Association of exposure to environmental vanadium and manganese with lung function among young children: A population-based study.

Exposure to environmental metals has been associated with health outcomes including respiratory health. Little is known about the impact of exposure to environmental metals on lung function among young children in general population. This study aimed to investigate the associations of exposure to metals with lung function among young children in a population-based cohort. A total of 1488 children aged 5-8 years attended a follow-up visit as part of the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort. We measured urinary samples of vanadium (median: 1.21 ng/mL; interquartile range (IQR): 0.73-1.98), manganese (median: 0.23 ng/mL; IQR: 0.13-0.47), arsenic (median: 40.51 ng/mL; IQR: 21.66-70.49), nickel (median: 1.09 ng/mL; IQR: 0.31-3.60), and cadmium (median: 0.26 ng/mL; IQR: 0.11-0.43) and performed lung function tests. Urinary vanadium concentrations were inversely associated with FVC (ß coefficient for the highest quartile versus the other quartiles: -33.40, p = 0.001), FEV1 (ß: -41.31, p < 0.001), FEV1/FVC ratio (ß: -1.00, p = 0.009), PEF (ß: -92.12, p = 0.004), and FEF25-75 (ß: -82.85, p < 0.001), after adjusting for relevant confounders. Urinary manganese concentrations were inversely associated with FVC (ß: -26.60, p = 0.007), FEV1 (ß: -31.62, p = 0.001), PEF (ß: -84.86, p = 0.009), and FEF25-75 (ß: -69.21, p = 0.002). Stratification analyses found inverse associations of urinary vanadium and manganese concentrations with lung function parameters predominantly among children exposed to environmental tobacco smoke. We did not find significant associations of urinary arsenic, nickel, and cadmium concentrations with lung function parameters. In conclusion, this study adds new evidence showing inverse associations of vanadium and manganese exposure with lung function among young children in the general population. Children with environmental tobacco smoke exposure are particularly vulnerable to adverse impact of vanadium and manganese exposure on lung function.

Trend in blood lead levels in Taiwanese adults 2005-2017.

This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 µg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 µg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682-8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000-1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004-1.014; P = 0.001) were significant predictors for BLL > 5 µg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000.

Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department.

BACKGROUND: Pediatric poisoning is a common emergency worldwide. Routine surveillance is required for public health authorities and physicians to update strategies for prevention and management of pediatric poisoning. This study investigated the epidemiology of poisoning among children admitted to an emergency department (ED). METHODS: This was a retrospective descriptive study. Data were collected from patients under 18 years old (y/o) presenting with poisoning at the largest ED in North Taiwan from 2011 to 2015. RESULTS: Five-year records of 590 patients-309 (52.3%) boys and 281 (47.7%) girls-were analyzed. The mean age was 5.07 y/o (Standard Deviation [SD] = 5.02 years), and 94.7% of events occurred at home. Incidence was highest from 6 p.m. to 12 a.m. (42.2%, n = 249). Most patients younger than 11 y/o were male, but this gender distribution was reversed in adolescents (11-17 y/o). Pharmaceutical ingestion (41.4%, n = 244) was the leading cause of poisoning; pesticide was the most common non-pharmaceutical poison ingested (9.5%, n = 55). Carbon monoxide (CO) intoxication (87.6%, n = 99) and snakebite (75%, n = 9) were the common causes of inhalation (n = 113) and venom (n = 12) poisoning, respectively. The mean duration of the ED stay was 5.45 h (SD = 7.39 h), and 101 cases (17.2%), including 21 cases (3.6%) requiring intensive care, were admitted to the hospital. All patients survived. CONCLUSION: Most poisonings occurred in young children, at home, by unintentional ingestion of a single substance, from 6 p.m. to 12 a.m. Female adolescents were the common intentional poisoning patients and pharmaceutical ingestion was the leading cause of poisoning. This kind of information enables ED physicians to improve preparations for pediatric poisoning cases and allows public health authorities to sharpen the focus of poisoning prevention efforts.

Rise of community-onset urinary tract infection caused by extended-spectrum ß-lactamase-producing Escherichia coli in children.

BACKGROUND: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. Few studies are available regarding community-onset UTIs caused by extended-spectrum ß-lactamase (ESBL)-producing bacteria in children. MATERIALS AND METHODS: During a 5-year period, hospitalized children with community-onset UTI caused by ESBL-producing Escherichia coli (case) and those with non-ESBL-producing E. coli (control) were identified. Patients with long-term care facility stay within the preceding month and those with urine cultures obtained >72 hours after admission were excluded. Clinical features and risk factors associated with the occurrence of ESBL-producing E. coli UTI were reviewed. RESULTS: The prevalence of UTI due to ESBL-producing E. coli increased slightly from 0.59% in 2002 to 0.96% in 2006. A total of 104 cases and 208 controls were included for comparison. The ciprofloxacin resistance of the ESBL-producing E. coli increased significantly in this period (p = 0.006). Pre-existing neurological diseases (p < 0.001), use of antibiotics in the past 3 months (p < 0.001), and recent hospitalization within 1 month (p < 0.001) were found to be potential risk factors. Moreover, previous exposure to third-generation cephalosporins (p < 0.001) and aminoglycosides (p < 0.001) was associated with the selection of ESBL-producing E. coli. Children with ESBL-producing E. coli UTIs had a longer hospital stay (p = 0.031) than those without. CONCLUSIONS: ESBL-producing E. coli gradually became coresistant to other broad-spectrum antibiotics, notably ciprofloxacin. UTIs caused by such resistant organisms led to a longer hospital stay and more antibiotic use. Reinforcement of infection control measures, especially hand washing in childcare settings and antibiotic stewardship, is critical to reduce the spread of ESBL-producing E. coli.

Sonographic finding of persistent renal pelvic wall thickening in children.

OBJECTIVE: Renal pelvic wall thickening (RPWT) is a sonographic finding, which is associated with urinary tract infection (UTI) and other genitourinary tract abnormalities. We aimed to determine the prevalence of RPWT and whether persistent RPWT related to vesicoureteral reflux (VUR). MATERIALS AND METHODS: We retrospectively reviewed sonographic findings of RPWT in children and adolescents referred for renal ultrasound study from January 2010 to December 2011. A total of 502 patients showing RPWT were included, 372 of whom received follow-up sonograms. Among them, 86 children underwent both follow-up sonograms and voiding cystourethrography studies. The association between persistent RPWT and VUR was analyzed. RESULTS: A total of 602 sonograms with RPWT were identified, accounting for a prevalence of 11.4%. Follow-up sonograms, revealing that these patients had recovered from RPWT, was found in 93.7% (459/490) of renal units and in 92.7% (345/372) of the patients. Children with persistent RPWT had a strong association with VUR occurrence (p = 0.018) and high VUR grading (p = 0.006) compared to those without persistent RPWT. CONCLUSION: RPWT is a common finding in children and adolescents. Persistent RPWT is associated with VUR, especially with high grade VUR. Complementary uroradiological studies should be performed for children and adolescents with persistent RPWT.

N-acetylcysteine prevents hypertension via regulation of the ADMA-DDAH pathway in young spontaneously hypertensive rats.

Asymmetric dimethylarginine (ADMA) reduces nitric oxide (NO), thus causing hypertension. ADMA is metabolized by dimethylarginine dimethylaminohydrolase (DDAH), which can be inhibited by oxidative stress. N-Acetylcysteine (NAC), an antioxidant, can facilitate glutathione (GSH) synthesis. We aimed to determine whether NAC can prevent hypertension by regulating the ADMA-DDAH pathway in spontaneously hypertensive rats (SHR). Rats aged 4 weeks were assigned into 3 groups (n = 8/group): control Wistar Kyoto rats (WKY), SHR, and SHR receiving 2% NAC in drinking water. All rats were sacrificed at 12 weeks of age. SHR had higher blood pressure than WKY, whereas NAC-treated animals did not. SHR had elevated plasma ADMA levels, which was prevented by NAC therapy. SHR had lower renal DDAH activity than WKY, whereas NAC-treated animals did not. Renal superoxide production was higher in SHR than in WKY, whereas NAC therapy prevented it. NAC therapy was also associated with higher GSH-to-oxidized GSH ratio in SHR kidneys. Moreover, NAC reduced oxidative stress damage in SHR. The observed antihypertensive effects of NAC in young SHR might be due to restoration of DDAH activity to reduce ADMA, leading to attenuation of oxidative stress. Our findings highlight the impact of NAC on the development of hypertension by regulating ADMA-DDAH pathway.