Lead intoxication: A summary of the clinical presentation among Thai patients

Lead is an important toxic metal found in industrial communities. Due to the industrialization in the recent decade in Thailand, lead intoxication as a toxicant-related disorder becomes a new public health problem. A retrospective study on clinical presentation of hospitalized patients with diagnosis of lead intoxication during year 1990–1999 in King Chulalongkorn Memorial hospital, the largest Thai Red Cross Society Hospital, was performed. All 14 cases diagnosed with lead intoxication were identified in our series. Average age of the subjects was 25.55 ± 21.93 years old. Male predominance was detected in our series (male:female = 12:2). Two main groups of subjects as; (1) childhood aged below 10 years old (male:female = 4:2) and (2) adult aged between 24 and 60 years old (n = 8, all male), can be identified. For the first group, the clinical presentations were convulsion (n = 3), unexplained anemia (n = 1), attention deficit (n = 1) and asymptomatic (n = 1), respectively. All of the subjects in this group presented the history of living at the old battery plant area. Five of the six cases came from the same village. For the second group, the clinical presentations were unexplained abdominal pain (n = 5), chronic renal failure (n = 1), unexplained anemia (n = 1) and asymptomatic (n = 1), respectively. Most of the subjects (75%) in this group presented the history of working in the battery plant for more than 10 years. Another case presented the history of gunshot and residual bullet in the bone marrow. The other one left is an interesting case with the history of prolonged usage of ritual pill and holy paper incineration. Like other studies, battery plant had strong relation with the lead intoxication. Although the total identified cases are rather few, there may be more undetected asymptomatic lead intoxication cases in the community. Specific control of lead resulted from battery plant and monitoring of the workers as public health strategies are still recommended. This work was a poster presentation at the IXth International Congress of Toxicology, 8–13 July 2001, Brisbane, Australia and the abstract was published in Toxicology Volume 164 (Abstracts of the IXth International Congress of Toxicology, 8–13 July 2001, Brisbane, Australia).     

Kinetic parameters of the inhibition of red blood cell aminolevulinic acid dehydratase by triethyl lead and its reversal by dithiothreitol and zinc

In chronic or acute exposure to triethyl lead, a de novo synthesis of aminolevulinic acid dehydratase (δ-ALAD) in bone marrow and an increased activity in circulating red blood cells can be demonstrated by activating the enzyme with dithiothreitol (DTT) and zinc. We determined the median inhibitory concentration and the apparent inhibition constant for triethyl lead on δ-ALAD. After dosing with triethyl lead, in vivo inhibition of ALAD only occurred at the high dose, but activation analysis in vitro showed increased ALAD activity to be present at all dose levels in a dose-dependent fashion. The use of an activation assay for red blood cell ALAD may have value as a bio-effects monitor of exposure to organic lead.     

Blood lead level and its relationship to essential elements in preschool children from Nanning,China

ObjectiveOur study aimed to assess the distribution of blood lead level and its relationship to essential elements in preschool children in an urban area of China.Design and methodsA total of 6741 children aged 0- to 6-year-old were recruited. Levels of lead, zinc, copper, iron, calcium, and magnesium in whole blood samples were determined using atomic absorption spectrometry.ResultsThe mean blood lead level (BLL) and the prevalence of BLL ≥ 10 μg/dl (5.26 ± 4.08 μg/dl and 6.84%, respectively) increased with age gradually, and there was a gender-difference for blood lead, copper, zinc and iron levels. Compared with the group of children who had BLLs < 5 μg/dl, the groups of 5 ≤ BLLs < 10 μg/dl and 10 ≤ BLLs < 15 μg/dl showed higher blood zinc, iron and magnesium levels, and a lower blood calcium level. A positive correlation of lead with zinc, iron and magnesium, and a negative correlation of lead with calcium were found in the group of children with BLL < 5 μg/dl.ConclusionAge- and gender-differences were found when assessing the BLL and intoxication prevalence in preschool children. Metabolic disorder of essential elements was found even with a low level of lead exposure.     

Estimation of Lead Elimination Rates for Liver and Kidney Using a Physiologically- Based Pharmacokinetic Model for Improved Human Risk Analysis

This research has studied the uncertainties in a physiologically-based pharmacokinetic (PBPK) model that describes uptake, accumulation, and elimination of Pb in the human body and to estimate the model's parameters. The model's application required probabilistic Pb exposure to humans which was accomplished by determining Pb content in various food items and food consumption patterns in a rural site near Kanpur, India. The important model parameters that varied were excretion constants, KE_LI and KE_KI (1/d), for elimination of Pb from liver and kidney. For estimating these parameters, the PBPK model's equations were reorganized by incorporating steady state conditions. Measured blood and urine Pb levels were used for estimating these parameters. A significant variability was observed in estimated parameters, KE_LI (0.112 to 0.248/day) and KE_KI (0.390 to 0.794/day). This research suggested that excretion parameters must be taken in a stochastic sense for obtaining proper estimates of human risk. In addition to KE_LI and KE_KI, variability (food quantity, Pb concentration in food items, and bodyweight) was considered for estimating blood Pb concentrations through PBPK modeling and Monte-Carlo simulation. It was demonstrated that by not considering the variability, health risk was underestimated (compare 8.98 × 10^?5 [no variability] to 9.34 × 10^?3 [with variability]).     

Influence of dietary lead on fluoride bioavailability in the rat

A factorial experiment was conducted with weanling rats fed a purified diet to determine the influence of dietary lead (0 or 100 ppm) as either lead acetate or lead carbonate on fluoride bioavailability (2 or 10 ppm as sodium fluoride). During the 6-wk study, both forms of lead depressed weight gain, regardless of the fluoride level, despite the fact that food intake was similar for all treatment groups. Both forms of lead produced a small, but significant, reduction in femur and second molar fluoride. This effect, however, could only be demonstrated in rats fed diets containing 10 ppm fluoride, indicating a significant interaction between lead and fluoride for these indices of fluoride bioavailability. This interactive effect between fluoride and lead was also demonstrated for apparent fluoride absorption. Both forms of dietary lead significantly increased the lead concentration of plasma, femur, liver, and kidney, and both forms of lead significantly increased the urinary excretion of delta-aminolevulinic acid. The level of dietary fluoride failed to influence these measurements. We therefore conclude that, although small amounts of dietary lead reduce fluoride bioavailability, small amounts of dietary fluoride do not appear to significantly influence the utilization of dietary lead.     

A cell-based approach to characterize antimicrobial compounds through kinetic dose response

The rapid spread of antibiotic resistance has created a pressing need for the development of novel drug screening platforms. Herein, we report on the use of cell-based kinetic dose response curves for small molecule characterization in antibiotic discovery efforts. Kinetically monitoring bacterial growth at sub-inhibitory concentrations of antimicrobial small molecules generates unique dose response profiles. We show that clustering of profiles by growth characteristics can classify antibiotics by mechanism of action. Furthermore, changes in growth kinetics have the potential to offer insight into the mechanistic action of novel molecules and can be used to predict off-target effects generated through structure–activity relationship studies. Kinetic dose response also allows for detection of unstable compounds early in the lead development process. We propose that this kinetic approach is a rapid and cost-effective means to gather critical information on antimicrobial small molecules during the hit selection and lead development pipeline.     

Assessing Heart Rate Variability Using A 12 lead ECG In Patients With Alcohol Dependence Syndrome

Heavy or hazardous drinking is associated with an increased risk of cardiac morbidity and mortality and this has been attributed to abnormalities in cardiac autonomic regulation. Current study aimed to assess the role of simple indices derived from 12 lead ECG in subjects with chronic alcohol dependence. Data suggested that alcohol group had significantly lower 12 lead ECG derived RR variability compared to age and gender matched controls. Study further supports the implication of 12 lead derived RR variability indices in various clinical settings.     

The Influence of Liquid to Soil Ratios on Arsenic and Lead Bioaccessibility in Reference and Field Soil

In vitro bioaccessibility testing is gaining popularity as a tool to estimate the oral bioavailability of contaminants in soil for human health risk assessment (HHRA). Bioaccessibility tests are used to measure the bioaccessible fraction of a contaminant in soil, which can then be used to estimate the bioavailable fraction. Inherent uncertainties are associated with bioaccessibility tests. Various test parameters need to be carefully considered in their development, including the liquid to soil (L/S) ratio employed. We used L/S ratios (v:wt) ranging from 25 ml:1 g to 1,000 ml:1 g in a modified relative bioaccessibility extraction procedure to investigate the effects on bioaccessibility of lead and arsenic in field and reference soils. General trends of increased percent bioaccessibility of lead and arsenic with increasing L/S ratio were observed in the reference soil. A similar positive relationship was observed for lead in the field soil; soluble arsenic concentrations were below the detection limit and data were insufficient to observe a trend. Percent bioaccessibility was significantly affected at each extreme of the L/S ratios tested (p < .05). Biological relevance, technical feasibility, and mathematical relationships with in vivo results should be considered when selecting an appropriate L/S ratio for bioaccessibility testing.