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Zhang L, Yao X, Chen Y, Li Y, Qin J, Tang S. Abdominal pain caused by Tibetan medicine: A case report of lead poisoning. Heliyon 2024; 10:e30167. [PMID: 38765025 PMCID: PMC11096953 DOI: 10.1016/j.heliyon.2024.e30167] [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] [Received: 02/08/2024] [Revised: 04/13/2024] [Accepted: 04/21/2024] [Indexed: 05/21/2024] Open
Abstract
Nowadays, lead poisoning in children commonly occurs, but lead poisoning caused by the administration of Tibetan medicine is rarely reported. This report describes the diagnosis and management of lead poisoning in a 16-year-old girl presented with abdominal pain, vomiting, and anemia with limb numbness, who had a childhood history of epilepsy and took Tibetan medicine intermittently to control the symptoms. After admission into hospital, Computed tomography showed high-density shadows in the gastrointestinal tract. Video-Electroencephalography showed no signs of seizure. Reflux esophagitis was observed in gastroscopy. And no obvious abnormalities in the colonic mucosa through colonoscopy. Bone marrow smear test showed basophilic stippling in the erythrocytes. The blood and urine lead levels of 626 and 75.9 μg/L, respectively. We therefore considered lead poisoning, and the patient improved after chelation therapy. Due to its atypical clinical manifestations, lead poisoning is easily misdiagnosed. Thus, clinicians should pay more attention to this disease. When abdominal pain, anemia, and neurological symptoms are present, the possibility of lead poisoning should be considered.
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Affiliation(s)
- Liang Zhang
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Xin Yao
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Yalun Chen
- Department of Geriatric Medicine, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Ying Li
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Jianping Qin
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
| | - Shanhong Tang
- Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu, Sichuan, 610083, China
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Eldhose R, Viggeswarpu S, Jambugulam M. Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms. BMJ Case Rep 2023; 16:e258065. [PMID: 38086570 PMCID: PMC10728943 DOI: 10.1136/bcr-2023-258065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
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.
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Affiliation(s)
- Raeba Eldhose
- Department of Geriatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Surekha Viggeswarpu
- Department of Geriatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Mohan Jambugulam
- Department of General Medicine, Christian Medical College, Vellore, Tamilnadu, India
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Sun G, Xiang P, Chen Y, Li Z, Wu B, Rao Y, Zhu Z. Diagnostic value of a logistic model of occupational lead poisoning using hematological parameters. J Int Med Res 2023; 51:3000605231213221. [PMID: 37994031 PMCID: PMC10666822 DOI: 10.1177/03000605231213221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE We investigated the predictive value of a logistic model utilizing hematological parameters in diagnosing occupational lead poisoning. METHODS This retrospective study (September 2020-December 2022) included patients with occupational lead poisoning. Differences in hematological parameters were compared between individuals with occupational blood lead poisoning and healthy individuals. We used logistic regression analysis to develop a diagnostic prediction model for occupational blood lead poisoning. Receiver operating characteristic (ROC) curves and corresponding area under the ROC curve values were used to assess the diagnostic value of hematological parameters and logistic models. RESULTS Compared with controls, several indicators were significantly higher in the group with blood lead poisoning, but others were significantly lower. Logistic regression analysis showed that the red blood cell distribution width coefficient of variation (RDW-CV), neutrophil/lymphocyte ratio (NLR), and percentage of small red blood cells (Micro%) were independent factors in diagnosing occupational blood lead poisoning. The logistic regression model constructed based on these three parameters had sensitivity 78.7% and specificity 83.8% for diagnosing occupational lead poisoning. CONCLUSION We identified RDW-CV, NLR, and Micro% as independent predictors in the diagnosis of occupational lead poisoning. A logistic regression model that includes these may contribute to better detection of occupational lead poisoning.
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Affiliation(s)
- Guokang Sun
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Pinpin Xiang
- Xiping Community Healthcare Center of Longquanyi District, Chengdu, China
| | - Yiping Chen
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zheng Li
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yanping Rao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zheng Zhu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Famouri F, Yazdi M, Feizii A, Saneian H, Nasri P, Kelishadi R. Comparison of Blood Lead Levels in Children and Adolescents with and without Functional Abdominal Pain. Adv Biomed Res 2023; 12:194. [PMID: 37694233 PMCID: PMC10492617 DOI: 10.4103/abr.abr_250_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/28/2023] [Accepted: 03/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background Functional abdominal pain is a health concern with chronic abdominal discomfort without clear etiology. Several etiologic factors are raised in this regard, one related to environmental factors. This study aimed to compare blood lead levels between children and adolescents with and without functional abdominal pain. Materials and Methods This case-control study was performed in 2019-2020 in Isfahan, Iran. The sample size was calculated as 70 cases and an equal number of controls. Cases were children and adolescents with functional gastrointestinal disorder (FGID), and controls were grouped age- and sex-matched. Controls were randomly selected from those referred for routine health screening. Both groups obtained blood lead, iron, and calcium levels. All participants completed the FFQ Food Consumption and Environmental Pollutants Questionnaire. Results Participants were 139 children (68 cases and 71 controls). The mean (SD) age was 9.40 (3.91) years in the FGID group and 8.79 (3.46) years in the controls (P = 0.330). The mean (SD) blood lead level was not significantly different between the FGID group and the controls (3.98 ± 2.56 vs 3.81 ± 1.96 μg/dl, respectively, P = 0.670). We found that 55.3% of children with high lead levels had FGID, while 44.4% of children with lower lead levels had FGID, but the difference was not statistically significant (P = 0.33). Conclusion We found that the lead level was higher in patients with FGID than in the controls; however, this difference was not significantly different. This might be because of elevated lead levels in both groups. Future ecological studies with a large sample size are necessary in this regard.
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Affiliation(s)
- Fatemeh Famouri
- Child Growth and Development Research Center, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Yazdi
- Child Growth and Development Research Center, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizii
- Department of Statistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Saneian
- Child Growth and Development Research Center, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peiman Nasri
- Child Growth and Development Research Center, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
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Rouzi L, Elhamri H, Kalouch S, Salam S, Moutawakil BE, Chaoui H, Badrane N, Fekhaoui M, Jouhadi Z. Lead poisoning with encephalic and neuropathic involvement in a child: case report. Pan Afr Med J 2022; 42:276. [PMID: 36405662 PMCID: PMC9636730 DOI: 10.11604/pamj.2022.42.276.33007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/30/2022] [Indexed: 08/02/2023] Open
Abstract
Lead is a toxic substance in our environment that affects adults and children of all socioeconomic backgrounds, lead poisoning is one of the most common exposures that can cause inter alia significant neurological and functional damage in humans. Children are particularly vulnerable because of the effects of the toxicity on their developing nervous systems with potentially irreversible consequences. We report a case of severe lead poisoning encephalo-neuropathy in a 3-year-old girl, admitted for progressive paraplegia, swallowing disorders, and aphasia. A multitude of investigations undertaken could not explain her atypic symptoms, so anamnesis was redone in the sense of a toxic origin, we found a notion of pica, and a traditional herbalist father, so probably consumption of medications based on traditional medicine products. A venous blood lead level (BLL) was extremely elevated at 176.4 μg/l. The child was treated with an oral chelator succimer (SUCCICAPTAL). During the two following months in the intensive care unit, the child showed progressive respiratory distress and worsening signs of the nervous system. Despite treatment and the use of lead chelators, the patient died due to septic shock. Lead is highly toxic even at very low exposure levels, at high levels of exposure, it can damage the reproductive organs, immune system, liver and kidneys. in children, it can affect neurocognitive and behavioral development that could be irreversible. Peripheral and central nervous system damage should be considered as a possible manifestation of lead poisoning.
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Affiliation(s)
- Latifa Rouzi
- Department of Zoology and Animal Ecology, Scientific Institute, Mohammed V University in Rabat, Rabat, Morocco
| | - Hecham Elhamri
- Department of Toxicology and Hydrology, National Institute of Hygiene, Rabat, Morocco
| | - Samira Kalouch
- Department of Pediatric Anesthesiology and Intensive Care Unit, Children's University Hospital Ibn Rochd, University Hassan 2, Casablanca, Morocco
| | - Siham Salam
- Department of Pediatric Radiology, Children's University Hospital Ibn Rochd, Casablanca, Morocco
| | - Bouchra El Moutawakil
- Department of Neurology, Hospital Ibn Rochd, Hassan 2 University, Casablanca, Morocco
| | | | | | - Mohammed Fekhaoui
- Department of Zoology and Animal Ecology, Scientific Institute, Mohammed V University in Rabat, Rabat, Morocco
| | - Zineb Jouhadi
- Department of Pediatric Infectious Diseases, Children's University Hospital Ibn Rochd, Hassan 2 University, Casablanca, Morocco
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Li C, Yu Y, Fang A, Feng D, Du M, Tang A, Chen S, Li A. Insight into biosorption of heavy metals by extracellular polymer substances and the improvement of the efficacy: a review. Lett Appl Microbiol 2021; 75:1064-1073. [PMID: 34562275 DOI: 10.1111/lam.13563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023]
Abstract
Heavy metals are continuously released into aquatic environments in which they accumulate. This phenomenon endangers public health because heavy metals accumulate along the food chain. However, conventional remediation methods are inefficient, expensive and yield toxic intermediate products, which adversely affect the environment. The discovery of green bio-adsorbents such as microbial extracellular polymer substance (EPS) has quickly attracted considerable worldwide attention because of their low cost, high removal efficiency of heavy metals and industrial availability. Hence, this review considers the sources, hazards and treatment methods of heavy metals pollution, particularly the biosorption mechanism of EPS to heavy metals and the influencing factors of the bio-adsorption process, which are significant in the efficient removal of heavy metals-containing wastewater treatment. This review also focuses on strengthening the process of EPS adsorption of heavy metals, which can further contribute to heavy metals removal. Finally, it has been proposed that improving the yield, stability, selectivity and recoverability of EPS is the key direction of further research.
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Affiliation(s)
- C Li
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - Y Yu
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - A Fang
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - D Feng
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - M Du
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - A Tang
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China
| | - S Chen
- School of Municipal and Environmental Engineering, Jilin University of Architecture and Technology, Changchun, People's Republic of China
| | - A Li
- State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin, People's Republic of China.,School of Municipal and Environmental Engineering, Jilin University of Architecture and Technology, Changchun, People's Republic of China
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