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Crabbe H, Verlander NQ, Iqbal N, Close R, White G, Leonardi GS, Busby A. ’As safe as houses; the risk of childhood lead exposure from housing in England and implications for public health’. BMC Public Health 2022; 22:2052. [PMID: 36352379 PMCID: PMC9644560 DOI: 10.1186/s12889-022-14350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIM Exposure to lead can harm a child's health, including damage to the nervous system, delayed growth, hearing loss, and many other adverse health effects, as well as implications for social, economic, educational and social well-being. Lead exposure in children is still a concern and cases require public health management to find the exposure source and interrupt the exposure pathway. Housing characteristics can indicate the presence of lead-contaminated paint and leaded water supply pipes. We aimed to explore the relationship between housing characteristics and elevated blood lead concentration (BLC) in children in England. METHODS We used a retrospective cohort design and included all cases of lead exposure in children reported to the UK Health Security Agency between 2014 and 2020 via surveillance. A case was a child aged under 16 years, resident in England, BLC of ≥ 0.48 μmol/L (10 µg/dL) and referred for public health management. We collected case demographic details and housing characteristics (age and type). We explored associations between elevated BLC and risk factors, using generalised linear mixed effects models and compared cases' housing type to that expected nationally. RESULTS Two hundred and sixty-six out of 290 cases met the case definition. There was no difference in BLCs between genders, age groups, deprivation, and housing type. After adjusting for reporting source, housing age and type, cases residing in housing built pre-1976 had a BLC of 0.32 (95%CI 0.02, 0.63) µmols/L (6.63 (95%CI 0.42, 13.0) µg/dL) higher than cases living in housing built after this time. Cases were 1.68 times more likely to be living in terraced housing (housing adjoined to one another) than other children and less likely to live in apartments and detached properties. CONCLUSION This study suggests an association between housing characteristics and BLC in children. Housing age and type may act as a proxy for lead exposure risk through exposure to leaded paint, lead water pipes, and lead contaminated dust from indoor and outdoor sources. Public health action should consider targeting families more at risk in older housing by raising awareness of the potential presence of lead pipes and paint. Interventions should include working with wider stakeholders including other housing and environmental professionals, the private sector, as well as parents and carers.
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Das S, Hataway F, Boudreau HS, Alam Y, George JA, Rushton W, Atti S, Kaur M, Holland MT. Management of Cerebral Herniation Secondary to Lead Encephalopathy: A Case Report. Front Neurol 2022; 13:893767. [PMID: 35669884 PMCID: PMC9163400 DOI: 10.3389/fneur.2022.893767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAdult lead encephalopathy is a rare but critical condition to recognize in modern healthcare settings. Few reports have described the medical and neurosurgical management of severe adult lead encephalopathy.Case PresentationA 22 year old woman presented with severe headache, anemia, vomiting, 40-lb weight loss, and constipation. At the time of presentation, she had extensive colonic radiopaque material and a serum lead concentration of 87 mcg/dl (normal <10). She rapidly developed anisocoria requiring emergent ventriculostomy insertion. Following CSF diversion, ICP mitigation, and lead chelation, she considerably improved in <2 weeks.ConclusionWe report one of the few instances of successful surgical and medical management of adult lead encephalopathy. Dedicated neurocritical care and neurosurgical teams are necessary in conjunction with toxicology in order to manage the advanced sequalae of severe lead poisoning.
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Affiliation(s)
- Somnath Das
- Department of Neurosurgery, University of Alabama Birmingham, Birmingham, AL, United States
| | - Felicia Hataway
- Department of Neurology, University of Alabama Birmingham, Birmingham, AL, United States
| | - Hunter S. Boudreau
- School of Medicine, University of Alabama Birmingham, Birmingham, AL, United States
| | - Yasaman Alam
- Department of Neurosurgery, University of Alabama Birmingham, Birmingham, AL, United States
| | - Jordan A. George
- School of Medicine, University of Alabama Birmingham, Birmingham, AL, United States
| | - William Rushton
- Office of Toxicology, University of Alabama Birmingham, Birmingham, AL, United States
| | - Sukhshant Atti
- Office of Toxicology, University of Alabama Birmingham, Birmingham, AL, United States
| | - Manmeet Kaur
- Department of Neurology, University of Alabama Birmingham, Birmingham, AL, United States
| | - Marshall T. Holland
- Department of Neurosurgery, University of Alabama Birmingham, Birmingham, AL, United States
- *Correspondence: Marshall T. Holland
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Roberts DJ, Crabbe H, Owodunni T, Gordon-Brown H, Close R, Reshat S, Sampson B, Ruggles R, Dabrera G, Busby A, Leonardi G. Case epidemiology from the first three years of a pilot laboratory-based surveillance system for elevated blood-lead concentrations among children in England, 2014-17: implications for public health action. J Public Health (Oxf) 2021; 42:542-549. [PMID: 31124565 PMCID: PMC7435212 DOI: 10.1093/pubmed/fdz024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Children incur lead toxicity even at low blood-lead concentrations (BLCs), and testing in England is opportunistic. We described epidemiology of cases notified to a passive laboratory-based surveillance system (SS), the Lead Poisoning in Children (LPIC) SS to inform opportunities to prevent lead exposure in children in England. METHODS Surveillance population: children <16 years of age and resident in England during the reporting period September 2014-17. Case definition: children with BLC ≥0.48 μmol/l (10 μg/dl). We extracted case demographic/location data and linked it with laboratory, area-level population and socio-economic status (SES) data. We described case BLCs and calculated age-, gender- and SES-specific notification rates, and age-sex standardised regional notification rates. RESULTS Between 2014 and 2017 there were 86 newly notified cases, giving an annual average notification rate of 2.76 per million children aged 0-15 years. Regionally, rates varied from 0.36 to 9.89 per million. Rates were highest in the most deprived quintile (5.38 per million), males (3.75 per million) and children aged 1-4 years (5.89 per million). CONCLUSIONS Males, children aged 1-4 years, and children in deprived areas may be at higher risk, and could be targeted for primary prevention. Varied regional notification rates suggest differences in clinician awareness of lead exposure and risk factors; guidelines standardising the indications for BLC-testing may assist secondary prevention.
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Affiliation(s)
- D J Roberts
- Field Epidemiology Training Programme Public Health England, Colindale, London, UK.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.,Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
| | - Helen Crabbe
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
| | - Tayo Owodunni
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
| | - Harriet Gordon-Brown
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
| | - Rebecca Close
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
| | - Shanel Reshat
- North East & North Central London Health Protection Team, Public Health England, London, UK
| | - Barry Sampson
- London Imperial Charing Cross Hospital Supra-regional Assay Service Trace Elements Laboratory, Charing Cross Hospital, London, UK
| | | | - Gavin Dabrera
- National Infection Service, Public Health England, Colindale, London, UK
| | - Araceli Busby
- North East & North Central London Health Protection Team, Public Health England, London, UK
| | - Giovanni Leonardi
- Environmental Epidemiology Group, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton, UK
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Keshri S, Goel AK, Garg AK. Reversal of Acute Lead Encephalopathy in a Child. Cureus 2021; 13:e15155. [PMID: 34178489 PMCID: PMC8216578 DOI: 10.7759/cureus.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Lead poisoning, fairly common in the 20th century, has decreased drastically in the last decade. Severe lead poisoning in the form of encephalopathy has a fatality rate of 28% to 45% and neurological sequelae in about 82%. We present the management of a case of lead encephalopathy that recovered without any significant neurological sequelae in a resource-limited setting. A previously healthy seven-year-old boy presented with complaints of falling unconscious on the ground while playing, followed by multiple episodes of seizures, vomiting, and altered sensorium. The patient had pallor, Glasgow coma score of E2V3M3, with features of raised intracranial pressure. Lead poisoning was suspected as the patient had four months of exposure to a battery recycling factory. Management of seizures and raised intracranial pressure was done. X-ray long bones showed lead lines at the metaphysis. Blood lead levels were highly elevated (139.96 mcg/dL). Investigations revealed iron deficiency anemia, vitamin D deficiency, and renal tubular injury in the form of proteinuria. D-penicillamine with supplements was started due to unavailability of other chelating agents. Encephalopathy improved, but patient had psychiatric symptoms of hallucinations and delusions. On the 12th day, CaNa2 EDTA was started, which resulted in significant improvement in the psychiatric symptoms. The patient had near-complete recovery in another one month, the patient being able to read, write, recite and speak as the pre-illness state. In conclusion, lead poisoning remains a significant health problem even today. Early recognition and management are of paramount importance in its outcome.
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Affiliation(s)
- Swasti Keshri
- Paediatrics Emergency Medicine, All India Institute of Medical Sciences, Raipur, IND
| | - Anil Kumar Goel
- Paediatrics, All India Institute of Medical Sciences, Raipur, IND
| | - Ankit Kumar Garg
- Orthopaedics, All India Institute of Medical Sciences, Raipur, IND
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Nakhaee S, Mehrpour M, Mortazavi B, Weiss ST, Mehrpour O. Central nervous system infections versus lead toxicity in the differential diagnosis of encephalopathy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:68. [PMID: 33088305 PMCID: PMC7554536 DOI: 10.4103/jrms.jrms_810_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/16/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahsa Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahareh Mortazavi
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Deputy of Research and Technology, Student Research Committee, Birjand University of Medical Science, Birjand, Iran
| | - Stephanie T Weiss
- Addiction Medicine Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Department of Medical toxicology, Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, CO, USA
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Yeter D, Banks EC, Aschner M. Disparity in Risk Factor Severity for Early Childhood Blood Lead among Predominantly African-American Black Children: The 1999 to 2010 US NHANES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1552. [PMID: 32121216 PMCID: PMC7084658 DOI: 10.3390/ijerph17051552] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
Abstract
There is no safe detectable level of lead (Pb) in the blood of young children. In the United States, predominantly African-American Black children are exposed to more Pb and present with the highest mean blood lead levels (BLLs). However, racial disparity has not been fully examined within risk factors for early childhood Pb exposure. Therefore, we conducted secondary analysis of blood Pb determinations for 2841 US children at ages 1-5 years with citizenship examined by the cross-sectional 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The primary measures were racial disparities for continuous BLLs or an elevated BLL (EBLL) ≥5 µg/dL in selected risk factors between non-Hispanic Black children (n = 608) and both non-Hispanic White (n = 1208) or Hispanic (n = 1025) children. Selected risk factors included indoor household smoking, low income or poverty, older housing built before 1978 or 1950, low primary guardian education <12th grade/general education diploma (GED), or younger age between 1 and 3 years. Data were analyzed using a regression model corrected for risk factors and other confounding variables. Overall, Black children had an adjusted +0.83 µg/dL blood Pb (95% CI 0.65 to 1.00, p < 0.001) and a 2.8 times higher odds of having an EBLL ≥5 µg/dL (95% CI 1.9 to 3.9, p < 0.001). When stratified by risk factor group, Black children had an adjusted 0.73 to 1.41 µg/dL more blood Pb (p < 0.001 respectively) and a 1.8 to 5.6 times higher odds of having an EBLL ≥5 µg/dL (p ≤ 0.05 respectively) for every selected risk factor that was tested. For Black children nationwide, one in four residing in pre-1950 housing and one in six living in poverty presented with an EBLL ≥5 µg/dL. In conclusion, significant nationwide racial disparity in blood Pb outcomes persist for predominantly African-American Black children even after correcting for risk factors and other variables. This racial disparity further persists within housing, socio-economic, and age-related risk factors of blood Pb outcomes that are much more severe for Black children.
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Affiliation(s)
- Deniz Yeter
- Independent Researcher, Kansas City, KS 66104, USA
| | | | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA;
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Leung AKC, Hon KL. Pica: A Common Condition that is Commonly Missed - An Update Review. Curr Pediatr Rev 2019; 15:164-169. [PMID: 30868957 DOI: 10.2174/1573396315666190313163530] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pica is a common condition in childhood that is commonly missed. OBJECTIVE To familiarize physicians with the clinical evaluation and management of children with pica. METHODS A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated. CONCLUSION Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, AB, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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