools. A total of thirty urban school children from South India, with an age group between 4-12 years consented for dual blood sampling and reported for the study. Venous and capillary blood samples were obtained simultaneously. Blood lead and zinc protoporphyrin (ZPP) levels were estimated using ESA Lead Analyzer and Haematofluorometer respectively. A significant correlation between capillary and venous ZPP (r=0.98) and lead (r=0.99) was observed. Rank sum test showed that there is no statistically significant difference between capillary and venous ZPP (P=0.891) and lead (P=0.672) values. This pilot study recommends that screening for lead may be done using capillary blood samples since significant correlation is observed between capillary and venous blood measurements. Obtaining samples using this mode is a non-invasive, less expensive, quick and easy method in children. Appropriately performed capillary sampling may be considered as an acceptable alternative to venipuncture for screening of blood for lead poisoning both in children and adults.

Fetal lead exposure: Encephalopathy in a child.

It is well known that lead exposure in the early period of pre pregnancy and antenatal life leads to serious health complications. In this case report, a five month old child who was suffering from encephalopathy was finally confirmed a victim of lead exposure, the source being the environment and the family. We report this case with complete clinical investigation including blood lead analysis. This case report highlights the various ways in which lead may accumulate in the body. It is also aimed at increasing awareness regarding the pathogenesis and clinical manifestations of lead toxicity. The literature survey done reveals that this is the youngest age at which lead toxicity has been documented in India.