Surma and lead poisoning

TFOS Lifestyle: Impact of cosmetics on the ocular surface

In this report the use of eye cosmetic products and procedures and how this represents a lifestyle challenge that may exacerbate or promote the development of ocular surface and adnexal disease is discussed. Multiple aspects of eye cosmetics are addressed, including their history and market value, psychological and social impacts, possible problems associated with cosmetic ingredients, products, and procedures, and regulations for eye cosmetic use. In addition, a systematic review that critically appraises randomized controlled trial evidence concerning the ocular effects of eyelash growth products is included. The findings of this systematic review highlight the evidence gaps and indicate future directions for research to focus on ocular surface outcomes associated with eyelash growth products.

Kohl containing lead (and other toxic elements) is widely available in Europe

Kohl is an eye cosmetic that was traditionally used in many Asian and African countries but that is now more widely available. Ingredients of kohl reported in previous studies seem to be rather variable but mention is frequently made of minerals based on Pb whose use in cosmetic products is prohibited in Europe. We purchased 23 products of kohl from retail outlets in five different European countries and over the internet and analysed their chemical composition by XRF and SEM-EDXS. The majority of the products (n = 17) did not conform with European legislation based on the presence of Pb (often as galena), whose concentrations ranged from a few mg kg^-1 to over 400000 mg kg^-1. Cadmium, another element prohibited in cosmetic products in Europe, was also present as a contaminant in 13 products at concentrations up to a few hundred mg kg^-1. In addition to heavy metals, minerals of other metals (e.g. Fe and Zn) appeared to be present in the nano-size range and might represent an additional health hazard. Clearly, the lack of quality control in the manufacture of kohl results in the widespread occurrence of toxic and unwanted elements and the trade of illegal products in Europe. In principle, shop sales would be relatively straightforward to prevent, but products traded through internet are more difficult to regulate.

A meta-analysis of blood lead levels in India and the attributable burden of disease

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 μg/dL (95% CI: 4.38-9.35) in children and 7.52 μg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Blood Lead Concentrations in Pre-School Children in Birmingham1

A survey has been undertaken of the distribution of blood lead concentrations in pre-school children attending nursery schools or day centres in Birmingham. The majority of levels in excess of 1.65 μmol/l were found in children of Asian origin. It is thought likely that the high blood lead concentration seen in these children is related to nutritional rather than environmental factors.

Heavy metal content of selected personal care products (PCPs) available in Ibadan, Nigeria and their toxic effects

There is a growing concern on heavy metals in consumer products due to their potential human health risks and environmental effects. In this study, the levels of zinc, cadmium, lead and nickel were assessed in 3 different classes of personal care products commonly used in Ibadan, Nigeria. Samples were analysed for heavy metals using Atomic Absorption Spectrophotometer (AAS) after acid digestion. Estimated daily intake (EDI) of the metals and Health Risk Index (HRI) were calculated to assess the human health risks associated with the use of these PCPs. The concentrations (mg/kg) of zinc ranged from 3.75 to 19.3, 1.88 to 112,000 and 19.8 to 217 respectively in creams, powders and eyeliners. Cadmium ranged from ND-0.50, ND-36.3 and ND-0.50 mg/kg while lead ranged from ND-6.25, ND-468 and 3.73-27.5 mg/kg and nickel ranged from ND-6.25, 0.13-107 and 2.75-22.7 mg/kg respectively. There were high concentrations of Cd, Pb and Ni in some of the samples when compared with the available permissible limits in cosmetics (Cd: 0.3 ppm, Pb: 10 ppm and Ni: 0.6 ppm while there is no permissible limit for Zn in cosmetics currently available). Prolonged use of PCPs may pose human health and environmental risks due to toxic metal loading through dermal contact and accumulation over a period of time. Hence, the need for necessary government agencies to regulate and enforce toxic metals in consumer products including cosmetics produced and imported into Nigeria to safeguard public health and the environment, which is the final sink.

Trace element content in tea brewed in traditional metallic and stainless steel teapots

The migration of metals in tea brewed in metallic teapots was investigated. The teapots were obtained from North Africa stores in Brussels in 2005-2006 and in 2011. Chinese gunpowder green tea, the most commonly used tea in the Moroccan community, was used to prepare the tea. Tea brewed in metallic teapots was compared to tea brewed in a glass vessel in order to evaluate the contribution of the tea and the teapots to the metal concentrations in the brewed tea. Tea samples were also collected in Moroccan households and in tearooms in Brussels. The elements As, Cd, Pb, Sn, Mn, Fe, Cr, Co, Ni, Cr, Cu, Zn, and Al were analyzed by high-resolution sector field inductively coupled mass spectrometry. The relationship between the metal composition of the alloy of the teapot and the metal concentration in tea was also investigated. Migration of Pb and to a lesser amount Ni, Cu, and Zn was observed in brass teapots and migration of Cd from a number of stainless steel teapots was observed. The soldering connecting the sprout to the teapot was shown to be an important source of Pb to the tea. High levels of Mn and Al were also observed in the brewed tea and these elements where shown to originate from the tea itself. Metal exposure from tea drinking was calculated for different tea consumption levels and different metal concentration levels and compared to toxicological reference values.

Global Public Health and the United Arab Emirates

The United Arab Emirates (UAE), as a rapidly developing country in the Middle East, is in a good position to contribute to global health. It can share its experience of dealing with public health problems characteristic of a desert environment, and it can learn from the experience of other nations in tackling challenges posed by globalization. The health issues particular to the region include heat stress, the effects of consanguineous marriages on families and society, and exposure to occupational and environmental hazards. As in many other developed countries, the UAE also has public health problems associated with smoking, road traffic accidents, and obesity. The experience of other countries in dealing with infectious diseases has helped the UAE implement preventive measures to cope with infections such as the recent H1N1 pandemic. International collaboration has advantages to the UAE in managing problems pertaining to global public health.

[Lead poisoning caused by prolonged use of kohl, an underestimated cause in French-speaking countries]

Use of kohl (called surma in India and Pakistan) as an eye cosmetic is very common, especially among women, children, and babies, not only in North Africa (Morocco, Algeria, Egypt), but also in the Near East and the Middle East, as well in India and Pakistan. This practice has now become widespread in European countries and North America. The cultural custom is very old and has been in use in Egypt since the Ancient Empire. In a great number of kohls available on the free market, lead sulfide is the main component and the very high lead concentration is a risk, particularly for women and children. We report the observation of a case of lead poisoning in a young Moroccan woman caused by prolonged use of a kohl and provide a review of the published literature. This case study should draw the attention of ophthalmologists in French-speaking areas to a public health problem, largely ignored, although real, considering the high lead concentrations found in the majority of kohls. Actions such as prohibition (importation and sale of eye cosmetics made of lead sulfide) have proved to be inadequate. Appropriate educational campaigns directed toward populations using eye cosmetics will be more effective over the long term.

Maternal nutritional status during pregnancy and surma use determine cord lead levels in Karachi, Pakistan

OBJECTIVES

To estimate the umbilical cord blood lead levels (BLLs) of Pakistani neonates and to identify determinants for umbilical BLLs.

METHODS

We conducted a cross-sectional study of mothers and infants at one of the two obstetric units of two tertiary care hospitals in Karachi during January-August 2005. Information from 540 mothers selected randomly from those registered for delivery was obtained about their pregnancy, diet, and current and past lead exposures. We collected umbilical cord blood for lead levels analyzed using graphite furnace atomic absorption spectrophotometry. We computed geometric and arithmetic means. We performed multiple linear regression analysis to identify factors associated with log-transformed umbilical cord BLLs. We also performed logistic regression analysis to identify determinants of high lead cord BLLs (10 microg/dl).

RESULTS

The geometric mean cord BLL of the neonates was 9.6 microg/dl; arithmetic mean (S.D.) was 10.8 microg/dl (5.7) with a median of 9.7 microg/dl and a range of 1.8-48.9 microg/dl. Women who reported intake of less than 58.5mg of elemental iron supplement per day during pregnancy had cord BLL of 10.0 microg/dl; in comparison those women who had higher iron intake had lower cord BLL (8.4 microg/dl). Those who used surma (an eye cosmetic) daily had higher cord BLL (11.5 microg/dl) as compared to those who used it less frequently (9.4 microg/dl). In multivariable linear regression model, higher iron intake, owning a car, and being in 2nd quartile of mid-arm circumference were associated with low lead levels while father's occupation in lead-based industry was associated with significantly higher umbilical cord BLLs. There was interaction of daily surma use and ethnicity. Geometric mean BLLs were varied among surma users by ethnicity.

CONCLUSIONS

Umbilical cord BLLs are high in Karachi, Pakistan, in comparison to those in developed countries such as United States. Measures are needed to reduce fetal lead exposure to prevent adverse affect on neurocognitive development. Association of low iron (below RDA of 60 mg per day) with high umbilical cord has implications for strengthening iron supplement intake during pregnancy. Umbilical cord BLLs differed among surma users by ethnicity.

Is lead considered as a risk factor for high blood pressure during menopause period among Saudi women?

This case-control study was designed to examine the association between blood lead levels and high blood pressure in a restricted subpopulation, Saudi women who were 45-93-year old, during or after menopausal period and not occupationally exposed to lead. Blood lead levels were assessed in 100 women with hypertension and 85 control subjects. Lead concentrations were measured in the whole blood using flameless atomic absorption spectrophotometry. Blood pressure measurements were performed according to the World Health Organization recommendations. Results revealed that the mean blood lead levels for hypertensive were 47.52+/-39.26 and 45.59+/-28.55 microg/l for controls. Participants were classified according to the median of blood lead levels in order to compute odds ratios. After controlling a number of potential confounding variables, the multiple logistic regression analysis revealed that women with blood lead levels of > or = 38.6 microg/l were 5.27 times more likely to be hypertensive than those with blood lead levels of < 38.6 microg/l, but of borderline significance (p = 0.06). Although such observation might support the hypothesis that the depletion of lead from bones during menopause increases blood lead levels placing women at increased risk for high blood pressure, there is a need for further studies with larger number of subjects. A number of risk factors, which were suspected to influence blood lead levels, were also investigated. Use of Kohl, duration of its use, osteoporosis disease and intake of calcium supplements were significantly associated with blood lead levels.

Cosmetic dermatitis - current perspectives

BACKGROUND

Increasing use of cosmetics by modern society has contributed alarming to an rise in the incidence of cosmetic dermatitis (CD). The causative agents are skin, hair, nail and eye cosmetics. Reported cases of cosmetic dermatitis represent only the tip of the iceberg, as most patients who experience an adverse reaction to cosmetics do not consult a physician but discontinue using the suspected items.

METHODS

A comprehensive history followed by adequate clinical examination and patch test is important to diagnose reaction to cosmetics. In addition other tests like Repeated Open Application Test (ROAT), usage test, elimination test and safety test are important, as many cosmetics and their ingredients are either weak allergens or irritants.

RESULTS

A wide variety of adverse reactions to cosmetics are seen which are of both irritant and allergic type. Pattern of CD varies in different parts of the world depending upon the type and frequency of different cosmetics used. Reactions are more commonly seen in females of younger age and the face is the most common site.

CONCLUSIONS

Though prevention is better than cure, but cosmetics have definitely infiltrated into our life style. We cannot prevent use of cosmetics but can only limit their use by educating their users and helping them in judicious selection of the required cosmetics.

A case of lead poisoning due to snooker chalk

A 3 year, 9 month old child with pica presented with a blood lead concentration of 1.74 micromol/l (360 microg/l). The source of poisoning was snooker chalk (lead content 7200 microg/g). She was treated with intravenous calcium disodium edetate chelation. Thirty months later her blood lead was 0.39 micromol/l (80 microg/l). This case illustrates the need to be vigilant for more unusual causes of lead poisoning in the home.

Acute lead encephalopathy in early infancy--clinical presentation and outcome

We studied 19 infants with a mean age of 3.8 months who presented with features consistent with acute lead encephalopathy following the use of traditional medicines. All presented with convulsions; CT scans of the brain on admission showed brain oedema in four, atrophy in four and normal findings in 11. Cerebrospinal fluid analysis in nine patients showed pleocytosis in six and a high protein content in eight. The median lead level in these 19 infants which encephalopathy was 3.6 mumol/l (74.5 micrograms/dl). Seven had a mean lead level of only 2.7 mumol/l (56.9 micrograms/dl) which is much below 70 micrograms/dl, the level usually proposed as the threshold for encephalopathy. Thirteen infants developed brain damage during follow-up; statistical analysis correlated the lead level at 2 months post chelation with an abnormal neurological outcome. Our findings indicate that in very young infants acute lead encephalopathy may occur at lead level lower than previously reported.

Blood lead in pregnant women in the urban slums of Lucknow, India

OBJECTIVES

To determine the concentrations of blood lead (PbB) in pregnant women in the slums of Lucknow, north India.

METHODS

Of the 203 designated municipal slums in Lucknow, 70 were randomly selected for study and a cohort of 500 pregnant women was enrolled. Each participant was interviewed with questions on possible sources of exposure to lead, surrogates of nutritional status were measured, and PbB was measured.

RESULTS

The mean PbB was 14.3 micrograms/dl and 19.2% of women had PbB > or = 20 micrograms/dl. PbB was not associated with age, height, weight, gestation, or history of abortions, although higher PbB was associated with higher parity. Women living inner city neighbourhoods near heavy vehicular traffic had PbB 2.2 micrograms/dl higher (95% confidence interval (95% CI) 0.8 to 3.6) than those living in other neighbourhoods. The PbB was not associated with reported use of piped water or the presence of paint in homes, and increasing PbB was unexpectedly associated with decreasing use of eye cosmetic "surma" and the duration of gestation.

CONCLUSIONS

The high PbB found in this population raises concern about fetal development and points to the urgent need to reduce exposure to lead.

Concentration of blood lead and ethnicity in the United Kingdom

The relation between concentration of blood lead and ethnic background in 779 children was examined with the analytical results from the trace element service at the Medical Toxicology Unit (MTU), Guy's and St Thomas's Hospital Trust for the period 1980-94. The ethnic identity was determined with the first and the second names of the investigated subjects. Of the patients of European origin (European) studied 72.8% v only 50.6% of the children with origins in the Indian subcontinent (Asian) had a concentration of blood lead < 100 micrograms/l. The percentage of subgroups with concentrations above the upper acceptable limit of 200 micrograms/l was significantly higher in Asian subjects (European 5% v Asian 26.5%), with the most pronounced difference in those with concentrations of blood lead of 500 micrograms/l (European 0.8% v Asian 10.5%). This study shows that a correlation exists between Asian ethnic background and concentration of blood lead in children. Factors such as cultural habits-for example, use of traditional remedies, cosmetics, diet- and socioeconomic status, may have contributed to this results.

Lead exposure in the city of Arar, Saudi Arabia

In follow-up to a case of lead encephalopathy, high prevalences of lead exposure (23%) and iron deficiency (60%) were found in children who lived in Arar, Saudi Arabia. Environmental factors had minor effects on the blood lead concentrations of these children. We concluded that traditional cosmetics and remedies were the major sources of lead exposure in this Arar population.

Kohl: a hazardous eyeliner

Kohl is a widely used traditional cosmetic. It is mainly worn around the eyes in the Middle East, Asia and Africa. The elemental composition of twenty-one kohl specimens originating from various parts of Saudi Arabia, India and the Middle East was determined by energy dispersive X-ray analysis (EDAX). The data indicates the presence of significant lead levels in two thirds (14/21) of the kohl specimens ranging from 2.9-100% (mean 48.5%). Other less frequent elements present in kohl preparations include aluminum, carbon, iron, titanium, calcium, magnesium, oxygen, silver silicon, sulfur and antimony. Seven kohl specimens were totally lead-free, four had a lead content in the range of 2.9-34.1% and ten had lead levels in excess of 84%. Carbon levels in excess of 60% were detected in six kohl samples. Antimony was present in only one kohl specimen at a concentration of 7.8%. Five western made eyeliner pencils analyzed for comparative purposes consistently revealed iron as a common constituent (mean 46%) but no lead or carbon were detected in these specimens. The findings of this study indicate that modern kohl preparations contain a number of metals derived from natural sources in addition to carbon. The predominance of lead in the kohl preparations tested is of major concern due to the documented adverse effects in humans and the increased susceptibility of children to lead intoxication. Application of lead-containing kohl needs to be considered as a source of lead in evaluating patients with symptoms of lead intoxication in regions where this tradition prevails. The documented toxic effects of lead in humans and the increased sensitivity of children to lead exposure serve to emphasize potential health risks of using traditional lead containing kohl preparations and the need for increased surveillance and regulation of the manufacture of kohl.

Lead, erythrocyte protoporphyrin, and hematological parameters in normal maternal and umbilical cord blood from subjects of the Riyadh region, Saudi Arabia

A survey was undertaken among 124 pregnant women living in Riyadh City to investigate the passage of lead from the pregnant mother to the unborn child. The mean maternal blood lead level was 5.49 +/- 2.6 micrograms/dl and for the umbilical cord was 4.14 +/- 1.81 micrograms/dl. Lead levels were higher in maternal than in the umbilical cord blood. The results are in agreement with other studies. In this study, an excellent correlation between the maternal and cord blood lead levels (r = .83, p < .0001) confirms the transfer of lead from the mother to the fetus. A weak but significant relationship was found between maternal blood lead concentrations and birth weight of newborns (r = -.271, p < .05), and it is concluded that low levels of lead exposure to pregnant women may be considered hazardous.

Lead poisoning from Asian traditional remedies in the West Midlands--report of a series of five cases

1. Traditional remedies are an unusual, but recognised cause of lead poisoning. Only two cases have previously been reported in this country. 2. We report a series of five cases of lead poisoning due to traditional remedies in the West Midlands. All developed typical clinical features. 3. Blood lead and zinc protoporphyrin (ZPP) concentrations were elevated 2-10 times the upper limit of normal. The remedies contained up to 60% lead by weight. One also contained traces of mercury, another arsenic, and a third aluminium and tin. 4. Confirmation of the medicines as the cause of the poisoning was made in one patient by measurement of lead isotopic ratios. 5. The present morbidity from traditional remedies may be far greater than is realised, and will continue until such time as the supply of harmful preparations can be effectively limited. There needs to be increased awareness of their dangers amongst doctors and the communities at risk. This will best be achieved by appropriately targeted education.

Distribution of blood lead levels in 1,047 Saudi Arabian children with respect to province, sex, and age

Relationships between blood lead concentrations in 1,047 children aged 2 mo to 16 y and age, sex, and province (i.e., residence) were examined. The relationships were consistent with other studies, in which mean blood lead concentrations reportedly increased during the first 5 y of life, after which began to decrease, reaching a minimum at approximately 16 y of age. However, boys who were more than 6 y of age had higher blood lead concentrations than similarly aged girls. Blood lead levels of children living in the Eastern Province were higher than levels found in children from other provinces. Most of the children in this study who had elevated blood lead concentrations resided in small towns, e.g., Ehssa, Abqiq, Hofouf, rather than in cities such as Dammam and Dahran. Factors, such as socioeconomic status and cultural habits (e.g., diet, use of traditional remedies and cosmetics), may have contributed to this result.

Kohl - the traditional eyeliner: Use and analysis

Kohl is a traditional powder-like mixture used as an eyeliner and to treat eye disease in many Middle and Far East countries. We studied kohl use among 360 individuals selected at random in Riyadh, Saudi Arabia. Kohl was used by 13% of males and 26% of females, especially the elderly and illiterate. Forty percent of females with children applied kohl to the eyes of their children during the first postnatal month. Analysis of five commercially available traditional kohl samples showed that some preparations have a high pH and a high lead concentration (88%), indicating that most preparations are lead-based rather than antimony-based. It is interesting to find that some kohl preparation have a weak antimicrobial effect against Streptococcus, Staphylococcus and Proteus species. The use of lead-based kohl is still a common and serious practice and should be discouraged, especially in children. The role of traditional kohl use in the pathogenesis of common ocular external diseases prevalent in Middle and Far East countries merits in investigation.

Attitudes to and perceived use of health care services among Asian and non-Asian patients in Leicester

A random sample of 449 Asian patients and 447 non-Asian patients were interviewed at home in their preferred language using a personally administered questionnaire comparing attitudes to and perceived use of health care services in Leicester. The overall response rate was 89.6%. There were differences in the responses of the Asian and non-Asian populations. With respect to communication, language as a barrier appears to be a diminishing problem among Asian patients in Leicester. However, Asian patients reported finding it more difficult to gain access to their general practitioners than non-Asian patients. More Asian than non-Asian patients would have preferred direct access to consultants and most respondents from both populations felt they should be able to request a hospital opinion from their general practitioner. More Asian patients disliked management of illness by telephone than non-Asian patients, the latter feeling that telephone advice could save them a trip to the surgery, or their general practitioner a home visit. However, both groups regarded home visiting as essential. Asian patients disliked deputizing services more than non-Asian patients, and there was some support for 24 hour surgeries, particularly among the Asian population, with doctors working in shifts. As Asian patients appear to differ from non-Asian patients with respect to attitudes and perceived need for health care services, this type of survey may form the basis for the more rational planning of health care delivery to ethnic minority patients in the future.

Seizures in a 10-week-old infant: lead poisoning from an unexpected source

Images

The cultural parameters of lead poisoning: a medical anthropologist's view of intervention in environmental lead exposure

This article identifies four culturally shaped sources of lead exposure in human societies: modern and historic technological sources: food habits; culturally defined health beliefs; and beauty practices. Examples of these potential sources of lead poisoning are presented from current cultures. They include the use of lead-glazed cooking pottery in Mexican-American households; folk medical use of lead in Hispanic, Arabic, South Asian, Chinese, and Hmong communities; as well as the use of lead as a cosmetic in the Near East, Southeast Asia, and South Asia. Four interacting cultural conditions that create barriers to the reduction of lead exposure and lead poisoning are identified and discussed. These are knowledge deficiencies, communication resistance, cultural reinterpretations, and incongruity of explanatory models.

Assessing the contribution from lead in mining wastes to blood lead

Lead has been recognized for years as an environmental pollutant of concern for young children. Nonetheless, many children in the United States still experience high body burdens of lead. Reducing exposure to lead must include an assessment of all potential sources of lead and a definition of routes of exposure. In this paper, the relationships between soil lead and blood lead concentrations in residents in communities with high soil lead concentrations resulting from past mining and ore processing (milling) activities are compared to those derived from studies in urban communities or communities with operating smelters. The impact of mine waste-derived lead in soil (usually in the form of lead sulfide) on blood lead is less than that for lead in soil derived from smelter, vehicle, or paint sources. Possible reasons for a reduced impact of lead sulfide on blood lead in children in mining communities include the following: lead from mining sources contributes less to lead in the immediate environment of children than lead from other sources; mine wastes typically are of larger particle size, which decreases the bioavailability of lead in the gastrointestinal tract; and lead sulfide is absorbed less in the gastrointestinal tract compared to other lead species. A reduced impact of mine waste-derived lead on blood lead may be important from a regulatory point of view. Expensive cleanup actions for lead-contaminated soils in mining communities based on acceptable soil lead concentrations derived from smelter or urban communities may be questionable in terms of reducing blood lead in children.

Haemorrhagic shock and encephalopathy: a new syndrome with a high mortality in young children

In the past year, ten infants have been admitted to hospital with a new or previously unrecognised disorder, characterised by an acute onset of encephalopathy, fever, shock, watery diarrhoea, severe disseminated intravascular coagulation, and renal and hepatic dysfunction. Seven of the infants died. No specific causative agent has been identified, but preliminary studies suggest that the pathophysiology of the disease may involve release of proteolytic enzymes (such as trypsin) into the circulation, with destruction of the microcirculation.

Lead sulphide and traditional preparations: routes for ingestion, and solubility and reactions in gastric fluid

Lead sulphide frequently occurs as a fallacious materia medica in traditional preparations used throughout the Moslem world. Although one of the least soluble lead compounds, use of this material as an eye powder has been directly associated with elevated blood-lead levels in children. Data are presented from animal studies which show the primary route for ingestion of the eye cosmetic is not transcorneal transport. Conversion of the sulphide to the more soluble (and hence more readily absorbed) chloride form is shown to occur in gastric fluid and, significantly, a marked dependence of the rate of dissolution on particle size is found. This may explain the disparity in previous reported values for the extent of absorption of ingested lead sulphide.

Lead encephalopathy in infants in Kuwait. A study of 20 infants with particular reference to clinical presentation and source of lead poisoning

Twenty patients aged between one and eighteen months (mean six months) were found to have lead encephalopathy. They were seen in one 30-bed ward during a four year period from 1977 to 1980. Blood lead was determined in 19 children and ranged between 2.9 and 12.4 mumol/l (60 and 257 micrograms/dl) mean 5.42 mumol/l (113 micrograms/dl). Two patients died before starting treatment. Of the 18 patients treated with B.A.L. (2.3 dimercaptopropanol) and EDTA (ethylenediaminetetra-acetic acid), three died. Eleven patients made an apparently complete recovery and four had neurological sequelae. The source of lead was traced in 18 patients: in 11 it was due to the liberal use of Kohl (also known as surma) commonly used as an eye cosmetic in the Arabian peninsula. Other local sources of lead poisoning are discussed.