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Meena P, Narayanan G, Murthy P. Rare case of chronic naphthalene ball ingestion in a young Indian woman. J Family Med Prim Care 2023; 12:2973-2975. [PMID: 38186784 PMCID: PMC10771217 DOI: 10.4103/jfmpc.jfmpc_352_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 01/09/2024] Open
Abstract
Chronic oral abuse of naphthalene balls is extremely rare. It is associated with different types of metabolic toxicity, neurological deficits and multiple organ failure. However, the psychological implication of naphthalene abuse is poorly understood. This is a unique case report of a 29-year-old lady who presented with a 17 year history of naphthalene ball consumption. Historically, there have been self-harm behaviors, fire setting, cleaning compulsions, and involuntary motor movements associated with naphthalene. A series of assessments were conducted to assess her personality, psychiatric symptoms and cognitive functions. Additionally, blood tests, CT scan and MRI were done. The patient's profile indicated no apparent medical, neurological or cognitive impairments. Her psychological profile revealed significant co-morbidities and marked personality pathology. The case study provides useful insights into the presentation of chronic naphthalene ball ingestion in an Indian woman, thereby indicating the need to identify psychosocial and biological markers longitudinally. It also highlights recognition of common household items that can be abused, suggesting better understanding of protecting vulnerable individuals from the same.
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Affiliation(s)
- Pratibha Meena
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Gitanjali Narayanan
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Wimalasiri I, Suraweera C. All in a scent - naphthalene dependence confined to pregnancy: a case report. BMC Psychiatry 2022; 22:723. [PMID: 36403047 PMCID: PMC9675229 DOI: 10.1186/s12888-022-04369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Inhalant or volatile substance use is a health issue with significant medical and psychiatric sequelae. Inhalants or volatile substances are volatile organic substances found in domestic and commercial products which are inhaled to obtain pleasurable effects. They are easily accessible, cheap, and legal. Common inhalants are spray, paints, glue and shoe polish whilst naphthalene or 'mothball' abuse is reported less commonly. We report a case of a 29-year-old female who inhaled and ingested naphthalene during her pregnancy. This case report is unique because the dependence on naphthalene was confined to pregnancy and resolved as soon as she delivered. This brings up the question whether pregnancy in general increases the risk of substance dependence in vulnerable populations or whether the dependence in this patient during pregnancy is due to individual factors. CASE PRESENTATION The patient we report is a 29-year-old female who developed a strong desire to inhale mothballs during her third pregnancy. The pattern of use started in the first trimester meeting the criteria for dependence syndrome and resolved completely by the second day following delivery. She had features suggestive of harmful use in her second pregnancy as well. CONCLUSIONS The case report emphasizes that pregnant women should be screened for psychoactive substance use. Equally important is the need for adequate psychoeducation about the myths and cultural beliefs associated with pregnancy-related cravings and the potentially devastating consequences of harmful cravings on the neonate and the mother. The case highlights how chemicals used in day-to-day activities can lead to dependence.
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Affiliation(s)
- Isuri Wimalasiri
- grid.415398.20000 0004 0556 2133University Psychiatry Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Chathurie Suraweera
- University Psychiatry Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
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Kuwada G, Murakami A, Glaser DW, Ingraham SE, Purohit PJ. Mothball Ingestion in the Setting of G6PD Deficiency Causing Severe Hemolytic Anemia, Methemoglobinemia, and Multiple Organ Failure in a Toddler. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:3-5. [PMID: 35028588 PMCID: PMC8742304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mothballs containing naphthalene or paradichlorobenzene are known to cause hemolysis and methemoglobinemia. They can also affect the other organs, including the kidneys, liver, lungs, and skeletal muscles. The involvement of 1 or 2 organs at a time has been commonly reported. However, more than 2 organ dysfunction in mothball intoxication is rare and usually indicates severe illness. The intoxication can have more pronounced symptoms in children with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We report this case of a previously healthy 13-month-old patient who presented with severe hemolysis, lactic acidosis, methemoglobinemia, acute renal failure, hepatic dysfunction, and rhabdomyolysis. He required aggressive fluid resuscitation, blood transfusions, and mechanical ventilation. The underlying etiology of his illness was initially unclear; however, upon repeated questioning, the father recalled the patient chewing on a mothball 3-4 days before admission. Hence, mothball intoxication was considered the most plausible clinical diagnosis in this patient. He was given N-acetylcysteine, instead of methylene blue, because of hepatic dysfunction and the fact that G6PD deficiency could not be ruled out in the presence of acute hemolysis. The patient made a full recovery after 2 weeks of intensive care unit management. G6PD testing after 3 months confirmed the deficiency. These mothballs are available in Hawai'i, but this is the first report of such a severe presentation to our knowledge. The presence of methemoglobinemia, severe hemolysis, and thorough history-taking helped us determine the diagnosis of mothball intoxication and enabled definitive treatment.
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Affiliation(s)
- Garrett Kuwada
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (GK, AM)
| | - Aiko Murakami
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (GK, AM)
| | - Darryl W. Glaser
- Department of Pediatrics, Kapi‘olani Medical Center for Women and Children, Honolulu, HI (DWG, SEI, PJP)
| | - Susan E. Ingraham
- Department of Pediatrics, Kapi‘olani Medical Center for Women and Children, Honolulu, HI (DWG, SEI, PJP)
| | - Prashant J. Purohit
- Department of Pediatrics, Kapi‘olani Medical Center for Women and Children, Honolulu, HI (DWG, SEI, PJP)
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Lin N, Kwarteng L, Godwin C, Warner S, Robins T, Arko-Mensah J, Fobil JN, Batterman S. Airborne volatile organic compounds at an e-waste site in Ghana: Source apportionment, exposure and health risks. JOURNAL OF HAZARDOUS MATERIALS 2021; 419:126353. [PMID: 34175701 PMCID: PMC9925107 DOI: 10.1016/j.jhazmat.2021.126353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 06/01/2023]
Abstract
Informal e-waste recycling processes emit various air pollutants. While there are a number of pollutants of concern, little information exists on volatile organic compounds (VOCs) releases at e-waste sites. To assess occupational exposures and estimate health risks, we measured VOC levels at the Agbogbloshie e-waste site in Ghana, the largest e-waste site in Africa, by collecting both fixed-site and personal samples for analyzing a wide range of VOCs. A total of 54 VOCs were detected, dominated by aliphatic and aromatic compounds. Mean and median concentrations of the total target VOCs were 46 and 37 μg/m3 at the fixed sites, and 485 and 162 μg/m3 for the personal samples. Mean and median hazard ratios were 2.1 and 1.4, respectively, and cancer risks were 4.6 × 10-4 and 1.5 × 10-4. These risks were predominantly driven by naphthalene and benzene; chloroform and formaldehyde were also high in some samples. Based on the VOC composition, the major sources were industry, fuel evaporation and combustion. The concentration gradient across sites and the similarity of VOC profiles indicated that the e-waste site emissions reached neighboring communities. Our results suggest the need to protect e-waste workers from VOC exposure, and to limit emissions that can expose nearby populations.
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Affiliation(s)
- Nan Lin
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA 48109; Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University, Shanghai, PR China 200025
| | - Lawrencia Kwarteng
- Department of Biological, Environmental and Occupational Health Sciences, University of Ghana, School of Public Health, P.O. Box LG13, Accra, Ghana
| | - Christopher Godwin
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA 48109
| | - Sydni Warner
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA 48109
| | - Thomas Robins
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA 48109
| | - John Arko-Mensah
- Department of Biological, Environmental and Occupational Health Sciences, University of Ghana, School of Public Health, P.O. Box LG13, Accra, Ghana
| | - Julius N Fobil
- Department of Biological, Environmental and Occupational Health Sciences, University of Ghana, School of Public Health, P.O. Box LG13, Accra, Ghana
| | - Stuart Batterman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA 48109.
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Simasotchi C, Chissey A, Jungers G, Fournier T, Seralini GE, Gil S. A Glyphosate-Based Formulation but Not Glyphosate Alone Alters Human Placental Integrity. TOXICS 2021; 9:220. [PMID: 34564371 PMCID: PMC8472883 DOI: 10.3390/toxics9090220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 12/27/2022]
Abstract
Glyphosate (G)-based herbicidal formulations, such as the most commonly used one, Roundup (R), are major pesticides used worldwide on food and feed. Pregnant women may be frequently exposed to R compounds. These are composed of G, which is declared as the active principle, and other products contained in formulations, named formulants, which have been declared as inerts and diluents by the manufacturers. These formulants have, in fact, been demonstrated to be much more toxic than G, in particular to placental and embryonic human cells. In this work, we thus compared the effect of G and a GT+ formulation named R, using placental perfusion ex vivo. R, but not G alone, was demonstrated to alter the placental permeability of a known small model molecule, antipyrine. Similar results were observed for the fetal venous flow rate. The transfer of G alone increases with time, but is significantly decreased in presence of its formulants. The perfusion of R provokes a destruction of fetal vessels, as demonstrated by immunohistochemistry. Formulants obviously alter the fetal-placental circulation and placental integrity according to time of exposure. Therefore, G does not appear to be the main toxic agent of R. Formulants, although undeclared, include polyoxyethanolamines, PAHs, or heavy metals, and may be responsible for this toxicity. These compounds are also present in other pesticides. The progressive blood flow reduction due to the toxic compounds of formulations may diminish the nutrient supply to the fetus, alter the development, and may enhance the poisoning effects. Although these are preliminary results, they could at least partially explain some adverse pregnancy outcomes in mothers exposed to pesticides or other environmental pollutants. The debate on glyphosate alone is proven insufficient for the understanding of the toxicity.
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Affiliation(s)
- Christelle Simasotchi
- Faculté de Pharmacie, Université de Paris, INSERM, U1139, 3PHM, 4 Avenue de l’Observatoire, F-75006 Paris, France; (C.S.); (A.C.); (T.F.); (S.G.)
| | - Audrey Chissey
- Faculté de Pharmacie, Université de Paris, INSERM, U1139, 3PHM, 4 Avenue de l’Observatoire, F-75006 Paris, France; (C.S.); (A.C.); (T.F.); (S.G.)
| | - Gérald Jungers
- Network on Risks, Quality and Sustainable Development, MRSH, Faculty of Sciences, University of Caen Normandy, Esplanade de la Paix, F-14032 Caen, France;
| | - Thierry Fournier
- Faculté de Pharmacie, Université de Paris, INSERM, U1139, 3PHM, 4 Avenue de l’Observatoire, F-75006 Paris, France; (C.S.); (A.C.); (T.F.); (S.G.)
| | - Gilles-Eric Seralini
- Network on Risks, Quality and Sustainable Development, MRSH, Faculty of Sciences, University of Caen Normandy, Esplanade de la Paix, F-14032 Caen, France;
| | - Sophie Gil
- Faculté de Pharmacie, Université de Paris, INSERM, U1139, 3PHM, 4 Avenue de l’Observatoire, F-75006 Paris, France; (C.S.); (A.C.); (T.F.); (S.G.)
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Shafer G, Arunachalam A, Lohmann P. Newborn with Perinatal Naphthalene Toxicity after Maternal Ingestion of Mothballs during Pregnancy. Neonatology 2020; 117:127-130. [PMID: 31751989 DOI: 10.1159/000504345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022]
Abstract
Maternal ingestion of naphthalene-containing mothballs is an uncommon cause of perinatal toxicity. Naphthalene toxicity is associated with methemoglobinemia, hypotension, hemolytic anemia, and hyperbilirubinemia, as well as other hepatic, renal, and respiratory complications. Naphthalene exposure is a common cause of toxicity in older children, but is rarely described in neonates. The neonatal cases described in the literature focus primarily on maternal inhalation as opposed to ingestion. We present a case of perinatal toxicity due to repeated maternal ingestion of naphthalene-containing mothballs during pregnancy. The patient presented with methemoglobinemia, hypotension, hemolytic anemia, and hyperbilirubinemia. Sepsis or pulmonary hypertension were the initial working diagnoses, as the mother did not provide the history of ingestion until after the patient's clinical status worsened. This case highlights the importance of obtaining a thorough maternal history and considering maternal ingestion when the etiology of symptoms is not clear.
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Affiliation(s)
- Grant Shafer
- Division of Neonatology, Baylor College of Medicine, Houston, Texas, USA, .,Division of Neonatology, Texas Children's Hospital, Houston, Texas, USA,
| | - Athis Arunachalam
- Division of Neonatology, Baylor College of Medicine, Houston, Texas, USA.,Division of Neonatology, Texas Children's Hospital, Houston, Texas, USA
| | - Pablo Lohmann
- Division of Neonatology, Baylor College of Medicine, Houston, Texas, USA.,Division of Neonatology, Texas Children's Hospital, Houston, Texas, USA
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