Burton's Line on the Gum Seen in Lead Poisoning Among Petroleum Refinery Workers in Kirkuk City, Iraq: A Case Series.

Lead poisoning is a serious occupational health risk, especially for those who work in fields where lead-containing products are frequently exposed, including petroleum refining. Three cases of lead poisoning among employees of the petroleum refinery in Kirkuk City, Iraq, have been presented in this case series, emphasizing the clinical significance of Burton's line (blue-purplish line or gingival pigmentation) on the gums as an indication of lead toxicity. Patients presented with typical gingival margin darkening along with symptoms like fatigue, headaches, abdominal pain, and neurological impairments. Subsequent laboratory analysis confirmed that all three patients had increased blood lead levels, which ranged from 30 to 43 µg/dL (normal range <10 µg/dL). In the process of refining petroleum, lead can be inhaled, ingested, or come into direct touch with lead-containing items. Burton's line identification is essential for prompt diagnosis and intervention. This case series highlights the importance of taking preventative action to lessen the risks of lead exposure and protect the well-being and safety of employees of petroleum refineries. Healthcare providers should be vigilant, and strict safety protocols, worker education, and regular monitoring are all essential.

Burtonian line in a patient with occupational lead poisoning.

More attention of the medical staff to this sign can lead to faster diagnosis and timely treatment of patients.

Lead Encephalopathy with Distinctive Brain Magnetic Resonance Imaging Findings.

Lead poisoning is a multisystem disorder, more commonly affecting children. Occupational exposure, traditional medicines, and contaminated alcohol have been associated with lead encephalopathy in adults. Herein, we report a patient of lead toxicity presenting to the emergency services as acute encephalopathy with symptomatic hyponatremia and chronic recurrent abdominal colic and vomiting. This 50-year-old battery mechanic had multisystem involvement with anemia, basophilic stippling, lead line on the gums, and chronic hypertension. The blood lead level was more than 65 mcg/dL. Computed tomography of the brain showed intracranial calcifications and the MRI brain showed bilateral symmetric involvement of the thalamus, basal ganglia, brainstem, and external capsule. His sensorium improved rapidly after the correction of hyponatremia, however, apathy and psychomotor slowing persisted. This case highlights the importance of recognizing clinical markers and characteristic imaging findings, which can provide clues to an early diagnosis of this otherwise rare clinical condition, and prompt chelation therapy and avoid further lead exposure.

Impact assessment of new sick clothes in patients with electrocardiogram monitoring / 中华危重病急救医学

Objective To design a new modified sick clothes for electrocardiogram (ECG) monitoring, and to observe its clinical application effect. Methods In order to overcome the shortcomings of the existing modified ECG monitoring clothes, a new type of modified sick clothes was designed on the basis of the traditional sick clothes, and a national utility model patent was obtained. 408 conscious patients with ECG monitoring admitted to department of neurology of the First Affiliated Hospital of Fujian Medical University from January 2015 to June 2018 were enrolled, and they were randomly divided into three groups according to the order of admission for comparing the wearing effect of three kinds of sick clothes. 133 patients dressed traditional clothes, while 139 patients dressed modified ECG monitoring clothes. According to the method reported in the literature, the pockets were removed on the basis of the traditional patient clothes, and a circular hole 5 cm in diameter was made at the position of the electrodes for ECG monitoring, which was used to pass through the lead wire and the electrodes. 136 patients dressed the new modified sick clothes. In view of the inconvenience of ECG monitoring and stimulation of patients' thoracic and abdominal skin by traditional sick clothes, the existing modified ECG monitoring clothes were not easy to operate, the location of electrodes sticking was not easy to judge and the lead line was messy, the new modified sick clothes were still based on the traditional ones. The three circular holes of the existing modified ECG monitoring clothes were made into incisions about 12 cm in length to facilitate the ECG monitoring lead line and electrodes sticking. A compression band or a simple patch was added to each side near the shoulder for tidying up the fixed lead. The self-evaluation of patient's comfort, the operation time of ECG monitoring by nurses, skin allergy rate and lead damage rate were recorded and compared among the three groups. Results Compared with the traditional sick clothes and the modified ECG monitoring clothes groups, the patients in the new modified sick clothes group had higher comfort [the proportion of no discomfort: 11.0% (15/136) vs. 0% (0/133), 5.8% (8/139); the proportion of severe discomfort: 0% (0/136) vs. 4.5% (6/133), 0.7% (1/139), all P < 0.05], the installation and disassembly time of ECG monitoring by nurses was significantly shortened [installation time (s): 69.12±16.47 vs. 96.74±3.89, 88.24±9.83; disassembly time (s): 50.24±4.54 vs. 75.76±4.98, 66.54±7.86, all P < 0.01], and the skin allergies rate [3.7% (5/136) vs. 15.8% (21/133), 8.6% (12/139)] and the insulation loss rate of the lead wires [2.9% (4/136) vs. 15.8% (21/133), 7.9% (11/139)] were significantly lowered (all P < 0.05). Conclusion The ECG monitoring patients using new modified sick clothes could increase their comfort, reduce the workload of nurses, save medical consumables, and have beautiful appearance and high practicability, which was worthy of clinical application.

Lead line in rodents: an old sign of lead intoxication turned into a new method for environmental surveillance.

The "lead line" was described by Henry Burton in 1840. Rodents are used as sentinels to monitor environmental pollution, but their teeth have not been used to determine lead. To determine whether lead deposits can be observed in the teeth of lead-exposed animals, since the gingival deposits known as "lead line" would likely have a correlate in the calcified tissue to which the gums are opposed during life. Male Wistar rats were exposed to lead in the drinking water (30 mg/L) since birth until 60 days-old. Molars and the incisors of each hemimandible were analyzed by scanning electron microscopy (SEM) on regular and backscattered electrons (BSE) mode. Elements were determined using electron dispersive spectroscopy (EDS). Clean cervical margins were observed on control teeth, as opposed to the findings of extensive deposits on lead-exposed animals, even in hemimandibles that had been exhumed after being buried for 90 days. BSE/EDS indicated that those deposits were an exogenous material compatible with lead sulfite. Presence of calcium, phosphorus, magnesium, carbon, lead, and oxygen is presented. Lead-exposed animals presented marked root resorption. The lead deposits characterized here for the first time show that the "lead line" seen in gums has a calcified tissue counterpart, that is detectable post-mortem even in animals exposed to a low dose of lead. This is likely a good method to detect undue lead exposure and will likely have wide application for pollution surveillance using sentinels.