Medical Specialties Commons^™

Serum Tumour Necrosis Factor Alpha In Osteopenic And Osteoporotic Postmenopausal Females: A Cross-Sectional Study In Pakistan, Rafat Murad, Zahra Shezad, Saara Ahmed, Mussarat Ashraf, Murad Qadir, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: To compare biochemical parameters serum tumour necrosis factor alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D in postmenopausal women.
Methods: This cross-sectional study was carried out from June 2015 to July 2016 at Jinnah Medical and Dental College, Karachi, and comprised postmenopausal women. Bone mineral density done by dual energy X-ray absorptiometryscan categorised subjects by World Health Organisation classification into normal (T score > -1) osteopenic (T score between -1 and -2.5) and osteoporotic (T score < -2.5). Biochemical parameters like tumour necrosis alpha, calcium, magnesium, bone-specific alkaline phosphatase and vitamin D were measured by solid phase enzyme amplified sensitivity immunoassay method. SPSS 16 was used to analyse the data.
Results: Of the 146 women, 34(23%) were normal, 93(67%) were osteopenic and 19(13%) were osteoporotic. There was significant difference in mean body mass …

A Gender-Based Comparison In Health Behaviors And State Of Happiness Among University Students, Rehana Rehman, Amara Zafar, Aleena Mohib, Mukhtiar Baig

Department of Biological & Biomedical Sciences

Objective: The presence of good healthy behaviors among university students is imperative for their future life. This study aimed to compare positive health behaviors and state of happiness between the two genders of Bahria University (BU), Karachi, Pakistan.
Subjects and methods: This cross-sectional study was conducted at BU, Karachi, Pakistan. A total 813 students participated in this study. The healthquestionnaire, adapted from Health and Behavior Survey and the Subjective Happiness Scale, was used to assess self-reported happiness. The data were analyzed using IBM SPSS version 22.
Results: Overall self-reported health behaviors were found to be more prevalent in females as …

Neonatal Purpura Fulminans, A Rare Genetic Disorder Due To Protein C Deficiency: A Case Report., Ghazala Irfan Kazi, Emaduddin Siddiqui, Saadia Tabassum, Badar Afzal, Irum Qamar Khan

Department of Emergency Medicine

Neonatal Purpura Fulminans is a rare and fatal disorder associated with perivascular haemorrhage and disseminated intravascular coagulation. Early clinical recognition, timely investigation and treatment is utmost important. A 6 days old baby boy was brought to emergency with blackish ulcers all over the body. Initially these were over the feet and scalp but later appeared on the abdomen. On examination, child was vitally stable, mildly icteric and had multiple erythematous large bullous blackish lesions on scalp, lower abdomen, perineum, back and soles. Neonatal reflexes and systemic examination was normal. Laboratory investigations showed normal CBC, PT/APTT and Protein S level while …

Treatment Of A Rare Vascular Complication Of Coronary Stenting In An Octagenarian, Hunaina Shahab, Bilal Hussain, Nasir Rahman, Fateh Ali Tipoo Sultan

Section of Cardiology

The ability of drug-eluting stent (DES) to inhibit intimal proliferation has resulted in a massive increase in their usage over the years. However, it is known that the application of DES can alter the normal cascade of vascular healing, resulting in delayed endothelialisation with risk of vascular complications. Coronary artery aneurysms (CAN) are defined as more than 50% dilatation of the coronary artery compared to the reference vessel diameter with the reported incidence after percutaneous intervention (PCI) being only around 0.35 to 6.0%. Previously, CAN had been reported with the use of bare metal stent secondary to stretch, stent fracture …

Myocarditis Mimicking Acute Coronary Syndrome - The Role Of Cardiac Magnetic Resonance Imaging In The Diagnosis, Fateh Ali Tipoo Sultan, Ghurfan Adnan

Section of Cardiology

Myocarditis is an inflammatory disease of myocardium with a wide range of clinical presentations. Myocarditis may mimic acute coronary syndrome (ACS) and adequate differential diagnosis is not possible by conventional tests. Cardiac magnetic resonance (CMR) has emerged as a leading imaging modality in the diagnosis of myocarditis in such patients. Here, we report three cases of myocarditis mimicking ACS with normal coronary arteries. CMR was used for confirming the diagnosis of myocarditis in all three patients presented here.

Electronic Cigarettes Use And Perception Amongst Medical Students: A Cross Sectional Survey From Sindh, Pakistan, Nousheen Iqbal, Zain A. Khan, Syed Muhammad Hamza Anwar, Omar Irfan, Babar Irfan, Ammar Mushtaq, Maria Bibi, Faraz Siddiqui, Javaid Khan

Section of Pulmonary & Critical Care

Objective: The manufacturers of electronic cigarettes (e-cigarettes) are actively marketing their product through electronic and social media. Undergraduate medical students are expected to have better knowledge and awareness as they directly interact with patients in their training, The purpose of this study is therefore, to determine knowledge, use and perception regarding e-cigarettes among medical students from Sindh, Pakistan.

Results: A cross-sectional study was conducted between 1st July and 30th September 2016 at five different medical colleges situated in the second largest province of Sindh, Pakistan. The data was collected through a structured, self-administered questionnaire. Of the 500 students, the mean …

Download Entire Issue: Gibbon Surgical Review, Volume 1, Issue 1, 2018

Gibbon Surgical Review

Table of Contents

• A First Year's Perspective on JeffMD, Somnath Das, MS1
• Spotlight on TJUH's Quality and Safety Group, Samantha L. Savitch, MS1
• Medical Student Involvement in Quality Improvement Research, Tyler M. Bauer, MS3
• Global Surgery: A Shift in the Global Health Paradigm, Myles S. Dworkin, MS3
• Thomas Jefferson University Design Vault, Victor B. Hsue, MS2
• Physician Spotlight: Ernest (Gary) L. Rosato, MD, FACS, Carrie E. Andrews, MS3
• The SCALPELS Program, Emily Papai, MS1

Influence Of Supportive Care On Chemotherapy Patients' Self-Care Behaviour And Satisfaction: A Pilot Study Conducted In Karachi, Pakistan, Salima Shams, Adnan Jabbar, Kashmira Nanji, Rafat Jan, Ambreen Tharani

School of Nursing & Midwifery

Background and aim: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program.
Methods: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals …

Volumetric Modulated Arc Therapy Treatment Planning Of Thoracic Vertebral Metastases Using Stereotactic Body Radiotherapy, Matthew Mallory, Damodar Pokhrel, Rajeev Badkul, Hongyu Jiang, Christopher Lominska, Fen Wang

Radiation Medicine Faculty Publications

Purpose/Objectives: To retrospectively evaluate the plan quality, treatment efficiency, and accuracy of volumetric modulated arc therapy (VMAT) plans for thoracic spine metastases using stereotactic body radiotherapy (SBRT).

Materials/Methods: Seven patients with thoracic vertebral metastases treated with noncoplanar hybrid arcs (NCHA) (1 to 2 3D-conformal partial arcs +7 to 9 IMRT beams) were re-optimized with VMAT plans using three coplanar arcs. Tumors were located between T2 and T7 and PTVs ranged between 24.3 and 240.1 cc (median 48.1 cc). All prescriptions were 30 Gy in 5 fractions with 6 MV beams treated using the Novalis Tx linac equipped with high definition …

Associations Between Neighbourhood Characteristics And Depression: A Twin Study., Hannah Cohen-Cline, Shirley A A Beresford, Wendy Elizabeth Barrington, Ross L Matsueda, Jon Wakefield, Glen E Duncan

Articles, Abstracts, and Reports

BACKGROUND: Depression is an important contributor to the global burden of disease. Besides several known individual-level factors that contribute to depression, there is a growing recognition that neighbourhood environment can also profoundly affect mental health. This study assessed associations between three neighbourhood constructs-socioeconomic deprivation, residential instability and income inequality-and depression among adult twin pairs. The twin design is used to examine the association between neighbourhood constructs and depression, controlling for selection factors (ie, genetic and shared environmental factors) that have confounded purported associations.

METHODS: We used multilevel random-intercept Poisson regression among 3738 same-sex twin pairs from a community-based twin registry …

Conserved Brain Myelination Networks Are Altered In Alzheimer's And Other Neurodegenerative Diseases., Mariet Allen, Xue Wang, Jeremy D Burgess, Jens Watzlawik, Daniel J Serie, Curtis S Younkin, Thuy Nguyen, Kimberly G Malphrus, Sarah Lincoln, Minerva M Carrasquillo, Charlotte Ho, Paramita Chakrabarty, Samantha Strickland, Melissa E Murray, Vivek Swarup, Daniel H Geschwind, Nicholas T Seyfried, Eric B Dammer, James J Lah, Allan I Levey, Todd E Golde, Cory Funk, Hongdong Li, Nathan D Price, Ronald C Petersen, Neill R Graff-Radford, Steven G Younkin, Dennis W Dickson, Julia R Crook, Yan W Asmann, Nilüfer Ertekin-Taner

Articles, Abstracts, and Reports

INTRODUCTION: Comparative transcriptome analyses in Alzheimer's disease (AD) and other neurodegenerative proteinopathies can uncover both shared and distinct disease pathways.

METHODS: We analyzed 940 brain transcriptomes including patients with AD, progressive supranuclear palsy (PSP; a primary tauopathy), and control subjects.

RESULTS: We identified transcriptional coexpression networks implicated in myelination, which were lower in PSP temporal cortex (TCX) compared with AD. Some of these associations were retained even after adjustments for brain cell population changes. These TCX myelination network structures were preserved in cerebellum but they were not differentially expressed in cerebellum between AD and PSP. Myelination networks were downregulated in …

Immediate Versus Delayed Insertion Of The Levonorgestrel Intrauterine Device In Postpartum Adolescents: A Randomized Pilot Study., Reni Soon, Katie Mcguire, Jennifer Salcedo, Bliss Kaneshiro

Articles, Abstracts, and Reports

This pilot study assessed the feasibility of conducting a larger randomized controlled trial comparing the proportion of adolescents using a levonorgestrel intrauterine device (LNG IUD) at six months postpartum when it is inserted immediately after vaginal delivery (within 10 minutes after placental expulsion) compared to insertion four to six weeks postpartum. Pregnant adolescents (14 to 19 years) who desired a LNG IUD for postpartum contraception were randomized to insertion of the LNG IUD either within 10 minutes of delivery of the placenta or at 4-6 weeks postpartum. Study follow-up visits were conducted at 4-6 weeks postpartum, 10 weeks postpartum, and …

2017 Well Being Trust Annual Report, Well Being Trust

Articles, Abstracts, and Reports

Tyler Norris, writing in the 2017 Well Being Trust Annual Report:

This is a promising moment for our nation, as the importance of mental health and well-being become obvious to growing numbers of Americans and awareness of mental health disorders, addiction and related conditions are emerging from the shadows and moving onto the front page. For a long time, diseases of despair— depression, anxiety, addiction, thoughts of suicide—have been stigmatized as character flaws or moral failures, and even today are widely viewed as a personal matter, something to be covered up, kept out of sight, never talked about. The responsibility …

In-Hospital Mortality And Post-Surgical Complications Among Cancer Patients With Metabolic Syndrome, Tomi Akinyemiju, Swati Sakhuja, Neomi Vin-Raviv

Epidemiology and Environmental Health Faculty Publications

Background

Metabolic syndrome (MetS) is an important etiologic and prognostic factor for cancer, but few studies have assessed hospitalization outcomes among patients with both conditions.

Methods

Data was obtained from the Healthcare Cost and Utilization project Nationwide Inpatient Sample (HCUP-NIS). Study variables were assessed using ICD-9 codes on adults aged 40 years and over admitted to a US hospital between 2007 and 2011 with primary diagnosis of either breast, colorectal, or prostate cancer. We examined in-hospital mortality, post-surgical complications, and discharge disposition among cancer patients with MetS and compared with non-MetS patients.

Results

Hospitalized breast (OR: 0.31, 95% CI: 0.20–0.46), …

A Rare Case: Rupture Of Internal Pudendal And Uterine Artery In A Vaginal Delivery, Novera G. Chughtai, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The management of puerperal hematomas after normal delivery has always been challenging for obstetricians. Vulvar, vulvovaginal, or paravaginal hematomas are common. On the other hand, retroperitoneal hematomas are uncommon and can be life-threatening. The diagnosis of vascular injury is rarely made preoperatively as atonic or traumatic postpartum hemorrhage (PPH), uterine rupture and amniotic fluid embolism are more common differential diagnoses. Injury to internal pudendal and uterine vessels is extremely rare in cases of vaginal delivery and, therefore, the literature on this topic is very scarce. We present a rare case of both internal pudendal and uterine artery rupture in a …

Applying Genomics In Heart Transplantation., Brendan J Keating, Alexandre C Pereira, Michael Snyder, Brian D. Piening

Articles, Abstracts, and Reports

While advances in patient care and immunosuppressive pharmacotherapies have increased the lifespan of heart allograft recipients, there are still significant comorbidities post-transplantation and 5-year survival rates are still significant, at approximately 70%. The last decade has seen massive strides in genomics and other omics fields, including transcriptomics, with many of these advances now starting to impact heart transplant clinical care. This review summarizes a number of the key advances in genomics which are relevant for heart transplant outcomes, and we highlight the translational potential that such knowledge may bring to patient care within the next decade.

The Role Of The Leukemia Inhibitory Factor Receptor In Neuroprotective Signaling, Stephanie M. Davis, Keith R. Pennypacker

Center for Advanced Translational Stroke Science Faculty Publications

Several neurotropic cytokines relay their signaling through the leukemia inhibitory factor receptor. This 190kDa subunit couples with the 130kDa gp130 subunit to transduce intracellular signaling in neurons and oligodendrocytes that leads to expression of genes associated with neurosurvival. Moreover, activation of this receptor alters the phenotype of immune cells to an anti-inflammatory one. Although cytokines that activate the leukemia inhibitory factor receptor have been studied in the context of neurodegenerative disease, therapeutic targeting of the specific receptor subunit has been understudied in by comparison. This review examines the role of this receptor in the CNS and immune system, and its …

Maladjustment Of Programmable Ventricular Shunt Valves By Inadvertent Exposure To A Common Hospital Device, R. Fujimura, Robert M. Lober, K. Kamian, L. Kleiner

Pediatrics Faculty Publications

Background: Programmable ventricular shunt valves are commonly used to treat hydrocephalus. They can be adjusted to allow for varying amounts of cerebrospinal fluid (CSF) flow using an external magnetic programming device, and are susceptible to maladjustment from inadvertent exposure to magnetic fields.Case Description: We describe the case of a 3‑month‑old girl treated for hydrocephalus with a programmable StrataTM II valve found at the incorrect setting on multiple occasions during her hospitalization despite frequent reprogramming and surveillance. We found that the Vocera badge, a common hands‑free wireless communication system worn by our nursing staff, had a strong enough magnetic field to …

Fibrolipomatous Hamartoma Of The Median Nerve With Macrodystrophia Lipomatosa, Muhammad Azeemuddin, Adeel A. Waheed, Noman Khan, Raza Sayani, Anwar Ahmad

Department of Radiology

Fibrolipomatous hamartoma (FLH) is a rare congenital condition that presents with a benign overgrowth of the bone and fibroadipose tissue termed as macrodystrophia lipomatosa (MDL). Although commonly seen in the median nerve, other peripheral nerves can be involved. Diagnosis can be made on magnetic resonance imaging (MRI) due to the characteristic coaxial cable appearance on axial images and the spaghetti appearance on sagittal images. Histology shows mature adipose and fibrous tissue infiltrating the epineural and perineural compartments. Multiple or debulking surgeries are often needed, with an emphasis on cosmetic aspects. We present one such case in which wide margin excision …

Myocardial Perfusion Imaging: The Gatekeeper And Advisor, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Role Of Interventional Radiology In The Management Of Peripheral Vascular Malformations: A Tertiary Care Center Experience., Misbah Tahir, Muhammad Anees Mumtaz, Anum Sultan, Raza Sayani

Department of Radiology

Peripheral vascular malformations (PVMs) represent a wide spectrum of vascular abnormalities occurring due to anomalous connections between arteries, veins, capillaries, and lymphatic channels at the microscopic level, in different combinations. They are rare and challenging to treat. Different operators may have different approaches based on their experience and expertise. Sclerotherapy either alone or in combination with embolization has been used as an independent method for the treatment of PVMs. Purpose The aim of this study is to assess the safety and efficacy of sclerotherapy and embolization, with or without surgery, for the treatment of peripheral vascular malformations, based on our …

A Comparison Of Oral And Intravenous Mouse Models Of Listeriosis, Michelle G. Pitts, Sarah E. F. D'Orazio

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Listeria monocytogenes is one of several enteric microbes that is acquired orally, invades the gastric mucosa, and then disseminates to peripheral tissues to cause systemic disease in humans. Intravenous (i.v.) inoculation of mice with L. monocytogenes has been the most widely-used small animal model of listeriosis over the past few decades. The infection is highly reproducible and has been invaluable in deciphering mechanisms of adaptive immunity in vivo, particularly CD8+ T cell responses to intracellular pathogens. However, the i.v. model completely bypasses the gut phase of the infection. Recent advances in generating both humanized mice and murinized bacteria, as well …

Oncolog, Volume 63, Number 03, March 2018, Bryan Tutt

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Local Consolidative Therapy Plus Immunotherapy or Targeted Agents for NSCLC: Clinical trials explore surgery/radiation plus immune checkpoint or tyrosine kinase inhibitors for metastatic non-small cell lung cancer
• INBRIEF: CAR T Cells Elicit Durable Responses in Large B Cell Lymphoma
• Managing Opioid Use in Cancer Patients: Vigilance and interventions ensure patient safety
• Hepatitis C Virus Linked to Head and Neck Cancers: Association of HCV with extrahepatic cancers has implications for HCV testing, treatment
• HOUSE CALL: Understanding cancer Risk and Risk factors-Your risk factors might affect your need for cancer screening

Intraoperative Femoral Head Dislodgement During Total Hip Arthroplasty: A Report Of Four Cases, Ahmed Siddiqi, Carl T. Talmo, James V. Bono

Orthopedic Surgery Resident Research

Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.

Extracorporeal Cellular Therapy (Elad) In Severe Alcoholic Hepatitis: A Multinational, Prospective, Controlled, Randomized Trial., Julie Thompson, Natasha Jones, Ali Al-Khafaji, Shahid Malik, David Reich, Santiago Munoz, Ross Macnicholas, Tarek Hassanein, Lewis Teperman, Lance Stein, Andrés Duarte-Rojo, Raza Malik, Talal Adhami, Sumeet Asrani, Nikunj Shah, Paul Gaglio, Anupama Duddempudi, Brian Borg, Rajiv Jalan, Robert Brown, Heather Patton, Rohit Satoskar, Simona Rossi, Amay Parikh, Ahmed Elsharkawy, Parvez Mantry, Linda Sher, David Wolf, Marquis Hart, Charles Landis, Alan Wigg, Shahid Habib, Geoffrey Mccaughan, Steven Colquhoun, Alyssa Henry, Patricia Bedard, Lee Landeen, Michael Millis, Robert Ashley, William Frank, Andrew Henry, Jan Stange, Ram Subramanian

Articles, Abstracts, and Reports

Severe alcoholic hepatitis (sAH) is associated with a poor prognosis. There is no proven effective treatment for sAH, which is why early transplantation has been increasingly discussed. Hepatoblastoma-derived C3A cells express anti-inflammatory proteins and growth factors and were tested in an extracorporeal cellular therapy (ELAD) study to establish their effect on survival for subjects with sAH. Adults with sAH, bilirubin ≥8 mg/dL, Maddrey's discriminant function ≥ 32, and Model for End-Stage Liver Disease (MELD) score ≤ 35 were randomized to receive standard of care (SOC) only or 3-5 days of continuous ELAD treatment plus SOC. After a minimum follow-up of …

A Research Agenda For Curing Chronic Hepatitis B Virus Infection., Harvey Alter, Timothy Block, Nathaniel Brown, Alan Brownstein, Carol Brosgart, Kyong-Mi Chang, Pei-Jer Chen, Francis V Chisari, Chari Cohen, Hashem El-Serag, Jordan Feld, Robert Gish, Jeffrey Glenn, Tim Greten, Haitao Guo, Ju-Tao Guo, Yujin Hoshida, Jianming Hu, Kris V Kowdley, Wenhui Li, Jake Liang, Stephan Locarnini, Anna S Lok, William Mason, Brian Mcmahon, Anand Mehta, Robert Perrillo, Peter Revill, Charles M Rice, Joann Rinaudo, Raymond Schinazi, Christoph Seeger, Kirty Shetty, John Tavis, Fabien Zoulim

Articles, Abstracts, and Reports

No abstract provided.

The Loose End: Neurology Without Rehabilitation, Ahmad Zaheer Qureshi, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

In recent years, successive therapies for previously untreatable neurological conditions have been introduced in clinical practice and these advance interventions have remarkably changed the landscape of neurosciences1,2 .But, rehabilitation of the functional impairments caused by neurological diseases is often overlooked or sometimes even neglected. In other words, the role of a comprehensive and early multidisciplinary rehabilitation in neurological disease is unrecognized and poorly understood even among neurologists and neurosurgeons. Usually, lifesaving neurosurgical management or solving a diagnostic riddle in neurology is attributed to successful patient management; however in reality, this is the first step in establishing a care plan for …

The Rare And The Unexpected; Miller Fisher Syndrome, Saad Waheed, Jawad Hussian, Aqsa Shehzadi

Pakistan Journal of Neurological Sciences (PJNS)

Miller Fisher Syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) which is an idiopathic neuromuscular paralysis. It is considered as autoimmune disease because there are antibodies which attack the nerve cell fibers resulting in paralysis of muscles. This disease exhibits a classic clinical triad of ataxia,areflexia, and ophthalmoplegiawhereas it could have more neurological symptoms.Basically it is diagnosed clinically but have a serological test for its confirmation i.e. anti-GQ1b antibody levels.Here, we report a stereotypical case of MFS with all of its cardinal symptoms with addition of some other symptoms like diplopia, ptosis of an eye and unilateral facial …

Biopsy Proven Case Of Creutzfeldt- Jacob Disease From Pakistan, Rizwana Shahid, Saad Shafqat

Pakistan Journal of Neurological Sciences (PJNS)

Creutzfeldt-Jakob disease (CJD) is a rare type of prion disease leading to a rapidly progressive dementia (RPD) and other associated neurological features specially startle myoclonus. The annual incidence of CJD has been reported to be 1 per million or 271 people in USA2, but from Asia especially from Pakistan, only few case reports have been published. The probable cause behind the rarity of this disease in our society is still unclear.The diagnosis of CJD requires a high level of suspicion and lack of the availability of specific markers like CSF 14-3-3 in our setup makes it more difficult. Similarly brain …

Bilateral Wrist Drop In A Middle Age Man, Ghulam Shabbir, Zakir Jan, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Peripheral neuropathy is a common disorder which often causes disability.Among metals lead intoxication leads to bilateral radial neuropathy. Patients with lead neuropathy present with weakness that primarily involves the wrist and finger extensors. Lead intoxication in humans causes axonal degeneration. We report a case of middle age male who presented with bilateral wristsdrop, workup revealed that he had bilateral radial nerve neuropathy which was secondary to his occupational exposure to lead causing lead intoxication. Chronic lead exposure as a risk factor for neuropathy should be identified and treated promptly as its avoidance and treatment can save major disabilities.