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Introduction: The aim of the study was to assess the effect of lead concentration and shift work on the occurrence of insomnia in the employees of the Zinc Steelworks in Miasteczko Śląskie in Poland. Materials and Methods : The study group consisted of 240 employees of the zinc smelter, reporting periodic and control examinations to the Occupational Medicine Clinic. Respondents were asked to complete a questionnaire consisting of the Athens Insomnia Scale and questions about the place and nature of work. Results: Analyzing the results of lead and zinc proporphiryn( ZPP) levels in the shift and non-shift subgroups of the study group, a slightly higher mean level of lead and ZPP was found in the shift subgroup. Using logistic regression, the probability of insomnia was determined depending on the concentration of lead and ZPP in the organism. As the level of lead and ZPP increases in the study group, the probability of insomnia increases. It is the largest among the examined group working in shifts. Conclusions: As the blood lead level increases, the likelihood of insomnia in steel plant workers increases.

The negative impact of lead exposure on young children and those who become pregnant is well documented but is not well known by those at highest risk from this hazard. Scientific evidence suggests that there is no known safe blood lead level (BLL), because even small amounts of lead can be harmful to a child's developing brain (1). In 2012, CDC introduced the population-based blood lead reference value (BLRV) to identify children exposed to more lead than most other children in the United States. The BLRV should be used as a guide to 1) help determine whether medical or environmental follow-up actions should be initiated for an individual child and 2) prioritize communities with the most need for primary prevention of exposure and evaluate the effectiveness of prevention efforts. The BLRV is based on the 97.5th percentile of the blood lead distribution in U.S. children aged 1-5 years from National Health and Nutrition Examination Survey (NHANES) data. NHANES is a complex, multistage survey designed to provide a nationally representative assessment of health and nutritional status of the noninstitutionalized civilian adult and child populations in the United States (2). The initial BLRV of 5 μg/dL, established in 2012, was based on data from the 2007-2008 and 2009-2010 NHANES cycles. Consistent with recommendations from a former advisory committee, this report updates CDC's BLRV in children to 3.5 μg/dL using NHANES data derived from the 2015-2016 and 2017-2018 cycles and provides helpful information to support adoption by state and local health departments, health care providers (HCPs), clinical laboratories, and others and serves as an opportunity to advance health equity and environmental justice related to preventable lead exposure. CDC recommends that public health and clinical professionals focus screening efforts on populations at high risk based on age of housing and sociodemographic risk factors. Public health and clinical professionals should collaborate to develop screening plans responsive to local conditions using local data. In the absence of such plans, universal BLL testing is recommended. In addition, jurisdictions should follow the Centers for Medicare & Medicaid Services requirement that all Medicaid-enrolled children be tested at ages 12 and 24 months or at age 24-72 months if they have not previously been screened (3).

PURPOSE: Lead Poisoning is a major health problem in Iran. We aimed to compare efficacy of a standard regimen (Succimer) with that of a low-priced combination of D-penicillamine and Garlic in outpatients with lead poisoning. METHODS: In this retrospective cross-sectional study, year-long clinical files of outpatients with lead poisoning in two referral toxicology clinics in Mashhad, Iran were reviewed. A total of 79 patients (all men), received either Succimer or a combination of D-penicillamen plus garlic (DPN + Gar), for 19 and 30 days, respectively. Clinical and laboratory data, including blood lead level (BLL), were analyzed and treatment expanses were compared between the two regimens. RESULTS: Of 79 male patients, 42 were treated by DPN + Gar and 37 received Succimer. Mean BLL of DPN + Gar group before treatment (965.73 ± 62.54 µg/L) was higher than that of the Succimer group (827.59 ± 24.41) (p

Introduction: Lead is a heavy metal with vast usage in the industry. Lead toxicity affects any organ in the body. It causes various clinical presentations, which leads to diagnostic complexity. Regarding recent increased observation of cases with lead toxicity in our center, we aimed to evaluate the frequencies of lead toxicity in patients referred to Imam-Reza Hospital’s laboratory and find a possible relationship between the blood lead level (BLL) and hematological and biochemical tests. Methods: From 2016 to 2017, the patients referred to Imam-Reza hospital’s laboratory to detect BLL enrolled in the study. Among them, 254 adult cases with BLLs≥10 μg/dl were selected. Complete blood counts and peripheral blood smear were done. Other lab data were extracted from hospital files. Results: The mean BLL of 1649 participants was 59.11±116.25 μg/dl, ranging from 0 to 1580. Sixty nine percent of them had lead toxicity. Eighty-one percent (n=1341) of patients were males and 18.7% (n=308) were females. In 254 selected cases, the mean BLL was 138.17±189.98 μg/dl. There were significant inverse correlations between BLL and red blood cell counts, hemoglobin, mean cell hemoglobin, total iron-binding capacity, target shape and basophilic stippling, as well as positive correlations between BLL and white blood cell counts, red cell distribution width, neutrophil counts and iron. Conclusion: Lead toxicity seems to be more frequent than it is expected. Patients with unexplained anemia with increased iron and decreased total iron-binding capacity are better to be evaluated for BLL.

A negative association between blood Pb level (BPbL) and vitamin D metabolites in occupationally exposed populations has been reported, but data from the general population are scarce. Furthermore, the association between BPbL and vitamin D binding protein (DBP) and free 25-hydroxyvitamin D (25(OH)D) has not been reported. We investigated the association of BPbL with DBP, total and free 25(OH)D in healthy adolescents (n 1347; age range 11–16 years) cross-sectionally selected from all Governorates of Kuwait, utilising multi-stage cluster random sampling. Pb in whole blood was analysed by inductively coupled plasma MS, and DBP with ELISA. Plasma 25(OH)D was analysed by LC-MS/MS, and free 25(OH)D was calculated utilising the levels and binding affinities of DBP and albumin for 25(OH)D. DBP was positively associated with BPbL (β = 0·81; 95 % CI 0·14, 0·22; P < 0·001). A negative association between BPbL and total 25(OH)D was non-significant (P = 0·24) when BPbL was used as a continuous variable but was significant when used as quartiles (P = 0·02). The negative association between BPbL and free 25(OH)D was significant whether BPbL was used as continuous, as quartiles or as cut-off point of

Background Bone is thought to be the reservoir of the human lead burden, and vitamin D is associated with bone turnover. We aimed to explore whether exposure to lower 25-hydroxy vitamin D (25(OH)D) levels was associated with higher blood lead levels (BLLs) by increasing the bone turnover rate in individuals with type 2 diabetes. Methods A total of 4103 type 2 diabetic men and postmenopausal women in Shanghai, China, were enrolled in 2018. Their 25(OH)D, β-C-terminal telopeptide (β-CTX), N-MID osteocalcin and procollagen type 1 N-peptide (P1NP) levels were detected. Their BLLs were determined by atomic absorption spectrometry. Mediation analyses were performed to identify the possible role that bone turnover played in the underlying mechanisms. Results In both the men and postmenopausal women, all three bone turnover markers were inversely associated with 25(OH)D and positively associated with the BLL (all P < 0.01) after adjusting for age, current smoking habits, metabolic parameters, duration of diabetes, vitamin D intake, and use of anti-osteoporosis medication. In the mediation analyses, none of the direct associations between 25(OH)D and BLL was significant for the three bone turnover markers, but all three bone turnover markers were found to be significant mediators of the indirect associations between 25(OH)D and BLL. Conclusion The association between vitamin D and BLL was fully mediated by bone turnover markers in type 2 diabetic patients (mediation effect). This finding suggested that vitamin D may protect against blood lead exposure from the bone reservoir by decreasing bone turnover in individuals with type 2 diabetes.

Lead is a heavy metal without a biological role. High level of lead exposure is known to be associated with hypertension, but the risk at low levels of exposure is uncertain. In this study, data from US NHANES 1999–2016 were analyzed. Adults with blood lead and blood pressure measurements, or self-reported hypertension diagnosis, were included. If not already diagnosed, hypertension was defined according to the AHA/ACC 2017 hypertension guideline. Results were analyzed using R statistics version 3.5.1 with sample weight adjustment. Logistic regression was used to study the association between blood lead level and hypertension. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated. Altogether, 39,477 participants were included. Every doubling in blood lead level was associated with hypertension (OR [95%CI] 1.45 [1.40–1.50]), which remained significant after adjusting for demographics. Using quartile 1 as reference, higher blood lead levels were associated with increased adjusted odds of hypertension (Quartile 4 vs. Quartile 1: 1.22 [1.09–1.36]; Quartile 3 vs. Quartile 1: 1.15 [1.04–1.28]; Quartile 2 vs. Quartile 1: 1.14 [1.05–1.25]). In conclusion, blood lead level is associated with hypertension in the general population with blood lead levels below 5 µg/dL. Our findings suggest that reducing present levels of environmental lead exposure may bring cardiovascular benefits by reducing blood pressure.

Exposure to lead, a toxic metal, can result in severe effects in children, including decreased ability to learn, permanent neurologic damage, organ failure, and death. CDC and other health care organizations recommend routine blood lead level (BLL) testing among children as part of well-child examinations to facilitate prompt identification of elevated BLL, eliminate source exposure, and provide medical and other services (1). To describe BLL testing trends among young children during the coronavirus disease 2019 (COVID-19) pandemic, CDC analyzed data reported from 34 state and local health departments about BLL testing among children aged

To see the present scenario of blood lead (BPb) levels of Silver Jewellery Workers (SJW) and its effects on haematological and heme biosynthesis parameters. Forty-two SJW of having an age range of 20-45 years were included for this study and compared with 50 healthy male subjects of the same age. Blood lead, RBC δ- aminolevulinic acid dehydratase (δ-ALDH), urinary δ- aminolevulinic acid (U- δ-ALA), urinary porphobilinogen (U-PBG) and haematological parameters were measured. Blood lead level of silver jewellery workers was significantly elevated (p

Graphical abstract, Highlights • BLL had a significant direct correlation with abnormal neurobehavior. • Serum serotonin levels were significantly lower in children with high blood lead levels (BLL). • Serum serotonin and dopamine receptor expression were upregulated in children with high BLL. • Serum serotonin levels had significant negative association with adverse neurobehavior. • Dopamine receptor expression had significant positive association with adverse neurobehavior., Present study aimed to assess the alterations in neurotransmitter expression and its association with Blood Lead Level (BLL) and neurobehavioral pattern in children. 72 school going children were recruited. Blood lead levels were determined by Atomic Absorption Spectrophotometer. Neurobehavioral state was assessed by means of population specific scale i.e. CPMS (Childhood Psychopathological measurement Schedule). Serum serotonin and dopamine were estimated by ELISA, receptor and transporter gene expressions were assessed by quantitative real time PCR. Significant positive correlation was observed between Total CPMS score (i.e. adverse neurobehaviour) and BLL. Further, serum serotonin levels and dopamine receptor expression showed a negative and positive association with BLL, respectively. In similarity, serum serotonin levels showed a negative correlation and dopamine receptor expression had a significant positive correlation with total CPMS score. Environmental exposure to Lead (Pb) may result in significant alterations in the neurotransmitter levels which may be associated with neurobehavioral changes in the children exposed to Pb.

Effect of use of Activated Carbon Fabric (ACF) mask on blood lead (PbB), lipid peroxide, erythrocytes-Superoxide Dismutase (SOD), Catalase, Ceruloplasmin, and liver functions tests of battery manufacturing workers (BMW) were studied. For this study, 36 male battery manufacturing workers, those who are regularly using ACF mask for two months were included. A blood sample was collected before and after using ACF masks from battery manufacturing workers and estimated the blood lead level, liver function tests, oxidative stress, and antioxidant status parameters by using the standard method. After two months use of ACF mask by BMW, the blood lead level (P

The risk of hearing loss from exposure to ototoxic chemicals is not reflected in occupational exposure limits and most jurisdictions. The aims of this research were to investigate dose-response relationships between exposure to lead, mercury, toluene, and styrene and hearing impairment based on current epidemiological evidence, conduct cross-jurisdictional comparisons, and investigate control measures for exposure to ototoxic chemicals. Ovid Medline and Ovid Embase databases were used to find relevant publications. A total of 86 epidemiological studies met the eligibility criteria for final evaluation. When significant associations between exposure and outcome were identified, exposure levels were evaluated to determine whether No Observed Adverse Effect Level (NOAEL) and Lowest Observed Adverse Effect Level (LOAEL) could be identified. Cross-jurisdictional comparisons included the U.K., U.S., Canada, and Australia occupational health and safety legislations. The majority of lead (75%), styrene (74%), and toluene (77%) studies showed significantly increased risks of hearing loss from exposure to these substances, although numerous studies on toluene (70%) and styrene (16%) compared auditory function between "solvent mixture" or "noise and solvent mixture" exposed groups and controls and not necessarily on groups exposed to a single agent. Based on five studies, blood lead ranges of 1-1.99 μg/dL to 2.148-2.822 μg/dL were identified as NOAELs while blood lead levels of 2 μg/dL up to 2.823-26.507 μg/dL were identified as LOAELs for hearing loss. Except for general duty clauses, the U.S., Canadian, and Australian jurisdictions have set no enforceable regulations specific to ototoxic chemical exposures. A biological exposure index of 2 μg/dL is recommended for prevention of hearing impairment from lead exposure. Based on Safe Work Australia, noise exposure limits may be reduced to 80 dB(A) for 8 hr. Other recommendations include performing audiometric testing and controlling exposure through all routes of entry.

Opium sale is prohibited in Iran, and sellers mix it with lead to increase the weight. Herein, we describe neuromuscular findings in nine patients who developed lead poisoning due to opium/drug consumption. The mean age of patients was 53 ± 3.5 years and their mean blood lead level was 122.6 ± 20.8 μg/dL. Most of the patients had an acute/subacute course presenting as axonal or demyelinating sensorimotor polyneuropathy, motor neuron disease, and multiple mononeuropathies with favorable response to the chelation therapy. Lead poisoning should be considered in patients with a history of opium use and neuromuscular symptoms.

Background: Uremic pruritus (UP) is commonly described as a daily or near-daily occurrence of itch that spans large bilaterally symmetrical surface areas. Blood lead level (BLL) has been noted to be associated with inflammation and nutritional status in long-term HD patients. Objective: To evaluate the possible relationship between BLL and UP in chronic HD patients. Patients and Methods: This Cross-Sectional Study was carried out in the Hemodialysis Unit in EL Agouza Hospital from November 2018 to the end of April 2019 and included 100 randomly selected patients with end- stage who received hemodialysis sessions thrice weekly, four hours /session, for more than 6 months. Dialysate with standard ionic composition and a bicarbonate-based buffer is used for all patients. Results: The mean age of the chosen patients were ±SD 48.6 ± 7.1 years and the difference among the groups was non-significant (p-value 0.116). The study included 42 females (42%) and 58 males (58%). There was no significant difference among the studied groups (p=0.292) regarding sex. According to Pruritus Onset in our study, there was a non-statistically significant difference among the studied groups. In our study, there was a statistically highly significant difference among different groups regarding Serum Lead (μg/dL) (p-value

Background We aimed to provide a quantitative summary of evidence for a relationship between prenatal lead (Pb) exposure and birth weight. Methods PubMed and Web of Science databases were searched for eligible epidemiological studies. We transformed findings in eligible studies with different effect-size metrics to standardized regression coefficients, and used fixed-effects or random-effects models to assess the pooled effects of prenatal Pb exposure on birth weight. Results There was a significant negative association between prenatal Pb exposure and birth weight. Birth weight reduction was associated with elevated lead levels in maternal blood (β = -0.094; 95% confidence interval [CI]: -0.157 to -0.030) and cord blood (β = -0.120; 95% CI: -0.239 to -0.001). Conclusions This meta-analysis is the first to provide a quantitative assessment of Pb exposure during pregnancy and an increased risk of lower birth weight.

Objective: Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. Methods: This descriptive cross-sectional study was performed on 30 cadavers, suspected of lead poisoning. The hospital records and the results of anatomical investigations were studied. Data were collected in a researcher-made questionnaire and analyzed in SPSS Version 22. Results: The results showed a significant correlation between the pathological results of pulmonary autopsy and the duration of drug use (P= 0.01). Also, the pathological results of cardiac autopsy had significant correlations with age (P= 0.006) and blood lead level (P= 0.03). Moreover, significant correlations were found between the pathological results of liver autopsy and age (P=0.00), between the pathological results of brain autopsy and the route of drug administration (P=0.01), and between the pathological results of kidney autopsy and age (P=0.00). Most pathological changes were observed in the brain and kidney tissues. Conclusion: Lead poisoning does not cause any specific pathological changes in the liver, heart, brain, lung, or kidney tissues; however, these non-specific changes, alone or together, can lead to death

The current study was aimed to ascertain the effect of blood lead level on brain tissues in patients with type 2 diabetes. A total of 300 human participants ages 27 to 60 years with type 2 diabetes (n = 150) and healthy individuals (n = 150) were included in this study. The serum samples were used for measuring HbA1c and fasting blood glucose. Blood lead level was measured using flame atomic absorption spectrophotometer. Magnetic resonance imaging sub-analysis was used to assess the brain hyperintensities. Brain hyperintensities were found in 55% of patients with diabetes and 6% of non-diabetic control group subjects. The deep white matter hyperintensities were observed in 45% of diabetic patients, while the subcortical hyperintensities were noted in 10% of cases. Entorhinal cortex changes (31%) and hippocampus changes (42%) were noted in diabetic patients with brain hyperintensities. Diabetic patients with brain hyperintensities showed higher blood lead levels, HbA1c, and fasting blood sugar (p

The objective was to determine if refugee females of reproductive age (FRA) are at risk of having elevated blood lead levels (BLL). A retrospective quality improvement project conducted at a Denver community health center (9/2014–3/2019) evaluated BLLs from initial domestic medical examinations (DME) in 312 FRA refugees (13–45 years). Associations between elevated BLL and demographic factors were explored using multivariable regression analysis. Of 312 FRA refugees, BLLs ranged from

We herein report a 24-year-old male construction worker with occupational lead poisoning who presented with acute abdomen and normocytic anemia. The levels of urinary delta-aminolevulinic acid and free erythrocyte protoporphyrin were elevated without any increase in the level of urine porphobilinogen. Detection of an elevated blood lead level of 100 μg/dL confirmed a diagnosis of lead poisoning. Chelation therapy with calcium disodium ethylenediaminetetraacetate resulted in prompt improvement of the clinical symptoms and the blood lead level. Clinicians should be aware that lead poisoning caused by occupational exposure can still occur sporadically in construction workers in Japan.

Background Abdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose. This study aimed to determine the prevalence of abdominal pain in patients seen in the Laghman Hakim Hospital ED and GI clinic who were lead-intoxicated, with or without opiate use disorder. Methods Between July 2017 and January 2018, patients seen in the ED and GI clinic of Loghman Hakim Hospital with unexplained abdominal pain or abdominal pain resistant to treatment were enrolled. Informed consent was obtained from potential enrollees. For standardization, a pre-designed data collection tool was developed for uniform data acquisition. Opiate use was determined historically. For this study, lead poisoning was defined as a blood lead level (BLL) greater than or equal to 30 μg/dL (1.45 μmol/L) with concomitant GI symptoms. Results Of 125 patients admitted, 28 (22.4%) had BLLs higher than 30 μg/dL. None of the patients had signs and symptoms of opioid withdrawal syndrome during evaluation. Elevated BLLs were significantly correlated with oral opium use/abuse, history of addiction for over the preceding 12 years. The daily opium use was more than 2.75 g. There was a statistical correlation between lead toxicity and abdominal pain consistency and intensity, constipation, and paresthesias. Anemia, leukocytosis, and abnormal liver enzyme tests were laboratory findings associated with lead toxicity. Four patients died, one of whom was diagnosed with lead toxicity. Conclusion Lead toxicity should be considered in the potential differential diagnosis of severe and resistant abdominal pain in patients referring to general EDs or GI clinics if a positive history of opium abuse exists.

Background Encephalopathy is an uncommon but serious presentation of lead toxicity. Objective We aimed to determine and follow-up the brain magnetic resonance imaging (MRI) abnormalities in the patients with lead encephalopathy due to ingestion of lead contaminated opium. Methods In a cross-sectional study during lead-contaminated opium outbreak, all lead-poisoned patients with any signs/symptoms of encephalopathy were included. Results Of 19 patients with lead encephalopathy, five died early and other five could not be sent to MRI during their hospitalization period. Mean age was 51 ± 11 years and males were dominant (89%). Median [IQR] blood lead level (BLL) was 101 [81, 108] μg/dL (range; 50 to 200 μg/dL). There was no correlation between MRI findings and signs/symptoms. MRI was normal in six and abnormal in three. Bilateral symmetric involvement of parieto-occipital lobes was observed. Gray matter, gray-white matter junction, and subcortical white matter were also affected. Follow-up MRI was performed in two with abnormal MRI which showed complete and near complete resolution of the abnormalities after cessation of opium use and treatment. Conclusion: There was no correlation between MRI findings and BLL. Complete recovery of brain MRI lesions was detected after cessation of opium use.

Lead is a widely used heavy metal, which is absorbed in humans by different routes. It causes wide varieties of health hazards including eye pathologies. Diabetic retinopathy (DR) is a common complication of diabetes mellitus. The current study was conducted to study blood lead level (BLL) as a risk factor for development of retinopathy among diabetics. Two hundred thirty-six diabetic patients, aged above 45 years, were examined for DR through dilated fundus examinations. Whole blood samples were collected for BLL assay by atomic absorption. Diabetic retinopathy was graded following the Scottish grading system. Diabetic retinopathy was observed in 75 (31.7%) cases. BLL was significantly higher (p = 0.0083) in DR cases [GM = 8.5 µg/dl (95% CI 8–9)] in comparison with the other diabetics without DR [GM = 10.25 µg/dl (95% CI 9.4–11). Also, BLL was significantly correlated with the grade of retinopathy (p value = 0.0023, r = 0.386). In addition, the data revealed that the effect of BLL in pathogenesis of DR was more significant among females and participants aged below 60 years. The current data suggested that high BLL can be considered as a contributing factor for development of DR among diabetics. Further larger and long-term studies are recommended for more robust data.

OBJECTIVES Multiple case reports of lead toxicity related to retained bullet fragments in pediatric patients sustaining gunshot wound have been published. The purpose of the present study was to determine whether the demographic and clinical characteristics of gunshot wounds (GSWs) could be classified high/low risk and whether routine blood lead monitoring is necessary in these patients. METHODS A single-center prospective case series of pediatric GSW patients presenting to the emergency department (ED). The data points that were collected and analyzed included age, sex, race, wound location, disposition, and baseline and follow-up lead levels within 6 months post-injury. RESULTS Twenty patients were enrolled in the study and the median age was 7.5 years (interquartile range 5.25-10.75); 75% of the patients were African American. A total of 15 patients (75%) had injuries in either a lower or upper extremity, 9 of whom required admission. Almost all of the injuries involving the head, chest, or abdomen required admission. Of the patients, 65% were admitted and 35% were discharged. All of the patients had an initial blood lead level taken, and follow-up lead levels were determined at 6 months post-injury to be

Aims: This study aimed to evaluate the association between blood lead level (BLL) and abdominal aortic calcification (AAC) in US adults aged ≥40 years.Methods: We obtained data from 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). Participants missing the data of BLL and AAC scores were excluded. BLL was measured using inductively coupled plasma mass spectrometry directly. AAC scores were quantified by Kauppila score system, and severe AAC was defined as AAC score >6. Weighted multivariable regression analysis and subgroup analysis were conducted to explore the independent relationship between BLL with AAC score and severe AAC.Results: A total of 1,530 participants were included with the mean BLL of 1.45 ± 1.31 ng/dl and mean AAC score of 1.40 ± 3.13. The prevalence of severe AAC was 7.98% overall, and participants in higher BLL quartile showed higher prevalence of severe AAC (Quartile 1: 3.55%, Quartile 2: 7.28%, Quartile 3: 9.88%, Quartile 4: 12.58%, P < 0.0001). BLL was positively associated with higher AAC score (β = 0.15, 95% CI: 0.02, 0.27, P = 0.021) and increased risk of severe AAC (OR = 1.11; 95% CI: 1.00–1.22; P = 0.047). Subgroup analysis and interaction test indicated that the association between BLL and AAC was similar in different population settings.Conclusions: Higher BLL was associated with higher AAC score and increased risk of severe AAC. Lead burden should be considered for people with AAC in clinical settings.

The objective of this report is to update the previous one. A mother developed pre-eclampsia at term and delivered an infant with multiple congenital abnormalities which were likely related to the mother’s high blood lead level. This level was due to a bullet lodged in the fourth lumbar vertebra for the previous 15 years. It increased during the third trimester from 31 to 85 micrograms per deciliter. The infant’s cardio-vascular birth defects were surgically repaired and she underwent repeated chelation which reduced her blood lead level to undetectable. Her other birth defects resolved, she completed high school and is in excellent health.

Occupational Lead (Pb) exposure increases reactive oxygen species and has been reported to impact inflammatory response by modulating intracellular signaling pathways. Selenium (Se) a vital component of the antioxidant system that plays an important role in modulating cytokines. The present study evaluated Se, malondialdehyde (MDA), total antioxidant capacity (TAC) and cytokines (IL-6, TNF-α, IL-10, IL-17a) in 81 Pb exposed male workers. The median (range) of blood lead level (BLL) and Se were 5 (0.50–31.76) µg/dL and 104 (46.9–189.6) µg/L respectively. The Se, TAC levels were decreased, and MDA, IL-6 levels were increased in the high Pb group (>5μg/dL). Blood lead level independently predicted oxidative stress and antioxidant status. Selenium, TAC levels negatively and MDA, IL-6 levels positively correlated with BLL. Association of Se with IL-6 and TAC suggests some probable role of Se in the underlined mechanism of Pb toxicity.

IMPORTANCE: Childhood lead exposure has been linked to disrupted brain development, but long-term consequences for structural brain integrity are unknown. OBJECTIVE: To test the hypothesis that childhood lead exposure is associated with magnetic resonance imaging (MRI) measurements of lower structural integrity of the brain in midlife. DESIGN, SETTING, AND PARTICIPANTS: The Dunedin Study followed a population-representative 1972-1973 birth cohort in New Zealand (N = 564 analytic sample) to age 45 years (until April 2019). EXPOSURES: Childhood blood lead levels measured at age 11 years. MAIN OUTCOMES AND MEASURES: Structural brain integrity at age 45 years assessed via MRI (primary outcomes): gray matter (cortical thickness, surface area, hippocampal volume), white matter (white matter hyperintensities, fractional anisotropy [theoretical range, 0 {diffusion is perfectly isotropic} to 100 {diffusion is perfectly anisotropic}]), and the Brain Age Gap Estimation (BrainAGE), a composite index of the gap between chronological age and a machine learning algorithm–estimated brain age (0 indicates a brain age equivalent to chronological age; positive and negative values represent an older and younger brain age, respectively). Cognitive function at age 45 years was assessed objectively via the Wechsler Adult Intelligence Scale IV (IQ range, 40-160, standardized to a mean of 100 [SD, 15]) and subjectively via informant and self-reports (z-score units; scale mean, 0 [SD, 1]). RESULTS: Of 1037 original participants, 997 were alive at age 45 years, of whom 564 (57%) had received lead testing at age 11 years (302 [54%] male) (median follow-up, 34 [interquartile range, 33.7-34.7] years). Mean blood lead level at age 11 years was 10.99 (SD, 4.63) μg/dL. After adjusting for covariates, each 5-μg/dL higher childhood blood lead level was significantly associated with 1.19-cm(2) smaller cortical surface area (95% CI, −2.35 to −0.02 cm(2); P = .05), 0.10-cm(3) smaller hippocampal volume (95% CI, −0.17 to −0.03 cm(3); P = .006), lower global fractional anisotropy (b = −0.12; 95% CI, −0.24 to −0.01; P = .04), and a BrainAGE index 0.77 years older (95% CI, 0.02-1.51 years; P = .05) at age 45 years. There were no statistically significant associations between blood lead level and log-transformed white matter hyperintensity volume (b = 0.05 log mm(3); 95% CI, −0.02 to 0.13 log mm(3); P = .17) or mean cortical thickness (b = −0.004 mm; 95% CI, −0.012 to 0.004 mm; P = .39). Each 5-μg/dL higher childhood blood lead level was significantly associated with a 2.07-point lower IQ score at age 45 years (95% CI, −3.39 to −0.74; P = .002) and a 0.12-point higher score on informant-rated cognitive problems (95% CI, 0.01-0.23; P = .03). There was no statistically significant association between childhood blood lead levels and self-reported cognitive problems (b = −0.02 points; 95% CI, −0.10 to 0.07; P = .68). CONCLUSIONS AND RELEVANCE: In this longitudinal cohort study with a median 34-year follow-up, higher childhood blood lead level was associated with differences in some MRI measures of brain structure that suggested lower structural brain integrity in midlife. Because of the large number of statistical comparisons, some findings may represent type I error.

Previous epidemiological studies showed that blood lead level (BLL) was associated with malaria infection and severity. Therefore, the present study aimed to qualitatively and quantitatively synthesize the evidence on the association between BLL and risk of malaria infection and severity using the systematic review and meta-analysis approach. Potentially relevant studies were identified from three databases using a combination of search terms. The quality of the included studies was assessed using the checklist for the cross-sectional studies developed by the Joanna Briggs Institute. The qualitative synthesis of the risk or odds of malaria infection in patients with BLL was performed as the outcome of each included study could not be pooled. The pooled mean BLL and prevalence of malaria infection of the included studies was estimated using a random-effect model. The heterogeneity of the outcomes among the included studies was assessed using the Cochran Q test and I2 statistics. The subgroup analysis of the study sites and participants was performed to explore the source(s) of heterogeneity of the outcomes. Publication bias was assessed in the case of more than 10 studies used for pooling of the same outcome. Among 114 potentially relevant studies identified from the databases, 6 eligible studies were included for qualitative and quantitative syntheses. The results showed that the pooled mean BLLs were 7.33 μg/dL in children (95% confidence interval (95%CI), 4.08–10.58; I2, 98.2%), 7.94 μg/dL in children with BLL > 45 mg/dL before chelation (95%CI, 7.87–8.01), 7.41 μg/dL in infants (95%CI, 7.34–7.48 μg/dL), 9.20 μg/dL in children with malaria (95%CI, 9.16–9.24 μg/ dL), and 36.37 μg/dL in pregnant women (95%CI, 34.43–38.31 μg/dL). The prevalence rates of malaria among participants (2381 participants, 803 malaria-positive patients) were 53% in children (95%CI, 50–57%; I2, 99.8%), 24% in children with BLL > 45 mg/dL before chelation (95%CI, 21–27%), 12% in infants (95%CI, 8–18%), and 21% in pregnant women (95%CI, 18–26%). The subgroup analysis of countries demonstrated that the prevalence rates of malaria among participants was 17% in Benin (95%CI, 13–21%; I2, 98.8%) and 36% in Nigeria (95%CI, 10–63%; I2, 99.4%). BLL associated with decreased risk of malaria was demonstrated by two studies conducted in Benin and Nigeria, while BLL associated with increased risk of malaria was demonstrated by a study conducted in Nigeria. BLL was associated with the risk of severe malaria, involving severe neurological features and severe anemia. In conclusion, the present systematic review and meta-analysis determined the current status of the studies on BLL and risk of malaria in African countries. Further studies are needed to investigate the impact of BLL on patients with malaria to help the clinician determine the risk of severity, such as the development of neurological features or severe anemia, among patients exposed to lead.

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 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.

OBJECTIVE To investigate the lead exposure levels, and the effect of blood lead level (BLL) on recurrent respiratory infections in children aged 3-7 years in Shenyang. METHODS A case-control study including 78 children with recurrent respiratory infections and 141 controls was performed. Venous blood was obtained for BLL, and a questionnaire was completed. RESULTS The BLL was significantly higher in children with recurrent respiratory infections than that in the control group [Median (IQR): 2.56 (1.29-6.19) vs 1.99 (0.90-5.92) µg/dL, P=0.029]. Children with BLL ≥1.95 µg/dL were more likely to be suffering from recurrent respiratory infections (OR=2.328, 95%CI=1.228-4.413) than those with BLL

Activated carbon fabrics (ACF) mask prevents the absorption of lead and reduce its adverse effects of human health. Aim of this study to know the blood lead level and its effects on heme biosynthesis and hematological parameters after using 2 months activated carbon fabric mask of battery manufacturing workers (BMW). Blood lead level, heme biosynthesis and hematological parameters were measured by using standard method. Blood lead level (P

The aim of this study was to investigate whether elevated blood lead level (BLL) is a risk factor for Helicobacter pylori infection. Upper gastrointestinal endoscopy was performed on 2,625 subjects...

Background Evidence of chronic low levels of exposure to heavy metals in Sri Lanka has emerged in a number of studies carried out in the recent past. The source and magnitude of such exposures have to be understood in order to assess the risk of adverse health effects of this exposure and to propose suitable public health interventions. Methods An assessment was carried out to quantify chronic exposure to cadmium, lead and arsenic through food in people living in an area in Sri Lanka, where prevalence of Chronic Kidney Disease of unknown origin (CKDu) is highest. First a dietary survey was carried out in the subjects to estimate the type and quantity of typical food items in order to estimate an average consumption. A model diet was formulated using this dietary consumption data; and this was thereafter used for estimation of chronic dietary exposure of selected contaminants. In parallel, the levels of contaminants of interest in the various identified food items: cadmium, lead and arsenic, were determined. Results Assuming the major route of intake is food, and based on the quantity and type of food items consumed, a 60 kg man is exposed to average doses of 83.7 μg cadmium, 924.1 μg lead, and 180.3 μg arsenic per week. The impact of chronic lead exposure was affirmed by a mean blood lead level of 3.0 μg/dL, with a maximum level of 8.8 μg/dL being observed in some cases. Conclusions Chronic low dose exposure of lead from food appears to be a public health concern in the studied population. Cadmium exposure through food appears to be of concern also. However, arsenic exposure through food appears to be within safe limits. As there are numbers of possible adverse health outcomes that can be associated with such estimated exposures of heavy metals, public health interventions are warranted to limit the described harmful exposures. Advocacy on dietary patterns and agronomic practices to lower the contaminants identified are the two broad strategies suggested.

Summary Background Irritable bowel syndrome and elevated blood lead level share certain gastrointestinal symptoms. Objective We measured blood lead levels in IBS patients, comparing them with IBS severity. Methods This cross-sectional study included 324 patients with newly diagnosed IBS and 147 healthy subjects as control. All participants completed a questionnaire on their current gastrointestinal symptoms and a blood sample was taken so as to determine the blood lead level via atomic absorption spectrophotometer technique. Patients were subsequently assessed in terms of IBS severity. Findings Mean blood lead level was significantly higher in the IBS group compared to the control group (7.5 ± 5.4 mcg/dL vs. 5.8 ± 3.4 mcg/dL, P = 0.001). Moreover, 59% of IBS patients and 44% of the healthy subjects had blood lead level > 5 mcg/dL (P = 0.004). Only 38% of patients with diarrhea alone versus 59–83% in the other groups had high blood lead levels (P Conclusion High blood lead level may be a concern in IBS patients, particularly in IBS-C and unclassified IBS groups and those with severe gastrointestinal manifestations.

This study aimed to compare the prevalence of elevated blood lead level in children with constipation to the population prevalence. We reviewed the charts of 441 children who were screened with a blood lead level on presenting to the gastroenterology clinic at UPMC Children’s Hospital of Pittsburgh for evaluation of constipation. The prevalence of blood lead level greater than 5 µg/dL was 1.36% (6/441; 95% confidence interval = 1.23% to 1.49%), which is significantly lower than the 4.01% prevalence in the population reported by the Center for Disease Control and Prevention. No patients had a blood lead level greater than 10 µg/dL. Age under 5 years old showed an increased odds of lead level greater than 5 µg/dL (odds ratio = 7.5; 95% confidence interval = 1.2 to 47.3, P < .05). We concluded that children seen in the gastroenterology clinic for constipation are unlikely to have an elevated blood lead level on routine screening.

Background The ger (“tent city”) areas in Mongolia are a product of rapid urbanization and transitional economic development combine with lack of institutional, administrative and financial capacity of governments to cope with the pace. These areas have become traps for inequities in social and environmental services and the associated effects on human health. Disparities in childhood lead exposure in such communities are largely unexplored. Methods We measured the concentrations of lead in blood of children, aged 4–7 years, in Erdenet (Orkhon Province) and Darkhan (Darkhan-Uul Province), the second and third largest cities in Mongolia. A survey instrument was used to gather information on influencing factors on lead exposure and the Strengths and Difficulties Questionnaire (SDQ) was used to assess a spectrum of behavioral problems among the children. Results The mean blood lead level (BLL) of children in the two cities was found to be 3.8 ± 2.6 μg/dL (range

Context While public health programs and policies have worked to reduce lead exposure, lead poisoning remains a major preventable public health concern in the United States. Objective In Clark County, Nevada, blood lead level (BLL) screening has historically been sparse. Thus, the purpose of this study was to evaluate the impact of the Southern Nevada Childhood Lead Poisoning & Prevention Program (CLPPP) in increasing screening efforts and identifying children with elevated blood lead levels (EBLLs). Main outcomes The proportion of children screened after the implementation of the CLPPP and the number of children identified with detectable BLLs. Results A total of 43 028 BLL results for children younger than 6 years were assessed from 2006 to 2011. More than 19% of children tested during the project period had a detectable BLL. The number of BLL tests for children younger than 6 years increased from 4180 in 2005-2006 to 9304 in just the second year of CLPPP implementation. Once the initial implementation grant was over and additional funding was unavailable, the BLL screening once again declined to 5541 in 2016-2017. Conclusion Evaluation of CLPPP activities suggests that outreach and education efforts, funded by the Centers for Disease Control and Prevention, played a significant role in increasing blood lead screening in Southern Nevada. However, despite these efforts, less than 5% of all children younger than 6 years were screened, which has declined further after the end of federal support.

Objective: This study aims to find the blood lead levels in pregnant women and its association with pre-eclampsia. Material and methods: The study included 44 healthy pregnant females and 23 pre-eclamptic women. Demographic data and common risk factors for lead toxicity were recorded including age, residence, occupation, husband occupation, passive smoking, use of cosmetics, kajal, surma, receiving supplements/vitamins, history of house remodelling, plumbing, source of potable water, paint in house, use of lead-glazed ceramic and pica. Venous blood was collected and lead level was determined by atomic absorption spectrometry. Results: The mean blood lead level was 2.38 ± 2.43 ug/dL in controls and 3.42 ± 2.18 ug/dL in preeclamptic women which was significantly higher (p = 0.0132). Strong correlation of BLL was observed with blood pressure in pre-eclamptic women. Pre-eclamptic patients were observed to be at increased risk of being lead exposed in terms of occupation and living conditions. Conclusion: Higher blood lead level is associated with increased risk of preeclampsia. Patients should be counselled for lifestyle modification to prevent complications. Keywords: Lead, Preeclampsia, Heavy metal, Pregnancy

Human exposure to toxic metals is on the increase especially in the developing world; this is compounded by the almost unavoidable application of the metals domestically and industrially and their implication in several genetic defects, aging and some chronic illnesses including Autism Spectrum Disorders (ASD). This study investigated the concentration of toxic metals (Pb and V) and micro-essential elements (Cu and Se) in children with ASD and controls in Nigeria towards establishing their possible associations with the aetiopathogenesis of ASD. Eight children clinically diagnosed by Paediatric Neurologist and Child Psychiatrist for ASD using DMS-IV and fifteen apparently healthy children (age range 2 - 12 years) were recruited as cases and controls respectively. Plasma levels of Pb, V, Cu and Se were analyzed using Induction ICP-MS. Results were analyzed using students t-test. The mean plasma lead and vanadium levels were (7.92 ± 1.30 μg/dl; 1.07 ± 0.22 μg/dl) and (6.83 ± 0.72 μg/dl; 2.59 ± 0.48 μg/dl) in children with ASD and in controls respectively. The result showed that blood lead level in ASD was slightly increased but not significant when compared with control (p < 0.433). On the other hand, plasma vanadium concentration in ASD was significantly reduced (1.07 ± 0.22 μg/dl) when compared with control (2.59 ± 0.48 μg/dl) (P < 0.038). Mean plasma copper was similar in all participants (1.98 ± 0.13, 2.23 ± 0.12) but selenium concentrations were significantly reduced (0.37 ± 0.05 mg/L; 0.57 ± 0.02 mg/L) in ASD relative to controls respectively. Given the physiological functions of vanadium and selenium, the observed reduced levels of the two elements in children with ASD may account for the speech and other neurological dysfunctions of the brain in ASD.

Objective: There is a paucity of evidence on the lead exposure and blood pressure association in Nigeria where lead exposure is still prevalent and poorly regulated. The objective of this study was to evaluate the association between lead exposure using blood lead level and blood pressure in Port Harcourt Nigeria. Methodology: A prospective cross sectional comparative study of adult subjects with occupational lead exposure and controls, performed in Port Harcourt, South-south Nigeria. Blood lead measured by atomic absorption spectrophotometry was used as the biomarker of lead exposure while systolic and diastolic blood pressures and other relevant variables were measured and analysed. Results: The mean systolic blood pressure was significantly higher in lead exposed subjects 118.49 (14.67) mmHg compared to controls 113.62 (11.31) mmHg (p = 0.008). No difference was observed in the mean diastolic blood pressure. A higher proportion of subjects had systolic and diastolic pressure > 140 mmHg and >90 mmHg compared to controls 9.47% vs. 1.25% and 10.51% vs. 2.54%, with (p = 0.016), OR = 8.27 , RR = 1.38 and (p = 0.028), OR = 4.59 , RR = 1.33 respectively. There was no significant statistical correlation between blood lead and blood pressure. Conclusion: The results of this study indicate a significant systolic blood pressure elevation and prevalence of hypertension among lead exposed workers in Port Harcourt Nigeria. Lager longitudinal research is needed to evaluate lead exposure and elevated blood pressure association in Nigeria. The findings call for better regulation of occupational lead exposure in Nigeria.

On May 17, 2017, the Food and Drug Administration (FDA) issued a safety recall for the Magellan Diagnostics' LeadCare Testing Systems due to the potential for inaccurately low blood lead test results when used with venous blood samples. The Centers for Disease Control and Prevention (CDC) announced a health alert with retesting recommendations because those with a blood lead level of concern may have been missed and not connected to the appropriate follow-up services. A qualitative evaluation of 9 state childhood lead poisoning prevention programs' experiences is presented in this report. Interviewees reported using a variety of media and notification methods to inform key stakeholders about the recall and recommendations. Challenges experienced by programs in responding to retesting recommendations include incomplete and out-of-date lists of LeadCare users; missing or inaccurate information in their surveillance database; not having large laboratories and hospitals consider contacting persons for retesting to be within their purview; and having limited staff members to conduct emergency response activities. Two of the 9 states report subsequent challenges with their retesting rates. The retesting recommendations were generally viewed positively. The interviewees' comments provide insight into steps CDC might take to better serve state and local lead programs. Programs' experiences have led to a better understanding of the roles of their program when emergency events occur, their relationship with stakeholders as related to the blood lead testing and reporting process, and areas of improvement in surveillance databases. Public health agencies at all levels have important roles to play in preventing lead exposures and providing needed services when exposures occur. Programs may achieve long-term benefits by improving surveillance systems and having a better understanding of laboratory practices. CDC will continue to provide timely information and recommendations to state and local public health agencies to inform both routine and emergency response activities.

Childhood lead poisoning continues to be a persistent environmental pediatric health problem in New Hampshire (NH). In 2015, 660 (4.9%) children younger than 6 years had blood lead levels of 5 µg/dL or more, the Centers for Disease Control and Prevention's recommended level for public health action. Yet, only 16.8% of NH children younger than 6 years were tested. NH's Healthy Homes and Lead Poisoning Prevention Program (HHLPPP) identified 2 barriers to blood lead testing and the opportunities to resolve them: (1) venous testing had lower compliance and resulted in costly follow-up time for providers and (2) lack of understanding in the medical community about the importance of blood lead testing. Strategies to engage pediatric providers needed to recognize the realities of this rural state. In 2016, a strategy with goals of increasing blood lead screening and testing rates statewide with focus on high-risk communities was developed and implemented. The 5-part integrated strategy included the following: (1) implement a medical education program for pediatric providers; (2) increase provider awareness of point-of-care testing equipment; (3) create and distribute medical reference materials; (4) develop parent reminders for blood lead tests; and (5) increase the availability of point-of-care testing equipment. During 2016, NH's HHLPPP presented 25 medical education sessions. Blood lead testing rates improved dramatically, especially at medical sites where both face-to-face education and point-of-care testing were implemented. NH's success serves as a model for other rural areas seeking to improve lead screening rates.

Introduction: Carpal tunnel syndrome (CTS) is a severe complication observed in long-term maintenance hemodialysis (MHD) patients. The most common cause of CTS is dialysis-related β2-microglobulin amyloidosis, which is associated with inflammation and oxidative stress in dialysis patients. Patients on MHD have higher blood lead levels (BLLs) than the general population. Lead (Pb) exposure in chronic dialysis patients has been noted to induce oxidative stress and inflammation. Therefore, lead-related inflammation and oxidative stress might contribute to CTS. Methods: The medical records of 866 MHD patients were reviewed. Two hundred and thirty-four patients with symptoms of CTS were surveyed by senior neurologists via physical examinations and nerve conduction studies. Patients in this study were stratified into groups with low-normal (20 μg/dL) BLLs. The associations between CTS and BLLs and the clinical data were analyzed. Results: Multivariate logistic regression analyses showed that Log BLL (OR: 54.810, 95% CI: 13.622–220.54, p 12.3 μg/dL (OR: 6.827, 95% CI: 3.737–12.472, p

1. Morri Markowitz, MD* 1. *Lead Poisoning Prevention and Treatment Program, Albert Einstein College of Medicine and Department of Pediatrics, Children's Hospital at Montefiore, The University Hospital for Albert Einstein College of Medicine, Bronx, NY 1. Whole blood is used to measure lead, which limits interpretation of blood lead level results. 2. The current lead poisoning intervention level is based on epidemiology, not toxicology. After completing this article, readers should be able to: 1. Describe updated knowledge about lead poisoning in children. 2. Explain why we use blood lead levels (BLLs), describe limitations in BLL interpretation, highlight the current reasons for intervening for a BLL of 5 μg/dL (0.24 µmol/L), and report the discovery of old lead sources (water and paint) in new locations (schools). 3. Discuss outcomes that support the reversibility of lead effects after treatment. Lead (Pb) poisoning can be assessed at 3 levels: the fundamental biochemical effects, subclinical organ dysfunction, and clinical disease. The presence of Pb in a child’s blood sample is an indicator that exposure and absorption have occurred. The blood Pb level (BLL) is a measure of potential toxicity because it is correlated with various health outcomes in groups of children. However, there are limitations to interpreting individual results. What is measured is not plasma Pb, the immediate and most threatening component of blood Pb, which can leave the blood compartment and enter cells. Rather, due to historical laboratory limitations, it is overwhelmingly (∼98%) red blood cell Pb content that is assessed. Thus, the BLL is a surrogate measure 2 steps removed from tissue cell Pb, the site of most toxicity. In addition, the reside time (similar to half-life, a term that is strictly defined as the time for radioactivity of an isotope to fall by 50%) of Pb atoms in blood is very different from that in the organs where it accumulates. If Pb atoms are injected into blood, half are gone in approximately 3 weeks. In contrast, those that reach and enter brain cells remain for 1 to 2 years. Most Pb …

Background:Despite declining lead exposure among U.S. children, childhood blood lead level (BLL) undertesting and elevation remains a public health issue. This study explores the impacts of maternal, infant, and neighborhood characteristics on the receipt of lead testing and having elevated BLLs (EBLLs) among children under age two.Methods:Pennsylvania infants born in 2015 and 2016 were followed to 24 months. Birth certificate data were linked to 2015 through 2018 blood lead surveillance data and neighborhood data on household income, poverty, and the burden of houses built before 1970. Generalized linear mixed models were used to examine the individual and neighborhood characteristics independently and/or interactively affecting the likelihood of lead testing and of having EBLLs.Results:A total of 48.6% of children were tested for BLLs, and 2.6% of them had confirmed EBLLs. The likelihood of lead testing and of having EBLLs among non-Hispanic black children was respectively 7% and 18% higher than white children. Children born to mothers with the lowest educational attainment (Conclusion:This cohort analysis provides more accurate estimates of lead screening rates and the percentages of EBLLs than cross-sectional analysis. Some maternal and infant demographics significantly impact the risk of undertesting and of having EBLLs, and some of the effects vary across different neighborhood characteristics. These findings can help lead prevention programs to target screening and treatment resources to children with specific characteristics.

Lead poisoning in children is a major public health concern worldwide, especially in developing countries. We conducted a cross-sectional study on 403 children aged from 3 to 14 years living nearly zinc–lead mining areas in two provinces in Vietnam (Bac Kan and Thai Nguyen) from 06/2016 to 10/2016 to identify risk factors for lead contamination. Results. The proportion of children withblood lead levels BLLs≥10 μg/dL was 80.51% in Bac Kan and 50% in Thai Nguyen; the mean blood lead level for children was14.41±9.42 μg/dL. In linear regression analyses, the body mass index was negatively associated with elevated BLLs withr=−0.404,p<0.05(95% CI: -0.801, -0.006). In multivariable regression analysis, several risk factors were associated with lead contamination including male sex (aOR=2.44, 95% CI: 1.13-5.24,p=0.02), play areas in Bac Kan (aOR=2.3(1.02-5.17),p=0.04), proximity of children’s home of less than 2 kilometers from the mine (aOR=2.90(1.54-5.44),p=0.001), and inattentive symptoms in Thai Nguyen (aOR=7.85, 95% CI 3.49-17.69,p=0.001). Environmental factors, including lead concentrations in the soil and ambient air samples in both locations, are many times higher than Vietnamese standards.

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient’s abdominal pain resolved within 4 days.

Objective To increase blood lead level screening rates in children at 12- and 24-month well visits through provider education and the implementation of a point-of-care (POC) lead screening program in 4 primary care practice offices located in and neighbored by counties with ≥5% prevalence of blood lead levels ≥5 μg/dL. Study design Baseline data were collected July 2017 to June 2018. All providers received education on screening recommendations and local prevalence of elevated blood lead levels in July 2018. POC testing began June 2019 at 1 of the 4 practice sites. Screening rates were measured by electronic medical record abstraction. Rates were plotted monthly on statistical process control charts during implementation and analyzed using logistic regression under an interrupted time series approach for program evaluation. Results There was a small but significant increase in screening following provider education (OR 1.04 per month, 95% CI 1.02-1.07). POC testing was associated with a substantial immediate increase (OR 4.17, 95% CI 2.45-7.09) and a substantial continued increase (OR 1.34 per month, 95% CI 1.17-1.54) in screening at the site that implemented POC. Conclusions POC testing substantially increases blood lead level screening rates at 12- and 24-month well visits and may be beneficial in other primary care settings.

Background Lead (Pb) is considered an endocrine-disrupting chemical. However, few studies have investigated the effects of low-level Pb exposure on plasma glucose levels. Herein, we aimed to investigate whether low-level Pb exposure causes elevated plasma glucose levels and the possible mechanisms involved. Methods We conducted a cross-sectional study of 5747 participants from 16 sites in China. The participants underwent measurements of anthropometric factors, blood lead level (BLL) and fasting plasma glucose (FPG). Wistar rats were exposed to 0.05% Pb through drinking water or fed with a high-fat diet (HFD) for 28 weeks. The relevant parameters of glucose homeostasis, hepatic glucose production (HGP) and gene expression levels of hepatic gluconeogenesis enzymes, including phosphoenolpyruvate carboxy kinase (PEPCK), glucose-6-phosphatase (G6PC) and fructose-1,6-bisphosphatase (FBP1), were measured. In addition, gene expression levels of gluconeogenesis enzymes were also measured in HepG2 cells administered with different concentrations of lead acetate for 24 h. Results In humans, after adjusting for confounders, the odds of having High_FPG (≥5.6 mmol/L) were significantly increased by 25% in the participants in the fourth BLL quartile (OR 1.25, 95% CI 1.05, 1.49). In the animals exposed to 0.05% Pb, FPG, HGP and hepatic gene expression levels of PEPCK, G6PC and FBP1 were increased. In addition, the mRNA expression levels of PEPCK, G6PC and FBP1 in HepG2 cells were also increased in response to Pb exposure. Conclusions These findings support the possibility that low-level Pb exposure may increase HGP by affecting key enzymes of hepatic gluconeogenesis, eventually resulting in impaired FPG and hyperglycemia.