Pediatric lead exposure from imported Indian spices and cultural powders

Assessment of prevalence of elevated blood lead levels and risk factors among children and pregnant women in Bihar, India

BACKGROUND

While modeled estimates and studies in contaminated areas indicate high lead exposure among children in Bihar, India, local data on lead exposure in the child population is limited.

OBJECTIVES

To characterize lead exposure, and assess potential sources of lead exposure among a state-representative sample of children and their pregnant mothers residing in Bihar.

METHODS

Blood samples were collected from 697 children under five and 55 pregnant women from eight districts in Bihar. Blood lead levels were determined using capillary blood and a portable lead analyzer. Household demographics, home environment, behavior, and nutrition information were collected through computer-assisted personal interviews with primary caregivers. Logistic regression was used to assess associations between potential risk factors and elevated blood lead levels.

RESULTS

More than 90% of children and 80% of pregnant women reported blood lead levels ≥ 5 μg/dL. Living near a lead-related industry and pica behavior of eating soil were significantly associated with increased odds of having elevated blood lead levels. Additional risk factors for having a blood level ≥5 μg/dL included the use of skin lightening cream (aOR = 5.11, 95%CI: 1.62, 16.16) and the use of eyeliners (aOR = 2.81, 95%CI: 1.14, 6.93). Having blood lead levels ≥ 10 μg/dL was also significantly associated with the household member who had an occupation or hobby involving the use of lead (aOR = 1.75, 95%CI: 1.13, 2.72).

DISCUSSION

Elevated blood lead levels were prevalent among children and pregnant women in Bihar, indicating the urgent need for a comprehensive lead poisoning prevention strategy.

Lead Levels in the Most Consumed Mexican Foods: First Monitoring Effort

Globally, there is growing concern over the presence of lead (Pb) in foods because it is a heavy metal with several toxic effects on human health. However, monitoring studies have not been conducted in Mexico. In this study, we estimated the concentrations of Pb in the most consumed foods and identified those that exceeded the maximum limits (MLs) for Pb in foods established by the International Standards. Based on the Mexican National Health and Nutrition Survey, 103 foods and beverages were selected and purchased in Mexico City retail stores and markets. Samples were analyzed twice using atomic absorption spectrophotometry. Values above the limit of quantification (0.0025 mg/kg) were considered to be detected. The percentage of detected values was 18%. The highest concentration was found in infant rice cereal (1.005 mg/kg), whole wheat bread (0.447 mg/kg), pre-cooked rice (0.276 mg/kg), black pepper (0.239 mg/kg), and turmeric (0.176 mg/kg). Among the foods with detected Pb, the levels in infant rice cereal, whole wheat bread, pre-cooked rice, and soy infant formula exceeded the MLs. The food groups with the highest percentages of exceeded MLs were baby foods (18%) and cereals (11%). Monitoring the concentration of contaminants in foods is essential for implementing food safety policies and protecting consumer health.

Lead Poisoning From Home-Prepared Indian Spices in 3 Families

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.

Lead Levels in Spices From Market Basket and Home Lead Investigation Samples in North Carolina

OBJECTIVES

Lead investigators in North Carolina found evidence that contaminated spices may contribute to children's elevated blood lead levels. We compared lead levels in samples of spices and other consumable products by country of purchase to inform consumer safety interventions and regulations.

METHODS

From February 1, 2011, through October 22, 2020, North Carolina lead investigators sampled spices and other consumable products from 103 homes of children with confirmed elevated blood lead levels. In 2017, the study team purchased 50 products frequently sampled during lead investigations, as a "market basket" sample, from local stores in or near Raleigh, North Carolina. The State Laboratory of Public Health analyzed 423 product samples using mass spectrometry. We extracted environmental sample results from lead investigations from the North Carolina Electronic Lead Surveillance System.

RESULTS

The median market basket lead result was 0.07 mg/kg (SD = 0.17); the maximum lead result was 0.88 mg/kg. The median home lead investigation sample result was 0.26 mg/kg (SD = 489.44); the maximum lead result was 6504.00 mg/kg in turmeric purchased in India. Among all samples, products purchased in India had more than triple the median lead levels (0.71 mg/kg) of those purchased in the United States (0.19 mg/kg).

CONCLUSIONS

Purchasing spices in the United States is an action that consumers can take that may reduce their lead poisoning risk. Regulatory agencies should consider a lead limit of <1 mg/kg as attainable for spices sold in US stores and for ingredients of any foods that may be consumed by children.

Assessing Analytical Methods for the Rapid Detection of Lead Adulteration in the Global Spice Market

Lead adulteration of spices, primarily via Pb chromate compounds, has been documented globally as a growing public health concern. Currently, Pb detection in spices relies primarily on expensive and time-consuming laboratory analyses. Advancing rapid Pb detection methods, inclusive of their accuracy and precision, would improve field assessments by food safety inspectors, stakeholders, and the public in the hope of reducing Pb exposure risks at its source. Here, we present two field procedures for Pb detection: portable X-ray fluorescence analysis (pXRF) and a simple colorimetric test. We assess their efficacy to detect Pb and its chemical form in seven spice types, including powders, spice-salt mixtures, and dried roots, compared to the proven laboratory technique, inductively coupled plasma mass spectrometry (ICP-MS). Lead concentrations measured using pXRF and ICP-MS were within 5% of each other for spice powders and 24% for dried roots. By pXRF, spice samples were analyzed within collection plastic bags without preparation, resulting in a detection limit of 2 mg Pb/kg for spice powders, which is comparable to national food standards. The colorimetric test utilized here targets hexavalent chromium, making the method selective to Pb chromate adulteration assuming that this is its dominant source in spices. Color development, and thus detection, was observed when Pb concentrations exceeded approximately 5-70 mg/kg in dried turmeric roots and 1000 mg/kg in spice powders; however, it was ineffective for the spice-salt mixture. We show that pXRF analysis and a colorimetric assay provide information that may improve field decisions about Pb adulteration in a range of spice types, helping to minimize Pb exposure.

Tracking the source of contaminant lead in children's blood

Pb isotope ratios are used for apportioning the sources of Pb in the blood of children (ages 1-6) screened for high blood Pb levels (>5 μg/dL) surrounding urban areas of Kansas City, MO. We compared Pb isotope ratios measured in the child's blood with those of the most likely sources of Pb in that child's home environment. The environmental sources sampled consisted of topsoils, paints, occupational sources (e.g., oil rig workers' uniforms, mechanics' clothes), indoor air filters, dusts, and dietary sources (e.g., spices). Blood lead levels (BLL) ranged from 2.9 to 12.7 μg/dL in children from the five homes participating in this study. Measurements of ²⁰⁶Pb/²⁰⁴Pb, ²⁰⁷Pb/²⁰⁴Pb and ²⁰⁸Pb/²⁰⁴Pb isotope ratios were made by multi-collector ICP-MS. Comparison of the Pb isotope ratios in home environment samples versus those in the child's blood in each home allowed the identification of possible sources of a child's Pb exposure in three homes. In five homes investigated, children's blood Pb levels were most likely to be derived from dusts inside, and topsoil outside, the homes, or a mixture thereof. In one case, blood Pb was derived from turmeric spice and, in another, the Pb was derived from paint. It is not always possible to directly link high BLLs to the environmental sources collected when Pb isotope ratios of the environmental samples did not overlap with those of the blood.

The effects of drying methods and harvest season on piperine, essential oil composition, and multi-elemental composition of black pepper

This study aimed to evaluate the piperine content, essential oil composition, and multi-elemental composition of black pepper samples according to different drying methods and harvest season. Differences in essential oil composition and B, Ca, K, Mg, and S were noted according to sampling campaign, indicating secondary metabolism plant alterations. Mechanical drying resulted in essential oil composition changes due to high temperature exposure during processing. Increases in Fe and Cr contents when employing mechanical dryers with direct heating were also observed, due to direct contact with metallic structures and particulate material from the burning process. The As and Pb contents of several samples were higher than the maximum permissible limits, reaching 0.46 and 0.56 mg kg^-1, respectively, thus surpassing legislation safety limitations for human consumption.

Environmental assessment of pediatric Lead exposure in Tehran; a prospective cross-sectional study

Background

Ingestion and inhalation are common routes of exposure for lead in humans. Developing countries still have unacceptably high rates of lead toxicity, especially in children. Studies on probable risk factors of lead poisoning in Iranian children are insufficient. In this study, we aimed to evaluate possible environmental factors in children with high blood lead concentrations living in Tehran and neighboring cities.

Methods

In a prospective cross-sectional study between March 2018 and March 2019 we followed all children referred from two pediatric gastrointestinal clinics with blood lead level (BLL) > 5 μg/dL in metropolitan Tehran to investigate possible environmental risk factors in their home. Household specimens including scratched wall paint, house floor dust, windowsill dust, tap water, and consumed spice were evaluated using atomic absorption method to detect lead concentrations. Epidemiological and environmental data collected through in-depth interviews with parents/guardians. Industrial areas were defined based on municipality maps on industrial places.

Results

Thirty of 56 parents/guardians with BLL > 5 μg/dL agreed to be followed through environmental investigation. The only categorical statistically significant risk factor was a history of lead poisoning in the family and living in an industrial zone. There was a positive correlation between BLL and interior windowsills dust lead level, r = 0.46, p = 0.01. Scratched paint lead level and BLL showed a significant positive correlation, r = 0.50, p = 0.005. House floor dust lead level (median = 77.4, p < 0.001) and interior windowsill dust lead level (median = 291, p = 0.011) were both significantly higher than the environmental protection agency (EPA) standards of 40 μg/ft2, 250 μg/ft2. Interior windowsill dust lead concentrations were significantly higher in industrial areas (p = 0.026).

Conclusion

Children’s playing environment should be cleaned more often to reduce dust. Moreover, specific rules may need to be implemented for paint lead concentrations and air pollution, especially in industrial areas.

Environmental assessment of pediatric Lead exposure in Tehran; a prospective cross-sectional study

BACKGROUND

Ingestion and inhalation are common routes of exposure for lead in humans. Developing countries still have unacceptably high rates of lead toxicity, especially in children. Studies on probable risk factors of lead poisoning in Iranian children are insufficient. In this study, we aimed to evaluate possible environmental factors in children with high blood lead concentrations living in Tehran and neighboring cities.

METHODS

In a prospective cross-sectional study between March 2018 and March 2019 we followed all children referred from two pediatric gastrointestinal clinics with blood lead level (BLL) > 5 μg/dL in metropolitan Tehran to investigate possible environmental risk factors in their home. Household specimens including scratched wall paint, house floor dust, windowsill dust, tap water, and consumed spice were evaluated using atomic absorption method to detect lead concentrations. Epidemiological and environmental data collected through in-depth interviews with parents/guardians. Industrial areas were defined based on municipality maps on industrial places.

RESULTS

Thirty of 56 parents/guardians with BLL > 5 μg/dL agreed to be followed through environmental investigation. The only categorical statistically significant risk factor was a history of lead poisoning in the family and living in an industrial zone. There was a positive correlation between BLL and interior windowsills dust lead level, r = 0.46, p = 0.01. Scratched paint lead level and BLL showed a significant positive correlation, r = 0.50, p = 0.005. House floor dust lead level (median = 77.4, p < 0.001) and interior windowsill dust lead level (median = 291, p = 0.011) were both significantly higher than the environmental protection agency (EPA) standards of 40 μg/ft², 250 μg/ft². Interior windowsill dust lead concentrations were significantly higher in industrial areas (p = 0.026).

CONCLUSION

Children's playing environment should be cleaned more often to reduce dust. Moreover, specific rules may need to be implemented for paint lead concentrations and air pollution, especially in industrial areas.

The urban lead (Pb) burden in humans, animals and the natural environment

Centuries of human activities, particularly housing and transportation practices from the late 19th century through the 1980's, dispersed hundreds of millions of tons of lead into our urban areas. The urban lead burden is evident among humans, wild and domesticated animals, and plants. Animal lead exposures closely mirror and often exceed the lead exposure patterns of their human partners. Some examples: Pigeons in New York City neighborhoods mimicked the lead exposures of neighborhood children, with more contaminated areas associated with higher exposures in both species. Also, immediately following the lead in drinking water crisis in Flint MI in 2015, blood lead levels in pet dogs in Flint were 4 times higher than in surrounding towns. And combining lead's neurotoxicity with urban stress results in well-characterized aggressive behaviors across multiple species. Lead pollution is not distributed evenly across urban areas. Although average US pediatric lead exposures have declined by 90% since the 1970s, there remain well defined neighborhoods where children continue to have toxic lead exposures; animals are poisoned there, too. Those neighborhoods tend to have disproportionate commercial and industrial lead activity; a history of dense traffic; older and deteriorating housing; past and operating landfills, dumps and hazardous waste sites; and often lead contaminated drinking water. The population there tends to be low income and minority. Urban wild and domesticated animals bear that same lead burden. Soil, buildings, dust and even trees constitute huge lead repositories throughout urban areas. Until and unless we begin to address the lead repositories in our cities, the urban lead burden will continue to impose enormous costs distributed disproportionately across the domains of the natural environment. Evidence-based research has shown the efficacy and cost-effectiveness of some US public policies to prevent or reduce these exposures. We end with a series of recommendations to manage lead-safe urban environments.

Challenges in diagnosing lead poisoning: A review of occupationally and nonoccupationally exposed cases reported in India

Lead is a nonessential metal which enters the body through various means and is considered as one of the most common health toxins. Several cases of lead poisoning are reported as a result of inhalation or ingestion of lead in employees working as painters, smelters, electric accumulator manufacturers, compositors, auto mechanics, and miners. In addition to occupational lead exposure, several cases of lead poisoning are reported in the general population through various sources and pathways. Innumerable signs and symptoms of lead poisoning observed are subtle and depend on the extent and duration of exposure. The objective of this review article is to discuss occupationally and nonoccupationally exposed lead poisoning cases reported in India and the associated symptoms, mode of therapy, and environmental intervention used in managing these cases. Lead poisoning cases cannot be identified at an early stage as the symptoms are very general and mimic that of other disorders, and patients might receive only symptomatic treatment. Knowledge about the various symptoms and potential sources is of utmost importance. Medical practitioners when confronted with patients experiencing signs and symptoms as discussed in this article can speculate the possibility of lead poisoning, which could lead to early diagnosis and its management.

Turmeric means "yellow" in Bengali: Lead chromate pigments added to turmeric threaten public health across Bangladesh

Adulteration is a growing food safety concern worldwide. Previous studies have implicated turmeric as a source of lead (Pb) exposure due to the addition of lead chromate (PbCrO₄), a yellow pigment used to enhance brightness. We aimed to assess the practice of adding yellow pigments to turmeric and producer- consumer- and regulatory-factors affecting this practice across the supply chain in Bangladesh. We identified and visited the nine major turmeric-producing districts of Bangladesh as well as two districts with minimal turmeric production. In each district, we conducted semi-structured interviews and informal observations with individuals involved in the production, consumption, and regulation of turmeric. We explored perceptions of and preferences for turmeric quality. We collected samples of yellow pigments and turmeric from the most-frequented wholesale and retail markets. We collected samples of turmeric, pigments, dust, and soil from turmeric polishing mills to assess evidence of adulteration. Interviews were analyzed through an inductive, thematic coding process, with attention focused on perceptions of and preferences for turmeric quality. Samples were analyzed for Pb and chromium (Cr) concentrations via inductively coupled plasma mass spectrometry and x-ray fluorescence. In total, we interviewed 152 individuals from across the supply chain and collected 524 samples of turmeric, pigments, dust, and soil (Table S3, Table S4). Turmeric Pb and Cr concentrations were highest in Dhaka and Munshiganj districts, with maximum turmeric powder Pb concentrations of 1152 μg/g, compared to 690 μg/g in the 9 major turmeric-producing districts. We found evidence of PbCrO₄-based yellow pigment adulteration in 7 of the 9 major turmeric-producing districts. Soil samples from polishing mills contained a maximum of 4257 μg/g Pb and yellow pigments contained 2-10% Pb by weight with an average Pb:Cr molar ratio of 1.3. Turmeric wholesalers reported that the practice of adding yellow pigments to dried turmeric root during polishing began more than 30 years ago and continues today, primarily driven by consumer preferences for colorful yellow curries. Farmers stated that merchants are able to sell otherwise poor-quality roots and increase their profits by asking polishers to adulterate with yellow pigments. Adulterating turmeric with lead chromate poses significant risks to human health and development. The results from this study indicate that PbCrO₄ is being added to turmeric by polishers, who are unaware of its neurotoxic effects, in order to satisfy wholesalers who are driven by consumer demand for yellow roots. We recommend immediate intervention that engages turmeric producers and consumers to address this public health crisis and ensure a future with Pb-free turmeric.

Blood Lead Levels of Children Using Traditional Indian Medicine and Cosmetics: A Feasibility Study

Background

Traditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 µg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied.

Methods

We assessed the feasibility of collecting BLLs in children attending Ayurvedic outpatient settings in India. Our pilot study took place over 3 days in the summer of 2010 at a large public Ayurveda hospital and a small pediatric clinic in southern India. Using a trained interpreter, we administered a standardized questionnaire in Malayalam, assessing sociodemographics, Ayurvedic medicine use, kohl use, and other potential risk factors for lead exposure, to parents of pediatric outpatients. We also analyzed BLLs using a portable lead analyzer.

Results

The study enrolled 29 children (mean age, 3.8 years). The mean BLL was 6.7 µg/dL (SD = 3.5; range, 3.5-20.2). Seventy-two percent of the children used Ayurvedic medicine in the past 2 years and 55% reported kohl use. Mean BLL of Ayurvedic users and nonusers was 6.2 µg/dL and 8.5 µg/dL, respectively (P = .08). Kohl users had a statistically significant higher BLL than nonusers (8.0 µg/dL vs 5.3 µg/dL, P = .03).

Conclusions

It is feasible to collect BLLs in pediatric Ayurvedic outpatient clinics in southern India. Collaborative relationships with community members and hospital staff were essential. Further research is needed to investigate Ayurveda and kohl use as risk factors for elevated lead burden among Indian children.

Prevalence of elevated blood lead levels among pregnant women and sources of lead exposure in rural Bangladesh: A case control study

Prenatal and early childhood lead exposures impair cognitive development. We aimed to evaluate the prevalence of elevated blood lead levels (BLLs) among pregnant women in rural Bangladesh and to identify sources of lead exposure. We analyzed the BLLs of 430 pregnant women randomly selected from rural communities in central Bangladesh. Fifty-seven cases were selected with the highest BLLs, ≥ 7 μg/dL, and 59 controls were selected with the lowest BLLs, < 2 μg/dL. An exposure questionnaire was administered and soil, rice, turmeric, water, traditional medicine, agrochemical, and can samples were analyzed for lead contamination. Of all 430 women, 132 (31%) had BLLs > 5 μg/dL. Most women with elevated BLLs were spatially clustered. Cases were 2.6 times more likely than controls to consume food from a can (95% CI 1.0-6.3, p = 0.04); 3.6 times more likely to use Basudin, a specific brand of pesticide (95% CI 1.6-7.9, p = 0.002); 3.6 times more likely to use Rifit, a specific brand of herbicide (95% CI 1.7-7.9, p = 0.001); 2.9 times more likely to report using any herbicides (95% CI 1.2-7.3, p = 0.02); and 3.3 times more likely to grind rice (95% CI 1.3-8.4, p = 0.01). Five out of 28 food storage cans were lead-soldered. However, there was minimal physical evidence of lead contamination from 382 agrochemical samples and 129 ground and unground rice samples. Among 17 turmeric samples, one contained excessive lead (265 μg/g) and chromium (49 μg/g). Overall, we found evidence of elevated BLLs and multiple possible sources of lead exposure in rural Bangladesh. Further research should explicate and develop interventions to interrupt these pathways.

Folk prescription for treating rhinitis as a rare cause of childhood lead poisoning: a case series

Background

Folk prescriptions continue to be important sources of childhood lead poisoning. Nasal spray folk prescriptions for treating rhinitis has only been reported once previously as a cause of lead poisoning.

Case presentation

We identified three pediatric cases of severe lead poisoning caused by nasal spray folk medicines prescribed for treating rhinitis. The three patients had similar clinical manifestations including: severe abdominal pain, headache, pale appearance and fatigue. Liver function tests were abnormal. Blood lead levels (BLLs) of the three patients were 91 μg/dL, 91 μg/dL, and 105 μg/dL, respectively. After chelation BLLs decreased. The lead content of the three folk remedies as measured by inductively coupled plasma mass spectrometry (ICP-MS) were 14.8, 22.3, and 33.4%. All the symptoms resolved during a course of chelation therapy. There were no severe side effects of treatment.

Conclusions

Nasal spray folk prescriptions for treating rhinitis may contain extremely high bio-accessible lead content and are potential sources of lead poisoning. Clinicians should be alert to this possibility especially in those children presenting with multisystem symptoms.

Blood Lead Levels and Potential Risk Factors for Lead Exposures Among South Asians in New York City

New York City’s South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.

Sensitized ZnO nanorod assemblies to detect heavy metal contaminated phytomedicines: spectroscopic and simulation studies

The immense pharmacological relevance of the herbal medicine curcumin including anti-cancer and anti-Alzheimer effects, suggests it to be a superior alternative to synthesised drugs. The diverse functionalities with minimal side effects intensify the use of curcumin not only as a dietary supplement but also as a therapeutic agent. Besides all this effectiveness, some recent literature reported the presence of deleterious heavy metal contaminants from various sources in curcumin leading to potential health hazards. In this regard, we attempt to fabricate ZnO based nanoprobes to detect metal conjugated curcumin. We have synthesized and structurally characterized the ZnO nanorods (NR). Three samples namely curcumin (pure), Zn-curcumin (non-toxic metal attached to curcumin) and Hg-curcumin (toxic heavy metal attached to curcumin) were prepared for consideration. The samples were electrochemically deposited onto ZnO surfaces and the attachment was confirmed by cyclic voltammetry experiments. Moreover, to confirm a molecular level interaction picosecond-resolved PL-quenching of ZnO NR due to Förster Resonance Energy Transfer (FRET) from donor ZnO NR to the acceptor curcumin moieties was employed. The attachment proximity of ZnO NR and curcumin moieties depends on the size of metals. First principles analysis suggests a variance of attachment sites and heavy metal Hg conjugated curcumin binds through a peripheral hydroxy group to NR. We fabricated a facile photovoltaic device consisting of ZnO NR as the working electrode with Pt counter electrode and iodide-triiodide as the electrolyte. The trend in photocurrent under visible light illumination suggests an enhancement in the case of heavy metal ions due to long range interaction and greater accumulation of charge at the active electrode. Our results provide a detailed physical insight into interfacial processes that are crucial for detecting heavy-metal attached phytomedicines and are thus expected to find vast application as sensors for the detection of selective metal contaminants.

Complementary and Alternative Medicine: A Cross-Sectional Observational Study in Pediatric Inpatients

The aim was to study the prevalence of complementary and alternative medicine use in acutely sick hospitalized children and factors associated with it. This is a cross-sectional, hospital-based study in a tertiary care center of Delhi, India. Children admitted to a pediatric unit during the study period were assessed using a specially designed questionnaire. Out of the total 887 admitted children, 161 (18.1%) were using complementary and alternate medicine in one form or another. Of these, 113 (70.2%) were using complementary and alternate medicine for the current illness directly leading to admission and the remaining 48 (29.8%) had used complementary and alternate medicine in past. The common complementary and alternate medicine use observed in our study was combined ayurveda and spiritual approach (25.5%), ayurveda (24.8%), spiritual (21.7%), homeopathic (13%), and 47.2% of children were using spiritual approach in form of Jhada (tying piece of cloth on arm or leg or keeping a knife by the side of child). The significant factors associated with complementary and alternate medicine use were younger age, female gender, and father being employed. Complementary and alternate medicine is commonly used even in acutely sick children.

Childhood Ingestions of Environmental Toxins: What Are the Risks?

Infants and children are at higher risk than adolescents and adults for exposure to environmental toxins via ingestion for a number of reasons: their smaller size (and proportionately larger dose of ingested toxins), their closer proximity to the ground, dirt, and indoor dust, their boundless curiosity and oral exploratory behaviors, pica habits that may persist into school-age for children with autism or other developmental delays, their proportionately larger daily water and milk intake, and food preferences that differ markedly from adolescents and adults. Children depend on adults to protect them and keep their home environment safe. Pediatric care providers can integrate environmental health topics into their well-child care practices, offering guidance and resources to parents concerned with reducing the risks to their children posed by hazards in their homes, daycare centers, preschools, schools, and the other environments in which they spend time. [Pediatr Ann. 2017;46(12):e466-e471.].

Lead poisoning among opium users in Iran: an emerging health hazard

Background

Lead (Pb) poisoning among people using opium has been an increasing problem in Iran. The present study highlights the clinical effects of lead toxicity associated with opium use in Iran, Kerman province.

Methods

Between January 2016 and June 2016, patients with signs and symptoms of Pb poisoning were questioned to assess whether they had a history of opium dependency. In total, 249 patients were enrolled onto this cross-sectional study, all were opium dependent. Para-clinical data including blood lead level (BLL), demographic information, user preferences, and symptoms were obtained.

Results

The patients used either opium (83.9%), refined opium (6.4%) or a combination of both (9.7%) via ingestion (71.9%), smoking (8.4%) or a combination of both (19.7%). The overall median BLL was 80.0 μg/dL [IQR: 51.7–119.0]. The median BLL did not differ significantly between opium and refined opium users. Further, BLL was not significantly affected by the type of substance, route of use, duration of use, or daily quantity consumed. Common symptoms included abdominal pain (86.9%), constipation (75.8%), anorexia (71.5%) and nausea (54.7%). Linear regression analysis showed log of BLL was significantly associated with abdominal pain, myalgia and anorexia.

Conclusions

The study unravelled an increase in opium-related Pb poisoning in the Kerman province. Raised awareness of this emerging Pb source and investigation of its aetiology is recommended. Pb poisoning should be considered among the primary differential diagnosis of opium users with gastrointestinal symptoms.

Toxicants in folk remedies: implications of elevated blood lead in an American-born infant due to imported diaper powder

Though most childhood lead exposure in the USA results from ingestion of lead-based paint dust, non-paint sources are increasingly implicated. We present interdisciplinary findings from and policy implications of a case of elevated blood lead (13-18 mcg/dL, reference level <5 mcg/dL) in a 9-month-old infant, linked to a non-commercial Malaysian folk diaper powder. Analyses showed the powder contains 62 % lead by weight (primarily lead oxide) and elevated antimony [1000 parts per million (ppm)], arsenic (55 ppm), bismuth (110 ppm), and thallium (31 ppm). These metals are highly bioaccessible in simulated gastric fluids, but only slightly bioaccessible in simulated lung fluids and simulated urine, suggesting that the primary lead exposure routes were ingestion via hand-mouth transmission and ingestion of inhaled dusts cleared from the respiratory tract. Four weeks after discontinuing use of the powder, the infant's venous blood lead level was 8 mcg/dL. Unregulated, imported folk remedies can be a source of toxicant exposure. Additional research on import policy, product regulation, public health surveillance, and culturally sensitive risk communication is needed to develop efficacious risk reduction strategies in the USA. The more widespread use of contaminated folk remedies in the countries from which they originate is a substantial concern.

An Update on Childhood Lead Poisoning

Childhood lead poisoning is a multi-faceted, complex condition, which affects not only the child's health and well-being, but also the family's housing security, economic status, job security, and stress level. This review updates the emergency department clinician on the management of childhood lead poisoning. Infants and children are at higher risk than adults for lead exposure due to their smaller size and proportionately larger dose of ingested toxins, their proximity to ground dirt and indoor dust, their energy and curiosity, their oral exploratory and pica behaviors, their proportionately larger daily water and milk intake, and dietary preferences that differ markedly from those of adults. Pediatric health care providers working in the emergency department can provide medical management, as well as preventive counseling and guidance, to parents of children presenting with evidence of acute or chronic lead poisoning.

Lead Content of Sindoor, a Hindu Religious Powder and Cosmetic: New Jersey and India, 2014-2015

OBJECTIVES

To assess the extent of lead content of sindoor, a powder used by Hindus for religious and cultural purposes, which has been linked to childhood lead poisoning when inadvertently ingested.

METHODS

We purchased 95 samples of sindoor from 66 South Asian stores in New Jersey and 23 samples from India and analyzed samples with atomic absorption spectrophotometry methods for lead.

RESULTS

Analysis determined that 79 (83.2%) sindoor samples purchased in the United States and 18 (78.3%) samples purchased in India contained 1.0 or more micrograms of lead per gram of powder. For US samples, geometric mean concentration was 5.4 micrograms per gram compared with 28.1 micrograms per gram for India samples. The maximum lead content detected in both US and India samples was more than 300 000 micrograms per gram. Of the examined US sindoor samples, 19% contained more than 20 micrograms per gram of lead (US Food and Drug Administration [FDA] limit); 43% of the India samples exceeded this limit.

CONCLUSIONS

Results suggested continued need for lead monitoring in sindoor in the United States and in sindoor carried into the United States by travelers from India, despite FDA warnings.

Assessment of acculturation in minority health research

Acculturation represents an important construct in the context of health disparities. Although several studies have reported relationships between various aspects of acculturation and health in minority populations, crucial inconsistencies remain. One likely reason for these inconsistencies may relate to limitations in the conceptualization and operationalization of acculturation, particularly in the context of health research. The acculturation construct underwent major conceptual and operational change when it was adapted from anthropology to psychology, and we argue another major shift is now required for use of this construct in health research. Issues include determining whether acculturation measures should focus on an individual's internal attitudes or overt behaviors; whether they should characterize cultural orientation status at a given point in time or change over time; whether measures should be culture-specific or more global in nature; how the issue of multiculturalism should be addressed; how measures can optimally incorporate multiple dimensions of acculturation; and whether proxy measures should be used. These issues are important in the context of health research because of their implications for determining the direct and indirect effects of cultural change on health-related biological and behavioral processes. We elaborate on and address each of these issues from a perspective that spans multiple disciplines across the biological and social sciences, and offer concrete recommendations with the ultimate goal of achieving a better understanding of the role of acculturation in minority health and health disparities.

Epidemiologic Characteristics of Children with Blood Lead Levels ≥45 μg/dL

OBJECTIVES

To identify risk factors and describe outcomes for children newly identified with blood lead levels (BLLs) ≥45 µg/dL in New York City (NYC) during 2004-2010 to promote timely identification as well as inform clinical practice and public health policy.

STUDY DESIGN

Inclusion criteria were residence in NYC and an elevated confirmatory venous test within 2 weeks of the initial BLL ≥45 µg/dL. Data collected during case coordination of these children were linked with blood testing data and home inspection reports. Children with BLLs ≥45 µg/dL also were compared with the general population of children younger than 18 years of age in NYC.

RESULTS

A total of 145 children <18 years of age were newly identified with BLLs ≥45 µg/dL. The mean age was 3.83 years, and the median time for BLL to decline below 10 µg/dL was 3.26 years. Major reported risk factors were eating paint (36%), spending time outside the US (34%), having a developmental delay (27%), using imported products (26%), being foreign born (14%), being of Pakistani descent (12%), eating soil (5%), and having sickle cell disease (4%). Compared with the age-standardized NYC population, cases were more likely to be Asian or black and live in housing built before 1940.

CONCLUSIONS

Although the incidence of lead poisoning has declined in the US, severe cases still occur. Physicians should be especially vigilant in certain at-risk populations including children who eat paint chips or soil, spend time outside the US (particularly in Pakistan), use imported products, or have developmental delays or sickle cell disease.

Stunting is associated with blood lead concentration among Bangladeshi children aged 2-3 years

BACKGROUND

Lead toxicity is of particular public health concern given its near ubiquitous distribution in nature and established neurotoxicant properties. Similar in its ubiquity and ability to inhibit neurodevelopment, early childhood stunting affects an estimated 34 % of children under 5 in low- and middle-income countries. Both lead and stunting have been shown to be associated with decreased neurodevelopment, although the relationship between these childhood burdens is underexplored. The association between lead exposure and stunting has been previously established, yet limited data are available on susceptibility windows.

METHODS

Whole blood lead samples were collected from rural Bangladeshi children at delivery (umbilical cord blood) and at age 20-40 months (fingerstick blood). Stunting was determined using the Child Growth Standards developed from the World Health Organization Multicentre Growth Reference Study. Children with height for age < -2 z-scores below the median of the WHO Child Growth Standards were classified as stunted in all analyses.

RESULTS

Median (IQR) umbilical cord and fingerstick blood lead levels were 3.1 (1.6-6.3) μg/dl and 4.2 (1.7-7.6) μg/dl, respectively. In adjusted multivariable regression models, the odds of stunting at 20-40 months increased by 1.12 per μg/dl increase in blood lead level (OR = 1.12, 95 % CI: 1.02-1.22). No association was found between cord blood lead level and risk of stunting (OR = 0.97, 95 % CI: 0.94-1.00).

CONCLUSIONS

There is a significant association between stunting and concurrent lead exposure at age 20-40 months. This association is slightly attenuated after controlling for study clinic site. Additional research including more precise timing of lead exposure during these critical 20-40 months is needed.

Evaluation of a New Optic-Enabled Portable XRF Instrument for Measuring Toxic Metals/Metalloids in Consumer Goods and Cultural Products

X-ray fluorescence spectrometry (XRF) is a rapid, non-destructive multi-elemental analytical technique used for determining elemental contents ranging from percent down to the µg/g level. Although detection limits are much higher for XRF compared to other laboratory-based methods, such as inductively coupled plasma mass spectrometry (ICP-MS), ICP-optical emission spectrometry (OES) and atomic absorption spectrometry (AAS), its portability and ease of use make it a valuable tool, especially for field-based studies. A growing necessity to monitor human exposure to toxic metals and metalloids in consumer goods, cultural products, foods and other sample types while performing the analysis in situ has led to several important developments in portable XRF technology. In this study, a new portable XRF analyzer based on the use of doubly curved crystal optics (HD Mobile^®) was evaluated for detecting toxic elements in foods, medicines, cosmetics and spices used in many Asian communities. Two models of the HD Mobile^® (a pre-production and a final production unit) were investigated. Performance parameters including accuracy, precision and detection limits were characterized in a laboratory setting using certified reference materials (CRMs) and standard solutions. Bias estimates for key elements of public health significance such as As, Cd, Hg and Pb ranged from -10% to 11% for the pre-production, and -14% to 16% for the final production model. Five archived public health samples including herbal medicine products, ethnic spices and cosmetic products were analyzed using both XRF instruments. There was good agreement between the pre-production and final production models for the four key elements, such that the data were judged to be fit-for-purpose for the majority of samples analyzed. Detection of the four key elements of interest using the HD Mobile^® was confirmed using archived samples for which ICP-OES data were available based on digested sample materials. The HD Mobile^® XRF units were shown to be suitable for rapid screening of samples likely to be encountered in field based studies.

Evaluation of portable XRF instrumentation for assessing potential environmental exposure to toxic elements

Portable instruments based on X-Ray Fluorescence Spectrometry (XRF) have the potential to assist in field-based studies provided the data produced are reliable. In this study, we evaluate the performance of two different types of XRF instrument (XOS prototype, and Thermo Niton XL3t). These two XRF analyzers were evaluated in a laboratory setting, and data were reported for 17 elements (As, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, Sn, Sr, Ti, V, and Zn). Samples analyzed (n=38) included ethnic herbal medicine products (HMP), ethnic spices (ES), and cosmetic products (CP). Comparison analyses were carried out using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES). In general, results reported for Cd, Cu and Pb by the XOS prototype analyzer, and based on the instrument's non-metal mode, were negatively biased (5 % to 95 %) compared to ICP-OES. In contrast, results reported for Pb, As, Cd, Cu and Zn by the Niton, based on using the soil mode, were positively biased, in some instances (Cd) by up to 4 orders of magnitude. While the sensitivity of both instruments was insufficient for reliably "quantifying" toxic elements below 15 mg/kg, XRF was still capable of positively "detecting" many elements at the low single digit mg/kg levels. However, for semi-quantification estimates of contaminants at higher levels, and with limited sample preparation, both XRF instruments were deemed fit for the purpose. This study demonstrates that modern XRF instrumentation is valuable for characterizing the elemental content of food, cosmetic, and medicinal products. The technology is particularly useful for rapidly screening large numbers of products (100s per day) in the field, and quickly identifying those that may contain potentially hazardous levels of toxic elements. Toxic elements can be confirmed by examining the raw spectrum, and the limitations of factory-based calibration are generally manageable for field-based studies.

Arsenic Speciation in Honeysuckle (Lonicera japonica Thunb.) from China

In this study, honeysuckle, a common Chinese herbal medicine, produced from different areas was investigated for total arsenic and arsenic species concentration. The total arsenic concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and ranged from 275 to 635 μg kg(-1). A microwave-assisted procedure with 1 % phosphoric acid (v/v) was used for the extraction of arsenic species in honeysuckle. The total arsenic species concentration found by liquid chromatography-inductively coupled plasma mass spectrometry (LC-ICP-MS) was in agreement with the total arsenic concentration determined by the ICP-MS analysis after the microwave digestion. Arsenate (As(V)) with an average proportion of 54.3 % was the predominant arsenic species in honeysuckle. The order of concentration is as follows: As(V) > arsenite (As(III)) > dimethylarsinic acid (DMA) > arsenobetaine (AsB) > monomethylarsonic acid (MMA). The proportion of organic arsenic (24.7 %) was higher than that in most terrestrial plants. Moreover, the distributions of arsenic species in the honeysuckle from different producing areas were significantly different. This study provides useful information for better understanding of the distribution of arsenic species in terrestrial plants.

[Gunshot wounds: should projectiles and fragments always be removed?]

BACKGROUND

Projectiles or metal fragments can remain lodged in the body of victims of gunshot injuries. This also applies to projectiles which do not tend to deform or fragment on impact. When a projectile fragments on penetration, jacket or lead core particles are likely to remain lodged in the affected region even if the projectile has exited the body.

AIM OF THE STUDY

A frequently asked question in the surgical management of such injuries is whether there are medical indications for the surgical removal of projectiles or fragments.

MATERIAL AND METHODS

This article presents some typical cases of patients who have received treatment at our institution and reviews the pertinent literature to show general recommendations in special cases concerning the removal of projectiles or fragments and when additional surgical trauma is justified. Parameters for decision making are presented in an algorithm.

RESULTS

From our own patients, 5 with remaining fragments in the soft tissue were invited for a clinical follow up. Serum probes and 24 h urine output was analysed for serum lead levels and urinary aminolevulinic acid levels. 74 months (max. 128 - min. 42 months) after injury we documented not elevated serum lead levels of 8.25 μg/ml and urinary aminolevulinic acid levels of 4.8 mg/24 h.

DISCUSSION

When lead-containing projectiles or fragments remain lodged in the body, monitoring is required and includes the measurement of serum lead levels and urinary aminolevulinic acid levels. The most important clinical symptoms of lead poisoning are gastrointestinal and neurological in nature. The treatment of choice for lead poisoning is the administration of chelating agents and removal of the lead source by surgical intervention.

Contaminated turmeric is a potential source of lead exposure for children in rural Bangladesh

Background. During the conduct of a cohort study intended to study the associations between mixed metal exposures and child health outcomes, we found that 78% of 309 children aged 20–40 months evaluated in the Munshiganj District of Bangladesh had blood lead concentrations ≥5 µg/dL and 27% had concentrations ≥10 µg/dL. Hypothesis. Environmental sources such as spices (e.g., turmeric, which has already faced recalls in Bangladesh due to high lead levels) may be a potential route of lead exposure. Methods. We conducted visits to the homes of 28 children randomly selected from among high and low blood lead concentration groups. During the visits, we administered a structured questionnaire and obtained soil, dust, rice, and spice samples. We obtained water samples from community water sources, as well as environmental samples from neighborhood businesses. Results. Lead concentrations in many turmeric samples were elevated, with lead concentrations as high as 483 ppm. Analyses showed high bioaccessibility of lead. Conclusions. Contamination of turmeric powder is a potentially important source of lead exposure in this population.

Medical toxicology case presentations: to chelate or not to chelate, is that the question?

Four case studies described in this article were presented to a panel of physicians participating in the ACMT "Use and Misuse of Metal Chelation Therapy" Symposium in February 2012. The individuals who participated in the panel are listed in the appendix. These cases highlight some of the practical questions facing medical providers when issues of metal toxicity and its treatment arise. Medical toxicologists are valuable resources for information, public debate, consultation, and treatment of patients with concerns about heavy metal exposure.

Intervention model for contaminated consumer products: a multifaceted tool for protecting public health

Lead-based paint and occupational lead hazards remain the primary exposure sources of lead in New York City (NYC) children and men, respectively. Lead poisoning has also been associated with the use of certain consumer products in NYC. The NYC Department of Health and Mental Hygiene developed the Intervention Model for Contaminated Consumer Products, a comprehensive approach to identify and reduce exposure to lead and other hazards in consumer products. The model identifies hazardous consumer products, determines their availability in NYC, enforces on these products, and provides risk communication and public education. Implementation of the model has resulted in removal of thousands of contaminated products from local businesses and continues to raise awareness of these hazardous products.

Study on Multi-Elements in Traditional Chinese Medicines Ophiopogon japonicus and Lotus Seeds by the ICP-AES with Microwave Digestion

Abstract: Determination of multi-elements were studied in the food cooked with medicinal herbs Ophiopogon japonicus（OJ） and Lotus seeds by ICP-AES after HNO3-H2O2 digestion with microwave. The average recoveries are in 91.7%~ 102.4% of As, Cr, Se, Cd, Cu, Mn, Zn, Al, Ba, Fe, Ni, respectively. The relative standard deviation(RSD)is less than 2.8% except Al （9.4%）and detection limit is in the range of 0. 10µg/L ~8.5µg/L except Al （79.6µg/L）. The difference was very obvious（p0.001,except As） that the elements’ content on the comparison OJ with Lotus seeds. There was rich of the trace elements Cu, Zn. The harmful element Al was on the high value（214.7µg/g）in the OJ. It is of important significance to assess the value of the food cooked with medicinal herbs by determination of multiply elements in Lotus seeds, and OJ with ICP-AES. Keyword: multi-elements, the trace elements, the harmful elements, Ophiopogon japonicus, Lotus seeds, ICP-AES

Heavy metal and pesticide content in commonly prescribed individual raw Chinese Herbal Medicines

Heavy metal and pesticide contamination has previously been reported in Chinese Herbal Medicines (CHMs), in some cases at potentially toxic levels. This study was conducted to determine general patterns and toxicological significance of heavy metal and pesticide contamination in a broad sample of raw CHMs. Three-hundred-thirty-four samples representing 126 species of CHMs were collected throughout China and examined for arsenic, cadmium, chromium, lead, and mercury. Of the total, 294 samples representing 112 species were also tested for 162 pesticides. At least 1 metal was detected in all 334 samples (100%) and 115 samples (34%) had detectable levels of all metals. Forty-two different pesticides were detected in 108 samples (36.7%), with 1 to 9 pesticides per sample. Contaminant levels were compared to toxicological reference values in the context of different exposure scenarios. According to a likely scenario of CHM consumption, only 3 samples (1%) with heavy metals and 14 samples (5%) with pesticides were found with concentrations that could contribute to elevated background levels of contaminant exposure. According to the most conservative scenario of CHM consumption, 231 samples (69%) with heavy metals and 81 samples (28%) with pesticides had contaminants that could contribute to elevated levels of exposure. Wild collected plants had higher contaminant levels than cultivated samples. Cadmium, chromium, lead, and chlorpyrifos contamination showed weak correlations with geographic location. Based on our assumptions of the likely mode of consumption of raw CHMs, the vast majority (95%) of the 334 samples in this study contained levels of heavy metals or pesticides that would be of negligible concern. However, given the number of samples with detectable contaminants and the range between the more likely and more conservative scenarios of contaminant exposure, more research and monitoring of heavy metals (especially cadmium and chromium) and pesticide residues (especially chlorpyrifos) in raw CHMs are advised.

Proton magnetic resonance spectroscopy in adults with childhood lead exposure

BACKGROUND

Childhood lead exposure adversely affects neurodevelopment. However, few studies have examined changes in human brain metabolism that may underlie known adverse cognitive and behavioral outcomes.

OBJECTIVE

We examined the association between mean childhood blood lead levels and in vivo brain metabolite concentrations as adults, determined by proton magnetic resonance spectroscopy (MRS) in a birth cohort with documented low-to-moderate lead exposure.

METHODS

Adult participants from the Cincinnati Lead Study [n = 159; mean age (± SD), 20.8 ± 0.9 years] completed a quantitative, short-echo proton MRS protocol evaluating seven regions to determine brain concentrations of N-acetyl aspartate (NAA), creatine and phosphocreatine (Cr), cholines (Cho), myo-inositol, and a composite of glutamate and glutamine (GLX). Correlation and multiple linear regression analyses were conducted.

RESULTS

Mean childhood blood lead levels were associated with regionally specific brain metabolite concentrations adjusted for age at imaging and Full-Scale intelligence quotient. Adjusted analyses estimated for a unit (micrograms per deciliter) increase in mean childhood blood lead concentrations, a decrease of NAA and Cr concentration levels in the basal ganglia, a decrease of NAA and a decrease of Cho concentration levels in the cerebellar hemisphere, a decrease of GLX concentration levels in vermis, a decrease of Cho and a decrease of GLX concentration levels in parietal white matter, and a decrease of Cho concentration levels in frontal white matter.

CONCLUSIONS

Gray-matter NAA reductions associated with increasing childhood blood lead levels suggest that sustained childhood lead exposure produces an irreversible pattern of neuronal dysfunction, whereas associated white-matter choline declines indicate a permanent alteration to myelin architecture.