In children

A much more serious drawback to using chiral drugs as racemic mixtures is illustrated by thalidomide briefly employed as a sedative and antinausea drug in Europe during the period 1959-1962 The desired properties are those of (/ ) thalidomide (S) Thalido mide however has a very different spectrum of bio logical activity and was shown to be responsible for over 2000 cases of serious birth defects in children born to women who took it while pregnant... 

THPOH—Ammonia—Tris Finish. By far the most effective finish for polyester—cotton textiles was a system based on the THPOH—NH treatment of the cotton component either foUowed or preceded by the appUcation of Tris finish to the polyester component. This combined treatment appeared to be effective on almost any polyester—cotton blend. A large amount of fabric treated in this way was sold throughout the United States and much of the rest of the world. Shortly after the introduction of Tris finishing, Tris was found to be a carcinogen. Most of the Tris treated production was in children s sleepwear, and this created a situation in which almost aU chemical fire-retardant-treated textiles were unfairly condemned as dangerous. Manufacturers mshed to replace chemically treated textiles with products produced from inherently flame-resistant fibers. Nowhere was the impact more severe than in the children s sleepwear market. New, safer materials have been introduced to replace Tris. Thus far none has been as completely effective. 

Preventive Measures. The intake uptake biokinetic model (lUBK) projects the impact of lead in the environment on blood lead. This model assumes conservatively high levels of intake and cannot account for chemical speciation, thus over-predictions of blood lead levels often occur. Nonetheless, because of the allegations of the impact of blood lead and neurobehavioral development, blood lead levels in children are being reduced adrninistratively to below 10 //g/dL. In order to do so, soil leads are being reduced to a level of between 500—1000 ppm where remediation is required. 

The alimentary symptoms may be overshadowed by neuromuscular dysfunction, accompanied by signs of motor weakness that may progress to paralysis of the exterior muscles or the wrist (wrist drop), and less often, of the ankles (foot drop). Encephalopathy, the most serious result of lead poisoning, frequendy occurs in children as a result of pica, ie, ingestion of inorganic lead compounds in paint chips this rarely occurs in adults. Nephropathy has also been associated with chronic lead poisoning (147). The toxic effects of lead may be most pronounced on the developing fetus. Consequendy, women must be particulady cautious of lead exposure (148). The U.S. Center for Disease Control recommends a blood level of less than 10 p.m per 100 mL for children. 

Reviews on the occurrence, biochemical basis, and treatment of lead toxicity in children (11) and workers (3,12,13) have been pubhshed. Approximately 17% of all preschool children in the United States have blood lead levels >10 //g/dL. In inner city, low income minority children the prevalence of blood lead levels >10 //g/dL is 68%. It has been estimated that over two million American workers are at risk of exposure to lead as a result of their work. PubHc health surveillance data document that each year thousands of American workers occupationally exposed to lead develop signs and symptoms indicative of... 

Pure selenium deficiency, without concurrent vitamin E deficiency, is not generally seen except in animals on experimental diets (113). In China, selenium deficiency in humans has been associated with Keshan disease, a cardiomyopathy seen in children and in women of child-bearing ages, and Kashin-Beck disease, an endemic osteoarthritis in adolescents (113). 

Arrhythmias. The first solution to cardiovascular problems arising from arrhythmias came about as a result of a complication caused by open-heart surgery. During procedures to correct congenital defects in children s hearts, the electrical conduction system often became impaired, and until it healed, the heart could not contract sufficiently without outside electrical stimulation. A system that plugged into a wall outlet was considered adequate until an electrical storm knocked out power, lea ding to the development of the first battery-powered external pacemaker. 

Tetracyclines are used as alternative dnigs in a variety of circumstances when the patient is unable to take the dnig of choice, eg, in patients allergic to penicillin (88,89). Tetracyclines are widely known to cause staining of teeth (and are therefore contra-indicated in children developing permanent teeth), photosensitivity, and, in the case of minocycline, vestibular toxicity. Details of these adverse effects and others associated with administration of tetracyclines have been comprehensively reviewed (96—101). 

Rarely, untreated heavy infections may cause ulceration, toxemia, and death in children. Pra2iquantel (1) or tetrachloroethylene (5) are both effective in the treatment of Fasciolopsis infection. 

Malaria affects an estimated 270 million people and causes 2—3 million deaths annually, approximately one million of which occur in children under the age of five. While primarily an affliction of the tropics and subtropics, it has occurred as far north as the Arctic Circle. The disease essentially has been eradicated in most temperate-zone countries, but some 1100 cases of malaria in U.S. citizens returning from abroad were reported to the Centers for Disease Control during 1990. Malaria is seen today in Southeast Asia, Africa, and Central and South America. It is on the increase in Afghanistan, Brazil, China, India, Mexico, the Philippines, Sri Lanka, Thailand, and Vietnam. Escalation of the disease is because of the discontinued use of the insecticide DDT which effectively kills mosquito larvae, but has been found to be toxic to Hvestock and wildlife. Also, chloroquine (6), a reUable dmg for the prophylaxis and treatment of falcipamm malaria, is ineffective in many parts of the world because of the spread of dmg-resistant strains. 

American trypanosomiasis, known as Chagas Disease, is limited to South and Central America, where it affects 16—18 million people aimuaHy in an area where 90 million are at risk. Although only an estimated 1% of infected individuals contract the disease, poverty and poor housing exacerbate it. There is a particularly high incidence of the disease in children. 

In the early 1950s, a number of cases of sickness occurred in children who had reportedly eaten candy and popcorn colored with excessive amounts of dye. As a result of these illnesses, new animal feeding studies were undertaken by the FDA. These studies were conducted at higher levels and for longer test periods than any experiments previously conducted and resulted in unfavorable findings for FD C Orange No. 1, FD C Orange No. 2, and FD C Red No. 32. 

L-Asparaginase is used for the treatment of appropriate lymphoproliferative disorders in two clinical trials, L-asparaginase was used in combination with chemotherapy for the treatment of refractory acute nonlymphocytic leukemia in children (24) and adults (25). A moderate efficacy, attributable to the enzyme, was demonstrated in both trials. 

Summary of Lowest Observed Effect Levels for Key Lead-Induced Health Effects in Children... 

Annual" Aggravation of chronic respiratory disease in children... 

Organoselenium compounds in particular, once ingested, are slowly released over prolonged periods and result in foul-smelling breath and perspiration. The element is also highly toxic towards grazing sheep, cattle and other animals, and, at concentrations above about 5 ppm, causes severe disorders. Despite this, Se was found (in 1957) to play an essential dietary role in animals and also in humans — it is required in the formation of the enzyme glutathione peroxidase which is involved in fat metabolism. It has also been found that the Incidence of kwashiorkor (severe protein malnutrition) in children is associated with inadequate uptake of Se, and it may well be involved in protection... 

Although extraordinary in its powers, aspirin is also more dangerous than commonly believed. Only about 15 g can be fatal to a small child, and aspirin can cause stomach bleeding and allergic reactions in long-term users. Even more serious is a condition called Reye s syndrome, a potentially fatal reaction to aspirin sometimes seen in children recovering from the flu. As a result of these problems, numerous other NSAIDs have been developed in the last several decades, most notably ibuprofen and naproxen. 

Lead is a heavy metal that remains in die bloodstream, causing mental retardation in children. It is believed that 3 X 10 7gofPbinl.00mL of blood is a health hazard. For this amount of lead... 

Generally the azoles are well tolerated in children and adults mild side effects like nausea and vomiting are seen in <5% of the patients treated with FLU. 

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