Case of Lead Poisoning Associated with Herbal Health Supplements.

BACKGROUND: Lead poisoning is a chronic health condition arising from prolonged ingestion and exposure to lead above permissible limits. Although reported globally, developing countries like India and neighboring countries are amongst the most affected by lead. OBJECTIVES: The aim of the present study was to evaluate lead poisoning associated with herbal health supplements in a suspected case. MATERIALS AND METHODS: A 31-year-old male reported consuming sixteen different herbal health supplements. The case and supplements were assessed for lead levels. The patient came from one of the metro cities of Uttar Pradesh state, India. RESULTS: The blood lead level of the case was found to be 78.40 µg/dL, which was much higher than the permissible limit of ≤5 µg/dL. Moreover, one of the supplements was found to have a very high lead content. CONCLUSIONS: The present study demonstrated a case of lead poisoning which was very likely due to high lead content present in one of the supplements. The case had typical neurological signs of lead toxicity such as irritability, frequent headache, mental dullness, generalized pain, muscle weakness, numbness and tingling, and twitching and shaking of the legs while sleeping. PATIENT CONSENT: Obtained. COMPETING INTERESTS: The authors declare no competing financial interests.

COVID-19 and Pneumolysis Simulating Extreme High-altitude Exposure with Altered Oxygen Transport Physiology; Multiple Diseases, and Scarce Need of Ventilators: Andean Condor's-eye-view.

BACKGROUND: Critical hypoxia in this COVID-19 pandemic results in high mortality and economic loss worldwide. Initially, this disease' pathophysiology was poorly understood and interpreted as a SARS (Severe Acute Respiratory Syndrome) pneumonia. The severe atypical lung CAT scan images alerted all countries, including the poorest, to purchase lacking sophisticated ventilators. However, up to 88% of the patients on ventilators lost their lives. It was suggested that COVID-19 could be similar to a High-Altitude Pulmonary Edema (HAPE). New observations and pathological findings are gradually clarifying the disease. METHODS: As high-altitude medicine and hypoxia physiology specialists working and living in the highlands for over 50 years, we perform a perspective analysis of hypoxic diseases treated at high altitudes and compare them to Covid-19. Oxygen transport physiology, SARS-Cov-2 characteristics, and its transmission, lung imaging in COVID-19, and HAPE, as well as the causes of clinical signs and symptoms, are discussed. RESULTS: High-altitude oxygen transport physiology has been systematically ignored. COVID-19 signs and symptoms indicate a progressive and irreversible failure in the oxygen transport system, secondary to pneumolysis produced by SARS-Cov-2's alveolar-capillary membrane "attack". HAPE's pulmonary compromise is treatable and reversible. COVID-19 is associated with several diseases, with different individual outcomes, in different countries, and at different altitudes. CONCLUSIONS: The pathophysiology of High-altitude illnesses can help explain COVID-19 pathophysiology, severity, and management. Early diagnosis and use of EPO, acetylsalicylic-acid, and other anti-inflammatories, oxygen therapy, antitussives, antibiotics, and the use of Earth open-circuit- astronaut-resembling suits to return to daily activities, should all be considered. Ventilator use can be counterproductive. Immunity development is the only feasible long-term survival tool.

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.

Impact of blood lead level on haemoglobin and intelligence among school children living near lead based industries.

Blood lead level and its impact on haemoglobin and intelligence among school children near lead based industries, and to supplement them with a nutritious food for its effect, were studied. Blood was withdrawn from 120 children (9-12 years) and lead was estimated by Lead Care Analyzer Kit and haemoglobin by auto analyser. Culture Fair Non-verbal Test was used to assess the Intelligence Quotient. After pre-test, the experimental group (n = 60) were given nutritional supplementation for 3 months and education on hygiene measures, while the control group (n = 60) did not receive them. Food supplementation and education significantly decreased the lead level in the experimental group (8.8±0.5 to 6.9±0.4, µg/dL, mean ± SE) but not in the control group. The intelligence score improved in the experimental group but not in the control group. A negative correlation was observed between the lead level and intelligence. No improvement was observed in the haemoglobin. This study shows that the blood lead level in children near lead based industries is high and is negatively correlated with intelligence. Supplementation of nutritious food and education on hygiene measures have decreased the lead level and increased the intelligence score.

Environmental lead levels in a coastal city of India: the lead burden continues.

BACKGROUND: Urbanization, rapid industrialization, increased vehicular traffic, and consequent increase in the use of petroleum fuels in India are constantly emitting lead along with other pollutants into the environment. Apart from atmospheric lead, this element is the most widely used in everyday life. Although infants and children are the most susceptible to the effects of lead, adults are also affected to varying degrees and it had ranked as one of the most serious environmental threats to human health. Hence, we must understand the benefits of preventing lead exposure as it reduces treatment costs, increases productivity in industry, and also reduces infant mortality. These are good enough reasons for a nation wide program to prevent lead poisoning. OBJECTIVES: In the view of elevated blood lead levels (BLL) in majority of the school children in the city of Mangalore, we aimed to identify the potential sources of lead in the environment which would have probably caused the elevated BLL. MATERIALS AND METHODS: More than 600 readings were taken throughout the city of Mangalore using X-ray fluorimeter. RESULTS: Our results showed that there were elevated levels of lead in the environment surrounding the battery repair shops, battery recyclers, automotive workshops, and tyre retreaders, but interestingly, the soil around the petrol bunks did not show elevated levels of lead. Among the paints, the yellow paint showed high levels of lead. CONCLUSION: Similar surveys would be useful elsewhere in India and in other developing countries in order to identify the potential sources of lead and to prevent lead poisoning.

Diagnosis, evaluation, and treatment of lead poisoning in general population.

Among the heavy metals, lead still remains the major toxic pollutant of the environment. Human exposure to lead can occur through numerous pathways including air, food, dust, soil, and water. In the present study 14 lead poisoned patients with non-occupational lead exposure were evaluated. They were followed up and compared against the controls with no history of lead exposure. The patients had high blood lead levels and symptoms of weakness, dizziness, abdominal pain, generalized body ache, loss of appetite, and anxiety. Repeated course of chelation therapy helped to bring down their body burden of lead. Alternative sources for lead exposure can cause severe lead poisoning in general population. Screening and medical management of such individuals is very important to identify and eliminate sources of lead. The treatment and management requires a thorough medical evaluation and environmental intervention.

Elevated blood lead levels and cytogenetic markers in buccal epithelial cells of painters in India: genotoxicity in painters exposed to lead containing paints.

BACKGROUND, AIM, AND SCOPE: Lead, a major contaminant, is highly used in paint manufacturing due to its anticorrosive properties. Recent reports indicated high lead content among Indian paints used for commercial purposes. Painters are continuously exposed to these lead containing paints during painting of both commercial as well as residential buildings. Lead is well-known for its genotoxicty in occupational workers; however, in Indian painters the genotoxic effects of lead have not been reported to date. Therefore we aimed to study the genotoxic end points in painters due to their long-term exposure to these high lead-containing Indian paints. MATERIALS AND METHODS: Study group selection was made after a questionnaire administration, which included questions about lifestyle and medical history to exclude exposure to the other potential sources of genotoxics. Blood and buccal cell samples were obtained from 30 male painters and from a similar number of age-matched controls of same location with no occupational exposure to lead. Blood lead levels (Pb-B) were measured in painters and controls. Micronucleus (MN) frequencies and nuclear changes, i.e., karyorrhexis, karyolysis, broken egg, and binucleated, were investigated in buccal epithelial cells. RESULTS: Painters had significantly (P < 0.01) greater lead levels in blood than the control group. MN frequencies and nuclear changes in buccal epithelial cells were also significantly (P < 0.01) elevated in painters as compared with control subjects. Regression analysis also revealed significant (P < 0.01) association of Pb-B with all the genotoxic endpoints in painters. Cytogenetic damage was significantly associated with Pb-B as no other co-founding factors (smoking, alcohols) showed significant difference between both groups. DISCUSSION: Lead is widely used in paints which may serve as potential source of exposure among painters due to their long-term engagement with paints. Our results clearly demonstrated genotoxicity among the exposed population as evident from increase micronucleus frequencies, frequent nuclear changes, and apoptosis. Many studies had previously related nuclear change events in buccal epithelial cells with the progression of different carcinomas. Furthermore in-depth investigations with larger sample size are needed to provide evidence to this effect. CONCLUSIONS: Here, we report cytogenetic toxicity to the exposed population by the high lead containing paints from India for the first time. Frequent, high and unregulated use of lead in paints may cause genetic mutation and may accelerate cytogenetic damage which may further lead to different carcinomas in painters. These findings need to be considered and necessary steps should be taken to protect the occupational workers engaged with these high lead-containing paints. RECOMMENDATIONS: The use of lead in paints is completely unregulated in India and routine surveillance of paints for lead content is still lacking. These paints are readily available in markets and are also used in other products (jewelry, miniblinds) which could be exported to other countries including United States and Europe. Serious consideration should be given to the inclusion of regulations and bans on the use of lead in paints. Moreover, attention should also be paid towards the use of various protective measures (face-masks, hand gloves, and separate clothes) by the workers as safe work practices during working periods.

Lead toxicity in a family as a result of occupational exposure.

This article describes an entire family manufacturing lead acid batteries who all suffered from lead poisoning. The family of five lived in a house, part of which had been used for various stages of battery production for 14 years. Open space was used for drying batteries. They all drank water from a well located on the premises. Evaluation of biomarkers of lead exposure and/or effect revealed alarming blood lead levels [(3.92+/-0.94) micromol L-1], 50 % reduction in the activity of delta-aminolevulinic acid dehydratase [(24.67+/-5.12) U L-1] and an increase in zinc protoporphyrin [(1228+/-480) microg L-1]. Liver function tests showed an increase in serum alkaline phosphatase [(170.41+/-41.82) U L-1]. All other liver function test parameters were normal. Renal function tests showed an increase in serum uric acid [(515.81+/-86.29) micromol L-1] while urea and creatinine were normal. Serum calcium was low [(1.90+/-0.42) mmol L-1 in women and (2.09+/-0.12) mmol L-1 in men], while blood pressure was high in the head of the family and his wife and normal in children. Lead concentration in well water was estimated to 180 microg L-1. The family was referred to the National Referral Centre for Lead Poisoning in India, were they were received treatment and were informed about the hazards of lead poisoning. A follow up three months later showed a slight decrease in blood lead levels and a significant increase in haemoglobin. These findings can be attributed to behavioural changes adopted by the family, even though they continued producing lead batteries.

Evaluation, diagnosis, and treatment of lead poisoning in a patient with occupational lead exposure: a case presentation.

Amongst toxic heavy metals, lead ranks as one of the most serious environmental poisons all over the world. Exposure to lead in the home and the workplace results in health hazards to many adults and children causing economic damage, which is due to the lack of awareness of the ill effects of lead. We report the case of a 22 year old man working in an unorganized lead acid battery manufacturing unit, complaining about a longer history of general body ache, lethargy, fatigue, shoulder joint pain, shaking of hands and wrist drop. Patient had blue line at gingivodental junction. Central nervous system (CNS) examination showed having grade 0 power of extensors of right wrist & fingers. Reflexes: Supinator- absent, Triceps- weak and other deep tendon reflexes- normal. Investigations carried out during the admission showed hemoglobin levels of 8.3 g/dl and blood lead level of 128.3 mug/dl. The patient was subjected to chelation therapy, which was accompanied by aggressive environmental intervention and was advised not to return to the same environmental exposure situation. After repeated course of chelation therapy he has shown the signs of improvement and is on follow up presently.

Lead poisoning as a result of infertility treatment using herbal remedies.

INTRODUCTION: Lead poisoning remains a major problem in our society due to the lack of awareness of its ill effects among the clinical community. The non-availability of blood lead levels at primary health centers results in many lead-poisoned cases being treated symptomatically, without the diagnosis being sought. CASE REPORT: We report a case here, presenting with colicky abdominal pain receiving symptomatic treatment initially; lead poisoning was confirmed following the estimation of blood lead levels. DISCUSSION: The consumption of unbranded herbal medicines as a causative factor for lead poisoning was confirmed by high lead content in the medicines. Surely, this demands public health programs to disseminate strategies to the medical personnel about the clinical implication of lead poisoning, as well as the general public for awareness and to prevent lead poisoning.

Health hazards by lead exposure: evaluation using ASV and XRF.

Globally, of many toxic heavy metals, lead is the most widely used for various purposes, resulting in a variety of health hazards due to environmental contamination. Lead in the workplace enters the workers through inhalation of lead-contaminated air, by ingestion, and sometimes through dermal exposure. Furthermore, exposure outside the workplace can occur from inhalation of lead-contaminated air, ingestion of lead-contaminated dust and soil, consumption of lead polluted water, lead adulterated food and lead supplemented medicine. In the present study, an evaluation of blood lead was carried out with the aid of a 3010 B lead analyser, based on the principle of anodic stripping voltametry (ASV), and environmental lead in paint, soil and dust samples by a field portable X-ray fluorescence (XRF) analyser. This revealed a high incidence of lead toxicity in most of the lead-based industrial workers in the four facilities tested in India and high levels of lead in the environmental samples. Developed countries have complied with the global standards for regulating environmental lead poisoning in the workplace, eliminating to some degree excessive exposure to lead. A developing country, such as India, can tackle this problem by implementing national and international policies. The US Occupational Safety and Health Administration (OSHA) and Environmental Protection Agency (EPA) regulations, which are of prime importance, or similar regulations, can be adapted for use in India and implemented to minimize lead exposure and to reduce the resultant health hazards.