[Lead poisoning in West Bank Arabs caused by contaminated flour].
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Flour↗
Biomedical subjects
E Weissenberg
Publications and source records attributed to E Weissenberg.
Combined use of zinc protoporphyrin (ZPP), mean corpuscular volume and haemoglobin measurements for classifying microcytic RBC disorders in children and young adults.
The diagnostic potential of the combined use of zinc-protoporphyrin (ZPP), mean corpuscular volume (MCV) and haemoglobin measurements for discriminating between iron deficiency anaemia, beta-thalassaemia minor and lead poisoning has been studied. Lead poisoning could be identified by ZPP greater than 50 micrograms/dl in the presence of normal MCV or ZPP greater than 150 micrograms/dl in the presence of microcytosis (MCV less than 80 fl) with a sensitivity of 97% and specificity 94%. Beta-thalassaemia minor was identified by the coexistence of microcytosis and ZPP less than 50 micrograms/dl with a sensitivity of 91% and specificity 79%. Iron deficiency anaemia defined by the combination of microcytosis and ZPP ranging from 50 to 150 micrograms/dl was identified with a sensitivity of 95%, but the specificity was only 51%, with many of the patients overlapping with thalassaemia minor. This problem did not exist in iron-deficiency anaemia with haemoglobin less than 10 g/dl as at that range no patients with uncomplicated thalassaemia minor have been encountered. A great advantage of the combined use of ZPP, MCV and haemoglobin for the initial screening of microcytic anaemia is its ease of performance and low cost. However, this information should only be regarded as presumptive evidence of disease, requiring subsequent confirmation by appropriate direct measurements such as transferrin saturation, serum ferritin, haemoglobin electrophoresis, or blood lead determinations.
Adolescent↗
Identification of community flour mills as the source of lead poisoning in West Bank Arabs.
Following the discovery of severe lead poisoning in members of several households in a West Bank village, studies were carried out to establish the magnitude of the problem in the community and to identify the source of lead poisoning. Forty-three patients with Centers for Disease Control risk group IV lead poisoning were identified and treated in three villages within a radius of about 10 km of each other. The prevalence of increased lead burden among 563 schoolchildren aged 10 to 18 years was 19% for Centers for Disease Control risk groups I and II and 11% for groups III and IV. A survey of potential sources excluded all items, except for locally ground flour, which was heavily contaminated in all affected households. Examination of community flour mills revealed that, in contrast to unprocessed grain, freshly ground flour contained large amounts of lead originating from lead fillings employed to fasten the housing of the driveshafts to the millstones. Systematic screening of 146 community stone mills in 92 West Bank villages showed significant lead contamination of flour in 33 mills (23%). In all cases, the source of lead contamination was identical. As methods of milling in the area are similar, a prompt investigation of this potential source of lead poisoning in other near-Eastern countries is indicated.
Adolescent↗
Stoneground flour as source of lead poisoning.
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Adolescent↗
Lead poisoning in a West Bank Arab Village.
Eleven patients from the West Bank village of Es-Sawiyeh were admitted with lead poisoning to two Jerusalem hospitals between November 1982 and January 1983. They all belonged to several households of a single large family. Colicky abdominal pains were present in five patients, weakness in four, behavioral changes ranging from irritability to frank psychosis in four, and paralysis in one. Anemia of various degrees was seen in all patients. Basophilic stippling and reticulocytosis were encountered in all patients with moderate to severe anemia. Therapy with edetate disodium calcium and penicillamine resulted in clinical improvement in all patients. A preliminary survey of 270 subjects in the same village disclosed 84 subjects with abnormally elevated blood lead levels, 17 of whom had grade IV lead burden according to the Centers for Disease Control risk classification. Contamination of homemade flour by lead used for stabilizing the metal parts of stone mills was the source of poisoning. As the method of milling in many West Bank villages is similar, these findings may have important implications to the well being of a large section of the rural West Bank population.
Adolescent↗
Iron depletion and blood lead levels in a population with endemic lead poisoning.
The effect of iron depletion on blood lead levels was studied in a group of 558 schoolchildren aged 10 to 18 residing in two West Bank Arab villages with a high prevalence of excessive lead exposure and clinical lead poisoning. Thirty percent of the subjects studied had whole-blood lead levels greater than 30 micrograms/dl, and 45% had whole-blood zinc erythrocyte protoporphyrin greater than 50 micrograms/dl. The percentage of abnormal blood lead values in subjects with normal serum ferritin and transferrin saturation (31%) was similar to that in subjects with one (28%) or two (25%) abnormal iron parameters. Likewise, there was no correlation between serum ferritin and blood lead levels in individual patients (r = 0.059). Normal distribution plots and mean levels of blood lead (27.3 micrograms/dl) were identical in the iron-deficient and iron-replete groups. These findings indicate that iron depletion does not affect blood lead levels and suggest that in man, unlike in experimental animals, iron depletion may not have a significant effect on lead absorption.
Adolescent↗
The Arjenyattah epidemic. A mass phenomenon: spread and triggering factors.
A massive epidemic of psychogenic aetiology occurred in three districts of the West Bank over two weeks in March-April, 1983. It affected 949 individuals, 727 (77%) of them adolescent females. The symptoms were not accompanied by positive physical signs or by laboratory findings. The epidemiological pattern was pathognomonic of that of a psychogenic disorder. The initial trigger was probably the odour of H2S escaping from a faulty latrine in the schoolyard of the first affected school. Subsequent spread of the disease was due to psychological and extra-medical factors, including publicity by the mass media. Spread was stopped immediately after closure of schools.
Abdomen↗
Lead poisoning by contaminated flour.
Between October 1982 and June 1983, 43 patients were identified with symptomatic lead poisoning in three Arab villages of the Nablus district. Because of the clustering of clinical poisoning by household units, investigation was focussed on potential sources common to all members of the households. After excluding water, olive oil and a variety of foodstuff, lead in high concentrations was discovered in locally ground flour in all affected households. The source of poisoning was lead poured into the fissures between the metal housing and the driveshaft of the millstone. Significant lead contamination of freshly ground flour was demonstrated in 23% of the 146 community flour mills operating in West Bank villages. Since the completion of these studies, similar outbreaks of lead poisoning caused by contaminated flourmills have been identified in the Upper Galilee and in Spain. As the methods of milling in the Mediterranean area are similar, a coordinated international effort is needed in order to eliminate this health hazard from countries where similar community stone mills are still in use.
Adult↗
Low pH beverages as a potential aid in the prophylaxis of cholera.
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Achlorhydria↗