Lead toxicity in a family as a result of occupational exposure

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 [(3.92+/-0.94) micromol L-1], 50 % reduction in the activity of delta-aminolevulinic acid dehydratase [(24.67+/-5.12) U L-1] and an increase in zinc protoporphyrin [(1228+/-480) microg L-1]. Liver function tests showed an increase in serum alkaline phosphatase [(170.41+/-41.82) U L-1]. All other liver function test parameters were normal. Renal function tests showed an increase in serum uric acid [(515.81+/-86.29) micromol L-1] while urea and creatinine were normal. Serum calcium was low [(1.90+/-0.42) mmol L-1 in women and (2.09+/-0.12) mmol L-1 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 microg L-1. 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.     

Apical hypertrophy caused by glycogen storage disease creating artifacts in myocardial perfusion imaging

A 46-year-old man with atrial fibrillation and coronary artery disease was referred for myocardial perfusion imaging for the evaluation of chest pain. The patient underwent adenosine stress and rest dual-isotope myocardial perfusion imaging. There was no adenosine-induced chest pain or EKG changes specific for ischemia. Myocardial perfusion images demonstrated an apical "hot spot" and decreased tracer activity in the base of the heart. The polar plots showed a bright center with a rim of significant (>2.5 SD) defect around the base of the myocardium. Ischemia in the base of the heart, with the apex of the heart seemingly normal, was rather puzzling and correlation with magnetic resonance images (MRI) showed apical hypertrophy. Examination of the history revealed that the patient was diagnosed with restrictive cardiomyopathy 2 years ago and endocardial biopsy showed intramyocardial glycogen on electron microscopy, suggesting glycogen storage disease. The case illustrates a "hot spot" resulting from apical hypertrophy creating artifactual fixed defects in myocardial perfusion images and in polar maps.     

Comparative study of peripheral blood smear, quantitative buffy coat and modified centrifuged blood smear in malaria diagnosis

The present study was aimed at modifying the centrifuged blood smear (modified centrifuged blood smear or MCBS), to make it a feasible and standardized procedure. The results obtained were compared with the current diagnostic methods - peripheral blood smear (PBS) and quantitative buffy coat (QBC). Blood samples collected from 100 suspected malaria patients were subjected to all three tests. It was found that PBS had 86.79% sensitivity and was absolutely specific. QBC was 96.22% sensitive and 93.61% specific. The majority of variations occurred in PBS negative cases; cases with parasite count Plasmodium falciparum. It was seen that by the addition of centrifugation to the conventional smear technique (MCBS) improved its sensitivity from 86.79% to near 100%. QBC and MCBS were found superior to PBS. Since MCBS combines principles of both QBC and PBS, it is as sensitive as QBC, as specific as PBS, and above all, easily performed and affordable.