Copper from cooking utensils as a cause of Indian childhood cirrhosis?
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Aluminium leaching from low quality (Al-Pb alloy) and high quality (Al-Mn alloy) utensils by water has been studied under different conditions of pH, boiling time and NaF concentrations. High fluoride concentration and low pH were found to enhance the leaching of Al more from low quality utensils than from high quality utensils.
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We investigated the implications of a change from disposable to regular crockery and cutlery, and the installation of a dishwasher on a 12-bedded-infectious diseases ward. A limited microbiological study of used disposable cutlery revealed contamination by methicillin-resistant Staphylococcus aureus of one utensil out of 12. Changing to conventional utensils could be recommended if a dishwasher meeting DHSS requirements was installed and safe working practices introduced.
Assaying chromium nickel and manganese for specific migrations with a 4%-acetic acid under specific time and temperature related conditions is an obligatory part of the hygienic safety surveillance. Routine surveillance of a larger number of imported cooking utensils has shown the specific migrations to be more or less above the maximum allowances for chromium and/or nickel, and less frequently so for manganese. Further tests with repeated extraction, however, revealed that the levels of all three metals in most of the unfit samples were within the allowed limits. With respect to our findings, and to a longer period of use of the cooking utensils, amendments to the current regulations demanding obligatory testing after repeated extraction seem justified.
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Modeling and physical guidance were compared for teaching 24 retarded males (mean age = 13.5, mean IQ = 25.3) to use a knife, fork, and spoon. Initial premeal training methods resulted in no improvement over baseline. The methods were revised to extend throughout meals, and a third method (physical guidance with praise) replaced a former control procedure. Methods involving physical guidance produced significant improvement while modeling did not. All groups then received physical guidance with praise which resulted in their achieving similar levels of performance. Follow-up observations revealed that correct utensil use continued under maintenance conditions.
Twenty-seven histopathologically proved cases of Indian childhood cirrhosis (ICC), 13 parents (father and mother) and nine siblings of ICC patients were studied from serum and urinary Cu, Zn, Mg and Cd levels by Atomic Absorption Spectrophotometer (AAS). Milk and drinking water from various sources were analysed for Cu, Zn, Mg and Cd contents, as was milk boiled and stored for up to six hours in various utensils. Serum and urinary Cu excretion were high (P less than 0.001) in ICC patients and within normal limits in siblings and parents. In ICC patients most hepatocytes contained multiple, coarse and dark brown orcein staining granules representing Cu associated protein. Serum Zn was low and urinary Zn excretion high in ICC patients (P less than 0.001 and P less than 0.01 respectively) and within normal limits in siblings and parents. Mg and Cd in serum and urine of ICC patients, siblings and parents were within normal limits. Cu content of milk boiled and stored in peetal (brass) utensils was high and directly related to the duration of storage; there was no change in Cu level in milk boiled and stored in steel and aluminium utensils. Zn, Mg and Cd levels in milk boiled and stored in peetal (brass) utensils remained unchanged. The levels of these elements in drinking water from various sources were also within limits as recommended by WHO (1971). Milk boiled and stored in peetal (brass) utensils seemed to account for increased Cu intake. Excessive Cu intake in ICC should be eliminated by avoiding brass utensils for boiling and storing milk. Some treatment to chelate excess Cu is also warranted.
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Lead-glazed pottery produced by obsolete methods in Lebanon and other countries in the Middle East is potentially hazardous when used in contact with acidic foods. This conclusion was deduced from the testing of 423 glazed utensils for the amount of lead leached by 4% acetic acid. Control measures, surveillance, and regulations are therefore warranted.