Prevalence of geophagy and knowledge about its health effects among native Sub-Saharan Africa, Caribbean and South America healthy adults living in France.

Geophagy is widespread among women from Sub-Saharan Africa, South America and the Caribbean and may persist in western countries. This practice may be associated with adverse effects such as anaemia, constipation or intestinal occlusion. We aimed to determine the prevalence of geophagy and the level of knowledge about its health effects among healthy adults originating from these countries and attending a travel medicine and international vaccination consultation in France. Among 101 travellers enrolled in the study, 83 (82.1%) were born in Sub-Saharan Africa and 13 (12.8%) in South America or the Caribbean. The mean duration of residence in France was 15.6 ± 10.4 years. Previous or current geophagy was present in 42 travellers [previous geophagy in 31 (30.7%) and current consumption in 11 (10.9%)]; 38 (90.5%) were women. The rate of awareness of harmful effects of geophagy as the risk of iron-deficient anaemia (18.8%) and soil-transmitted intestinal parasitic infections (11.9%) was low overall. Women with previous or current geophagy more often had history of iron therapy compared to those who never consumed, both during pregnancy (50.0 versus 14.3%; p = 0.0009) and outside pregnancy (47.4 versus 2.8%; p < 0.0001). Despite a long period of residence in France, geophagy was still a current practice among 10.9% of Sub-Saharan, South American and Caribbean travellers, who are poorly informed of its harmful effects. Therefore, specific information tailored to Sub-Saharan, South American and Caribbean about the risks of geophagy should be implemented in western countries.Level of evidence Level V, descriptive cross-sectional survey.

Pica, a Little-Known Condition in Dentistry. Case Report / Pica, una Condición Poco Conocida en Odontología. Reporte de un Caso

ABSTRACT: Pica is a condition associated with the chronic, compulsive consumption of a particular substance or material that is not considered food. Culturally it is not accepted by society and its nutritional value is non-existent. When this behavior is repeated consistently for more than one month, it is considered to be Pica. This eating disorder does not have a clear etiology, but is associated with; orality in children, psychotic disorders, nutritional deficiencies, psychosocial problems, autism, family problems, OCD, stress, abuse, family separations and other traumatic events. In order to detect it, it is necessary to perform a correct anamnesis, clinical examination, radiographic examination, complementary examinations such as blood count, as well as a relationship of trust between the dentist and the patient are necessary. All of them will be able to guide us and make us come out of suspicion that this harmful behavior exists, since patients often hide it.

RESUMEN: Pica es una condición asociada al consumo compulsivo y crónico de alguna sustancia o material en particular, que no es considerada alimento. Culturalmente no es aceptado por la sociedad y su valor nutricional es inexistente. Cuando esta conducta se repite consiste-ntemente durante más de un mes, se considera como Pica. Este desorden de comportamiento alimenticio no tiene una etiología clara, pero se asocia a la oralidad en niños, trastornos psicóticos, deficiencias nutricionales, problemas psicosociales, autismo, problemas familiares, TOC, estrés, abuso, separaciones familiares y otros eventos traumáticos. Para detectarla, es necesaria una correcta anamnesis, examen clínico, radiográfico, exámenes complementarios como hemograma, además de una relación de confianza rapport odontólogo- paciente. El conjunto de ellos nos podrán guiar y salir de sospecha que esta conducta dañina existe, ya que los pacientes muchas veces lo esconden.

Factors Associated with Geophagy and Knowledge About Its Harmful Effects Among Native Sub-Saharan African, Caribbean and French Guiana HIV Patients Living in Northern France.

Geophagy, or the ingestion of earth or clay, is widespread among women of Sub-Saharan African, Caribbean or French Guiana origin. Little is known about this practice among HIV patients native of these countries and who are followed-up in France. The aims of this study were to determine (i) the prevalence and factors associated with geophagy among HIV patients native of these countries, (ii) patients' knowledge about the harmful effects of geophagy, and (iii) the association of geophagy with iron deficiency, or a history of anemia or constipation. Among the 119 included patients, current geophagy and previous geophagy were present in 11/119 (9%) and 47/119 (40%) patients, respectively. Female gender was the only factor associated with consumption (OR 5.37; 95% CI 2.07-15.92 p = 0.001). Awareness about the risk of iron-deficient anemia was low (24%). Preventive education should be integrated into the care of HIV adults from countries in which geophagy is a culture and widely accepted practice.

[Geophagy and pregnancy: current knowledge and management. Clinical experiences of an obstetrical department in French Guiana]. / Géophagie et grossesse: état des connaissances et conduite à tenir. Expérience d'une maternité de Guyane française.

OBJECTIVE: To provide an overview of the current state of knowledge concerning the determinants and consequences of geophagy during pregnancy. METHOD: Bibliographic searching of articles published in English or French and included in the Scopus database, and reporting of our experience with the management of geophagic pregnant women at the maternity unit of Saint-Laurent-du-Maroni (French Guiana). RESULTS: Geophagy is a little known practice initiated by various stimuli, including nausea and iron deficiency. Sustained geophagy during pregnancy has many consequences, due to complex ionic interactions with the digestive tract. Clay consumption may lead to iron deficiency, which may even be life-threatening in cases of post-partum haemorrhage in severely anaemic women. For the foetus, in addition to the known risk of preterm birth associated with maternal anaemia, maternal geophagy may lead to overexposure to heavy metals, including aluminium in particular. This practice should therefore be considered potentially damaging to the neurological development of the child. The ionic imbalances caused by the ingestion of clay over a long period should be systematically evaluated and corrected, given the secondary malabsorption they may cause, often necessitating parenteral feeding.

Pica em gestantes adolescentes / Pica in pregnant teenagers

Objetivo: Descrever a pica em gestantes adolescentes e o efeito desse comportamento no resultado perinatal. Métodos: Estudo longitudinal com 227 gestantes/puérperas adolescentes e seus recém-nascidos, realizado no período de 2007 a 2010. Os dados foram coletados por consulta aos prontuários e por entrevista padronizada para identificaþÒo do comportamento de pica. Resultados: A pica foi referida por 19.8% das adolescentes. Comparando-se as gestantes com e sem o comportamento de pica constatou-se, respectivamente, que a média do ganho de peso no terceiro trimestre (4.87 kg e 6.10 kg; p = 0.019), o ganho de peso no segundo e terceiro trimestres (10.07 kg e 11.58 kg; p = 0.039) e o ganho de peso semanal no terceiro trimestre (0.42 kg e 0.53 kg; p = 0.010) foram significativamente menores na presenþa desse comportamento. A pica foi mais prevalente nas adolescentes com menor idade (p = 0.000) e condiþ§es de saneamento inadequado na moradia (p = 0.007). A pica nÒo associou-se O: adequaþÒo do ganho de peso gestacional, intercorrÛncias gestacionais, anemia, peso e idade gestacional ao parto e intercorrÛncias dos recém-natos. ConclusÒo: O comportamento de pica deve ser investigado no pré-natal e reconhecido como fator de risco para menor ganho de peso gestacional entre as gestantes adolescentes.(AU)

Pica em gestantes adolescentes / Pica in pregnant teenagers

Objetivo: Descrever a pica em gestantes adolescentes e o efeito desse comportamento no resultado perinatal. Métodos: Estudo longitudinal com 227 gestantes/puérperas adolescentes e seus recém-nascidos, realizado no período de 2007 a 2010. Os dados foram coletados por consulta aos prontuários e por entrevista padronizada para identificação do comportamento de pica. Resultados: A pica foi referida por 19.8% das adolescentes. Comparando-se as gestantes com e sem o comportamento de pica constatou-se, respectivamente, que a média do ganho de peso no terceiro trimestre (4.87 kg e 6.10 kg; p = 0.019), o ganho de peso no segundo e terceiro trimestres (10.07 kg e 11.58 kg; p = 0.039) e o ganho de peso semanal no terceiro trimestre (0.42 kg e 0.53 kg; p = 0.010) foram significativamente menores na presença desse comportamento. A pica foi mais prevalente nas adolescentes com menor idade (p = 0.000) e condições de saneamento inadequado na moradia (p = 0.007). A pica não associou-se à: adequação do ganho de peso gestacional, intercorrências gestacionais, anemia, peso e idade gestacional ao parto e intercorrências dos recém-natos. Conclusão: O comportamento de pica deve ser investigado no pré-natal e reconhecido como fator de risco para menor ganho de peso gestacional entre as gestantes adolescentes.

Plasma and urinary aluminum concentrations in severely anemic geophagous pregnant women in the Bas Maroni region of French Guiana: a case-control study.

The clays consumed by geophagous individuals contain large quantities of aluminum, a known neurological and hematological toxin. This is the first study to evaluate the risk of aluminum poisoning in geophagous individuals. Blind determinations of plasma and urinary aluminum concentrations were carried out in 98 anemic geophagous pregnant women and 85 non-anemic non-geophagous pregnant women. Aluminum concentrations were significantly higher (P < 0.0001) in the geophagous anemic women than in the controls, with odds ratios of 6.83 (95% confidence interval [CI] = 2.72-19.31) for plasma concentrations (13.92 ± 14.09 µg/L versus 4.95 ± 7.11 µg/L) and 5.44 (95% CI = 2.17-14.8) for urinary concentrations (92.83 ± 251.21 µg/L versus 12.11 ± 23 µg/L). The ingested clay is the most likely source of this overexposure to aluminum. If confirmed, the clinical consequences of this absorption for pregnant women and their offspring should be explored.

Polipica durante el embarazo: geofagia asociada al consumo de tiza y pagofagia a la ingesta de jabón / Polypica during pregnancy: geophagia associated to chalk consumption and pagophagia simultaneous to soap intake

La polipica es un trastorno que se manifiesta por el consumo persistente de dos o más sustancias no nutritivas. Se describen dos casos de puérperas que presentaron este hábito durante el embarazo, una refiere el consumo diario de tierra y tiza; la otra gestante manifiesta la ingesta diaria de hielo junto con el consumo de jabón con una frecuencia 1 vez a la semana. Ambas mujeres presentaron antecedentes familiares para el trastorno. La evaluación antropométrica fue adecuada tanto para las gestantes como para los neonatos, no obstante en las mujeres la ingesta de hierro resultó deficiente y los parámetros bioquímicos revelaron anemia ferropénica.

Polypica is a disorder that manifests itself through the persistent consumption of two or more non-nutritious substances. Two cases were reported regarding puerperal women who presented the habit during pregnancy, one of them referred due to her daily consumption of earth and chalk and the other gestating woman because she revealed the daily intake of ice together with soap consumption with a frequency of one time a week. Both women had family backgrounds for the disorder. The anthropometric evaluation was adequate both for pregnant women and neonates; however, iron intake was deficient for women and biochemical parameters revealed iron deficiency anemia.

Ingestão de itens não alimentares (Pica) em pacientes em diálise peritoneal / Intake of non-food items (Pica) in peritoneal dialysis patients

Introdução: A palavra pica é definida como o desejo intenso e persistente da ingestão de itens não-alimentares com pouco ou nenhum valor nutricional.Pacientes em diálise podem estar propensos a tal distúrbio. Objetivo: Investigar a prevalência de pica em pacientes em diálise peritoneal. Métodos:Através de entrevista e aplicação de questionário, foram avaliados 106 pacientes maiores de 20 anos, submetidos à diálise peritoneal ambulatorial contínua(DPAC) ou à diálise peritoneal automatizada (DPA). Nos pacientes que apresentavam pica, foram coletados exames bioquímicos, incluindo: albumina,cálcio, creatinina, ferritina, ferro, fósforo, glicemia, hematócrito, hemoglobina, potássio, transferrina e uréia séricos, além do Kt/V para determinação da adequação dialítica. Os pacientes tiveram peso e estatura medidos, para cálculo do índice de massa corporal (IMC). Resultados: A idade dos pacientes foi de 57,1±14,3 anos (média±DP). Observou-se que 32% (n=34) dos indivíduos entrevistados apresentavam pica. Destes, a maioria dos praticantes(76,5%, n=26) era do sexo feminino. Os itens ingeridos em maior prevalência foram: gelo (25%), vinagre (20,8%) e suco de limão puros (12,5%). Não houvediferença significativa na presença de pica entre obesos e não obesos, assim como o problema não foi associado à anemia, sobrepeso ou à inadequacidade dialítica. Conclusão: A ingestão de itens não-alimentares não é um achado incomum na população em diálise peritoneal.

Introduction: The word pica is defined as an intensive and persistent desire for the intake of non-food items with little or no nutritional value. Dialysis patientsmay be susceptible to such disturbance. Objective: To investigate the prevalence of pica in a population of peritoneal dialysis patients. Methods: An openinterview and a questionnaire were applied to 106 patients in continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD).Patients younger than 20 years were excluded from the study. For those patients who presented pica, biochemical analysis was performed, which included the serum measurements of albumin, calcium, creatinine, ferritin, iron, phosphorus, glucose, hematocrit, hemoglobin, potassium, transferrin and urea. Moreover, the delivery dose of dialysis was assessed by the calculation of Kt/V. Also, the body mass index (BMI) was calculated using measured weight and height. Results: The pica practice was observed in 32% (n=34) of the PD patients, whose age was 57.1±14.3 years (mean ±SD). From these patients, the majority of pica practitioners (76.5%, n=26) was female. The most reported consumed items were: ice (25%), pure vinegar (20.8%) and lemon juice(12.5%). There was no significant difference in the presence of pica between obese and non-obese patients, and the problem was not associated w i t h anemia, overweight or dialysis inadequacy. Conclusion: The intake of non-food items is not an uncommon finding in the peritoneal dialysis population.

[Blood lead levels in children and environmental legacy of a lead foundry in Brazil]. / Chumbo no sangue de crianças e passivo ambiental de uma fundição de chumbo no Brasil.

OBJECTIVE: To determine the blood lead levels in children living near an inactive lead foundry in the city of Santo Amaro da Purificação, state of Bahia, in September of 1998; and to identify factors associated with differences in these levels. METHODS: Cross-sectional study with children between 1 and 4 years of age living within 1 km of the lead foundry. Mothers or guardians of 47 children answered a questionnaire concerning ingestion of clay, soil, plaster and/or other materials (pica), and other relevant epidemiological aspects. The concentration of lead in blood was determined by atomic absorption espectrophotometry. RESULTS: The mean blood lead level was 17.1 +/- 7.3 micro g/dL. Blood lead levels were approximately 5 micro g/dl greater among children with pica, regardless of age, visible presence of scum surrounding the home, employment status of the father, family history of lead poisoning, and malnutrition. CONCLUSIONS: The environmental legacy of the lead foundry, which was shut down in 1993, continues to represent a relevant risk factor for increased blood lead levels in children, especially those presenting pica.

Chumbo no sangue de crianças e passivo ambiental de uma fundição de chumbo no Brasil / Blood lead levels in children and environmental legacy of a lead foundry in Brazil

OBJETIVO: Determinar os níveis de chumbo no sangue de crianças que moravam próximo a uma fundiçäo de chumbo desativada na Cidade de Santo Amaro da Purificaçäo, Estado da Bahia, em setembro de 1998; e identificar fatores associados à variaçäo destes níveis. MÉTODOS: Estudo de corte transversal com crianças de 1 a 4 anos de idade que residiam a menos de 1 km da fundiçäo. Mäes ou responsáveis por 47 crianças responderam questionários sobre transtornos do hábito alimentar (comer barro, terra, reboco ou outros materiais) e outros aspectos epidemiológicos relevantes. A concentraçäo de chumbo no sangue foi determinada por espectrofotometria de absorçäo atômica. RESULTADOS: O nível médio de chumbo foi de 17,1 ± 7,3 mig/dL. Os níveis de chumbo no sangue foram cerca de 5 mig/dL mais elevados em crianças que tinham transtorno do hábito alimentar, independentemente da idade, presença de escória visível no peridomicílio, situaçäo de emprego do pai, história familiar de intoxicaçäo pelo chumbo e desnutriçäo. CONCLUSÖES: O passivo ambiental da fundiçäo de chumbo, desativada em 1993, permanece como um fator de risco relevante para elevar os níveis desse metal no sangue de crianças, particularmente aquelas que apresentam transtornos do hábito alimentar

Environmental factors associated with blood lead levels in Venezuelan children.

A preliminary study explored the relative contribution of residential sources of lead exposure on mentally challenged children who attend "special education" institutions (GI) compared to a group of age and sex matched school children (G2). We captured descriptive information and analyzed demographic variables, personal and household information, medical effects, environmental exposure factors, and children habits. Home paint, dust, soil, and water sampling was conducted and blood lead (BPb) levels determined. Eighteen G1 and 20 G2 children were studied. The mean G1 BPb was 16.9 +/- 7.9 microg/dl and was significantly higher than that in G2. Fifty percent of G1 children had PbB >20 microg/dl and 72.2% were >10 microg/dl. Low muscular strength, decreased osteotendinose reflexes, fine and gross motricity, deficient equilibrium, and hipotonic muscular tone coincided with >18 microg/dl BPb levels. In 61.1% of G1 homes paint lead levels were higher than permissible levels and 33.3% had dust lead exceeding that level. The high BPb levels in G1 probably resulted from ingestion of household paint, dust, and soil via "hand-to-mouth" activity. Environmental exposure to lead can be an important source of lead intake by infants and children and could affect neurological development. This study provides new insights currently unavailable for these children in Venezuela.

Perforación intestinal por pica / Small bowel perforation due to pica

Se presenta el caso de paciente masculino de 24 años de edad, con antecedentes del uso de diversos inhalantes tóxicos, que ingresó al Servicio de Urgencias del Hospital General de México, con un cuadro de abdomen agudo y oclusión intestinal. Fue sometido a laparotomía, encontrandose oclusión intestinal complicada con perforación, causada por objetos extraños, como tapas de refresco y licor, papel de aluminio, limones en fracciones, plásticos y huesos de pollo, que en total sumaron 24. Se le realizó resección intestinal, ileostomía y procedimiento de Hartmann para el segmento distal. Su evolución posoperatoria fue tórpida. Fue sometido a dos reoperaciones más por obstrucción y evisceración. Esta última, se presentó nuevamente y fue ocasionada por la gran inquietud secundaria a síndrome de abstinencia a algún tóxico no determinado y tuvo que ser manejado con abdomen abierto contenido hasta su egreso 20 días después. En conclusión, el fenómeno de pica es muy raro, generalmente se presenta en pacientes con deficiencia mental, pero también puede presentarse en pacientes con estado neurológico alterado que, por efecto de drogas o alcohol, ingieren todo tipo de objetos, los cuales en determinado momento puedan causar un cuadro de obstrucción y/o perforación en cualquier parte del tubo digestivo. Es importante reconocer el síndrome de abstinencia a tóxicos, para evitar posibles complicaciones posoperatorias

Blood lead levels in children with foreign bodies.

To determine the risk of increased blood lead levels in children with aural, nasal, or gastrointestinal foreign bodies, the authors prospectively obtained venous blood lead and erythrocyte protoporphyrin levels from 40 study patients and two control groups without foreign bodies (65 patients presenting to a medical clinic and 40 patients presenting to an emergency department). A questionnaire was used to assess environmental and behavioral risk factors for lead poisoning in the three groups. Mean blood lead level was higher in children with foreign bodies (P less than .001), and they were more likely to have a venous blood lead value of more than 1.2 mumol/L (25 micrograms/dL, P less than .01) than patients in either control group. Seventy-eight percent of study patients had no prior lead screening by parent's report vs 64% of emergency department control subjects and 55% of medical clinic control subjects. Control patients in the emergency department had the same incidence of elevated blood lead values as patients enrolled from the medical clinic (6%). No differences in environmental risk factors were found among the three groups. Study patients more often had a history of pica or ingestion of a poison than control patients from the medical clinic. Inner-city children with foreign bodies have increased lead exposure and may have an increased risk for lead poisoning. In areas of high prevalence of lead poisoning, children with foreign bodies should be screened for lead poisoning in the emergency department. General lead screening in the emergency department may be justified for high-risk, inner-city populations.

Visceral larva migrans in seven members of one family in Trinidad.

The occurrence of the first seven cases of visceral larva migrans in Trinidad and Tobago is described. All cases occurred in children of the same family. The ELISA test was used to confirm the clinical diagnosis.

PIP: Visceral larva migrans is a syndrome caused by the extraintestinal migration of larval nematodes of wild and domestic animals through human tissues. Most cases occur in children under 5 years of age, with the common dog round worm apparently being the primary causative agent. This paper describes the occurrence of the first 7 cases of visceral larva migrans in Trinidad and Tobago. Cases occurred among siblings in the same family and were confirmed using the ELISA test. A mentally retarded 10-year old East Indian male was admitted to the Port of Spain General Hospital with a strong history of pica, recurrent wheezing, and epilepsy. Five siblings and one cousin were found living under extremely unsanitary conditions and in dire poverty. All had pica and Toxocara canis eggs were found in the dirt surrounding the dwelling. These eggs are most probably the common source of infection. Infection with Toxocara species is probably far more common than reported in Trinidad, given the large stray dog population and areas of primitive sanitary conditions. ELISA tests could be used to reveal additional infections in the country.

Tricobezoar y úlcera gástrica en pediatría: reporte de 1 caso / Gastric trichobezoar and ulcer in pediatric patient: a case report

Presentamos un caso de tricobezoar gástrico diagnosticado en una paciente pediátrica que presentaba tricotilomanía y tricofagia. Se halló además una úlcera gástrica no sangrante en curvatura mayor, hallazgo radiográfico confirmado en el acto quirúrgico en que se extirpó el tricobezoar. Se hace una revisión sobre las características más importantes que acompañan a esta rara patología

Quantitative assessment of geophagous behaviour as a potential source of exposure to geohelminth infection.

The most common form of pica, geophagy, has direct adverse nutritional effects and also exposes children to soil-borne infection. Existing methods for assessing geophagy are either inappropriate for field use (radiology) or unreliable (reporting). A new method is described, based on the measurement of soil-derived silica in stools. More than 90% of silica is excreted within one gut transit period of ingestion. The amount excreted is proportional to the amount ingested. Faecal levels of dietary silica (less than 2% dry wt stool) can be distinguished from levels due to geophagy (up to 25% dry wt stool). Studies in 2 children's homes in Jamaica showed that 33% and 66% of children were geophagous, ingesting up to 10 g soil day-1. The geophagy of less than 20% of the children accounted for greater than 60% of the total soil ingested. This overdispersion of exposure to soil-borne infection may contribute to the observed aggregation of geohelminth infection.