Open Access Case Study

Bilateral Endogenous Endophthalmitis in an Asian Female

Jesa Nadine V. Protasio, Archimedes L. D. Agahan

Journal of Advances in Medicine and Medical Research, Page 5381-5384
DOI: 10.9734/BJMMR/2014/12352

Aims: To report a case of bilateral endogenous endophthalmitis in an elderly Asian female.
Presentation of Case: An elderly Filipino female complaining of sudden blurring of vision of the right eye sought consult at our institution. Ophthalmologic examination, and vitreous tap were done for both eyes and systemic work-up was facilitated to localize the source of infection. Vitreous sample of the right eye yielded positive for Klebsiella pneumoniae, but cultures were sterile on the left. Systemic work-up revealed a complicated nephrolithiasis. Within 24 hours of her admission, vision rapidly deteriorated to no light perception. There was no return in vision despite systemic and topical antibiotic treatment.
Discussion: Endogenous endopthalmitis is a relatively rare condition. Among Asians, the patient at highest risk for endogenous endophthalmitis is a diabetic with Klebsiella hepatobiliary infection. However, this patient was found to have a urinary tract infection.
Conclusion: Klebsiella pneumoniae endopthalmitis confers a poor prognosis necessitating a high index of suspicion and early intervention.

Open Access Case Study

Use of DonnatalTM Elixir in the Treatment of Neonatal Abstinence Syndrome

Alyssa Brzenski, Mark Greenberg

Journal of Advances in Medicine and Medical Research, Page 5446-5450
DOI: 10.9734/BJMMR/2014/12419

We present the case of a 6-week-old male infant with Neonatal Abstinence Syndrome (NAS) in which DonnatalTM (phenobarbital, hyoscyamine, atropine, hyoscine) Elixir was used as an adjunct therapy. The infant was born to a mother taking 130mg of methadone per day since conception. Due to NAS, he was treated with a methadone taper and oral clonidine. Yet, despite the majority of symptoms being suppressed with these medications, he remained stricken with colicky pain, unresponsive to supplemental opioids. A trial of DonnatalTM resulted in relief of symptoms and completion of his opioid taper. We recommend DonnatalTM as part of the treatment plan for refractory abdominal symptoms in cases of NAS.

Open Access Short Communication

Acute Myocardial Infarction Due to Coronary Artery Dissection in a Premenopausal Woman, Possible Contribution of Aortic Coarctation and Review of Literature

Selcuk Coskun, Fehmi Kacmaz, Pınar Koksal Coskun, Tayfun Aybek

Journal of Advances in Medicine and Medical Research, Page 5439-5445
DOI: 10.9734/BJMMR/2014/11912

It is well-known that coronary artery disease (CAD) is the most cause of death in all over the world and generally been considered as a disease of elderly people and occasionally middle-aged men. Emerging data displays an important sex-based difference in CAD. Therefore CAD in the female population especially in premenopausal women is still identified less often and is treated less aggressively compared to that in the male population. The incidence of CAD in women older than 65 years is similar to that in men. However It is generally acknowledged that the risk for CAD is very low in premenopausal women by the reason of protective effect of woman hormones. Herein we report acute myocardial infarction due to coronary artery dissection in a premenopausal women, and conceivable contribution of aortic coarctation.

Open Access Original Research Article

Skin Color and Self-reported Sun Exposure Scores are Associated with Serum 25-Hydroxyvitamin D Concentrations in a Multi-ethnic Population Living in South Florida

Sahar Ajabshir, Joel C. Exebio, Gustavo G. Zarini, Ali Nayer, Michael McLean, Lemia Shaban, Fatma G. Huffman

Journal of Advances in Medicine and Medical Research, Page 5312-5323
DOI: 10.9734/BJMMR/2014/10551

Aims: The aim was to investigate the association between serum 25-hydroxyvitamin D [25(OH)D], skin color and sun exposure score.
Study Design: Cross-sectional
Place and Duration of Study: Florida International University, Robert Stempel College of Public Health and Social Work, Department of Dietetics and Nutrition, Miami, Florida from July 2012 to October 2012.
Methodology: Seventy six adults, ages 18-36 years living in South Florida participated in the study. Skin color was quantified by a IMS Smart Probe 400 scanner and 25(OH)D was measured by ELISA. A sun exposure questionnaire was used to record the weekly sun exposure scores. A food frequency questionnaire was used to record daily vitamin D intake.
Results: Multiple-linear regression analysis indicated that sun exposure, forearm skin color and vitamin D intake were significant predictors of 25(OH)D (P=.004, P=.003 and P=.021 respectively). This association held after controlling for covariates (B=.371, P=.027 for forearm, B=.031, P=.005 for total sun exposure and B=.689, P=.003 for vitamin D intake).
Conclusion: Skin color, sun exposure along with vitamin D intake may be used as an indirect non-invasive tools to estimate 25(OH)D levels in healthy individuals in South Florida.

Open Access Original Research Article

Effect of Admission Hyperglycaemia on Infarct Size and Clinical Outcome in Black Patients with Acute ISCHAEMIC Stroke, Northeast Nigeria

M. M. Watila, Y. W. Nyandaiti, A. Ahidjo, S. A. Balarabe, A. Ibrahim, B. Bakki, I. D. Gezawa, M. Gadzama, S. A. Bwala

Journal of Advances in Medicine and Medical Research, Page 5324-5334
DOI: 10.9734/BJMMR/2014/12120

Aims: To determine the relationship between admission blood glucose level, infarct size and stroke outcome in black African patients with acute ischaemic stroke.
Study Design: The study was cross-sectional.
Place and Duration of Study: University of Maiduguri Teaching Hospital, Northeast Nigeria, from January 2006 to January 2009.
Methodology: Sixty-two patients were recruited and clinical characteristics recorded. Stroke severity was assessed using the National Institutes of Health Stroke Score (NIHSS); disability assessed using Modified Rankin score (mRS) and Barthel Activity of Daily Living (ADL) index (BI). Infarct volume was calculated from CT scan using the ‘method of measurements of the largest diameters’. Random blood glucose (RBG) was measured on admission, and dichotomised into those with hyperglycaemia > 7mmol/L those without < 7 mmol/L. Bivariate statistics were used to compare characteristics and outcome. Kaplan-Meier Statistic was used to compare mortality rates. The influence of hyperglycaemia on infarct volume and outcome was determined using logistic regression.
Results: Fourteen (22.6%) patients had hyperglycaemia on admission. Those with hyperglycaemia had a larger infarct volume (P < .0001) and higher NIHSS (P = .003) on presentation. They had worse stroke outcome (Discharge BI: P = .001; NIHSS: P < 0.0001; mRS: P = .001) and higher 30-day mortality (P = .005). Admission RBG positively correlated with infarct size (P < .001), NIHSS (P = .01), mRS (P = .02) and negatively with BI (P = .02). Survival time is significant with Log Rank (P = .009) and Wilcoxon test statistics (P = .006). Hyperglycaemia predicted a larger infarct (OR = 4.46, P = < .0001), poorer NIHSS on discharge (OR = 3.44, P = .001), poorer mRS (OR = 2.53, P = .02) and 30 – day mortality (OR = 2.04, P = .046).
Conclusion: Hyperglycaemia is associated with a larger infarct size, severe stroke at presentation and a worse stroke outcome.

Open Access Original Research Article

Retrocrural Space Obliteration as CT Diagnostic Sign of Massive Chylothorax in Thoracic Injuries

Marco Matteoli, Marta Vincigurra, Lara Cristiano, Chiara De Dominicis, Ilaria Mastroiacovo, Gioia Papale, Luca Tabbì, Mohsen Ibrahim, Giulio Maurizi, Michele Rossi, Vincenzo David

Journal of Advances in Medicine and Medical Research, Page 5335-5347
DOI: 10.9734/BJMMR/2014/12302

Purpose: Blunt traumatic chylothorax could be distinguished in CT (Computer Tomography) scan as low attenuated fluid, due to chylomicrons inside, however blood intermixture in chylous effusion could make densitomery higher and hide chylothorax, due to the possible presence of an underlying hemothorax. The objective of the study is to demonstrate the specificity of retrocrural space obliteration, as additional CT sign to quickly identify and treat chylothorax.
Materials and Methods: This retrospective study was undertaken since May 2012 until May 2013 and included patients scheduled for MDCT (Multi Detector CT) scan before a thoracentesis procedure diagnostic for hemothorax and chylothorax. Were used as a controls, MDCT scans performed for thoracic or thoracic-abdominal trauma, or after a thoracic surgery procedure.
Results: Comparison of CT findings revealed significant difference in densitometry between the two groups of effusions (P=0,003), a difference in inability of visualization of retrocrural space (P=0,0002) and cisterna chily (P=0,0009). Inability to observe thoracic duct was not different between the two groups (P=0,8805).
Conclusion: Negative density (-16,7+8HU) in effusions, due to the presence of fat inside, was usually observed in almost 6 anterior regions or at least 2 upper anterior regions and it’s the best way to distinguish a chylo-thorax to hemo-thorax. Most accurate CT scan differentiation between post traumatic massive bloody and chylous leakage can be done after assessment of a lower densitometry of effusion and inability in observing chylous structures and fat in retrocrural space due to chylous leakage inside.

Open Access Original Research Article

Prevalence and Determinants of Anaemia among HIV Positive Pregnant Women Attending Ante-Natal Clinic at the Jos University Teaching Hospital, Jos, North-central Nigeria

A. G. Ohihoin, J. Musa, A. S. Sagay, I. A. O. Ujah, E. C. Herbertson, A. Ocheke

Journal of Advances in Medicine and Medical Research, Page 5348-5356
DOI: 10.9734/BJMMR/2014/11833

Aim: To determine the prevalence and determinants of anaemia in HIV positive pregnant women attending ante-natal clinic at Jos University Teaching Hospital, North-Central Nigeria.
Methods: A cross sectional study was carried out among HIV positive pregnant women as the study group and HIV negative pregnant women as control group at the ante-natal clinic of the Jos University Teaching Hospital (JUTH) Jos, North-Central Nigeria from January to December 2007.
The prevalence of anaemia in the experimental group was determined. The possible determinants of anemia were ascertained and the relationship between variables determined using methods of linear regression and chi square test.
Results: A total of 230 pregnant women were recruited for the study (115 HIV positive versus 115 HIV negative). The overall prevalence of anemia was 27.6%. The prevalence among HIV positive pregnant women was 33.7%, compared to a prevalence of 21.7% among HIV negative pregnant women. This difference was however not statistically significant. There was a statistically significant relationship between the use of anti-retroviral therapy and the development of anaemia (X2 = 5.98, P = 0.014, OR = 1.15). An inverse relationship was established between haemoglobin status and viral load.
Conclusion: The prevalence of anemia is high among HIV positive pregnant women. There is an inverse relationship between viral load and haemoglobin status. The use of highly active anti-retroviral therapy (HAART) for the management of these patients can be regarded as good practice since ART reduces viral load.

Open Access Original Research Article

Aspirin as Primary Prevention of Acute Coronary Heart Disease Events

Stephen P. Glasser, Martha Hovater, Todd M. Brown, George Howard, Monika M. Safford

Journal of Advances in Medicine and Medical Research, Page 5357-5367
DOI: 10.9734/BJMMR/2014/11212

Background/Objective: Aspirin for primary prophylaxis is controversial. This study evaluated associations between prophylactic aspirin use and incident acute coronary heart disease (CHD) events.
Methods and Results: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study was accessed for aspirin use examining black and white hazards for incident CHD, for men and women, each adjusting incrementally for sampling, socio-demographics, and CHD risk factors. Stratified models examined risks across strata of the Framingham risk score, and all-cause mortality. 23,949 participants (mean 64 yo), had 503 incident events over a 3.5 year follow-up. Prophylactic aspirin use was not associated with incident acute CHD, HR 1.05 (95% CI 0.86, 1.29). Modeling had little impact on the HR (1.09 {95% CI 0.89, 1.33) nor did the addition of risk factors (HR 1.00 {95% CI 0.81, 1.23). Aspirin use was not associated with incident CHD for any Framingham risk level. Findings were similar when including all aspirin users (not just those taking aspirin prophylactically), and when examining associations with all-cause mortality. There was no excess hospitalized bleeding in the aspirin users.
Conclusion: Aspirin was not associated with lower risk for incident acute CHD overall, or within race, gender, or Framingham Risk Score.

Open Access Original Research Article

Exploring Medicine Information Needs of Hypertensive Patients Using Short Message Service

O. J. Ola-Olorun, M. O. Afolabi, T. O. Oyebisi, A. O. Ogunsina, A. O. Akintomide, R. A. Adebayo

Journal of Advances in Medicine and Medical Research, Page 5368-5380
DOI: 10.9734/BJMMR/2014/8858

Aims: To explore the pattern of unmet medicine information needs of hypertensive patients on long term therapy and their attitude to use of SMS (mobile phone short message service) for medicine information exchange with hospital pharmacists.
Sample: 117 hypertensive patients on long term therapy who had been accessing care for at least one year.
Study Design: An exploratory medicine information exchange programme followed by a cross-sectional survey.
Place and Duration of Study: Outpatient Clinic of Department of Cardiology at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between October, 2010 and May, 2011.
Methods: Patients were prompted with SMS twice weekly for 5-8 months for use of their medication with advice to send their medicine information needs to the hospital pharmacist. Received messages were subjected to content analysis to identify their themes. A semi-structured questionnaire was used to explore patient attitude to the use of SMS. The 17-item questionnaire was designed on a 5-point Likert scale for responses with weights of 0-4. Data obtained were analysed using both descriptive and inferential statistics. These include frequencies and mean of weighted averages (MWA); tests of relationships, associations and of differences in means.
Results: A total of 63 SMS texts were received from the respondents and 44% of the messages expressed medicine information needs. Majority of the enquiries were related to indications and adverse effects. The patients’ attitude to the use of SMS for medicine information exchange with pharmacists was generally positive (MWA=3.13) with no significant demographic effects. Some (46%) of the patients called for institutionalisation of the medicine information exchange programme.
Conclusion: The unmet medicine information needs of chronic hypertensive patients in the study were related mainly to indications and side effects of prescribed and non-prescribed medications and the patients clamoured for use of SMS in redressing the anomaly.

Open Access Original Research Article

Body Mass Index and Blood Pressure Pattern through Menarcheal Age in an Italian Village

Vincenzo Maggisano, Flavia Chiarotti, Anna Livia Loizzo, Alberto Loizzo

Journal of Advances in Medicine and Medical Research, Page 5385-5397
DOI: 10.9734/BJMMR/2014/7006

Aims: Recent investigations correlated early menarche to cardiovascular risk factors in adulthood, whereas others underlined relationship of menarcheal age to body mass index (BMI) and dysmetabolic conditions. Our aim was to assess whether early menarche could indicate an increased risk factor for enhanced blood pressure and/or hypertensive-range values (systolic/diastolic blood pressure beyond the 95th percentile) within the narrow window of the sexual maturation, 12y to 14y.
Methodology: 463 Caucasian Italian girls were studied at both 12y and 14y: body height (BH), weight (BW), BMI, systolic-diastolic blood pressure (SBP, DBP), presence-absence of menarche were recorded.
Results and Discussion: Lowest quartile for BH, BW, BMI in 12y girls was associated with lower probability (~-20%) of having menarche before 14y. Conversely, girls who developed menarche before 12y, at 12y showed higher average BH, BW, BMI, SBP/DBP values versus girls who developed menarche after 12y (about +3.2%;+16.2%;+8.8%;+5.5%;+9.2%, respectively). However, 14y girls of all groups showed similar average SBP and DBP and similar prevalence for hypertensive-range values. Interestingly, at 12y BMI was correlated to hypertensive values of both 12y and 14y (X2=17.5; X2=15.9; respectively; P<.001). Regression analysis showed that unitary increase of BMI at 12y yielded an increase of 1.04 mmHg for SBP and 0.55 mmHg for DBP in 14y girls.
Conclusions: Early menarcheal age (before 12y) was accompanied by higher SBP and DBP at 12y, but also by higher BH, BW and BMI, versus girls with menarche after 12y. However, early menarcheal age did not influence average SBP/DBP and prevalence of hypertensive-range values in 14y girls. BMI was strongly related to menarcheal status at both 12y and 14y, thus indicating that within this age (12y to 14y) BMI influenced both menarcheal triggering and blood pressure. Further investigations are needed to verify whether cardiovascular risk factors are influenced also in adult age by early menarche, or by high BMI at 12y-14y.

Open Access Original Research Article

Possible Protective Effects of Garlic, Ginkobiloba and Silymarin on Cisplatin Hepatotoxicity in Protein-Malnourished Rats

Essam Ezzeldin, Yehia Raslan, Toqa El-Nahhas, Yousif A. Asiri

Journal of Advances in Medicine and Medical Research, Page 5398-5414
DOI: 10.9734/BJMMR/2014/9559

Background: Protein malnutrition (PM) is one of the major public health problems in developing countries. Cisplatin (CDDP) is an effective anticancer drug that elicits many hepatotoxicity. CDDP hepatotoxicity restricts its clinical use under long term treatment.
Objectives: The study was carried out to determine the possible protective effects of fresh garlic homogenate (FGH), Ginkobiloba extract (GBE) or silymarin (Sly) on cisplatin hepatotoxicity in protein malnourished rats.
Methods: Sprague-Dawley rats were divided into NF set and PM set. Each set divided into control group and seven treated groups received cisplatn and FGH, GBE or Sly and its combinations with cisplatin. Biochemical changes, reactive oxygen species (ROS) and superoxide dismutase (SOD), Malondialdehyde (MDA) and glutathione (GSH) parameters were evaluated. Liver samples were examined for histopathological changes
Results: Cisplatin increased ALT and AST, as well as liver body weight ratio. ROS parameters showed a significant increase in MDA and nitric oxide (NO) and decrease in glutathione and SOD. PM potentiates cisplatin side effects. FGH, GBE or Sly attenuate cisplatin toxicity and liver histopathological changes.
Conclusion: PM potentiates cisplatin toxicity. FGH, GBE or Sly has partial protective effects against the cisplatin- induced toxicity induced in NF and PM rats.

Open Access Original Research Article

Frequency of HLA-DRB1 in Iraqi Patients with Guillain-Barre Syndrome

Batool Mutar Mahdi, Zaki Noah Hasan

Journal of Advances in Medicine and Medical Research, Page 5415-5420
DOI: 10.9734/BJMMR/2014/10283

Background: Genetic backgrounds play an important role in susceptibility to and protection against Guillain Barré Syndrome. Certain human leukocyte antigens have been found to be associated with Guillain Barré Syndrome.
Aim of Study: This study aimed to study the relationship between the susceptibility of HLA Class II "DRBI" allele's frequencies in a sample of Iraqi's patients with Guillain Barré Syndrome compared with a healthy control group using PCR-SSOP method.
Patients and Methods: Thirty consecutive Iraqi Arab Muslim patients with Guillain-Barre syndrome admitted in the Neurological Department in neurosciences Hospital between September-2012 to June-2013 were assessed for HLA genotyping for HLADRB1. A control group consisted from thirty healthy volunteers among the staff of Al-Kindy College of Medicine that did not have any neurological disorders whether recent or previously and had negative family history for this diseases or other neurological disorders. HLA genotyping for HLADRB1 was performed for each patient and for the control persons using the PCR with sequence-specific oligoneucleotide primers. Allele frequencies were compared across groups.
Results: There was a significant higher rate of DRB1*03:01 frequencies in patients with GBS compared with healthy controls (p=0.007, Odds ratio=5.687, 95% CI: 1.59-20.33)
Conclusions: HLA-DRB1*03:01 may have association with susceptibility to Guillain-Barre syndrome.

Open Access Original Research Article

Falls in Elderly with Plantar Changes

Prato Sabrina Canhada Ferrari, Santos Fânia Cristina, Trevisani Virginia Fernandes Moça

Journal of Advances in Medicine and Medical Research, Page 5421-5430
DOI: 10.9734/BJMMR/2014/10882

Aims: The purpose of this study was to evaluate the prevalence of falls among older people with plantar changes in order to preserve their autonomy and independence.
Study Design: A cross-sectional, descriptive, analytical study was conducted based on a sample of elderly people.
Place and Duration of the Study: Department of Geriatrics and Gerontology at the Federal University of Sao Paulo/UNIFESP - Brazil, between March, 2007 and December, 2008.
Methodology: The study sample consisted of 100 elderly people of both genders, aged ≥ 60 years. After patients were included in the study, are search protocol was applied with the following information: demographic data (age, gender, race, marital status, housing, and education) and anthropometric data (height, weight, and body mass index (BMI)).
Results: The foot types and major injuries were: 83% had valgus feet, 52% had flat feet, 64% had skin lesions, 63% had lesions, and 53% had toenail deformities. Regarding the number of falls in the previous year, 40% did not report having fallen, 44% fell at least once, and 16% fell two or more times. The frequency of falls among older people with plantar changes in the present study (60%) was relatively higher than in other studies. About half of the general population will be affected by a change in the foot, and the incidence and severity increase with age.
Conclusion: Plantar changes were common among the elderly in this study and can directly affect the balance and gait cycle and, therefore, may be a contributing factor to functional disability and falls in the geriatric population.

Open Access Original Research Article

Prevalence of Syphilis among Pregnant Women in Two Health Care Facilities in South Western Nigeria

O. A. Olowe, O. B. Makanjuola, R. A. Olowe, J. O. Olaitan, O. Ojurongbe, S. O. Fadiora

Journal of Advances in Medicine and Medical Research, Page 5431-5438
DOI: 10.9734/BJMMR/2014/11242

Aims: The prevalence of syphilis has been reported to be on the increase worldwide as a result of the HIV/AIDS pandemic. Maternal syphilis puts the fetus at risk of congenital syphilis with the attendant health risks including intrauterine death. This study was carried out to determine the seroprevalence among pregnant women attending antenatal care unit of two tertiary care facilities in South Western Nigeria.
Study Design: A Cross-sectional study was carried out.
Place and Duration of Study: LAUTECH Teaching Hospital, Osogbo and State Specialist Hospital, Osogbo, Nigeria from October 2012 to May 2013.
Methodology: Three hundred and ninety-four pregnant women were recruited for this cross-sectional descriptive study carried out from October 2012 to May 2013. A semi-structured questionnaire for socio-demographic information was administered and venous blood samples collected after obtaining informed consent and giving a health talk on mother-to-child transmission of Human Immunodeficiency Virus. Screening for syphilis was done using the qualitative Rapid Plasma Reagin (RPR) test. All reactive sera then had their RPR titre quantified. The confirmatory test for reactive sera was carried out using the Treponema pallidum haemagglutination (TPHA) test.
Results: Eight (2%) of the 394 samples were reactive for RPR; while 4(1.0%) were positive for THPA, giving a 1.0% seroprevalence rate. Out of all the women positive for RPR, most (75%) were without any formal education while the remaining 2 had only primary education. All 4 samples that were confirmed positive by THPA were from women with no formal education. Of the 8 positive sample for RPR titre values ranged from 1:2 to 1;8 with higher titres found in those that were TPHA positive.
Conclusion: Even though the study recorded low prevalence rate of syphilis in both facilities, it is important to note that the cases were asymptomatic. Therefore routine screening for syphilis in antenatal clinic should be encouraged to prevent mother to child transmission of syphilis.

Open Access Review Article

Alzheimer Disease and Environmental Exposure to Neurotoxic Factors: A Controversy

Hélène Sordet-Guépet, Patrick Manckoundia

Journal of Advances in Medicine and Medical Research, Page 5298-5311
DOI: 10.9734/BJMMR/2014/10762

Background: Common neurodegenerative diseases including Alzheimer disease are a major public health issue because of their high prevalence and etiopathogenic complexity. Ageing, combined with a genetic predisposition and modifiable risk factors including cardiovascular factors, has been shown to be the main risk factor of Alzheimer and related diseases. The international scientific community suspects that physicochemical environmental factors may be involved. The lack of consensus justifies a general review of current knowledge on the role of environmental neurotoxic factors in the occurrence of some neurodegenerative diseases, particularly Alzheimer disease.
Methodology: A literature search was conducted on PubMed using the keywords dementia, dementia syndrome, Alzheimer disease, Alzheimer type dementia, exposure, neurotoxicity aluminium, mercury, pesticide. After reading all of the abstracts and ruling out irrelevant articles, only relevant articles in English or French were selected. We read more than 600 abstracts and based on these we selected and read 352 articles, 176 for each of the two authors. Finally, our bibliography includes 78 articles.
Results: The neurotoxicity data from animal experiments are old, and in the professional environment there is no evidence regarding the gradient of environmental toxicity. Synergistic, multiple-factor neurotoxicity is complex and difficult to document epidemiologically as it is due to a cumulative toxic continuum rather than a dose/effect relationship. Within this recognized multi-causal model of neurodegenerative diseases, particularly Alzheimer disease, chronic exposure to neurotoxic products has a real pathogenic effect on the central nervous system though certain aspects of this effect are not entirely proven.
Conclusion: The lack of overall agreement about precautions for heavy metals does not mean that latent and prolonged exposure to these products is safe, especially with regard to the potential risk of worsening neurodegenerative diseases.