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Moody EC, Colicino E, Wright RO, Mupere E, Jaramillo EG, Amarasiriwardena C, Cusick SE. Environmental exposure to metal mixtures and linear growth in healthy Ugandan children. PLoS One 2020; 15:e0233108. [PMID: 32413070 PMCID: PMC7228047 DOI: 10.1371/journal.pone.0233108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stunting is an indicator of poor linear growth in children and is an important public health problem in many countries. Both nutritional deficits and toxic exposures can contribute to lower height-for-age Z-score (HAZ) and stunting (HAZ < -2). OBJECTIVES In a community-based cross-sectional sample of 97 healthy children ages 6-59 months in Kampala, Uganda, we examined whether exposure to Pb, As, Cd, Se, or Zn were associated with HAZ individually or as a mixture. METHODS Blood samples were analyzed for a mixture of metals, which represent both toxins and essential nutrients. The association between HAZ and metal exposure was tested using multivariable linear regression and Weighted Quantile Sum (WQS) regression, which uses mixtures of correlated exposures as a predictor. RESULTS There were 22 stunted children in the sample, mean HAZ was -0.74 (SD = 1.84). Linear regression showed that Pb (β = -0.80, p = 0.021) and Se (β = 1.92, p = 0.005) were significantly associated with HAZ. The WQS models separated toxic elements with a presumed negative effect on HAZ (Pb, As, Cd) from essential nutrients with presumed positive effect on HAZ (Se and Zn). The toxic mixture was significantly associated with lower HAZ (β = -0.47, p = 0.03), with 62% of the effect from Pb. The nutrient WQS index did not reach statistical significance (β = -0.47, p = 0.16). DISCUSSION Higher blood lead and lower blood selenium level were both associated with lower HAZ. The significant associations by linear regression were reinforced by the WQS models, although not all associations reached statistical significance. These findings suggest that healthy children in this neighborhood of Kampala, Uganda, who have a high burden of toxic exposures, may experience detrimental health effects associated with these exposures in an environment where exposure sources are not well characterized.
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Affiliation(s)
- Emily C. Moody
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ezekiel Mupere
- Department of Paediatrics & Child Health, Mulago Hospital, Kampala, Uganda
| | - Ericka G. Jaramillo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Chitra Amarasiriwardena
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Sarah E. Cusick
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
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Ansari JA, Mahdi AA, Malik PS, Jafar T. Blood Lead Levels in Children Living Near an Informal Lead Battery Recycling Workshop in Patna, Bihar. J Health Pollut 2020; 10:200308. [PMID: 32175179 PMCID: PMC7058140 DOI: 10.5696/2156-9614-10.25.200308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Lead can cause significant biological and neurologic damage, even at small concentrations, and young children are at higher risk. Informal recycling of lead batteries and lead-based workshops/industries have increased the burden of lead toxicity in developing countries, including India. Many informal recycling lead battery workshops have been established by the local people of Patna, Bihar as self-employment opportunities. However, most of the residents are not aware of the risk factors associated with lead poisoning. OBJECTIVES The present pilot study aimed to assess blood lead levels (BLLs) and hemoglobin levels among children aged between 3 to 12 years in the settlement of Karmalichak near Patna, India. MATERIALS AND METHODS Children residing near the informal lead battery manufacturing unit were selected for BLL assessment. A total of 41 children were enrolled in the questionnairebased survey. RESULTS All the children in the present study had detectable lead concentrations in their blood. Only 9% of the studied children had a BLL ≤5 μg/dl, while 91% children had a BLL above >5 μg/dl. CONCLUSIONS The present study carried out in children of Karmalichak region of Patna, India was an attempt to better understand the problem of lead toxicity, describe the epidemiology of its adverse effects, identify sources and routes of exposure, illustrate the clinical effects and develop strategies of prevention so that remedial measures may be taken by government agencies and regulatory bodies. In view of the high lead levels in children in the study area, attempts are being made to develop strategies for future prevention by relocating the informal battery recycling workshops from the area. Moreover, parents have been advised to increase nutritional supplementation of children by providing calcium-, iron- and zinc-rich foods, including milk and vegetables. PARTICIPANT CONSENT Obtained. ETHICAL APPROVAL The study was approved by the ethical committee of Era's Lucknow Medical College & Hospital, Era University, Lucknow (India). COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Jamal Akhtar Ansari
- Department of Biochemistry, King George's Medical University, Lucknow, India
- Department of Chemistry, Shibli National PG College, Azamgarh, India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George's Medical University, Lucknow, India
- Era University, Lucknow, India
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Olympio KPK, Gonçalves CG, Salles FJ, Ferreira APSDS, Soares AS, Buzalaf MAR, Cardoso MRA, Bechara EJH. What are the blood lead levels of children living in Latin America and the Caribbean? ENVIRONMENT INTERNATIONAL 2017; 101:46-58. [PMID: 28159393 DOI: 10.1016/j.envint.2016.12.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Information on the prevalence of lead exposure is essential to formulate efficient public health policies. Developed countries have implemented successful public policies for the prevention and control of lead poisoning. In the United States, Canada, Japan and the European Union, for instance, periodically repeated prevalence studies show that blood lead levels (BLLs) in children have decreased overall. Although BLL of Latino children in the U.S. have also dropped in recent years, the geometric mean remains higher than that of white children. Little is known about lead exposure in children in Latin America and the Caribbean (LAC). In this review, we responded to two questions: What is currently known about lead sources and levels in children in LAC? Are there public policies to prevent children's exposure to lead in LAC? METHOD We conducted a literature review covering the period from January 2000 to March 2014 in the PubMed and Lilacs databases to obtain English, Portuguese and Spanish language studies reporting the prevalence of BLLs in children aged 0-18years living in LAC countries. No specific analytical method was selected, and given the scarcity of data, the study was highly inclusive. RESULTS Fifty-six papers were selected from 16 different LAC countries. The children's BLLs found in this review are high (≥10μg/dL) compared to BLLs for the same age group in the U. S. However, most studies reported an association with some type of "lead hot spot", in which children can be exposed to lead levels similar to those of occupational settings. Only Peru and Mexico reported BLLs in children from population-based studies. CONCLUSIONS Most BLLs prevalence studies carried out in LAC were in areas with known emission sources. The percentage of children at risk of lead poisoning in LAC is unknown, and probably underestimated. Thus, there is an urgent need to establish public health policies to quantify and prevent lead poisoning, specifically by prioritizing the identification and control of "hot spots".
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Affiliation(s)
| | - Cláudia Gaudência Gonçalves
- Departamento de Controle Ambiental/Grupo Técnico Permanente de Áreas Contaminadas - Secretaria do Verde e Meio Ambiente de São Paulo, Brazil
| | - Fernanda Junqueira Salles
- Departamento de Saúde Ambiental, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Agnes Silva Soares
- Sustainable Development and Health Equity, Pan American Health Organization, Washington, DC, United States
| | - Marília Afonso Rabelo Buzalaf
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Maria Regina Alves Cardoso
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
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Shrestha A, Sharma S, Gerold J, Erismann S, Sagar S, Koju R, Schindler C, Odermatt P, Utzinger J, Cissé G. Water Quality, Sanitation, and Hygiene Conditions in Schools and Households in Dolakha and Ramechhap Districts, Nepal: Results from A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010089. [PMID: 28106779 PMCID: PMC5295339 DOI: 10.3390/ijerph14010089] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/20/2022]
Abstract
This study assessed drinking water quality, sanitation, and hygiene (WASH) conditions among 708 schoolchildren and 562 households in Dolakha and Ramechhap districts of Nepal. Cross-sectional surveys were carried out in March and June 2015. A Delagua water quality testing kit was employed on 634 water samples obtained from 16 purposively selected schools, 40 community water sources, and 562 households to examine water quality. A flame atomic absorption spectrophotometer was used to test lead and arsenic content of the same samples. Additionally, a questionnaire survey was conducted to obtain WASH predictors. A total of 75% of school drinking water source samples and 76.9% point-of-use samples (water bottles) at schools, 39.5% water source samples in the community, and 27.4% point-of-use samples at household levels were contaminated with thermo-tolerant coliforms. The values of water samples for pH (6.8–7.6), free and total residual chlorine (0.1–0.5 mg/L), mean lead concentration (0.01 mg/L), and mean arsenic concentration (0.05 mg/L) were within national drinking water quality standards. The presence of domestic animals roaming inside schoolchildren’s homes was significantly associated with drinking water contamination (adjusted odds ratio: 1.64; 95% confidence interval: 1.08–2.50; p = 0.02). Our findings call for an improvement of WASH conditions at the unit of school, households, and communities.
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Affiliation(s)
- Akina Shrestha
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
- School of Medical Sciences, Kathmandu University, P.O. Box 11008, Dhulikhel, Nepal.
| | - Subodh Sharma
- Aquatic Ecology Centre, School of Science, Kathmandu University, P.O. Box 6250, Dhulikhel, Nepal.
| | - Jana Gerold
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
| | - Séverine Erismann
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
| | - Sanjay Sagar
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
| | - Rajendra Koju
- School of Medical Sciences, Kathmandu University, P.O. Box 11008, Dhulikhel, Nepal.
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
| | - Guéladio Cissé
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, P.O. Box, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4001 Basel, Switzerland.
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Zhang F, Liu Y, Zhang H, Ban Y, Wang J, Liu J, Zhong L, Chen X, Zhu B. Investigation and Evaluation of Children's Blood Lead Levels around a Lead Battery Factory and Influencing Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060541. [PMID: 27240393 PMCID: PMC4923998 DOI: 10.3390/ijerph13060541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
Lead pollution incidents have occurred frequently in mainland China, which has caused many lead poisoning incidents. This paper took a battery recycling factory as the subject, and focused on measuring the blood lead levels of environmental samples and all the children living around the factory, and analyzed the relationship between them. We collected blood samples from the surrounding residential area, as well as soil, water, vegetables. The atomic absorption method was applied to measure the lead content in these samples. The basic information of the generation procedure, operation type, habit and personal protect equipment was collected by an occupational hygiene investigation. Blood lead levels in 43.12% of the subjects exceeded 100 μg/L. The 50th and the 95th percentiles were 89 μg/L and 232 μg/L for blood lead levels in children, respectively, and the geometric mean was 94 μg/L. Children were stratified into groups by age, gender, parents' occupation, distance and direction from the recycling plant. The difference of blood lead levels between groups was significant (p < 0.05). Four risk factors for elevated blood lead levels were found by logistic regression analysis, including younger age, male, shorter distance from the recycling plant, and parents with at least one working in the recycling plant. The rate of excess lead concentration in water was 6.25%, 6.06% in soil and 44.44% in leaf vegetables, which were all higher than the Chinese environment standards. The shorter the distance to the factory, the higher the value of BLL and lead levels in vegetable and environment samples. The lead level in the environmental samples was higher downwind of the recycling plant.
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Affiliation(s)
- Feng Zhang
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
| | - Yang Liu
- Jiangyin Municipal Center for Disease Prevention and Control, Wuxi 214434, China.
| | - Hengdong Zhang
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
| | - Yonghong Ban
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
| | - Jianfeng Wang
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
| | - Jian Liu
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
| | - Lixing Zhong
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
| | - Xianwen Chen
- Jiangyin Municipal Center for Disease Prevention and Control, Wuxi 214434, China.
| | - Baoli Zhu
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210009, China.
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Evaluation of dietary exposure to minerals, trace elements and heavy metals from the muscle tissue of the lionfish Pterois volitans (Linnaeus 1758). Food Chem Toxicol 2013; 60:205-12. [DOI: 10.1016/j.fct.2013.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/13/2013] [Accepted: 07/17/2013] [Indexed: 11/19/2022]
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Mandour RA, Ghanem AA, El-Azab SM. Correlation between lead levels in drinking water and mothers' breast milk: Dakahlia, Egypt. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2013; 35:251-6. [PMID: 22968229 DOI: 10.1007/s10653-012-9480-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 08/30/2012] [Indexed: 05/10/2023]
Abstract
This study was performed on fifty-two drinking tap water samples (surface and groundwater) collected from different districts of Dakahlia Governorate and fifty-two breast milk samples from lactating mothers hosted in Dakahlia Governorate hospitals. All these samples were subjected to lead analysis. Lead level in drinking groundwater showed higher levels than in drinking surface water. Also, an elevation of lead levels in breast milk of mothers drinking groundwater was noticed when compared with that of mothers drinking surface water. The comparison between mean lead levels in drinking water and mothers' breast milk samples showed positive relationship. Lead concentrations in breast milk of the studied samples were elevated by exposure to smoking. We conclude that prolonged contact with lead plumbing can increase the lead content in tap water with subsequent increase in lead burden in infant fed formula and infant blood. Also, we recommend that chemical analyses must be carried out periodically for the surface and groundwater to ensure the water suitability for drinking purposes. Passive exposure to smoking during lactation should be avoided. Capsule: Prolonged contact with lead plumbing can increase the lead content in tap water with subsequent increase in lead burden in infant fed formula and infant blood.
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Affiliation(s)
- Raafat A Mandour
- Toxicology Unit - Emergency Hospital, Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
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Machado S, Rabelo TS, Portella RB, Carvalho MDF, Magna GAM. A study of the routes of contamination by lead and cadmium in Santo Amaro, Brazil. ENVIRONMENTAL TECHNOLOGY 2013; 34:559-571. [PMID: 23837305 DOI: 10.1080/09593330.2012.692717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The problem of contamination by cadmium and lead in Santo Amaro, Brazil, has been studied since 1970 and the severity of this contamination case has been demonstrated by many authors. This study evaluates the persistence of the superficial soil contamination around the metallurgical plant and attempts to correlate the lead and cadmium concentrations to the past atmospheric emissions from the lead plant and with the presence of lead debris under urban road surface and in the backyards of homes. Past emissions still play an important role in soil contamination. In areas without debris, about 30% of the soil samples had lead concentrations above the agricultural use limit of 180 parts per million (ppm) (according to CONAMA 420, 2009), 20% of the samples had concentrations above 300 ppm (maximum for residential use) and 9.6% of the samples had concentrations above 900 ppm (maximum for industrial use). These concentrations are higher cldse to the chimney of the metallurgical plant. An average lead concentration of 1316 ppm was found in the backyard samples. About 80% of the houses had lead concentrations above 300 ppm and about 50% of the samples had values above 900 ppm, indicating the importance of the lead debris in the contamination scenario. Although a matter of concern, the cadmium concentrations seem to be less problematic than lead at the present time, probably due to the higher mobility of cadmium. The cadmium concentrations in the atmospheric dispersion and backyard samples showed similar trends, while the influence of the lead debris on the soil contamination is less evident.
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Affiliation(s)
- Sandro Machado
- Science and Technology of Materials, Federal University of Bahia, Federação, Salvador-BA, Brazil.
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Dooyema CA, Neri A, Lo YC, Durant J, Dargan PI, Swarthout T, Biya O, Gidado SO, Haladu S, Sani-Gwarzo N, Nguku PM, Akpan H, Idris S, Bashir AM, Brown MJ. Outbreak of fatal childhood lead poisoning related to artisanal gold mining in northwestern Nigeria, 2010. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:601-7. [PMID: 22186192 PMCID: PMC3339453 DOI: 10.1289/ehp.1103965] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 12/20/2011] [Indexed: 05/18/2023]
Abstract
BACKGROUND In May 2010, a team of national and international organizations was assembled to investigate children's deaths due to lead poisoning in villages in northwestern Nigeria. OBJECTIVES Our goal was to determine the cause of the childhood lead poisoning outbreak, investigate risk factors for child mortality, and identify children < 5 years of age in need of emergency chelation therapy for lead poisoning. METHODS We administered a cross-sectional, door-to-door questionnaire in two affected villages, collected blood from children 2-59 months of age, and obtained soil samples from family compounds. Descriptive and bivariate analyses were performed with survey, blood lead, and environmental data. Multivariate logistic regression techniques were used to determine risk factors for childhood mortality. RESULTS We surveyed 119 family compounds. Of 463 children < 5 years of age, 118 (25%) had died in the previous year. We tested 59% (204/345) of children < 5 years of age, and all were lead poisoned (≥ 10 µg/dL); 97% (198/204) of children had blood lead levels (BLLs) ≥ 45 µg/dL, the threshold for initiating chelation therapy. Gold ore was processed inside two-thirds of the family compounds surveyed. In multivariate modeling, significant risk factors for death in the previous year from suspected lead poisoning included the age of the child, the mother's work at ore-processing activities, community well as primary water source, and the soil lead concentration in the compound. CONCLUSION The high levels of environmental contamination, percentage of children < 5 years of age with elevated BLLs (97%, > 45 µg/dL), and incidence of convulsions among children before death (82%) suggest that most of the recent childhood deaths in the two surveyed villages were caused by acute lead poisoning from gold ore-processing activities. Control measures included environmental remediation, chelation therapy, public health education, and control of mining activities.
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Affiliation(s)
- Carrie A Dooyema
- Healthy Homes and Lead Poisoning Prevention Branch, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Counter SA, Buchanan LH, Ortega F. Neurophysiologic and neurocognitive case profiles of Andean patients with chronic environmental lead poisoning. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2009; 72:1150-1159. [PMID: 20077183 DOI: 10.1080/15287390903091772] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This report presents case profiles of three siblings in a family of lead (Pb) glazing workers living in a Pb-contaminated Andean village who presented with extreme plumbism (blood Pb levels: 47 to 128 microg/dl) from childhood to adolescence. These cases are examples of persons who have chronic Pb poisoning as a result of prolonged occupational and environmental exposure in a Pb-glazing ceramic cottage industry in the study area. Using behavioral and physiological techniques for measuring the integrity of the peripheral and central auditory systems, including otoacoustic emissions, and replicated auditory brainstem electrophysiological potentials, the authors found normal auditory neurosensory function in each patient, thus ruling out hearing impairment as a basis for adverse neurocognitive outcomes. This finding is contrary to the prevailing view regarding the detrimental effects of Pb poisoning on the cochlear and auditory brainstem of children. Performance on tests of visual spatial intelligence and auditory memory/attention was below average in these patients, which may underlie their reported learning disabilities. In two of the cases, there was an improvement in cognitive performance following a lowering of PbB levels from chelation therapy and Pb prevention education, suggesting some level of reversibility of their neurocognitive deficits. Nevertheless, these case profiles suggest that if the patients persist in Pb-glazing activities, in spite of repeated chelation therapy and family counseling, they may continue to be re-intoxicated and remain at risk for learning disabilities and other neurological impairments.
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Affiliation(s)
- S Allen Counter
- Department of Neurology, Harvard Medical School/The Biological Laboratories, Cambridge, Massachusetts, USA.
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