Treatment of Lead-exposed Children

PEDIATRICS ◽  
1996 ◽  
Vol 98 (1) ◽  
pp. 161-162
Author(s):  
Steven M. Marcus
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Treatment Guidelines ◽  
Clinical Symptoms ◽  
Double Blind ◽  
Developmental Abnormalities ◽  
Lead Encephalopathy

I am writing in response to the recommendations in the statement "Treatment Guidelines for Lead Exposure in Children," by the Committee on Drugs, reported in the July 1995 issue of Pediatrics. The Committee did an admirable job in reviewing the various aspects of treating lead poisoning; however, there are several points that were made that need to be clarified. Although no one would argue that treatment is indicated for lead encephalopathy, there have been no studies, to my knowledge, of a double-blind, controlled nature, showing that treatment of lead poisoning, in the absence of clinical symptoms, is of any use in either reversing any neurologic or developmental abnormalities or, in fact, in prevention of such.

Screening to Prevent Lead Poisoning

PEDIATRICS ◽  
1974 ◽  
Vol 54 (5) ◽  
pp. 626-628
Author(s):  
Richard W. Moriarty
Keyword(s):  
Natural History ◽  
Lead Poisoning ◽  
Diagnostic Tests ◽  
Chelating Agents ◽  
Clinical Evidence ◽  
Clinical Symptoms ◽  
Blood Lead ◽  
Blood Lead Levels ◽  
Lead Levels ◽  
Lead Encephalopathy

The absence of fully effective treatment for lead encephalopathy, and the suggestive evidence that lead poisoning may cause brain damage even in the absence of overt encephalopathy, have led to massive efforts to prevent such damage. These preventive efforts have been directed toward screening to identify children who have absorbed an undue amount of lead from their environment, reducing their further exposure to lead, and removing already absorbed lead from those most in danger of developing ill effects. This approach has been codified in the Surgeon General's Report of 19701 which makes the following recommendations: 1. All young children who live in or visit old dilapidated buildings should have periodic blood lead determinations. 2. Any child with repeated blood lead levels over 40µg/100 ml whole blood should be considered to be at risk of lead poisoning, h ave current sources of exposure to lead investigated and corrected, and be followed closely to ensure that he does not develop higher blood lead levels or clinical symptoms. 3. All children with blood lead levels between 50 and 79µg/100 ml should have diagnostic tests for metabolic and clinical evidence of lead poisoning and be treated immediately if such evidence is present. 4. All children with blood lead levels over 80µg/100 ml should be hospitalized immediately and treated with chelating agents. Many aspects of this approach are subjects of current controversey, and the last word will not be written until much better knowledge of the natural history and ecology of lead poisoning is available.

scholarly journals Risk Of Lead Intoxication In Exposed Workers

2014 ◽  
Vol 7 (2) ◽  
pp. 123-127
Author(s):  
Tanja P. Kuneva ◽  
Diana B. Apostolova ◽  
Zlatka B. Stoyneva ◽  
Aneta B. Ivanova ◽  
Vladimira V. Boyadzhieva ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Clinical Observation ◽  
Toxic Hepatitis ◽  
Clinical Symptoms ◽  
Signs And Symptoms ◽  
Severe Form ◽  
Lead Intoxication ◽  
Metal Absorption ◽  
Exposed Workers

Summary A clinical observation of 15 workers exposed to lead, engaged in recycling of lead accumulators, was carried out. The exposition to lead aerosols varied from 2 months to 14 years. High levels of lead absorption and excretion after application of antidote therapy were found in all workers followed up. There were no manifestclinical signs and symptoms in 7 workers whom we suspected to be lead carriers. Anemia was diagnosed in 8 of the investigated persons. Severe form of intoxication, including paresis of both radial nerves, was established in one worker. Subacute lead poisoning, presenting with lead colic, anemia, toxic hepatitis and toxic polyneuropathy, was diagnosed in three persons with only several months of intensive lead exposure. Association between lead exposure, metal absorption and clinical symptoms in investigated persons were discussed.

scholarly journals Single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy versus tiotropium monotherapy in patients with COPD

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Sandeep Bansal ◽  
Martin Anderson ◽  
Antonio Anzueto ◽  
Nicola Brown ◽  
Chris Compton ◽  
...  
Keyword(s):  
Health Status ◽  
Triple Therapy ◽  
Treatment Guidelines ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Fluticasone Furoate ◽  
Double Blind ◽  
Once Daily ◽  
Copd Patients ◽  
Severe Copd

AbstractChronic obstructive pulmonary disease (COPD) treatment guidelines do not currently include recommendations for escalation directly from monotherapy to triple therapy. This 12-week, double-blind, double-dummy study randomized 800 symptomatic moderate-to-very-severe COPD patients receiving tiotropium (TIO) for ≥3 months to once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 mcg via ELLIPTA (n = 400) or TIO 18 mcg via HandiHaler (n = 400) plus matched placebo. Study endpoints included change from baseline in trough forced expiratory volume in 1 s (FEV1) at Days 85 (primary), 28 and 84 (secondary), health status (St George’s Respiratory Questionnaire [SGRQ] and COPD Assessment Test [CAT]) and safety. FF/UMEC/VI significantly improved trough FEV1 at all timepoints (Day 85 treatment difference [95% CI] 95 mL [62–128]; P < 0.001), and significantly improved SGRQ and CAT versus TIO. Treatment safety profiles were similar. Once-daily single-inhaler FF/UMEC/VI significantly improved lung function and health status versus once-daily TIO in symptomatic moderate-to-very-severe COPD patients, with a similar safety profile.

scholarly journals Clinical Trial of Efficacy and Toxicity of Disoproxil Tenofovir Fumarate and Emtricitabine for Mild to Moderate SARS-CoV-2 Infections

2021 ◽  
Author(s):  
Aldo A M Lima ◽  
Erico A G Arruda ◽  
Roberto J Pires-Neto ◽  
Melissa S Medeiros ◽  
J Quirino-Filho ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vitamin C ◽  
Respiratory Infection ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Suspicion ◽  
Pharmacological Intervention ◽  
Controlled Clinical Trial ◽  
Double Blind

This study aimed to evaluate the efficacy and toxicity of tenofovir (TDF) and TDF combined with emtricitabine (TDF/FTC) in patients with mild to moderate COVID-19 infections. We conducted a randomized, double-blind, placebo-controlled clinical trial in patients with clinical suspicion of mild to moderate respiratory infection caused by SARS-CoV-2 who were treated at an outpatient clinic. Patients were randomly recruited to take 10 days of TDF (300 mg/day), TDF (300 mg/day) combined with FTC (200 mg/day) or placebo Vitamin C (500 mg/day). The primary parameter was the score of symptoms and predictive signs of COVID-19, assessed on the seventh day of patient follow-up. From a total of 309 patients with clinical suspicion of SARS-CoV-2, 227 met the inclusion criteria and were randomly distributed into the following groups: (a) 75 (one did not initiate treatment) in the TDF group; (b) 74 in the TDF combined with FTC group; and (c) 77 in the Vitamin C group (placebo). Of the 226 patients, 139 (62%) were positive for SARS-CoV-2. Fever (37.8oC), ageusia or dysgeusia, anosmia or dysosmia, and two or more clinical symptoms or signs were significantly associated with SARS-CoV-2 infection. There was no significant change in clinical score based on clinical symptoms and signs between treatment groups. Patients with mild to moderate infection by SARS-CoV-2 had higher concentrations of G-CSF, IL-1β, IL-6 and TNF-α compared to patients without infection. Patients with mild to moderate respiratory infection, with fever (37.8oC), loss of smell, loss of taste and two or more symptoms, have a better prediction for the diagnosis of COVID-19. Patients with SARS-CoV-2 showed higher and more persistent proinflammatory cytokines profile compared to patients not infected with SARS-CoV-2. Pharmacological intervention with TDF or TDF combined with FTC did not change the clinical signs and symptoms score in mild to moderate respiratory infection in patients with SARS-CoV-2 compared to the Vitamin C group (placebo).

scholarly journals The Effects of Propolis Extract Administration on HIV Patients Receiving ARV

2021 ◽  
Vol 13 (1) ◽  
pp. 75-83
Author(s):  
Erwin Astha Triyono ◽  
Sarah Firdausa ◽  
Heru Prasetyo ◽  
Joni Susanto ◽  
James Hutagalung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Placebo Group ◽  
Clinical Symptoms ◽  
Cd4 Count ◽  
Controlled Clinical Trial ◽  
Human Immune System ◽  
Hiv Patients ◽  
Double Blind ◽  
Significant Difference

BACKGROUND: Human immunodeficiency virus (HIV) is an infectious disease that targets the human immune system by attacking cluster of differentiation (CD)4 cells. The use of propolis in HIV patients is expected to be safe and beneficial in terms of increasing endurance and immunity by its role in increasing CD4 level. This study aimed to analyze the influence of propolis supplementation in increasing the CD4 level in anti-retroviral (ARV)-treated HIV patients.METHODS: Double-blind randomized controlled clinical trial was conducted in 50 HIV patients who took regular ARV therapy. The subjects were divided into two groups, one group was treated with ARV and propolis, while another one was given ARV and placebo. The CD4 cell count was measured during pre-treatment, in the 3rd month, in the 6th month after treatment. The level of hemoglobin, leukocyte, and platelets were also measured. The SF-12 questionnaire was used to evaluate quality of life of the subject.RESULTS: Out of 50 subjects, 43 subjects completed the study, which were 19 subjects from the propolis group and 24 subjects from the placebo group. After 3-month of treatment, there was a statistically significant difference in the incrwase of CD 44 level in propolis group, while the increment was not significant in the placebo group. After 6-month treatment, the increase of CD4 level was occurred in both groups, propolis and placebo, however the increment was not statistically significant. The levels of hemoglobin, leukocyte, and platelets were not altered by the treatment and remained normal throughout the study. The quality of life was improved during the study; however, it was also not statistically significant. Mild adverse events occurred in 3 subjects which were relieved after the treatment stopped.CONCLUSION: Based on the result of this study, the administration of propolis on HIV patients receiving ARV bring significant difference in the increase of CD4 in propolis group from baseline to 3 month after the treatment. While in placebo group, this increment was not significant. At the end of study, CD4 count continued to rise up, however the increase was not statistically significant. There are no hemoglobin, leukocyte, platelets, and quality of life abnormalities. Therefore, it is necesary to do further research with a spesific CD4 count. However, it may be beneficial in relieving the clinical symptoms and quality of life of patient living with HIV.KEYWORDS: CD4, ARV, HIV, propolis

scholarly journals A Single Administration of AZP-3601, a Novel, Long-Acting PTH Analog, Induces a Significant and Sustained Calcemic Response: Preliminary Data From a Randomized, Double-Blind, Placebo-Controlled Phase 1 Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A254-A254
Author(s):  
Soraya Allas ◽  
Michel Ovize ◽  
Michael D Culler ◽  
Clarisse Geraul ◽  
Jeroen van de Wetering ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Clinical Symptoms ◽  
Phase 1 ◽  
High Dose ◽  
Single Administration ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Healthy Humans ◽  
Dose Dependent

Abstract Hypoparathyroidism is a rare disease characterized by a deficiency in parathyroid hormone (PTH) that results in hypocalcemia and hyperphosphatemia. Current treatment approaches, including high dose oral calcium and active vitamin D, as well as recombinant human PTH (1–84), do not provide adequate or consistent control of either serum calcium or clinical symptoms over a full 24-hour period. AZP-3601 is a novel 36 amino-acid PTH analog that has been designed to potently bind to the R0 conformation of the PTH1 receptor, which results in prolonged signaling responses in vitro and prolonged calcemic responses in animals despite having a short circulating half-life. A Phase 1 double-blind, placebo-controlled, single and multiple ascending dose study is being conducted to evaluate the safety, tolerability and pharmacodynamics of AZP-3601 in healthy adults. Here we report data from the first cohorts of the single ascending dose portion of the study. Sequential cohorts of 4 (cohort 1) to 8 (cohort 2 to 4) healthy male subjects aged 18–60 years, with a body mass index of 19–28 kg/m2, were assigned to receive 5, 10, 20 or 40μg of AZP-3601 or placebo at a ratio of 3:1. The study drug was administered in the morning by subcutaneous injection in the abdominal wall and was well tolerated with no remarkable adverse events. As compared with placebo controls, AZP-3601 treatment produced a clear, dose-dependent increase in mean albumin-adjusted serum calcium values from baseline. The normal physiological diurnal variation of albumin-adjusted serum calcium was gradually attenuated with 5 and 10μg AZP-3601, and was completely eliminated with 20μg. With the dose of 40μg AZP-3601, mean albumin-adjusted serum calcium values were significantly increased but stayed within normal laboratory range and remained elevated through at least 24 hours post-administration. We observed a dose-dependent decrease in mean endogenous serum PTH that was significantly correlated with the concomitant increase in mean serum calcium. These data provide initial evidence of the pharmacodynamic effect of AZP-3601 in healthy humans characterized by a sustained calcemic response for at least 24 hours following a single administration.

scholarly journals Effectiveness of hair lead concentration as biological indicator of environmental and professional exposure s

2020 ◽  
pp. 11-14
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Urine Analysis ◽  
Lead Concentration ◽  
Graphite Furnace ◽  
Ambient Air ◽  
Control Group ◽  
Professional Exposure ◽  
Hair Samples ◽  
Exposed Workers

Introduction: Biological monitoring is highly recommended to assess occupational and environmental exposures to toxic chemicals. In this context, blood and urine are conventional matrices for lead poisoning biotoxicological assessment. Blood and urine analysis are more contributive for recent lead exposure. Chronic lead exposure may have different characteristics. long-term exposure could be responsible of insidious poisoning which cannot always be assessed by these usual matrices. The aim of this study is to demonstrate that human hair can be used as an alternative matrix to detect chronic toxic exposure among occupationally and non-occupationally leadexposed subjects. Material and Method: This case-control study analyzed blood, urine and hair sampled from 40 exposed workers versus a control group of 30. Particulate matters of lead are collected from different workplace ambient air. Analysis is realized using the graphite furnace atomic absorption spectrometry. Correlations are studied between the different matrices in both groups and between seniority and lead concentrations in biological samples. Results This study concerned 70 male subjects: forty battery manufacturing factory workers and thirty controls (non-exposed to lead in their workplaces). The results showed a significant correlation between lead levels in the three matrices and the intensity of exposure among both groups (Pb hair-blood P=0.017;Pb hair-urine<0.000). Hair lead concentrations study among cases in function of occupational seniority confirmed the stability of this matrix (Pb>3000 µg/g of hair at 20 years). The study of hair lead concentration according to workplace showed a significantly higher exposure for the station of assemblers. Conclusion Hair is an efficient biological sample to assess lead poisoning especially for chronic exposure. Hair is easy to collect, to handle and gives reproducible results that may be useful in monitoring of exposed workers. Key words Lead poisoning, monitoring, exposure, hair samples.

Lead Paint Exposure in Migrant Labor Camps

PEDIATRICS ◽  
1972 ◽  
Vol 49 (4) ◽  
pp. 604-606 ◽  
Author(s):  
Michael E. Osband ◽  
James R. Tobin
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Migrant Labor ◽  
Farm Labor ◽  
Lead Paint ◽  
Rural Settings ◽  
Labor Camps ◽  
Migrant Farm

During the summer of 1970, 117 migrant farm labor camps were studied for lead paint hazard. Of these, 115 had lead-based paint on their structures. The average dwelling had 50% of its surfaces painted with lead-based paints. The average dwelling had 40% of its paint in a peeling or chipping state. We conclude that all children living in such housing should be recognized as having been subjected to lead exposure. Because of this, lead poisoning should be more thoroughly looked for in rural settings.

Bald Eagle Lead Exposure in the Upper Midwest

2014 ◽  
Vol 5 (2) ◽  
pp. 208-216 ◽  
Author(s):  
Sarah E. Warner ◽  
Edward E. Britton ◽  
Drew N. Becker ◽  
Michael J. Coffey
Keyword(s):  
Lead Poisoning ◽  
Lead Exposure ◽  
Clinical Signs ◽  
Local Environment ◽  
Bald Eagle ◽  
Haliaeetus Leucocephalus ◽  
Upper Midwest ◽  
Bald Eagles ◽  
Potential Source ◽  
Liver Lead Concentration

Abstract In 2012, we examined lead exposure in 58 bald eagles Haliaeetus leucocephalus found dead in Iowa, Minnesota, and Wisconsin. We determined lead concentrations in livers, examined differences in exposure among ages and between sexes, and recorded clinical signs consistent with lead poisoning. Most (60%) of the bald eagles had detectable lead concentrations, and 38% of the 58 had concentrations within the lethal range for lead poisoning. We found no differences in exposure based on sex or age, but we did find an inverse relationship between body and liver mass and liver lead concentration. The high percentage of lead-exposed bald eagles encouraged us to further examine potential sources of lead in our local environment. We initiated a study on the Fish and Wildlife Service's Upper Mississippi River National Wildlife and Fish Refuge to investigate if discarded offal piles from hunter-killed deer were a potential source of lead exposure to scavenging wildlife such as the bald eagle. Radiographs showed that 36% of offal piles in our sample area contained lead fragments ranging from 1 to 107 particles per pile. Our study indicated that 1) lead exposure rates for bald eagles found dead in our Upper Midwest study area were high, 2) more than one-third of the bald eagles found dead in Iowa, Minnesota, and Wisconsin had liver lead concentrations consistent with lead poisoning, and 3) discarded offal piles from deer shot with lead ammunition can be a potential source of lead exposure for bald eagles.

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