LEAD & HEALTH

B i b l i o g r a p h y

ENVIS Centre

National Institute of Occupational Health

Meghani Nagar, AHMEDABAD

Front page Wrist drop http://www.henriettesherbal.com/files/images/old/thomas/thomas-lead-poisoning.thumbnail.jpg Candles: http://farm1.static.flickr.com/78/187443419_d236880476.jpg Paints: http://i.treehugger.com/images/2007/10/24/paint_india.jpg Battery http://earth2tech.files.wordpress.com/2009/01/pbc-battery.jpg Glass http://www.fi.edu/learn/brain/images/protect/DrinkingWater%27.jpg Lipsticks http://seattletimes.nwsource.com/ABPub/2007/10/26/2003977465.jpg X-ray http://www.atsdr.cdc.gov/csem/lead/images/hands.png Basophilic stripling http://www.lenntech.com/images/Water%20Borne%20Diseases/Lead-poisoning.jpg Backpage Ingots http://www.museumoflondon.org.uk/learning/features_facts/digging/crafts/images/large_lead_pig.jpg

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Working Team

Dr. Sunil Kumar Scientist F & Coordinator ENVIS Centre

Dr. Rajnarayan Tiwari Scientist C

Ms. Shruti Patel Senior Technical Assistant

Ms. Shiva Murarka Junior Technical Assistant

Printed and Published by Director

National Institute of Occupational Health Meghaninagar, Ahmedabad

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PREFACE

ead (Pb) is a ubiquitous metal, which affects human health and also alters the immune response. It ranks as one of the most serious environmental pollutants among the toxic heavy metals, which has been used by mankind for several years

because of its wide variety of application. Human are exposed to lead from various sources and a myriad of pathways like air, water, dust, soil and food. The common sources of lead exposure are use of certain products containing lead such as lead soldered cans, some health care products, folk remedies, artisans ceramics etc. Its exposure is common among industrial workers. Workers were exposed to lead in smelting, painting, plumbing, printing and many other industrial activities. Automotive use of leaded gasoline continues to be an important source of occupational as well as environmental exposure to lead. When ingested, lead accumulates in the blood, bones, and soft tissue of the body. High concentrations of lead in the body can cause permanent damage to the central nervous system, the brain, the kidneys, and red blood cells. The adverse health effects of lead pollution are known to be more pronounced in vulnerable populations such as infants, children, pregnant women and foetuses as lead is more easily absorbed into growing bodies and their tissues. Lead poisoning can be treated if treatment begins before too much damage has occurred. Lead is removed through a process called chelation, using drugs to bind to the metal in the bloodstream, flushing it out in the urine. Conversely, lead pollution remains a public health concern in developing countries such as India. Exposure to lead remains a major public concern due to its adverse effects on health in general and brain development even with low exposure level. This bibliography is prepared on the basis of the available data on environmental and occupational exposure to lead and human health from India. The data were collected through searching various databases such as PubMed, Medline, Toxline and other websites such as Goggle and consulting various journals and arranged chronologically. We are thankful to the Ministry of Environment & Forest (MoEF) for financial assistance and Dr. SP Sharma Project Director (EI), MoEF for constant encouragement and suggestions.

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Dr. P.K. Nag Director NIOH

Dr. Sunil Kumar, Scientist F & Coordinator ENVIS Centre,

NIOH

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1. Ahamed M, Fareed M, Kumar A, Siddiqui WA, Siddiqui MK Oxidative stress and neurological disorders in relation to blood lead levels in children Redox Rep. 2008;13(3):117-22 Industrial Toxicology Research Centre, M.G. Marg, Lucknow, India ahamedma@notes.udayton.edu

Oxidative stress plays a pivotal role in the pathogenesis of neurological disorders. Free radical generation appears to be the mode of lead toxicity. We evaluated the effects of blood lead levels on oxidative stress parameters in children suffering from neurological disorders. Thirty children (aged 3-12 years) with neurological disorders (cerebral palsy [n=12], seizures [n=11], and encephalopathy [n= 7]) were recruited in the study group. Sixty healthy children (aged 3-12 years) from similar socio-economic environments and not suffering from any chronic disease were taken as the controls. Blood lead levels and oxidant/antioxidant status were determined. Mean blood lead level was significantly higher while delta-aminolevulinic acid dehydratase (-ALAD) activity, a biomarker for lead exposure, was significantly lower in the study group as compared to the control group (P

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The magnitude of occupational lead exposure and its impact on liver functions was assessed in battery manufacture workers around Kolhapur (Maharashtra). Blood lead, urine lead, erythrocyte zinc protoporphyrin, urine -amino laevulinic acid and porphobilinogen levels were measured together with standard routine biochemical tests of liver functions in battery manufacture workers along with non-exposed controls subjects. Blood lead levels were considerably high in the workers (53.63±16.98; range 25.8–78g/dl) compared to the controls (12.52±4.08; range 2.8-22g/dl). The liver functions in these workers were normal, demonstrating preservation of hepatocellular and synthetic functions of liver. There was good correlation (r=0.67) between blood lead and urinary -amino laevulinic acid levels in the worker group and no such correlation was observed in case of the control group (r=0.02). The results indicates that early screening and regular monitoring of industrial workers by urinary -amino laevulinic acid levels is urgently needed to prevent long term adverse effects of lead exposure. Key words: Lead, Occupational exposure, Liver functions, Battery recycling 3. Madhavi D, Devi KR, Sowjanya BL

Increased frequency of chromosomal aberrations in industrial painters exposed to lead-based paints J Environ Pathol Toxicol Oncol 2008;27(1):53-9 Department of Zoology, Osmania University, Hyderabad 500 007, Andhra Pradesh, India madhavi_sangam@yahoo.com

The investigation was carried out in the peripheral lymphocytes of industrial painters who were exposed to dust and fumes of lead-based paints. Samples of peripheral blood were collected from 102 workers out of which 40 were smokers and 62 were nonsmokers. The painters in both the categories were divided in to 3 groups based on duration of exposure. Control data of 30 nonsmokers and 20 smokers belonging to the same socioeconomic group but not exposed to either radiation or toxic chemicals were studied. There was a significant increase in the frequency of chromosomal aberrations in the workers when compared to the controls. Further, smoking had an added effect on the frequency of aberrant metaphases. 4. Mamtani M, Patel A, Kulkarni H

Association of the pattern of transition between arousal states in neonates with the cord blood lead level Early Hum Dev 2008 Apr;84(4):231-5 Lata Medical Research Foundation, Nagpur

In this study of 167 neonates who demonstrated a total of 1010 transitions between arousal states, we considered whether specific state transitions were associated with umbilical cord

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blood lead levels. We found that the arousal patterns of neonates with varying levels (10 g/dL) of lead exposure could not be distinguished based on the NBAS scoring system alone, but their transition state patterns revealed striking differences. Specifically, the neonates with the highest lead levels were more fidgety, had more state transitions from state 5 or 6, and were least likely to fall from awake states back into lower states. Arousal state transition pattern is thus a novel correlate of umbilical cord blood lead that may be useful for risk stratification of the neonates. 5. Ravichandran B, Krishnamurthy V, Ravibabu K, Raghavan S, Rajan BK, Rajmohan HR

Assessing dust exposure in an integrated iron and steel manufacturing plant in South India Work. 2008;30(2):195-200 Regional Occupational Health Centre, Bangalore Medical College Campus, Bangalore, India. ravichandran65@yahoo.com

A study to monitor and estimate respirable particulate matter (RPM), toxic trace metal concentrations in the work environment was carried out in different sections of an integrated steel manufacturing industry. The average RPM concentration observed varied according to the section blast furnace was 2.41 mg/m3 energy optimization furnace, 1.87 mg/m3 sintering plant, 0.98 mg/m3 continuous casting machine, 1.93 mg/m3. The average trace metal concentration estimated from the RPM samples like iron, manganese, lead and chromium did not exceed ACGIH prescribed levels. 6. Raviraja A, Babu GN, Bijoor AR, Menezes G, Venkatesh T

Lead toxicity in a family as a result of occupational exposure Arh Hig Rada Toksikol. 2008 Jun;59(2):127-33 Department of Biochemistry and Biophysics, St. John's Medical College, Koramangala, Bangalore, Karnataka, India. raviraj_po@rediff.com

This article describes an entire family manufacturing lead acid batteries who all suffered from lead poisoning. The family of five lived in a house, part of which had been used for various stages of battery production for 14 years. Open space was used for drying batteries. They all drank water from a well located on the premises. Evaluation of biomarkers of lead exposure and/or effect revealed alarming blood lead levels [(3.920.94) mol/L], 50 % reduction in the activity of delta-aminolevulinic acid dehydratase [(24.675.12) U/L] and an increase in zinc protoporphyrin [(1228480) g/L]. Liver function tests showed an increase in serum alkaline phosphatase [(170.4141.82) U/L]. All other liver function test parameters were normal. Renal function tests showed an increase in serum uric acid [(515.8186.29) mol/L] while

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urea and creatinine were normal. Serum calcium was low [(1.900.42) mmol/L in women and (2.090.12) mmol/L in men], while blood pressure was high in the head of the family and his wife and normal in children. Lead concentration in well water was estimated to 180 g/L. The family was referred to the National Referral Centre for Lead Poisoning in India, were they were received treatment and were informed about the hazards of lead poisoning. A follow up three months later showed a slight decrease in blood lead levels and a significant increase in haemoglobin. These findings can be attributed to behavioural changes adopted by the family, even though they continued producing lead batteries. 7. Sadhu HG1, Amin BK2, Parikh DJ1, Sathawara NG1, Mishra U1, Virani BK2, Lakkad BC1,

Shivgotra VK1, Patel Shruti1

Poisoning of workers working in small lead-based units Indian J Occup Environ med 2008;12(3):139-141 1National Institute of Occupational Health, Meghani Nagar, Ahmedabad - 380 016, India 2Department of Medicine, B J Medical College, Civil Hospital, Ahmedabad - 380 016, India Correspondence Address: Harsiddha G Sadhu National Institute of Occupational Health, Meghani Nagar, Ahmedabad - 380 016 India

Background: No data are available with the labor departments among the workers of small-scale lead-based units with regard to lead poisoning. One hundred and ninety-five workers were investigated for lead exposure and three were found exceeding the limit of 80 mg/dL, which required a treatment for lead poisoning. Aim: To assess the exposure and health risk in workers working in small lead-based units. Setting and Design: Random sampling is selected from the cross-sectional medical study. Methods and Materials: Medical examination-cum-biochemical/hematological investigations along with blood lead estimation were carried out in these workers. Statistical Analysis: Epi-Info and SPSS 16.0 were used for statistical analysis. Results and Conclusion: Workers' blood lead levels were brought down from 114.4, 110.0 and 120.6 mg/dL with treatment of D-penicillamine to 40 mg/dL. It may be concluded that lead poisoning is a preventable public health problem that particularly affects the industrial workers in small lead-based units. Keywords: Lead poisoning, small-scale industry, treatment, workers 8. Srinivasa, Gowd S, Govil PK

Distribution of heavy metals in surface water of Ranipet industrial area in Tamil Nadu, India Environ Monit Assess. 2008, Jan; 136(1-3):197-207 National Geophysical Research Institute, Hyderabad, 500 007, India govilpk@rediffmail.com

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Ranipet industrial area is about 120 km from Chennai on Chennai-Bangalore highway and is a chronic polluted area identified by Central Pollution Control Board of India. It is one of the biggest exporting centers of tanned leather in India. The total numbers of industries located in and around Ranipet town are 240 tanneries along with ceramic, refractory, boiler auxiliaries plant, and chromium chemicals. Studies were carried out to find out the contamination of surface water bodies due to industrial effluents. The results reveal that the surface water in the area is highly contaminated showing very high concentrations of some of the heavy/toxic metals like Cadmium ranging from 0.2 to 401.4g/l (average of 51.1g/l), Chromium 2.4-1,308.6 (average of 247.2g/l), Copper 2.1-535.5 g/l (average of 95.5g/l), Nickel 1.6-147.0g/l (average of 36.7g/l), Lead 6.4-2,034.4 g/l (average of 467.8g/l) and Zinc 20.8-12,718.0g/l (average of 3,760.4g/l). The concentration levels of these metals are much above the permissible limits in surface water and are health hazards especially for the people working in the tannery industries. It was observed that the people in the area are seriously affected and suffering from occupational diseases such as asthma, chromium ulcers and skin diseases. Distribution of metals, their contents at different locations, and their effects on human health are discussed in this paper. 9. Vishwanath P, Prashant A, Devanand D, Nayak N, D'souza V, Venkatesh T

Screening of school children for blood lead levels and attempts to reduce them by nonpharmacological means in a coastal city of India Indian J Med Sci 2008;62(5):185-92 Department of Biochemistry, Kasturba Medical College, Mangalore, India mvps@rediffmail.com

Lead is a major health hazard, especially in children. Impact of lead poisoning on our society is not known. Effectiveness of environmental interventions in reducing blood lead levels is not exactly known, though the Center for Disease Control and Prevention strongly advocates use of such means. Aims: We aimed at screening school children for blood lead levels (BLLs) and reducing the BLLs of children with preliminary BLL> 20g/dL by environmental intervention and intensive education. Materials and Methods: To assess the extent of lead poisoning, a screening of 106 children was done, which showed that children belonging to a particular government primary school had higher BLLs. A second screening program of 87 children conducted in that school showed that only 19% had BLL 20g/dL. Thirty-eight children having BLL>20g/dL were selected from the two

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screening programs. After removing all potential sources of lead from their environment and educating them about the ways to prevent exposure to lead, follow-up of their BLLs was carried out at an interval of 6 months for a period of 1 year. Statistical Analysis: Values of the different follow-up studies were compared using repeated-measure ANOVA. Results: Our results showed that there was a significant (P

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Environmental lead toxicity is an old but persistent public health problem throughout the world and children are more susceptible to lead than adults because of their hand to mouth activity, increased respiratory rates and higher gastrointestinal absorption per unit body weight. In the last decade children's blood lead levels have fallen significantly in a number of countries. Despite this reduction, childhood lead toxicity continues to be a major public health problem for certain at-risk groups of children, and concern remains over the effects of lead on intellectual development. The currently approved clinical intervention method is to give chelating agents, which bind and removed lead from lead burdened tissues. Studies indicate, however, that there is a lack of safety and efficacy when conventional chelating agents are used. Several studies are underway to determine the beneficial effect of nutrients supplementation following exposure to lead. Data suggest that nutrients may play an important role in abating some toxic effects of lead. To explain the importance of using exogenous nutrients in treating environmental lead toxicity the following topics are addressed: (i) different sources of lead exposure/current blood lead levels and (ii) protective effects of nutrients supplementation (some essential elements and vitamins) in lead toxicity. 12. Ahamed M, Singh S, Behari JR, Kumar A, Siddiqui MK

Interaction of lead with some essential trace metals in the blood of anemic children from Lucknow, India Clin Chim Acta. 2007 Feb;377(1-2):92-7 Analytical Toxicology Division, Industrial Toxicology Research Centre, PO Box-80, MG Marg, Lucknow-226001, India. ahamed1123@rediffmail.com

Background: The effects of lead on the hematological system results in the inhibition of heme synthesis and in anemia. Lead may affect the absorption and metabolism of essential trace metals also. There is little information especially from the northern region of India regarding the relationship between blood lead levels 10g/dl and anemia in children. We performed a cross-sectional study to evaluate the association of blood lead levels 10g/dl with anemia, and its effect on hematological system and some essential trace metals in children. Methods: A total of 75 children aged 1-7 years, 50 anemic (Hb8 g%) and 25 non-anemic (Hb>8 g%), drawn from Lucknow, India and nearby areas were recruited to determine blood levels of lead, iron, zinc, copper, and calcium along with hematological parameters [delta-aminolevulinic acid dehydratase (delta-ALAD) hemoglobin (Hb), hematocrit, and ascorbic acid]. Results: Based on Centre for Disease Control and Prevention's intervention level of blood lead, children were categorized into those with blood lead

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(n=19) (GI) and those with blood lead

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Health hazards caused by heavy metals have become a great concern to the population. Lead and arsenic are one of the most important current global environmental toxicants. Their toxic manifestations are being considered caused primarily due to the imbalance between pro-oxidant and antioxidant homeostasis and also due to a high affinity of these metals for thiol groups on functional proteins. They also interfere with a number of other body functions and are known to affect central nervous system (CNS), hematopoietic system, liver and kidneys and produce serious disorders. They produce both acute and chronic poisoning, of which chronic poisoning is more dangerous as it is very difficult to revert back to normal condition after chronic exposure to these insidious metals present in our life. Despite many years of research, we are still far from an effective treatment of chronic plumbism and arsenicosis. Current approved treatment lies in the administration of chelating agents that forms an insoluble complex with the metal and removes it. They have been used clinically as antidotes for treating acute and chronic poisoning. The most widely used chelating agents are calcium disodium ethylenediamine tetra acetic acid (CaNa2EDTA), D-penicillamine and British anti-lewisite (BAL). Meso 2,3 dimercaptosuccinic acid (DMSA), an analogue of BAL, has been tried successfully in animals as well as in humans. But it is unable to remove the metal from intracellular sites. Effective chelation therapy for intoxication by heavy metals depends on whether the chelating agents are able to reach the intracellular site where the heavy metal is firmly bound. One of the important approaches has been the use of combination therapy. This includes use of structurally different chelators or a combination of an adjuvant/ antioxidant/ herbal extracts and a chelator to provide better clinical/ biochemical recovery. A number of other strategies have been suggested to minimize the numerous problems. This article presents the recent development made in this area with possible directions for future research. 15. Geraldine M, Herman DS, Venkatesh T

Lead poisoning as a result of infertility treatment using herbal remedies Arch Gynecol Obstet 2007 Apr; 275(4):279-81 National Referral Centre for Lead Poisoning in India (NRCLPI), Department of Biochemistry and Biophysics, St. John's Medical College, St. John's National Academy of Health Sciences, Koramangala, Bangalore, 560 034 Karnataka, India gere1@rediffmail.com

Introduction: Lead poisoning remains a major problem in our society due to the lack of awareness of its ill effects among the clinical community. The non-availability of blood lead levels at primary health centers results in many lead-poisoned cases being treated symptomatically, without the diagnosis being sought.

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Case Report: We report a case here, presenting with colicky abdominal pain receiving symptomatic treatment initially; lead poisoning was confirmed following the estimation of blood lead levels. Discussion: The consumption of unbranded herbal medicines as a causative factor for lead poisoning was confirmed by high lead content in the medicines. Surely, this demands public health programs to disseminate strategies to the medical personnel about the clinical implication of lead poisoning, as well as the general public for awareness and to prevent lead poisoning. 16. Hanif SA, Rahman A, Rizvi SJ

A study of occupation-related lead toxicity in lock factory workers in district Aligarh Journal of Forensic Medicine & Toxicology 2007, 24(2) Department of Forensic Medicine, J. N. Medical College, A.M.U., Aligarh

The present study was conducted to assess lead toxicity in lock factory workers in district Aligarh. Blood samples were collected from the workers and lead was estimated by standard method using beam atomic absorption spectrophotometer. In all factory workers the level was found to be high and the ‘p’ value was determined for statistical significance. To carry the study further the effect of lead on kidneys and blood pressure was sought. Individual renal function tests were performed and blood pressure was taken as detained in the text. Statistically the level determined was insignificant. A fall in hemoglobin was statistically significant. The systolic and diastolic blood pressure reading were subjected to ‘t’ test and showed no association with blood lead level. 17. Herman DS, Geraldine M, Venkatesh T

Evaluation, diagnosis, and treatment of lead poisoning in a patient with occupational lead exposure: a case presentation J Occup Med Toxicol. 2007; 2:7 Department of Biotechnology, MLSC, Kasturba Medical College, Manipal University, Manipal, Karnataka, India hsdsouza@gmail.com

Amongst toxic heavy metals, lead ranks as one of the most serious environmental poisons all over the world. Exposure to lead in the home and the workplace results in health hazards to many adults and children causing economic damage, which is due to the lack of awareness of the ill effects of lead. We report the case of a 22 year old man working in an unorganized lead acid battery manufacturing unit, complaining about a longer history of general body ache, lethargy, fatigue, shoulder joint pain, shaking of hands and wrist drop.

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Patient had blue line at gingivodental junction. Central nervous system (CNS) examination showed having grade 0 power of extensors of right wrist & fingers. Reflexes: Supinator- absent, Triceps- weak and other deep tendon reflexes- normal. Investigations carried out during the admission showed hemoglobin levels of 8.3 g/dl and blood lead level of 128.3g/dl. The patient was subjected to chelation therapy, which was accompanied by aggressive environmental intervention and was advised not to return to the same environmental exposure situation. After repeated course of chelation therapy he has shown the signs of improvement and is on follow up presently. 18. Kumar A, Pastore P

Lead and cadmium in soft plastic toys Current Science, 93(6), 25:2007; 818 Toxics Link, H2, Ground Floor, Jungpura Extension, New Delhi 110 014, India abhay@toxicslink.org

It is widely accepted that no level of lead or cadmium in the blood should be considered safe for children and hence every effort should be made to ensure that their environment remains free from any such toxic metals. Toys made of polyvinyl chloride (PVC) are potentially toxic to children as PVC contains both lead and cad-mium. Lead or cadmium compounds act as stabilizers but they readily leach out. Moreover, they can also be used in pigments to impart bright colours to toys in order to attract children. Chewing and swallowing beha-viour of children is a common source of lead and cad-mium exposure. The present study was undertaken to ascertain the levels of total lead and cadmium in soft plastic toys. A total of 111 non-branded toy samples, purchased randomly from three metropolitan cities of Delhi, Mumbai and Chennai, were analysed for levels of lead and cadmium. Lead and cadmium were found to be present in all tested samples in varying concentrations. Keywords: Polyvinyl chloride, risk, standards, toys, toxicity. 19. Madan K, Sharma PK, Makharia G, Poojary G, Deepak KK

Autonomic dysfunction due to lead poisoning Auton Neurosci. 2007 Mar 30;132(1-2):103-6 Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar-110029, New Delhi, India

We present a case history of a 24 years old male who developed autonomic dysfunction, intestinal pseudo-obstruction and anemia due to lead poisoning. Concomitant recording of blood levels of lead and autonomic function showed a gradual decline in blood lead level (98.8g/dL at week 0, 56g/dL at week 6, and 40g/dL at week 52) and gradual improvement in autonomic functions. Decrease in blood lead levels with DMSA (Meso-2, 3-dimercaptosuccinic acid) therapy showed

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improvement in autonomic functions. At week 0, the patient had severe loss of autonomic tone and autonomic reactivity, which improved at week 6. At the 52nd week, most of the autonomic parameters had normalized except for the persistence of mild loss of parasympathetic reactivity. 20. Naha N, Manna B

Mechanism of lead induced effects on human spermatozoa after occupational exposure Kathmandu Univ Med J (KUMJ). 2007 Jan-Mar;5(1):85-94 The Oxford College of Physiotherapy, Bangalore, India

Objectives: Occupational lead exposure caused several types of male reproductive impairments in different working populations. In the present study we examined the paint factory workers of active reproductive age and compared the data with the non-occupationally exposed desk jobholders taken as control from Bangalore, India. Materials and methods: In the above perspective, sperm cell morphology, morphometery and motile activity were assessed. Routine seminal biochemistry, cell cycle phase analysis of sperm head DNA, estimation of serum reproductive hormones and metal levels in blood and semen were also taken into account. Result: Low sperm velocity, ATPase activity, gross and forward progressive motility with high stationary motile spermatozoa revealed lowering of cellular activity after lead exposure (p

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21. Patil AJ1, Bhagwat VR2, Patil JA1, Dongre NN1, Ambekar JG1, Das KK3 Biochemical aspects of lead exposure and toxicity in spray painters of Western Maharashtra (India) J. of Environ Hlth Res, 6(2), 2007 1 Department of Biochemistry, BLDE.A’s Sri BM Patil Medical College, Bijapur-586103 Karnataka, India. 2 Department of Biochemistry, Govt. Medical College, Dhule, Maharashtra, India 3 Environmental Health Research Unit, Department of Physiology, Al Ameen Medical College, Bijapur-586108, Karnataka, India Correspondence: Kusal K. Das, Ph.D, Professor of Physiology, Al-Ameen Medical college Bijapur- 586 108, Karnataka, India. Telephone.: 91-8352-272502.

The present study was undertaken to assess biochemical, ematological and antioxidant status of possible lead exposed spray painters of Western Maharashtra (India). Thirty spray painters (SP) and thirty-five normal healthy subjects were taken (age 20-40 years) from the Western Maharashtra for this study. Venous blood samples and random urine samples were collected from both the groups. The blood Pb level of SP group (N=30) was found to be in the range of 7.5-45.7g/dL (Mean±SD, 22.32±8.87g/dL) whereas that of the unexposed control group (n=35) was in the range of 2.8-22.0g/dL (Mean±SD, 12.52±4.08g/dL). The blood lead level (Pb-B) and urinary lead level (Pb-U) were significantly increased in SP group as compared to control group. Though activated and non-activated erythrocyte-ALAD activities in SP group did not show any significant change as compared to the control group, the ratio of activated/non-activated erythrocyte ALAD activities in SP group showed a significant increase (p

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22. Patil AJ, Bhagwat VR, Patil JA, Dongre NN, Ambekar JG, Das KK Occupational lead exposure in battery manufacturing workers, silver jewelry workers, and spray painters in western Maharashtra (India): effect on liver and kidney function J Basic Clin Physiol Pharmacol. 2007;18(2):87-100 Department of Biochemistry, BLDE.A's Sri BM Patil Medical College, Bijapur, Karnataka-586103, India.

We studied liver and kidney function tests of occupational lead exposed Battery Manufacturing Workers (BMW) (n=30), Silver Jewelry Workers (SJW) (n=30), and Spray Painters (SP) (n=35) and normal healthy subjects (n=35), all 20 to 40 years of age, in Western Maharashtra (India). Venous blood and random urine samples were collected from all groups. The blood lead (Pb-B) and urinary lead (Pb-U) levels were significantly increased in all experimental groups, except urinary lead excretion in SJW as compared with the controls. Liver functions tests parameters (serum transaminase enzymes SGOT, AST, SGPT, ALT) activities were significantly increased only in SP; no alteration was noticed in BMW and SJW as compared with the control group. Serum total protein levels were significantly decreased in all three experimental groups as compared with control subjects. Serum albumin concentrations were significantly decreased in SJW, SP, and increased in BMW. The serum globulin levels, however, were significantly decreased, and the albumin/globulin (A/G) ratio was increased in BMW and SJW as compared with the control. The bilirubin level was significantly increased only in BMW. Blood urea was significantly increased only in BMW, and blood urea and serum uric acid were decreased in SJW. The serum creatinine level was not significantly altered in any experimental groups. Increased Pb-B values in all experimental groups indicate the greater rate of lead absorption and impairment of liver and kidney functions in all three types of occupational lead-exposed workers of Western Maharashtra (India).

23. Rao GM, Shetty BV, Sudha K Evaluation of lead toxicity and antioxidants in battery workers Biomedical Research 2007; 19 (1): 1-4 Department of Biochemistry, Kasturba Medical College, Mangalore, India

Oxidative damage has been proposed as one of the possible mechanisms involved in Pb toxicity. To investigate this hypothesis we estimated various blood antioxidants in 25 battery workers. Lead was analysed by Anodic stripping voltametry (ASV), all other parameters by spectrophotometric methods. Lead level was significantly high in battery workers (p=0.000). Erythrocyte superoxide dismutase (SOD) activity significantly decreased (p=0.00), whereas reduced glutathione (GSH) significantly increased (p

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peroxidation and percentage hemolysis remained unaltered. There was a strong negative correlation between blood lead level and SOD activity in the study group. Therefore, the changes in the levels of some antioxidants may play an important role in abating hazards of lead poisoning. Key Words: Lead toxicity, battery workers, antioxidant enzymes, TBARS, GSH 24. Sukumar A, Subramanian R

Relative element levels in the paired samples of scalp hair and fingernails of patients from New Delhi Sci Total Environ. 2007,Jan 1;372(2-3):474-9 School of Environmental Sciences, Jawaharlal Nehru University, New Delhi-110 067, India. sukumarindia@rediffmail.com

Specific elements are bioconcentrated in human hair and nails, which have unique advantages of application in population monitoring studies thereby, recognized as biological tools for disease diagnosis and prevention. However, investigations are meager for relative element profile in hair and nails of same subjects. In this study, hair and nails were analyzed to find effects of age, sex, smoking habit, diet, urban and rural exposure gradients, occupation, and health on element levels. Scalp hair and fingernails were sampled along with a questionnaire from urban and rural subjects of New Delhi; patients of hypertension, coronary heart disease, and diabetes were identified clinically. Cadmium, chromium, copper, nickel, lead and zinc concentrations were determined by AAS in both the samples; CRM (human hair powder) analysis showed acceptable precision and accuracy in element measurement. In comparison to controls, Cr-H and Zn-H levels were lower respectively in female hypertensive and total hypertensive subjects, whereas, Zn-N and Cu-N were lower respectively in total CHD and diabetic subjects, and hypertensive and CHD urban subjects. Cd concentrations were higher in both the samples of tobacco smoking rural subjects than that of non-smokers. Farmers had lower Pb-H than rural businessmen did. Cr, Cu, Ni, and Zn concentrations were different due to rural and urban gradient but not to the influence of age, sex, and diet. Pb value was alone correlated between the paired samples. Thus, higher Cd levels in the smokers and lower Cr, Cu and Zn levels in the patients were observed. 25. Turgut S, Polat A, Inan M, Turgut G, Emmungil G, Bican M, Karakus TY, Genc O

Interaction between anemia and blood levels of iron, zinc, copper, cadmium and lead in children Indian J Pediatr. 2007 Sep;74(9):827-30 Department of Physiology, Pamukkale University Faculty of Medicine, Denizli, Turkey.sturgut@pau.edu.tr

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Objective: Anemia is a widespread problem among infants and children in many parts of the world, and it is often associated with some trace elements (iron, zinc, copper) and heavy metals (cadmium and lead). Aim of this study was to investigate the relationship between anemia and these elements. Methods: This research was performed on 256 children (mean age 6.80.2) living in Denizli city center. We observed iron deficiency anemia (IDA) in 23 children, iron deficiency without anemia (ID) in 36 children and only anemia (ferritin level normal) (OA) in 18 children, and 179 children were found healthy and they were regarded as controls. Blood samples were taken from subjects and the concentrations of zinc, copper, iron, cadmium and lead in serum were measured with atomic absorption spectrophotometer. Results: The levels of copper, cadmium and lead in serum were significantly higher in children with IDA than those of controls (p

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0.592, P

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Globally, of many toxic heavy metals, lead is the most widely used for various purposes, resulting in a variety of health hazards due to environmental contamination. Lead in the workplace enters the workers through inhalation of lead-contaminated air, by ingestion, and sometimes through dermal exposure. Furthermore, exposure outside the workplace can occur from inhalation of lead-contaminated air, ingestion of lead-contaminated dust and soil, consumption of lead polluted water, lead adulterated food and lead supplemented medicine. In the present study, an evaluation of blood lead was carried out with the aid of a 3010 B lead analyser, based on the principle of anodic stripping voltametry (ASV), and environmental lead in paint, soil and dust samples by a field portable X-ray fluorescence (XRF) analyser. This revealed a high incidence of lead toxicity in most of the lead-based industrial workers in the four facilities tested in India and high levels of lead in the environmental samples. Developed countries have complied with the global standards for regulating environmental lead poisoning in the workplace, eliminating to some degree excessive exposure to lead. A developing country, such as India, can tackle this problem by implementing national and international policies. The US Occupational Safety and Health Administration (OSHA) and Environmental Protection Agency (EPA) regulations, which are of prime importance, or similar regulations, can be adapted for use in India and implemented to minimize lead exposure and to reduce the resultant health hazards. 29. Jain NB, Hu H

Childhood correlates of blood lead levels in Mumbai and Delhi Environ Health Perspect. 2006, Mar; 114(3):466-70 Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA

Background: Lead exposure has previously been associated with intellectual impairment in children in a number of international studies. In India, it has been reported that nearly half of the children have elevated blood lead levels (BLLs). However, little is known about risk factors for these elevated BLLs. Methods: We conducted a retrospective cross-sectional analysis of data from the Indian National Family Health Survey, a population-based study conducted in 1998-1999. We assessed potential correlates of BLLs in 1,081 children who were

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models. Compared with children 3 months of age, children 4-11 and 12-23 month of age had 84 and 146% higher BLLs, respectively (p

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Metal toxicants may affect immune regulation with an increased incidence of infectious diseases, cancer or autoimmune diseases. Lead is the leading environmental toxin among heavy metals and has aroused concern, as continuous low-level exposure leads to a variety of health problems. We compared serum immunoglobulins (Ig) and reactive oxygen and nitrogen intermediates (super oxide and nitric oxide (NO)) in culture supernatant of lead-exposed (blood lead; Pb-B>10g/dL) individuals with that of unexposed healthy controls (blood lead

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higher than that in the non-monsoon season (Geometric Mean=7.3 g/dL, SD=4.0 g/dL). A seasonal periodicity of lead in PM10 was found, with lead in monsoon season (Geometric Mean=0.04g/m3, SEM=0.000667g/m3) lower than that in the non-monsoon season (Geometric Mean=0.38g/m3, SEM=0.10g/m3). The overall level of airborne dust (PM10) in monsoon season (56.2g/m3) was lower than in the non-monsoon season (273.0g/m3), presumably due to precipitation. The comparatively higher BLLs in the monsoon season, in the presence of lower air lead levels, suggest ingestion of water or food, with greater lead contamination in the monsoon season, as a possible pathway contributing to elevated BLLs in these children in the monsoon season. These results demonstrate a significant success of the public health system in Bombay, India-achieved by the removal of lead from gasoline. The emphasis should shift in the study region towards sources of lead exposure other than leaded gasoline (lead in paints, lead in Herbal medicines and lead in Kohl). 33. Pasha SA, Sankar S, Reddy SC, Das PG, Jamil K

Lead-induced genotoxicity in lymphocytes from peripheral blood samples of humans: in vitro studies Drug Chem Toxicol. 2006 Jan;29(1):111-24 Genetics Department, Bhagwan Mahavir Medical Research Centre, Hyderabad, India.

Lead is a known toxicant that has been implicated in encephalopathy in children and may affect the gastrointestinal and hematopoietic and other systems in adults. In fact, lead has been shown to compete with calcium for entry into the synaptosome and induce toxic effects. The aim of the current study was to evaluate the cytotoxic and genotoxic effects of lead by using lymphocytes from human peripheral blood in vitro. The LC50 for lead nitrate as determined by Trypan blue dye exclusion technique was found to be 3.14 mM. Chromosomal aberration frequency at sublethal doses (1/10 of LC50) as determined by examining the metaphase chromosomes (karyotyping) did not show significant aberrations except for some aneuploidy and about 2-4% gaps, breaks (3-4%), and about 5% satellite associations. However, significant DNA damage was determined by SCGE (Comet assay). The comet tail length proportionately increased with increasing lead nitrate concentration. Thus, Pb can induce single-strand DNA breaks, possibly by competing with metal binding sites. 34. Patel KS, Shrivas K, Hoffmann P, Jakubowski N

A survey of lead pollution in Chhattisgarh State, Central India Environ Geochem Health. 2006 Feb-Apr; 28(1-2):11-17 School of Studies in Chemistry, Pt. Ravishankar Shukla University, Raipur, CG, India patelks55@hotmail.com

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Lead (Pb) is of major environmental concern due to its toxicological importance. The anthropogenic emission of Pb is at least 100 times higher than natural emissions. Soil and dust are significant sources of Pb exposure. Lead is generally immobile in soil and accumulates in the upper layers. Lead particles may enter homes via shoes, clothes, pets, and windows. Central India is rich in deposits of natural resource materials such as coal, pyrite, dolomite, and alumina that contain Pb and other heavy metals at the trace levels, and the substantial exploitation of these materials has tended to increased contamination of water and geological formations. Here we present data on Pb concentrations in the water, soil and sediment samples (n=158) collected from 70 locations in Chhattisgarh state, Raipur region. Lead concentrations in the surface water (n=44), groundwater (n=44), soils (n=60) and sediments (n=10) ranged from 6 to 1410, 3 to 52, 12.8 to 545, and 31 to 423 g/g, with mean values of 305, 16, 102 and 190g/g, respectively. Most of the Pb fractions of >80% can be leached out with the chemical extractants EDTA, acetic acid, and hydroxylamine hydrochloride. Lead has accumulated in the soil clay fraction due to its relatively large surface area and decreases with increasing depth in the soil profile. 35. Patil AJ, Bhagwat VR, Patil JA, Dongre NN, Ambekar JG, Jailkhani R, Das KK

Effect of lead (Pb) exposure on the activity of superoxide dismutase and catalase in battery manufacturing workers (BMW) of Western Maharashtra (India) with reference to heme biosynthesis Int J Environ Res Public Health. 2006, Dec; 3(4):329-37 Department of Biochemistry, BLDEA's Shri BM Patil Medical College, Bijapur, Karnataka--586103, India

The aim of this study was to estimate the activity of superoxide dismutase (SOD) and catalase in erythrocytes and malondialdehyde (MDA) in plasma of battery manufacturing workers (BMW) of Western Maharashtra (India) who were occupationally exposed to lead (Pb) over a long period of time (about 15 years). This study was also aimed to determine the Pb intoxication resulted in a disturbance of heme biosynthesis in BMW group. The blood Pb level of BMW group (n=28) was found to be in the range of 25.8-78.0 g/dL (mean+SD, 53.63+16.98) whereas in Pb unexposed control group (n=35) the range was 2.8-22.0g/dL (mean+SD, 12.52+4.08). The blood level (Pb-B) and urinary lead level (Pb-U) were significantly increased in BMW group as compared to unexposed control. Though activated d- aminolevulinic acid dehydratase (ALAD) activities in BMW group did not show any significant change when compared to control group but activated / non activated erythrocyte - ALAD activities in BMW group showed a significant increase. Erythrocyte- zinc protoporphyrin (ZPP), urinary daminolevulinic acid (ALA-U) and porphobilinogen

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(PBG-U) of BMW groups elevated significantly as compared to control. A positive correlation (r=0.66, p1.0) were observed in control group. Hematological study revealed a significant decrease of hemoglobin concentration; packed cell volume (%) and other blood indices and a significant increase of total leucocytes count in BMW group in comparison to control group. The serum MDA content was significantly increased (p

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concentration (p

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development. Our study objective was to determine if iron fortification reduces blood lead levels in urban, lead-exposed, iron-deficient children in Bangalore, India. Design, Setting, and Participants. A randomized, double blind, controlled school-based feeding trial was done in 5- to 13-year-old iron-deficient children (n=186). At baseline, a high prevalence of lead poisoning was found in the younger children. Subsequently, all 5- to 9-year-old children participating in the trial (n=134) were followed to determine if iron fortification would affect their blood lead levels. Intervention. Children were dewormed and fed 6 days/week for 16 weeks either an iron-fortified rice meal (15 mg of iron per day as ferric pyrophosphate) or an identical control meal without added iron. Feeding was directly supervised and compliance monitored. Outcome Measures. Hemoglobin, serum ferritin, C-reactive protein, transferrin receptor, zinc protoporphyrin, and blood lead concentrations were measured. Results. The prevalence of iron deficiency was significantly reduced in the iron group (from 70% to 28%) compared with the control group (76% to 55%). There was a significant decrease in median blood lead concentration in the iron group compared with the control group. The prevalence of blood lead levels 10 µg/dL was significantly reduced in the iron group (from 65% to 29%) compared with the control group (68% to 55%). Conclusions. Our findings suggest providing iron in a fortified food to lead-exposed children may reduce chronic lead intoxication. Iron fortification may be an effective and sustainable strategy to accompany environmental lead abatement. 39. Ahamed M, Verma S, Kumar A, Siddiqui MK

Environmental exposure to lead and its correlation with biochemical indices in children Sci Total Environ. 2005 Jun 15;346(1-3):48-55 Analytical Toxicology, Industrial Toxicology Research Centre, MG Marg, Lucknow-226001, India

Lead is a global concern because of its ubiquity in the environment and known to be associated with abnormal neurobehavioral and cognitive development of young children. There is no study from India to describe a composite profile of blood lead and its biochemical influences in children. The present study was aimed at determining the proportion of children with >10g/dL blood lead levels (BLLs), association between BLLs, and sociodemographic characteristics, if any, and alterations in biochemical indices in the blood as an underlying mechanism of lead intoxication. A total of 62 children (4-12 y) of Lucknow and nearby areas were recruited to determine BLLs, delta-amimolevulinic acid dehydratase (delta-ALAD) activity, catalase (CAT) activity, and malondialdehyde (MDA) and glutathione (GSH) levels in the blood. Mean level of blood lead was 7.473.06g/dL (2.78-15.0) and 29%-exceeded 10g/dL, CDC intervention level. The BLLs were found to be significantly influenced by social status,

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area of residence, source of water supply, maternal educational status (p

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41. Clark CS, Thuppil V, Clark R, Sinha S, Menezes G, D'Souza H, Nayak N, Kuruvilla A, Law T, Dave P, Shah S Lead in paint and soil in Karnataka and Gujarat, India J Occup Environ Hyg. 2005, Jan; 2(1):38-44 Department of Enviromental Health, University of Cincinnati, Cincinnati, Ohio 45267, USA clarkcs@uc.edu

Blood lead surveys in several areas of India have found very high percentages of children with elevated blood lead levels. Fifty-three percent of children under 12 years of age in a seven-city screening had blood lead levels equal to or greater than 10g/dL, the level currently considered elevated by the U.S. Centers for Disease Control and Prevention (CDC). A number of these surveys focused on populations near lead smelters or in areas with high lead levels from combustion of lead-containing gasoline. There is little information available, however, on the levels of lead in paint in India and in soil. Field portable X-ray fluorescence analyzers were used to determine environmental lead levels in paint, dust, air, soil, and other bulk samples near several lead-using industries and in the residential environments of children with very high blood lead levels, at least four times as high as the CDC limit. Soils near industrial operations, such as secondary lead smelters, and battery dismantling units contained levels up to 100,000 ppm of lead. Four of 29 currently available paints from five manufacturers measured 1.0 mg/cm2 or above--the current U.S. definition of lead-based paint in housing-after the application of a single coat; four others measured at least 1.0 after three coats, and three others likely reached this level after the application of an additional one or two coats. In 5 of 10 homes of the elevated blood lead children, three or more locations in or around the home were found to have lead paint levels of 1.0 mg/cm2 or higher. Soil exceeding the U.S. standard for residential areas (400 ppm) was found at only one of the houses. Other sources of lead exposure, including traditional ayurvedic medicine tablets, were also observed. Similar surveys would be useful elsewhere in India and in other developing countries. 42. Ghose MK, Paul R, Banerjee RK

Assessment of the status of urban air pollution and its impact on human health in the city of Kolkata Environ Monit Assess. 2005, Sep;108(1-3):151-67 Centre of Mining Environment, Indian School of Mines, Dhanbad 826004, India ghosemrinal@eudoramail.com

Air pollution has significant effects on exacerbation of asthma, allergy and other respiratory diseases. Like many other magacities in the world the ambient air quality of Kolkata is also being deteriorated day by day. Automobile exhausts and certain industrial

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pollutants produce O3 by photochemical reactions. The particulate matter, particularly less than 10 m in size, can pass through the natural protective mechanism of human respiratory system and plays an important role in genesis and augmentation of allergic disorders. Sources of air pollution in the area and the unique problem arising out of the emission from the vehicles, industries, etc. have been described. Ambient air quality was monitored along with micrometeorological data and the results are discussed. The status of air pollution in the area has been evaluated and a questionnaire survey was conducted to estimate the allergic symptoms and exposure to assess the respiratory disorders. The data are analysed to evaluate the critical situation arising out of the emission of air pollutants and the impact on human health due to respirable diseases (RDs) to middle class sub-population (activity-wise) in the area are assessed. A strategic air quality management plan has been proposed. For the mitigation of air pollution problems in the city, the different measures to be adopted to maintain the balance between sustainable development and environmental management have been discussed. 43. Goswami K, Gachhui R, Bandopadhyay A

Hepatorenal dysfunctions in lead pollution J Environ Sci Eng. 2005 Jan;47(1):75-80 Department of Biochemistry, Vivekananda Institute of Medical Sciences, 99, Sarat Bose Road, Kolkata 700026, India

Environmental and occupational lead pollution is a common problem in both developing and industrialised countries. Both hepatotoxicity and nephrotoxicity are known to occur in persons with exposure to heavy metals. We studied both liver function and renal function and blood lead concentraton in random population sample of 372 men (age range, 24 to 55 years). In all the subjects we measured both liver and renal function tests and both blood lead and urinary concentration of lead. Raised blood and urinary lead concentrations were associated with moderate changes in liver function and abnormal renal function, reflected in decrease of albumin and increased levels of liver enzymes and raised urea and creatinine concentrations, and with a reduction in creatinine clearance rate as compared to apparently normal subjects. These findings emphasis the importance of measurement of blood lead concentrations in adults in the genereal population to combat the effects of lead toxicity before the clinical signs predominate. 44. Jain NB, Laden F, Guller U, Shankar A, Kazani S, Garshick E

Relation between blood lead levels and childhood anemia in India Am J Epidemiol. 2005, May 15; 161(10):968-73 VA Boston Healthcare System, West Roxbury, MA 02132, USA Nitin_Jain@hms.harvard.edu

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Lead pollution is a substantial problem in developing countries such as India. The US Centers for Disease Control and Prevention has defined an elevated blood lead level in children as 10g/dl, on the basis of neurologic toxicity. The US Environmental Protection Agency suggests a threshold lead level of 20-40g/dl for risk of childhood anemia, but there is little information relating lead levels

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called chelates. They have been used clinically as antidotes for acute and chronic poisoning. 2, 3-dimercaprol (BAL) has long been the mainstay of chelation therapy for lead or arsenic poisoning. Meso 2, 3, -dimercaptosuccinic acid (DMSA) has been tried successfully in animals as well as in a few cases of human lead and arsenic poisoning. DMSA could be a safe and effective method for treating lead or arsenic poisoning, but one of the major disadvantages of chelation with DMSA has been its inability to remove lead from the intracellular sites because of its lipophobic nature. Further, it does not provide protection in terms of clinical/ biochemical recovery. A new trend in chelation therapy is to use combined treatment. This includes the use of structurally different chelators or a combination of an adjuvant and a chelator to provide better clinical/biochemical recovery in addition to lead mobilization. The present review article attempts to provide update information about the current strategies being adopted for a safe, effective and specific treatment for two major toxic metals or metalloid. 46. Muzi G, Dell'Omo M, Murgia N, Curina A, Ciabatta S, Abbritti G

Lead poisoning caused by Indian ethnic remedies in Italy Med Lav. 2005 Mar-Apr; 96(2):126-33 Institute of Occupational Medicine and Toxicology, University of Perugia, Italy medlav@unipg.it

Background: Complementary or alternative medicine has become widespread in Western Countries and since the remedies are “natural” they are believed to be free of toxic effects and health risks. Ethnic remedies may contain lead, other metals and toxic substances. Objectives: To show how lead poisoning as a result of using ethnic remedies may be severe enough to cause serious damage to health, and to increase awareness among family doctors and occupational physicians of the risks associated with ethnic remedies. Methods and results: Description of ethnic remedy-related lead poisoning in 2 native Italian adults, with clinical, laboratory and toxicological data. Conclusions: When metal poisoning is diagnosed, ethnic remedies should be included among the putative sources so as to avoid erroneous attribution to workplace exposure and application of unneeded preventive measures. 47. Naha N, Bhar RB, Mukherjee A, Chowdhury AR

Structural alteration of spermatozoa in the persons employed in lead acid battery factory Indian J Physiol Pharmacol. 2005, Apr; 49(2):153-62 Regional Occupational Health Centre (Eastern), (ICMR), Block DP, Sector V, Salt Lake, Kolkata 700 091 niv_639@yahoo.co.in

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Lead is one of the industrially heavy metals that caused adverse effects on male reproductive system among battery factory workers, but information on the possible impact of lead on the structural integrity of sperm cell is limited. Thus present study was undertaken to assess the structural details of human spermatozoa of lead acid battery factory workers. Blood and semen samples were collected from total 80 workers (7-15 years exposure) and 40 non-occupationally exposed control subjects. The lead exposed battery factory workers showed lowering (P< 0.001) of sperm count, density, motility and semen volume along with an increase incidence of sperm abnormality and prolong liquefaction time. Structural alteration of sperm cell was prevalent among the exposed population as evidenced by significantly (P

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Expression and kinase activity of the heme-regulated-eIF-2alpha kinase or -inhibitor (HRI) are induced during cytoplasmic stresses leading to inhibition of protein synthesis. Using a reporter construct with HRI promoter, we have determined the promoter activity during heat-shock and lead toxicity in human K562 cells. These two conditions induced HRI promoter activity by 2- to 3-fold. Contrary to this, hemin, a suppressor of HRI kinase activity, downregulated HRI promoter activity and stimulated hemoglobin synthesis. Interestingly, when hemin-treated cells were transfected and exposed to lead, hemin compromised lead-effect substantially by downregulating HRI promoter activity, HRI transcription and HRI kinase activity. These results together suggest that heme signaling in relation to translation regulation is not only restricted to the cytoplasm (modulating HRI kinase activity) alone but it also spans to the nucleus modulating HRI expression. Hemin may thus be useful for alleviation of stress-induced inhibition of protein synthesis. 50. Sharma M, Maheshwari M, Morisawa S

Dietary and inhalation intake of lead and estimation of blood lead levels in adults and children in Kanpur, India Risk Anal. 2005 Dec;25(6):1573-88 Environmental Engineering and Management Program, Department of Civil Engineering, Indian Institute of Technology Kanpur, Kanpur, India mukesh@iitk.ac.in

This research was initiated to study lead levels in various food items in the city of Kanpur, India, to assess the dietary intake of lead and to estimate blood lead (PbB) levels, a biomarker of lead toxicity. For this purpose, sampling of food products, laboratory analysis, and computational exercises were undertaken. Specifically, six food groups (leafy vegetables, nonleafy vegetables, fruits, pulses, cereals, and milk), drinking water, and lead air concentration were considered for estimating lead intake. Results indicated highest lead content in leafy vegetables followed by pulses. Fruits showed low lead content and drinking water lead levels were always within tolerable limits. It was estimated that average daily lead intake through diet was about 114g/day for adults and 50g/day in children; tolerable limit is 250g/day for adults and 90g/day for children. The estimated lead intakes were translated into the resultant PbB concentrations for children and adults using a physiologically-based pharmacokinetic (PBPK) model. Monte Carlo simulation of PbB level variations for adults showed that probability of exceeding the tolerable limit of PbB (i.e., 10g/dL) was 0.062 for the pre-unleaded and 0.000328 for the post-unleaded gasoline period. The probability of exceeding tolerable limits in PbB level was reduced by a factor of 189 in the post-unleaded scenario. The study also suggested that in spite of the

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introduction of unleaded gasoline, children continue to be at a high risk (probability of exceeding 10g/dL=0.39) because of a high intake of lead per unit body weight.

51. Sharma R, Pervez S Toxic metals status in human blood and breast milk samples in an integrated steel plant environment in Central India Environ Geochem Health 2005, Feb; 27(1):39-45 Department of Chemistry, Govt. Arts, Science & Commerce College, Durg,, 491001, India

Owing to its unique nutritional and immunological characteristics, human milk is the most important food source for infants. Breast milk can, however, also be a pathway of maternal excretion of toxic elements. Selected toxic elements (As, Pb, Mn, Hg and Cd) were determined in human breast milk and blood samples obtained from 120 subjects related to an integrated steel plant environment located in central India. Samples of breast milk and blood from subjects living outside the steel plant environment were also analyzed for comparative study. Higher levels of these toxic elements were found in blood samples as compared to breast milk samples. Plant workers showed the higher presence of these metals in their breast milk and blood samples compared to the residents of the area and the subjects living outside the industrial environment, respectively. Mn, Pb and Hg have shown a higher tendency to associate with blood and breast milk than As and Cd. The order of occurrence of these metals in blood and milk samples thus found is Mn>Pb>Hg>As>Cd.

52. Singhal M, Tiwari OP Lead poisoning Indian Journal of Radiology and Imaging 2005: 15(2):247-249 Department of Radiodiagnosis, MGM Medical College and Associated MY Hospitals, Indore, MP, India

Lead poisoning or plumbism in children can be traced to pica (eg, dirt eating), acute ingestion of lead-based paints or consumption of home remedies. Lead poisoning in children presents with non-specific and vague symptomatology, however in serious conditions it may present with encephalopathic features. Radiologically it is characterized by presence of dense transverse bands in the growing metaphyseal regions. Here we report a case of chronic lead poisoning in a child of 18 months, which presented with encephalopathy.

53. Centers for Disease Control and Prevention (CDC) Lead poisoning associated with Ayurvedic medications-five states, 2000-2003 MMWR Morb Mortal Wkly Rep. 2004, Jul 9; 53(26):582-4

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Although approximately 95% of lead poisoning among U.S. adults results from occupational exposure, lead poisoning also can occur from use of traditional or folk remedies. Ayurveda is a traditional form of medicine practiced in India and other South Asian countries. Ayurvedic medications can contain herbs, minerals, metals, or animal products and are made in standardized and nonstandardized formulations. During 2000-2003, a total of 12 cases of lead poisoning among adults in five states associated with ayurvedic medications or remedies were reported to CDC. This report summarizes these 12 cases. Culturally appropriate educational efforts are needed to inform persons in populations using traditional or folk medications of the potential health risks posed by these remedies. 54. Gokhale SB, Patil RS

Size distribution of aerosols (PM10) and lead (Pb) near traffic intersections in Mumbai (India) Environ Monit Assess. 2004, Jul; 95(1-3):311-24 Department of Civil Engineering, Indian Institute of Technology, Delhi, Hauz Khas, New Delhi, India gokhale_sharad@yahoo.com

The size distribution of aerosols was measured near traffic intersections of Marol link road in air quality control region (AQCR1), which is a moderately industrial area and Dadar Khodad circle in AQCR2, which is a heavily commercial core of the Mumbai City. The reason behind selecting the two unidentical regions was to study the contribution from vehicles to the size separated PM10 and that of Pb. It is recognised that particulates in urban air are responsible for serious health effects. As very small particles are assumed to be important for the adverse health effects, the particle size distribution is thus an important factor that needs to be addressed whenever the particulates pollution is concerned. The size measurements were done with a cascade impactor of eight stages with a back-up filter. It effectively separates the particulate matter into nine-sizes ranging from 0.0-0.4 to 9.0-10.0m. Samples were analysed in nine-particle size fractions with special reference to a toxic metal - lead (Pb) by atomic absorption spectrophotometry (AAS). It was found that PM10 and Pb at both the intersections could easily be classified by the size distribution. The fractions of the PM10 and that of Pb showing a tendency of trimodal distributions with the first peak at coarse mode approximately 9.0-10.0m, second at approximately 5.8m and the third at coarse mode approximately 1.1m. The significant percentage of Pb was found in the range below 2.5m at both the intersections. However, Pb in AQCR1 is found in the coarser range as well, which could probably be the influence of various industrial

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activities in the area. PM10 concentration values in the coarser range in AQCR2 are associated with the resuspension of dust particles and mechanical erosions.

55. Kapil U Suri S Is iron deficiency anemia linked with higher lead levels in India? A public health concern Indian Pediatr. 2004, Dec; 41(12):1275

Iron deficiency and elevated lead levels are common amongst children and have the potential for long-term morbidity. Iron deficiency anemia (IDA) is associated with lower cognitive function and behavioral problems. Elevated lead levels have been associated with anemia, decreased IQ, impaired attention and speech performance, increased school failure, hyper activity and disturbed social behavior. It is well documented that lead is more readily absorbed in the presence of both malnutrition and iron deficiency anemia. Early detection and treatment of both these conditions is important.

56. Kuruvilla A, Pillay VV, Venkatesh T, Adhikari P, Chakrapani M, Clark CS, D'Souza H, Menezes G, Nayak N, Clark R, Sinha S Portable lead analyzer to locate source of lead Indian J Pediatr. 2004 Jun;71(6):495-9 Kasturba Medical College, Mangalore, India ajeenellickal@hotmail.com

Objective: To investigate the sources of lead in the environment in children with elevated blood, with the help of a Field Portable X-Ray Fluorescence Analyzer. Methods: One hundred and seven school children were chosen for this study on a random basis, from Mangalore and Karnataka. Their blood lead was analyzed. Of the cases analyzed, 10 students whose blood lead level was more than 40 microg/dl were investigated using a field portable X-Ray Fluorescence Analyzer. This is the first time such a device has been available for this purpose in India. Results: The 'likely' source of lead exposure could be determined in eight cases which was from the immediate environment of the children like 'lead-based' paint on surfaces in the house, on playground and other exterior equipment; lead storage batteries, contaminated dust and soil and other lead-containing substances. Conclusion: The use of an X-Ray Fluorescence Analyser appeared to be useful in determining the source of lead. 57. Mohanraj R, Azeez PA, Priscilla T

Heavy metals in airborne particulate matter of urban Coimbatore Arch Environ Contam Toxicol. 2004, Aug; 47(2):162-7 Environmental Impact Assessment Division, Salim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore-641 108, India

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Exposures to airborne metals are known to cause physiological responses in organisms and wide-ranging health effects in humans. Hence determination of metals in particulate matter is important from a toxicological perspective. In the current study heavy metals associated with respirable (RSPM) and nonrespirable (NRSPM) fractions of suspended particulate matter were estimated in air samples from six stations in Coimbatore, India, during March 1999 to February 2001. The mean quantity of heavy metals in RSPM was in the order Zn > Cu > Pb > Ni > Cr > Cd. Concentrations of these heavy metals were in the range of BDL (below detectable level) to 2,147 ng/m3 in RSPM. The highest level of lead (2,147 ng/m3) was recorded at an industrial station. The station also had the highest mean value (481544.3 ng/m3), suggesting the importance of industrial operations in determining the ambient concentrations of lead. Significant positive correlation among metals excepting lead and copper suggests that they originate mostly from a common source. Air samples of urban and industrial areas showed higher concentrations than residential (Urban) and suburban areas. 58. Jain N

Lead Toxicity and Childhood Anemia in India Proceedings of Public Health and the Environment, The 132nd Annual Meeting of APHA Nov. 6-10 2004, Washington DC Channing Laboratory, Brigham & Women's Hospital, Harvard Medical School, VAMC-HMS, 1400 VFW Parkway, West Roxbury, MA 02132, 6173237700, ext. 5160, Nitin_Jain@hms.harvard.edu

Background: Lead pollution is an enormous problem in developing countries such as India. The US Centre for Disease Prevention and Control recommends blood lead levels (BLLs)

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BLLs

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Exposure to industrial chemicals like lead, mercury, selenium, chromium, benzene hexachloride cyclohexane, formaldehyde, chlordecone, carbon disulphide, vinyl chloride and many others adversely affect male reproductive function. Lead exposure causes sperm tail abnormalities. Semen lead concentration was correspondingly increased with blood lead levels in those subjects who were exposed to lead 6 h daily over an average period of 6 years. Mercury affects the process of steroidogenesis and reduces testosterone blood levels. Exposure to selenium dioxide causes significant alterations in sperm morphology. Stainless steel workers exposed to the fumes of hexavalent chromium suffer an increased risk of reduced sperm quality and count. Benzene hexachloride cyclohexane (BHC), the cheapest insecticide, is a potent male gonadotoxic agent. The industrial exposure to formaldehyde of male workers causes the diminution of steroidogenesis. Dibromochloropropane (DBCP), a fumigant against nematodes, causes infertility in male workers. Chlordecone, a highly stable chlorinated hydrocarbon pesticide, causes oligospermia and reduction in motility. Exposure to carbon disulphide causes androgenic deficiency. Vinyl chloride monomer, a plasticiser, showed wide ranging sperm abnormalities. The toxic insult of these chemicals on male gametogenic and non-gametogenic cells may be due to sperm protein damage, oxidative damage to sperm head DNA and nuclear protein or oxidative damage of sperm by ROS. Germinal cell injury due to exposure of chemicals involves the interaction of androgen binding protein-heat shock protein 27 (ABP-hsp 27) and protein kinase (PKA). 61. Dixit RC, Verma SR, Nitnaware V, Thacker NP

Heavy metals contamination in surface and groundwater supply of an urban city Indian J Environ Health. 2003, Apr;45(2):107-12 National Environmental Engineering Research Institute, Nehru Marg, Nagpur 440 020

There is a continuous increase in the demand of water supply in cities due to the industrialization and growing population. This extra supply is generally met by groundwaters or nearby available surface waters. It may lead into incomplete treatment and substandard supply of drinking water. To ensure that the intake water derived from surface and groundwater is clear, palatable, neither corrosive nor scale forming, free from undesirable taste, odor and acceptable from aesthetic and health point of view, the final water quality at Delhi have been evaluated. The final water supply of four treatment plants and 80 tubewells at Delhi were surveyed in 2000-2001 for cadmium, chromium, copper, iron, lead, manganese, nickel, selenium and zinc. The levels of manganese, copper, selenium and cadmium were found marginally above the Indian Standards (IS) specification regulated for drinking water. The data was used to assess the final water quality supplied at Delhi.

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62. Hu H

Study of Lead Exposure & Outcomes amongst Children in Chennai Crisp Data Base National Institutes of Health; CRISP/2003/ TW005914-01A1,2003 Howard.hu@channing.harvard.edu, Harvard Sch of Public Hlth, 655 Huntington Ave/Bldg 1 RM1414, Bboston, MA 02115

Lead exposure poses a major environmental health problem in India. No direct studies have yet been performed in India to investigate the impact of lead exposure on outcomes such as neurobehavioral development. We propose to build upon a collaborative effort initiated during the proposed PI's work as a Senior Fulbright Scholar and work with colleagues at the Sri Ramachandra Medical College and Research Institute of Chennai (formerly known as Madras), Tamil Nadu, India, to study 750 children aged 4-6 attending specific public schools in the area of Chennai. These schools will be chose to represent areas of the city that are high-high, high-low, low-high, and low-low with respect to traffic and industry. For each child we will measure levels of lead in blood and shed primary teeth; assess visuospatial function (using Raven's Progressive Matrices), visuomotor function (using the Wide Range Assessment of Visual Motor Abilities), behavior (using Conners' Rating Scale-Revised), and IQ (using the Binet-Kamath test); collect blood for the extraction of DNA and genotyping for polymorphisms of the Aminolevulinic Acid Dehydratase (ALAD), apoliproprotein E, and transferrin genes; and collect data on covariates. With this information we will describe lead exposure and exposure-dose relationships and test specific hypotheses on the relationship of lead dose to neurobehavioral outcomes and the modifying effect of genetic polymorphisms on these same relationships. This research promises to provide novel scientific information on lead toxicity as well as important information on the impact of lead exposure on pediatric neurobehavioral development in urban India. It will also serve as a nidus for building collaborative environmental health research between the U.S. and India. Keywords: blood chemistry, child psychology, middle childhood (6-11), preschool child (1-5), cooperative study, porphobilinogen synthase, environmental health, genotype, genetic polymorphism, India, human subject, transferring, lead poisoning, developmental neurobiology, intelligence test, neuropsychology, developmental psychology, gene environment interaction, neurotoxicology, clinical research, apolipoprotein E, behavioral /social science research tag, outcomes research 63. Kalra V, Chitralekha KT, Dua T, Pandey RM, Gupta Y

Blood lead levels and risk factors for lead toxicity in children from schools and an urban slum in Delhi J Trop Pediatr. 2003, Apr; 49(2):121-3 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India vkalra@medinst.ernet.in

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This cross-sectional study was conducted to estimate the mean blood lead levels (BLL) and prevalence of lead toxicity in a representative sample of schoolchildren and children residing in an urban slum. In addition, the association of potential environmental risk factors with elevated BLL was studied. Children aged 4-6 years were selected from schools of the South zone of Delhi (n=125) and from an urban slum (n= 65). Risk factors were recorded using a pre-tested questionnaire and blood lead and zinc protoporphyrin (ZPP) levels were estimated. The mean BLL was 7.8 g/dl (SD 3.9) and the proportion of children with blood lead 10 g/dl was 18.4 per cent. Distance of the residence or school from a main road appeared to be associated with higher blood lead concentrations, but these differences were not statistically significant. In our setting, vehicular pollution may be a major contributing factor in lead contamination of the environment. 64. Menezes G, D'souza HS, Venkatesh T

Chronic lead poisoning in an adult battery worker Occup Med (Lond)2003, Oct; 53(7):476-8 Department of Biochemistry and Biophysics, National Referral Center for Lead Poisoning in India (NRCLPI), St John's Medical College, St John's National Academy of Health Sciences, Koramangala, Bangalore 560 034, India venky_tv@hotmail.com

Abstract: Background Lead poisoning is a common environmental health hazard in developing countries. Incidences of lead poisoning are seen in all age groups, especially in adults working in lead-based industries, where many still remain unaware of the adverse effects of exposure to unusually high levels of lead. Methods: We report the case of an adult battery worker, who initially received symptomatic treatment because of clinical misdiagnosis. Later, he was treated with appropriate chelators, which helped to decrease blood lead levels drastically. However, being unable to change his occupation, he continues to be exposed to potentially lethal doses of lead. Conclusions: A key role for health agencies, besides providing opportunities for diagnosis and therapy, should be to increase public awareness about this widespread environmental hazard through education, documentation and communication. Keywords: Battery worker; blood lead; chelator; chronic lead poisoning 65. Mishra KP, Singh VK, Rani R, Yadav VS, Chandran V, Srivastava SP, Seth PK

Effect of lead exposure on the immune response of some occupationally exposed individuals Toxicology. 2003, Jun 30; 188(2-3):251-9 Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

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Lead is a ubiquitous pollutant in the industrial environment, which poses serious threats to human health. In the past 20 years increasing attention has been paid to the effects of lead exposure on health. This toxic metal alters the immune response of animals as well as humans. To study the immunological effects of occupational exposure to lead, we examined lymphocyte proliferation, natural killer (NK) cell cytotoxicity and interferon-gamma production with peripheral blood mononuclear cells (PBMCs) of individuals occupationally exposed to lead. We selected three different groups of individuals exposed to lead: three-wheeler drivers (30), battery workers (34) and silver jewelery makers (20); and unexposed healthy volunteers (30) as control for comparison. Our results indicate that though lymphocyte proliferation to phytohaemagglutinin (PHA) is inhibited in lead exposed individuals as compared with unexposed volunteers, there is no correlation between inhibition of lymphocyte proliferation and blood lead level. NK cell cytotoxicity remains unaffected in individuals exposed to lead as compared with controls. On the other hand, we observed that interferon-gamma (IFN-gamma) was significantly elevated in T cell mitogen, PHA, stimulated PBMCs culture supernatant of lead exposed individuals. We found significant positive correlation between blood lead levels and IFN-gamma produced in culture supernatant on stimulation with PHA. In brief, this study demonstrates that lead can affect the immune response of the occupationally exposed individuals such as three-wheeler drivers, battery reconditioning workers and silver jewelery makers. 66. Naha N1, Chowdhury AR2

Toxic effect of lead on human spermatozoa: A study among pigment factory workers Ind ianJ Occup Environ Med 2005,9(3): 118-123 1 Department of Physiology, College of Medical Sciences, Chitwan, Nepal, India 2 Industrial Toxicology Division, Regional Occupational Health Center (E), (ICMR), Kolkata, India Correspondence Address: A R Chowdhury, Deputy Director (Sr. Grade), Regional Occupational Health Center (E), Indian Council of Medical Research, Block-DP,Sector-V, Salt Lake,Kolkata - 700 091, India

Occupational lead exposure caused male reproductive impairment, but information on spermatozoa activity, motility, and maturation is limited. In the above perspective, spermatozoa morphology, motility, activity, and nutritional status in lead exposed workers (7-15 years exposure) were assessed. Low sperm velocity, gross, and forward

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progressive motility with high stationary motile spermatozoa revealed lowering of sperm cell activity after exposure (P

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69. Sharma R, Pervez S

Enrichment and exposure of particulate lead in a traffic environment in India Environ Geochem Health 2003,Sep; 25(3): 297-306 Department of Chemistry, Government VYT Postgraduate Autonomous College, Durg, CG- 491001, India shamshp@yahoo.co.in

Enrichment of lead in respirable suspended particulate matter (RSPM) and exposure of human blood to particulate lead in traffic environment were investigated. Samples of RSPM, non-respirable suspended particulate matter (NRSPM) and total suspended particulate matter (TSPM) were collected in 10 sampling sites located on National Highway No. 6, Drug-Bhilai section of Chhattisgarh State of India. Forty blood samples, out of which 20 of highway traffic personnel with chronic exposure and other 20 of general population who were residing more than 10 km away from the National Highway, were collected. Samples of particulate matter were weighed and analysed for particulate lead. Results have shown a higher concentration of average RSPM and TSPM in all the sampling sites compared to the Indian permissible limits. Geometric mean of lead levels was found in the range of 0.880-1.414 g/m3 (TSPM) in the study sites. Concentrations of lead in RSPM have shown a higher enrichment (range 2.645-3.171) relative to NRSPM. Blood lead levels in traffic personnel and general population were found in the range of 56.70-101.17 g/dL and 7.92-31.22 g/dL, respectively. 70. Singh VK, Mishra KP, Rani R, Yadav VS, Awasthi SK, Garg SK

Immunomodulation by lead Immunol Res. 2003; 28(2):151-66 Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India singh@afrri.usuhs.mil

Lead, a potential human carcinogen, is a ubiquitous environmental pollutant in the industrial environment that poses a serious threat to human health. This toxic lead can modulate the immune response of animals as well as humans. In some instances, the immune system appears to be exquisitely sensitive to lead as compared with other toxicological parameters. Both stimulation and suppression of immune response have been demonstrated in lead exposed animals and humans depending on the T helper (Th)1 vs Th2 response. Although the majority of data accumulated to date pertains to the effects of lead in small laboratory rodents, there is little reason to believe that similar quantifiable effects do not occur in domestic and food-producing animals owing to basic functional similarities of the immune system of mammals. In this review, we have discussed the immunomodulatory role of the toxic heavy metal, lead, on cellular

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and humoral components of the immune system with particular reference to effector cells such as B cells, T cells, natural killer (NK) cells, and soluble mediators such as cytokines, chemokines, and nitric oxide (NO). 71. Suk WA, Ruchirawat KM, Balakrishnan K, Berger M, Carpenter D, Damstra T, De Garbino JP,

Koh D, Landrigan PJ, Makalinao I, Sly PD, Xu Y, Zheng BS Environmental threats to children's health in Southeast Asia and the Western Pacific Environ Health Perspect. 2003, Aug; 111(10):1340-7 Center for Risk and Integrated Sciences, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA suk@niehs.nih.gov

The Southeast Asia and Western Pacific regions contain half of the world's children and are among the most rapidly industrializing regions of the globe. Environmental threats to children's health are widespread and are multiplying as nations in the area undergo industrial development and pass through the epidemiologic transition. These environmental hazards range from traditional threats such as bacterial contamination of drinking water and wood smoke in poorly ventilated dwellings to more recently introduced chemical threats such as asbestos construction materials; arsenic in groundwater; methyl isocyanate in Bhopal, India; untreated manufacturing wastes released to landfills; chlorinated hydrocarbon and organophosphorous pesticides; and atmospheric lead emissions from the combustion of leaded gasoline. To address these problems, pediatricians, environmental health scientists, and public health workers throughout Southeast Asia and the Western Pacific have begun to build local and national research and prevention programs in children's environmental health. Successes have been achieved as a result of these efforts: A cost-effective system for producing safe drinking water at the village level has been devised in India; many nations have launched aggressive antismoking campaigns; and Thailand, the Philippines, India, and Pakistan have all begun to reduce their use of lead in gasoline, with resultant declines in children's blood lead levels. The International Conference on Environmental Threats to the Health of Children, held in Bangkok, Thailand, in March 2002, brought together more than 300 representatives from 35 countries and organizations to increase awareness on environmental health hazards affecting children in these regions and throughout the world. The conference, a direct result of the Environmental Threats to the Health of Children meeting held in Manila in April 2000, provided participants with the latest scientific data on children's vulnerability to environmental hazards and models for future policy and public health discussions on ways to improve children's health. The Bangkok Statement, a pledge resulting from the conference proceedings, is an important first step in creating a

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global alliance committed to developing active and innovative national and international networks to promote and protect children's environmental health. 72. Weide R, Engelhart S, Farber H, Kaufmann F, Heymanns J, Koppler H

Severe lead poisoning due to Ayurvedic Indian plant medicine Dtsch Med Wochenschr 2003,Nov 14;128(46):2418-20 Haem.Onc.Ko@t-online.de

History and clinical findings: A 39-year-old woman with a history of slowly progressive muscular dystrophia was transferred to us for further evaluations of a hypochromic, microcytic anaemia. The patient complained about progressive muscle weakness, loss of appetite and constipation, sleep disorders as well as muscle and back pain. Clinical examination revealed a tetraparesis without any detectable muscle reflexes and atrophic muscles of the extremities. A bilateral radial paresis was found with a loss of power. Investigations: She presented with a hypochromic, microcytic anaemia with haemoglobin of 7.9g/dl. Re-evaluation of her peripheral blood smear showed basophilic stippling of the erythrocytes. Bone marrow biopsy revealed a marked dyserythropoiesis with 50% ring sideroblasts. After the examination of the bone marrow, the blood lead level was found to be grossly elevated up to 880g/l. Diagnosis: Re-evaluation of the patient's history revealed that she had been to India for an Ayurvedic treatment approach to improve her muscle dystrophia. She had taken regularly 4 different natural plant pills, which she had bought in an Ayurvedic health centre. Toxicologic analysis of these pills revealed one to have a lead concentration of 50.4 mg/g. Treatment and course: The patient was treated with 16 infusions of sodium-EDTA followed by a 4-week treatment with dimercaptopropionic acid orally. Her neurological condition improved and the radial paresis resolved gradually so that she could return to work. Her haematological parameters normalized. Conclusion: This case report underscores the importance, while asking patients for their drug history, to ask additionally if natural plant medicine is taken or applied regularly. The report reveals that Ayurvedic pills from India may have a high concentration of lead and may cause severe poisoning. 73. Ernst E

Heavy metals in traditional Indian remedies Eur J Clin Pharmacol. 2002, Feb; 57(12):891-6 Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, UK E.Ernst@exeter.ac.uk

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The growing popularity of traditional Indian remedies necessitates a critical evaluation of risks associated with their use. This systematic review aims at summarising all available data relating to the he