Blood lead level risk factors and reference value derivation in a cross-sectional study of potentially lead-exposed workers in Iran.

OBJECTIVES: This exploratory investigation aimed to measure blood lead levels and associated risk factors in exposed workers in Iran, and to derive appropriate reference values for blood lead in this population as a means of epidemiological comparison. DESIGN: Cross-sectional. SETTING: Manufacturing plants with potential lead exposure in Southern Khorasan Province, Iran. PARTICIPANTS: The study included 630 workers, selected through stratified random sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary measures in this exploratory investigation were venous blood lead concentration (BLC) and associated risk factors of age, gender, work experience, cigarette smoking and history of opium use. The secondary measures were symptoms associated with lead toxicity. Data analyses were conducted using Student's t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis test, Spearman correlation coefficient and regression analysis. RESULTS: Mean and median BLCs were 6.5±8.1 µg/dL and 3.9 µg/dL (IQR: 2.9-5.8), respectively. Of the subjects, 85 (13.5%) had BLC ≥10 µg/dL. The derived reference BLC value in this study was 30 µg/dL for men and 14 µg/dL for women. Increasing work experience and age were associated with BLC >10 µg/dL. Radiator manufacturers were up to 12.9 times (95% CI 4.6 to 35, p<0.005) more likely than painters to have BLC >10 µg/dL. Most subjects reported multiple symptoms. CONCLUSIONS: The mean BLC was above the maximum recommended concentration. There was a significant relationship between higher BLC and age or working in a printing factory or radiator manufacturing. These findings can direct efforts towards reducing occupational lead exposure.

Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report.

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month's duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 µg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.

The effects of warmed intravenous fluids, combined warming (warmed intravenous fluids with humid-warm oxygen), and pethidine on the severity of shivering in general anesthesia patients in the recovery room.

BACKGROUND: Shivering is a common complication of general and epidural anesthesia. Warming methods and many drugs are used for control of shivering in the recovery room. The present study is a randomized clinical trial aimed to investigate the effects of two interventions in comparison with pethidine which is the routine treatment on shivering in patients undergoing abdominal surgery with general anesthesia. MATERIALS AND METHODS: Eighty-seven patients undergoing abdominal surgery by general anesthesia were randomly assigned to three groups (two intervention groups in comparison with pethidine as routine). Patients in warmed intravenous fluids group received pre-warmed Ringer serum (38°C), patients in combined warming group received pre-warmed Ringer serum (38°C) accompanied by humid-warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The elapsed time of shivering and some hemodynamic parameters of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data were analyzed by software SPSS (v. 16) with the significance level being P < 0.05. RESULTS: The mean of elapsed time in the warmed intravenous serum group, the combined warming group, and the pethidine group were 7 (1.5) min, 6 (1.5) min, and 2.8 (0.7) min, respectively, which was statistically significant (P < 0.05). The body temperatures in both combined warming and pethidine groups were increased significantly (P < 0.05). CONCLUSIONS: Combined warming can be effective in controlling postoperative shivering and body temperature increase.