Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 1.594
Filter
2.
Spinal Cord Ser Cases ; 10(1): 28, 2024 Apr 23.
Article in English | MEDLINE | ID: mdl-38653970

ABSTRACT

INTRODUCTION: Retained shrapnel from gunshots is a common occurrence; however, retained shrapnel within the spinal canal is exceedingly uncommon. Guidelines for removal and treatment of these cases are a difficult topic, as surgical removal is not necessarily without consequence, and retention can lead to possible further injury or a secondary disease process of plumbism, which can be difficult to diagnose in this population. CASE PRESENTATION: This case report provides a unique example of a young patient with retained shrapnel from a gunshot. This patient suffered an initial spinal cord injury due to a gunshot and secondarily presented with abdominal pain, fatigue, elevated blood lead levels, and was diagnosed with plumbism. This was addressed with operative removal of shrapnel and posterior instrumented spinal fusion, resulting in decreased lead levels and symptom resolution postoperatively. DISCUSSION: Lead toxicity risk in patients with retained shrapnel, particularly in the spine, warrants vigilant monitoring. While management guidelines lack consensus, symptomatic lead toxicity may necessitate intervention. Residual neurological deficits complicate evaluation, emphasizing individualized management decisions.


Subject(s)
Foreign Bodies , Lead Poisoning , Spinal Cord Injuries , Wounds, Gunshot , Humans , Male , Foreign Bodies/complications , Foreign Bodies/surgery , Lead/blood , Lead Poisoning/diagnosis , Lead Poisoning/etiology , Spinal Cord Injuries/diagnosis , Spinal Fusion/methods , Wounds, Gunshot/complications , Wounds, Gunshot/surgery , Child
4.
JAMA Pediatr ; 178(5): 473-479, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38497944

ABSTRACT

Importance: There is no level of lead in drinking water considered to be safe, yet lead service lines are still commonly used in water systems across the US. Objective: To identify the extent of lead-contaminated drinking water in Chicago, Illinois, and model its impact on children younger than 6 years. Design, Setting, and Participants: For this cross-sectional study, a retrospective assessment was performed of lead exposure based on household tests collected from January 2016 to September 2023. Tests were obtained from households in Chicago that registered for a free self-administered testing service for lead exposure. Machine learning and microsimulation were used to estimate citywide childhood lead exposure. Exposure: Lead-contaminated drinking water, measured in parts per billion. Main Outcomes and Measures: Number of children younger than 6 years exposed to lead-contaminated water. Results: A total of 38 385 household lead tests were collected. An estimated 68% (95% uncertainty interval, 66%-69%) of children younger than 6 years were exposed to lead-contaminated water, corresponding to 129 000 children (95% uncertainty interval, 128 000-131 000 children). Ten-percentage-point increases in block-level Black and Hispanic populations were associated with 3% (95% CI, 2%-3%) and 6% (95% CI, 5%-7%) decreases in odds of being tested for lead and 4% (95% CI, 3%-6%) and 11% (95% CI, 10%-13%) increases in having lead-contaminated drinking water, respectively. Conclusions and Relevance: These findings indicate that childhood lead exposure is widespread in Chicago, and racial inequities are present in both testing rates and exposure levels. Machine learning may assist in preliminary screening for lead exposure, and efforts to remediate the effects of environmental racism should involve improving outreach for and access to lead testing services.


Subject(s)
Drinking Water , Environmental Exposure , Lead Poisoning , Lead , Humans , Chicago , Retrospective Studies , Cross-Sectional Studies , Environmental Exposure/adverse effects , Child, Preschool , Lead/blood , Infant , Lead Poisoning/epidemiology , Lead Poisoning/diagnosis , Lead Poisoning/etiology , Male , Female , Water Pollutants, Chemical/analysis , Child
5.
Occup Environ Med ; 81(3): 159-162, 2024 Mar 08.
Article in English | MEDLINE | ID: mdl-38302418

ABSTRACT

INTRODUCTION: Lead exposure from discharged lead dust is a recognised risk at firing ranges. We report a lead poisoning outbreak among staff and their close contacts at a UK civilian indoor 24 m firing range. METHODS: A retrospective review was undertaken of data collected on all patients at risk of lead poisoning identified either by direct referral to the Clinical Toxicology clinicians at the West Midlands Poisons Unit, or via the Trace Elements Supra-Regional Assay Service Laboratory at Sandwell hospital. RESULTS: Eighty-seven patients were identified as having possible lead exposure, either at the firing range or via close contacts. Of these, 63 patients aged between 6 months and 78 years attended for blood lead concentration (BLC) testing. The highest BLC at presentation was 11.7 µmol/L (242 µg/dL). Only nine patients reported any symptoms at presentation. Fifteen patients received lead chelation therapy with oral dimercaptosuccinic acid (or succimer) 30 mg/kg/day or intravenous sodium calcium edetate (EDTA) 75 mg/kg/day, dependent on stock availability. DISCUSSION: This report highlights the need for vigilance of lead poisoning as an occupational hazard in the UK, including at recreational facilities such as indoor firing ranges. It emphasises the importance of regulation of lead exposure in the workplace, particularly given the vague symptoms of lead poisoning, and proposes re-appraisal of UK legislation. This report also highlights potential issues surrounding stock availability of rarely used antidotes for uncommon presentations in the event of an outbreak of poisoning.


Subject(s)
Lead Poisoning , Lead , Humans , Infant , Chelating Agents/adverse effects , Lead Poisoning/epidemiology , Lead Poisoning/etiology , Succimer/adverse effects , Disease Outbreaks , United Kingdom/epidemiology
6.
Toxicol Ind Health ; 40(1-2): 41-51, 2024.
Article in English | MEDLINE | ID: mdl-37984499

ABSTRACT

Lead is one of the heavy metals that is toxic and widely distributed in the environment, and children are more sensitive to the toxic effects of lead because the blood-brain barrier and immune system are not yet well developed. The objective of the study was to investigate the clinical characteristics of lead poisoning in children aged 0∼6 years in a hospital in Guangxi, and to provide scientific basis for the prevention and treatment of lead poisoning. We collected and analyzed the clinical data of 32 children with lead poisoning admitted to a hospital in Guangxi from 2010 to 2018. The results showed that most of the 32 cases presented with hyperactivity, irritability, poor appetite, abdominal pain, diarrhea, or constipation. The hemoglobin (HGB), mean corpusular volume (MCV), mean corpuscular hemoglobin (MCH), and hematocrit (HCT) of the lead-poisoned children were all decreased to different degrees and were below normal acceptable levels. Urinary ß2-microglobulin was increased. Blood lead levels (BLL) decreased significantly after intravenous injection of the lead chelator, calcium disodium edetate (CaNa2-EDTA). In addition, HGB returned to normal levels, while MCV, MCH, and HCT increased but remained below normal levels. Urinary ß2-microglobulin was reduced to normal levels. Therefore, in this cohort of children, the high-risk factors for lead poisoning are mainly Chinese medicines, such as baby powder. In conclusion, lead poisoning caused neurological damage and behavioral changes in children and decreased erythrocyte parameters, leading to digestive symptoms and renal impairment, which can be attenuated by CaNa2-EDTA treatment.


Subject(s)
Lead Poisoning , Lead , Child , Infant , Humans , Lead/toxicity , China/epidemiology , Edetic Acid , Lead Poisoning/epidemiology , Lead Poisoning/etiology , Hematocrit , Hemoglobins
7.
BMJ Case Rep ; 16(12)2023 Dec 12.
Article in English | MEDLINE | ID: mdl-38086570

ABSTRACT

Lead poisoning, often associated with occupational exposure, can also arise from intake of traditional and herbal medicines with high lead content. Geriatric patients displaying gastrointestinal symptoms from such sources are frequently misdiagnosed. An individual in his 70s reported to our geriatric clinic with vomiting, constipation and anaemia. A meticulous history unveiled his recent intake of herbal remedies. Heavy metal assay indicated elevated lead levels in his blood and urine, consistent with the high lead content we measured in the herbal medication. Following supportive treatment, nutritional supplementation and chelation therapy with calcium disodium EDTA, he improved. Follow-up tests indicated a decrease in lead levels and resolution of anaemia. This case emphasises the importance of considering lead poisoning as a potential diagnosis in patients with unexplained symptoms, particularly when there is a history of herbal or alternative medication intake. Timely recognition and appropriate management can lead to better outcome.


Subject(s)
Anemia , Lead Poisoning , Plants, Medicinal , Male , Humans , Aged , Lead , Lead Poisoning/diagnosis , Lead Poisoning/drug therapy , Lead Poisoning/etiology , Vomiting/chemically induced
10.
J Health Care Poor Underserved ; 34(1): 431-446, 2023.
Article in English | MEDLINE | ID: mdl-37464504

ABSTRACT

In 1934, the Federal Housing Authority precluded mortgage loans to residents of neighborhoods with non-White families or where housing was deteriorated; these were declared "hazardous" and labeled red on maps. In 1962 three redlined north Brooklyn neighborhoods had 41 children, all Black and Puerto Rican, with lead levels >60ug/dL. A review of public polices in the U.S. from 1898 to the present revealed that lead poisoning followed an income gradient with multiple disproportionate effects on non-White children in redlined neighborhoods. The poisonings diminished when federal and local regulations prevented lead exposure. While redlining had profound influences on both likelihood and severity of lead poisoning and its consequences, it was a mediator of effects. The principal causes were federal policies failing to prevent environmental contamination and local governments failing to prevent exposure.


Subject(s)
Lead Poisoning , Lead , Residence Characteristics , Child , Humans , Hispanic or Latino , Housing , Lead Poisoning/epidemiology , Lead Poisoning/etiology , Lead Poisoning/prevention & control , Black or African American
11.
JBJS Case Connect ; 13(2)2023 Apr 01.
Article in English | MEDLINE | ID: mdl-37319263

ABSTRACT

CASE: A 38-year-old man with a tibial plateau fracture required treatment for elevated blood lead level (BLL) from retained bullet fragments in the same knee from a gunshot wound 21 years earlier. Oral succimer presurgery and postsurgery decreased the BLL from 58 to 15 µg/dL. CONCLUSION: Parenteral chelation has been previously recommended to mitigate an increase in BLLs during surgical intervention to remove bullet fragments. Oral succimer was an effective and well-tolerated alternative to intravenous chelation. Further research is needed to determine the optimal route, timing, and duration of chelation in patients with elevated BLL in need of bulletectomy.


Subject(s)
Lead Poisoning , Wounds, Gunshot , Male , Humans , Adult , Succimer , Lead , Lead Poisoning/drug therapy , Lead Poisoning/etiology , Wounds, Gunshot/surgery , Wounds, Gunshot/complications , Chelating Agents
12.
J Med Toxicol ; 19(4): 401-404, 2023 10.
Article in English | MEDLINE | ID: mdl-37365427

ABSTRACT

INTRODUCTION: Antenatal lead exposure is associated with multiple adverse maternal and fetal consequences. Maternal blood lead concentrations as low as 10 µg/dL have been associated with gestational hypertension, spontaneous abortion, growth retardation, and impaired neurobehavioral development. Current treatment recommendations for pregnant women with a blood lead level (BLL) ≥ 45 µg/dL include chelation. We report a successful case of a mother with severe gestational lead poisoning treated with induction of labor in a term infant. CASE REPORT: A 22-year-old G2P1001 female, at 38 weeks and 5 days gestation, was referred to the emergency department for an outpatient venous BLL of 53 µg/dL. The decision was made to limit ongoing prenatal lead exposure by emergent induction as opposed to chelation. Maternal BLL just prior to induction increased to 70 µg/dL. A 3510 g infant was delivered with APGAR scores of 9 and 9 at 1 and 5 min. Cord BLL at delivery returned at 41 µg/dL. The mother was instructed to avoid breastfeeding until her BLLs decreased to below 40 µg/dL, consistent with federal and local guidelines. The neonate was empirically chelated with dimercaptosuccinic acid. On postpartum day 2, maternal BLL decreased to 36 µg/dL, and the neonatal BLL was found to be 33 µg/mL. Both the mother and neonate were discharged to an alternative lead-free household on postpartum day 4.


Subject(s)
Lead Poisoning , Lead , Humans , Infant , Infant, Newborn , Female , Pregnancy , Young Adult , Adult , Lead Poisoning/diagnosis , Lead Poisoning/drug therapy , Lead Poisoning/etiology , Chelating Agents/therapeutic use , Succimer/therapeutic use , Labor, Induced
13.
N Engl J Med ; 388(18): e63, 2023 May 04.
Article in English | MEDLINE | ID: mdl-37125777
14.
J Public Health Manag Pract ; 29(5): E208-E213, 2023.
Article in English | MEDLINE | ID: mdl-37129378

ABSTRACT

CONTEXT: Sources and pathways of lead exposure in young children have not been analyzed using new artificial intelligence methods. OBJECTIVE: To collect environmental, behavioral, and other data on sources and pathways in 17 rural homes to predict at-risk households and to compare urban and rural indicators of exposure. DESIGN: Cross-sectional pilot study. SETTING: Knox County, Illinois, which has a high rate of childhood lead poisoning. PARTICIPANTS: Rural families. METHODS: Neural network and K-means statistical analysis. MAIN OUTCOME MEASURE: Children's blood lead level. RESULTS: Lead paint on doors, lead dust, residential property assessed tax, and median interior paint lead level were the most important predictors of children's blood lead level. CONCLUSIONS: K-means analysis confirmed that settled house dust lead loadings, age of housing, concentration of lead in door paint, and geometric mean of interior lead paint samples were the most important predictors of lead in children's blood. However, assessed property tax also emerged as a new predictor. A sampling strategy that examines these variables can provide lead poisoning prevention professionals with an efficient and cost-effective means of identifying priority homes for lead remediation. The ability to preemptively target remediation efforts can help health, housing, and other agencies to remove lead hazards before children develop irreversible health effects and incur costs associated with lead in their blood.


Subject(s)
Lead Poisoning , Lead , Child , Humans , Child, Preschool , Environmental Exposure/prevention & control , Artificial Intelligence , Cross-Sectional Studies , Pilot Projects , Lead Poisoning/diagnosis , Lead Poisoning/epidemiology , Lead Poisoning/etiology , Dust/analysis , Housing
15.
Front Public Health ; 11: 1132199, 2023.
Article in English | MEDLINE | ID: mdl-37213598

ABSTRACT

Background: Lead is a toxic element of the environment that leads to major complications once it enters the blood stream, affecting multiple organs and systems of the body. Methods: We present a case of a 6-month-old female infant diagnosed with lead poisoning after presenting for routine child health care. The child's mother denied that the infant had a history of exposure to lead-containing substances. After a month of calcium supplementation, the patient's blood lead level remained elevated. We then tested the blood lead level of the mother and father. The results showed that the blood lead level of the mother was 77.0 µg/L and that of the father was 36.9 µg/L. The high blood lead level of the mother attracted our attention. We found that the mother had been using an external traditional Chinese medicine, Hu Wang Fen, which contains lead. After the mother's discontinuation of use of the traditional medicine, the child was treated with symptomatic treatment and chelation therapy. Subsequently, the patient's blood lead level decreased significantly. Results: Lead toxicity can be a life-threatening problem because of its potential for severe complications. In children, there is no safe blood lead level, and the toxic effects of lead can be prevented by the awareness and avoidance of traditional Chinese medicines that may contain lead. Conclusion: Even though the diagnosis of lead poisoning remains difficult in children, it must be taken into consideration by the clinician when treating a child using traditional Chinese medicines.


Subject(s)
Lead Poisoning , Lead , Child , Humans , Infant , Female , Lead Poisoning/diagnosis , Lead Poisoning/etiology , Medicine, Chinese Traditional , Mothers
16.
Sci Total Environ ; 882: 163383, 2023 Jul 15.
Article in English | MEDLINE | ID: mdl-37068684

ABSTRACT

Lead (Pb) is a neurotoxic metal, and no level of lead exposure is safe for children. China has still experienced problems on child lead poisoning even though the Chinese government has phased out leaded gasoline since 2000. The underlying problem affecting the lead pollution-related health of children in China remains to be comprehensively investigated. It is found that although the significant decline of BLLs, as the Geometric Mean (GM), from 91.40 µg/LGM in 2001 to 37.52 µg/LGM in 2018 is observed, the average BLLs of children are still above 50 µg/L or more [average 59.70 (60.50-65.02, 95 % CI) µg/LGM] after phasing out leaded gasoline since 2000 in China. Lead exposure causes 29.67 MID per 1000 children with a loss of 98.23 (59.40-146.21, 95 % CI) DALYs per 1000 in China, which is greater than the levels reported from the Western Pacific Region and other low- and middle-income countries. A significant correlation is observed between the number of child crimes (NoCCs) and the outcomes of long-term lead exposure for children in China. Although the disparities in BLLs in China are strongly influenced by unequal distributions of potential multi-lead related sources (soil lead, PM2.5 lead, dust lead), unbalance development of local industrialization and economies, as well as incorrect health care for younger children, the notable emissions from coal combustion (CC) and non-ferrous metals (NMS) exploitation dominate the crucial sources of low-level lead exposure to children after phasing out leaded gasoline in China currently. Faced with the unequal and disparate distribution of BLLs in China, the big bottleneck is to decrease the BLLs exertions of 36-45 µg/L in the next few decades. The Chinese government needs to make more efforts on developing more strict guidelines, implementing more policy strategies on prevention and management of blood Pb poisoning, and monitoring the nationwide changes in children's BLLs continuously.


Subject(s)
Lead Poisoning , Lead , Humans , Child , Environmental Exposure , Gasoline , Environmental Pollution , Lead Poisoning/epidemiology , Lead Poisoning/etiology , China/epidemiology
17.
JAMA ; 329(12): 1040, 2023 03 28.
Article in English | MEDLINE | ID: mdl-36897599

ABSTRACT

This JAMA Patient Page describes lead poisoning, its health effects, diagnosis, treatment, and prevention measures.


Subject(s)
Lead Poisoning , United States , Humans , Lead Poisoning/diagnosis , Lead Poisoning/etiology
18.
Clin Pediatr (Phila) ; 62(8): 824-829, 2023 09.
Article in English | MEDLINE | ID: mdl-36660959

ABSTRACT

Spice consumption, along with other environmental factors, can contribute to pediatric lead poisoning. Although public health efforts have increased awareness of contamination of spices, false assumptions regarding the safety of home-prepared spices have emerged. Here, we present the clinical features, family beliefs, and environmental toxicology of 3 spice-associated pediatric lead poisoning cases.


Subject(s)
Lead Poisoning , Spices , Humans , Child , Lead Poisoning/etiology
19.
Arch Environ Occup Health ; 78(2): 98-101, 2023.
Article in English | MEDLINE | ID: mdl-35400302

ABSTRACT

Identifying the source of lead is a key measure in the management of childhood lead poisoning. In cases with multiple potential sources or with unusual circumstances, this identification can be complex. By comparing the lead isotopic ratios (IRs) between the potential sources and the blood sample from the patient, it is possible to identify which source caused the poisoning. We report here the case of a 13-years-old girl, screened for lead poisoning as she was known to eat paint chips from two walls in her apartment. Her blood lead level was 395 µg/L, and the environmental investigation came back negative. X-ray fluorescence found lead concentration in paints to be below the regulatory threshold of 1 mg/cm2. As there was no other potential source of lead exposure in this case, a comparative analysis of the IRs of lead between the child's blood and two presumed sources (bathroom and kitchen paints) was performed. This analysis confirmed the source of lead intoxication to be the paints in the apartment, mostly from the bathroom wall.


Subject(s)
Lead Poisoning , Lead , Adolescent , Child , Female , Humans , Environmental Exposure/analysis , Isotopes/analysis , Lead Poisoning/etiology , Paint
20.
Environ Res ; 218: 114944, 2023 02 01.
Article in English | MEDLINE | ID: mdl-36473524

ABSTRACT

Housing-based lead paint dust is the most common source of lead exposure for US-born children. Although year of housing construction is a critical indicator of the lead hazard to US children, not all housing of the same age poses the same risk to children. Additional information about housing condition is required to differentiate the housing-based lead risk at the parcel level. This study aimed to identify and assess a method for gathering and using observations of exterior housing conditions to identify active housing-based lead hazards at the parcel level. We used a dataset of pediatric blood lead observations (sample years 2000-2013, ages 6-72 months, n = 6,589) to assess associations between observations of exterior housing conditions and housing-based lead risk. We used graphical and Lasso regression methods to estimate the likelihood of an elevated blood lead observation (≥3.5 µg/dL). Our methods estimate a monotonic increase in the likelihood of an elevated blood lead observation as housing conditions deteriorate with the largest changes associated with homes in the greatest disrepair. Additionally we estimate that age of home construction works in consort with housing conditions to amplify risks among those houses built before 1952. Our analysis indicates that a survey of external housing conditions can be used in combination with age of housing in the identification process, at the parcel level, of homes that pose a housing-based lead hazard to children.


Subject(s)
Lead Poisoning , Lead , Child , Humans , Infant , Child, Preschool , Lead/analysis , Lead Poisoning/epidemiology , Lead Poisoning/etiology , Housing Quality , Environmental Exposure/analysis , Housing , Dust/analysis , Paint/analysis
SELECTION OF CITATIONS
SEARCH DETAIL
...