History Of Pica Research Articles

Endoscopic Treatment of Gastric Bezoars: A Report of Three Cases

Bezoars, including phytobezoars, trichobezoars, and pharmacobezoars, are accumulations of undigested substances in the gastrointestinal tract. We report three cases of gastric bezoars. Case 1: An 86-year-old woman presented with a one-month history of abdominal pain and vomiting. Esophagogastroduodenoscopy revealed gastric bezoars; consumption of 2 L of cola daily for 2 weeks resulted in complete disappearance of the bezoars. Case 2: An asymptomatic 63-year-old woman underwent esophagogastroduodenoscopy, which revealed a gastric bezoar. Cola spraying and endoscopic lithotomy were ineffective; therefore, the patient underwent laparoscopic removal of the bezoar for management of small bowel obstruction secondary to the bezoar fragments. Case 3: A 6-year-old girl with a history of pica underwent two laparoscopic surgeries 10 months apart for recurrent trichobezoars. We report our treatment approach in three patients who presented with gastric bezoars.

EP467 - Bowel obstruction due to colonic lithobezoar in a patient with PICA

Abstract A 16-year-old girl was admitted with complaints of abdominal distension, severe pain, vomiting, chest discomfort, and an inability to pass gas. She disclosed a history of PICA, regularly consuming brick and cement. She had no significant medical history but reported suffering from constipation for over two years. Physical examination revealed a markedly distended, tender abdomen with hyper-resonance. Digital rectal examination detected soft, breakable stool in the rectum. A chest X-ray demonstrated massive bowel distension, causing lung compression. Clinical impression was of bowel obstruction secondary to constipation, leading to NG tube insertion, NBM status, and analgesia administration. A CT abdomen and pelvis confirmed a markedly distended rectum with impacted faeces, proximal faecal loading, and colon dilatation consistent with severe pseudo-obstruction. Other abdominal organs were compressed but otherwise normal, with no signs of ischemia, free air, or free fluid. Patient was taken to emergency theatre for examination under anaesthesia and manual evacuation. Six litres of stool were manually evacuated, along with removal of ingested stone-like substances, leading to suspicion of lithobezoar. This was followed by a four-litre saline washout. Postoperatively, patient received regular enemas, laxatives, and monitoring. She spent three days in the Intensive Care Unit due to persistent metabolic acidosis, necessitating ventilatory support. Afterward, she was transferred to the surgical ward, where she was monitored overnight before being discharged with laxatives and dietary advice. Patient was referred to dietitians for addressing her PICA and eating habits, with plans for psychiatric follow-up initiated through a referral from her GP.

History of Pica, Obesity, and Their Associations with Anemia in Pregnancy: A Community-Based Cross-Sectional Study.

Anemia in pregnancy represents a major global health problem, and progress is insufficient to meet the World Health Assembly's global nutrition target of halving anemia prevalence by 2030. We assessed the prevalence and factors associated with anemia among pregnant women in northern Sudan. This community-based cross-sectional study was conducted at Almatamah, River Nile State, Sudan. Sociodemographic and obstetric data were collected using a questionnaire. Hemoglobin (Hb) was measured using an automated hematology analyzer. Multivariate and simple linear regression analyses were performed. A total of 586 pregnant women were enrolled. Their median (interquartile range, IQR) age was 25 (21-30) years. The median (IQR) of body mass index (BMI) was 26.67 (24.34-30.04) kg/m2. The median (IQR) for Hb was 11.0 (10.0-11.9) g/dL. Of the 586 women, 271 (46.2%) had anemia (Hb: <11 gm/dL). In multivariate analysis, increasing BMI and obesity were significantly associated with decreased odds ratios (ORs) of anemia, while pica was associated with increased ORs of anemia. In conclusion, anemia in pregnant women is a major public health problem, as approximately half of pregnant women in northern Sudan have anemia. Increasing BMI and obesity were associated with a lower risk for anemia. More efforts are needed to improve the maternal nutritional status for good pregnancy outcomes.

Current Approach to The Child with Pica

Pica is an eating disorder that is characterized by the ingesting of non-food substances. Although pica is common in young children, it is an overlooked condition. Although the etiology of pica is not known for certain, some hypotheses are emphasized. The prevalence of pica varies according to societies. Pica is a clinical diagnosis based on the The Diagnostic and Statistical Manual of Mental Disorders-V diagnostic criteria. In children, pica management can be achieved with a multidisciplinary approach. It should be acted on together with child psychiatry. Patient and family education are important. If there are nutritional deficiencies such as iron or zinc deficiency, it should be replaced. This review provides important information about the current approach to the child with pica. It will also shed light on the evaluation of children with a history of pica.

Study of Prevalence of Anaemia and Haematological Parameters in Children of Maharashtra below 12 years

Background: Anaemia is a widespread public health problem associated with increase risk of morbidity andmortality especially in children and women of reproductive age.Method: 120 children below 12 years of age suffering with anaemia were studied. The blood examination wasdone to rule out PCV, MCV, MCH, MCHC, RPW, Hb% PS study, reticulocytecount and serum Iron (Fe), serumB12 and folic acids.Results: 65 (54.1%) had Iron deficiency, 17 (14.1%) had Thalassemia, 13 (10.8%) had Megaloblast anaemia,12 (10%)anaemia of acute haemorrhage, 7 (5.83%) had sickle cell anaemia, 4 (3.33%) had Aplastic anaemic, 2 (1.66%) hadleukaemia. Clinical manifestation included mainly pallor 120 (100%),103 (85.8%) weakness and fatigability 42(35%) fever, 29 (24%) had IC term, 24 (20%) shortness of breathing, 21 (27.5%) hepatomegely, 15 (12.5%) history ofpica, 23 (19.1%) had mild, 59 (49.1%) had moderate, 38 (31.6%) had severe anaemic on the basis of haemoglobinlevel profile.Conclusion: Iron deficiently is the major cause of anaemia followed by thalassemia, megaloblastic, acutehaemorrigic sickle cell, aplastic anaemia. This pragmatic study in children certainly helps the nutrition expert andpaediatrician to treat such children efficiently to avoid morbidity and mortality.

ANEMIA IN CHILDREN AGED 12-59 MONTHS PRESENTING WITH HISTORY OF PICA

Background: Anemia, being a major public health problem has affected both developed and underdeveloped countries. Pica is common presentation of iron deficiency anemia.&#x0D; Objective: To determine the frequency of iron deficiency anemia in children with pica&#x0D; Methodology: This was a cross sectional study conducted at RHC Kot Qazi, Tehsil Lawa, District Chakwal, Punjab, and Pediatrics department, Sahara Medical College, Narowal over a 4-month period. After taking ethical approval, sample size of 277 children aged up to 59 months were enrolled. Preschoolers and school going children of either gender coming to outdoor patient department of Rural Health Centre, Kot Qazi and Pediatrics department, Sahara Medical College, Narowal with history of pica were included. Information gathered included duration of pica, substances consumed and perceived as pica, a detailed dietary history inclusive of age at the time of weaning and amount of milk consumed per day. One cc of heparinized blood sample was collected and sent to laboratory for complete blood count. Data was entered in SPSS and presented as frequency and percentages.&#x0D; Results: Of the 277 children with history of pica, 153 (55.2%) were male and 124 (44.82%) were females. The overall mean age of the sample was 47.23 ± 6.169 months. Out of 219 children, 76 (35.15 %) were mildly anemic, 99 (45.60%) were moderately anemic, 32 (14.86%) were severely anemic, while 12 (4.39%) were non anemic. 58 (21.48%) patients didn’t show up with their Hb results.&#x0D; Conclusion: Moderate Iron deficiency anemia is found in pre-school children with history of pica.

Anaemia In Preschool Children:its Correlation With Pica

Introduction: According to the third National Family Health Survey, 79% of Indian children are anaemic. Pica is characterized by the persistent ingestion of non-nutritive substances such as plaster, charcoal, chalk, and earth for at least one month in a manner that is inappropriate for their developmental level. We investigated the correlation between pica behaviour and anaemia in preschool children. Methods: In total, 103 children of ages six to 48 months attending the OPD were randomly included in this study for six months; they presented with clinical features of anaemia. Complete blood count and peripheral blood film examination were carried out. The children were assessed clinically for signs and symptoms of anaemia. History of ingestion of clay, sand, chalk, wall paints etc was asked from the parents. Results: Most of the children (90.3%) had microcytic hypochromic anaemia with a mean haemoglobin value of 8.82 g / dl. The mean age was 18 months, and boys slightly outnumbered girls. In total, 57.3% of children had a positive history of pica, and all of them were found to be anaemic. However, no significant statistical correlation was observed between anaemia and history of pica. Conclusions: All children with history of pica were anaemic and the most common type of anaemia was microcytic hypochromic. Although no significant statistical correlation was observed between and history of pica, it is very important for the clinicians to be cautious of this common condition and evaluate for anaemia

Study of prevalence of anaemia and haematological parameters in children below 12 years

Anaemia is a major global health problem; it results in significant morbidity and mortality among children 85 children below 12 years having anaemia were studied. Complete blood count was done to determine PCV, MCV, MCH, MCHC, RDW, Hb %, along with Peripheral smear (PS) study, Reticulocyte count and Serum iron (Fe), Serum B and Folic acid levels were done Types of anaemia were 50(58.8%) Iron deficiency anaemia, 12(14.1%) Thalassemia, 8 (9.41%) Megaloblastic anaemia, 7(8.23%) Anaemia of acute haemorrhage, 5 (5.88%) Sickle cell anaemia, 2(2.35%) Aplastic anaemia, 1(1.17%) Leukemia. The clinical manifestations were 85 (100%) pallor, 71(83.5%) weakness and fatigability, 32(37.6%) fever, 23(27.05%) 17(20%) shortness of breath, 15(17.6%) hepatomegaly, 12(14.1%) cough, 11(12.9%) history of pica, 11 (12.9%) spleenomegaly, 9(10.5%) petechiae, 8(9.4%) Nausea/vomiting, 8(9.4%) koilonychia, 4(4.7%) hyper pigmentation, 5(5.8%) tremors. Out of the total number of patients screened 18(21.1%) had mild, 39(45.8%) moderate and 28(32.9%) had severe anaemia. The present study of anaemia had Iron deficiency as the major cause followed by Thalassemia, Megaloblastic anaemia, acute Haemorrhage, Sickle cell anaemia and Aplastic anaemia. This study will be helpful to paediatricians to treat such patients efficiently to avoid morbidity and mortality.

Factors Responsible for Iron Deficiency Anemia in Children Under Five Years

Objective: To determine the frequency of factors responsible for iron deficiency anemia in children under five years of age at tertiary care Hospital. Methodology: This cross-sectional study was done at the paediatric department of Muhammad Medical College MirpurKhas, during six months from October 2020 to March 2021. All the children with of (&lt;5 years), presented at Paediatric OPD and of either gender were included. After taking complete clinical examination, parents were interviewed reading history of diet. After obtaining informed consent from the parents, a 3ml blood sample was taken from each case and was immediately sent to the Hospital diagnostic laboratory for the complete blood count (CBC). Anemia was defined as hemoglobin level &lt;11g/dl. All the data was gathered via self-made study proforma and SPSS version 26 was used for the purpose of data analysis. Results: A total of 58 children with anemia were studied, their mean age was 02.91+1.29 years, mean Hb was 7.22+1.27mg/dl. Males were 56.9% and females were 40.1%. History of Buffalo milk consumption was in 53.4% children, history of pica was in 27.6%, Caffeine containing food history was in 84.5% of the cases, age of weaning &lt;12 months was in most of the cases and non-iron containing food consumption was also commonest. Most of the cases 55.20% had moderate anemia and 43.10% had severe anemia. The severity of childhood anemia was statically significant according to the type of milk consumption, type of food and caffeine containing food (p-&lt;0.05), while it was statistically insignificant according to the gender and age of weaning (P-&gt;0.05). Conclusion: As per study conclusion the Buffalo milk consumption, history of pica, caffeine containing food, age of weaning &lt;12 months and non-iron containing food consumption were observed to be the commonest factors responsible for childhood anemia. Key words: Iron deficiency anemia, factors, diet

Paediatric Blood Lead Levels and its Correlation with Anaemia: A Study from Central India

Introduction: Lead is a toxic element used commonly in many products like lead-acid batteries, paints, toys etc. Young children are particularly vulnerable to lead poisoning because of higher absorption capacity in comparison of adults. Safe level of lead exposure has to be established yet. Literature suggests a threshold lead level of 20-40 μg/dL for a decrease in haemoglobin in children. Aim: To assess the correlation between Blood Lead Levels (BLL) and anaemia in children. Materials and Methods: This cross-sectional study was conducted in a Paediatric Tertiary Care Hospital of Gwalior, Madhya Pradesh, India, during the period of May 2019 to September 2020. A 81 children between one to five years of age were included in study. Information was collected regarding general profile of the children and other parameters like socio- economic status (Modified Kuppuswamy scale), history of pica, application of surma, type of toys used, scholastic performance and somatic symptoms. Routine blood investigations were done including Haemoglobin (Hb) and BLL through venous blood sampling. BLL were done at Defense Research and Development Establishment (DRDE) Gwalior. Data entry was done in Microsoft Office Excel 2010 and analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. Chi-square test with Yates correlation was applied and p-value &lt;0.05 was considered statistically significant. Results: Among 81 study subjects, 53 were males and 28 were females. Total 48 (59.2%) children had Hb &lt;11 gm/dL, 42 (51.8%) children had BLL &lt;5 μg/dL and 32 (39.5%) had BLL between 5-10 μg/dL. There were 9% children (n=7) with BLL more than 10 μg/dL and none beyond 15 μg/dL. In the children it was found to have BLL ≥5 μg/dL, 20 children had Hb levels between 7-11 gm/dL whereas 19 had Hb levels above 11 gm/ dL. No statistically significant association was found between the BLL and childhood anaemia. Conclusion: This study did not show any relationship between BLL and Hb in children of age one to five years. Scarcity of diagnostic tools for detecting BLL and lack of public awareness regarding the probable sources of lead and its complications may result in missing the diagnosis.

Pica behaviors in pediatric patients with sickle cell disease: a scoping review protocol.

The objective of this review is to explore existing literature regarding pica in pediatric patients with sickle cell disease and to identify associated interventions and outcomes. Pica is a psychological eating disorder that is characterized by the consumption of items that contain no nutritional value. The ingestion of non-food items causes complications that can be harmful or even fatal. Approximately one-third of patients with sickle cell disease will also develop pica behaviors. This review will consider studies that include pediatric patients from 18 months to 18 years of age who have been diagnosed with any type of sickle cell disease and have a history of pica. The study will examine interventions used in any setting to treat pediatric patients with sickle cell disease and pica and associated outcomes. Any study type will be considered for inclusion. Databases to be searched will include CINAHL (EBSCO), Embase (Elsevier), Europe PubMed Central (PubMed), Psychology and Behavioral Sciences Collection (EBSCO), and Scopus (Elsevier). Data will be extracted from included papers by two independent reviewers. The data extracted will include details about the populations, concept, context, and study methods of significance to the review questions and objective. The extracted data will be presented in diagrammatic or tabular form in a manner that aligns to the objectives and scope of this review.

A complicated case of bowel obstruction with sepsis and methamphetamine toxicity in a child with pica

In this report, a pediatric case of bowel obstruction with sepsis complicated by methamphetamine toxicity is described. The decedent, an eleven-year-old female with a clinical history of pica, was found unresponsive in her home and pronounced dead following unsuccessful resuscitative efforts. Radiologic imaging showed multiple radio-opaque foreign objects in the stomach and bowel. Autopsy revealed a green leafy substance, coins and other metallic items, folded paper, and plastic in her stomach and bowels. Postmortem iliac blood and urine tested positive for amphetamine and methamphetamine. While the decedent's medical history and autopsy findings provided evidence consistent with bowel obstruction with sepsis due to the ingestion of foreign materials, the high methamphetamine concentration was suggestive of concurrent methamphetamine toxicity. Unique complications associated with this case include the phenomenon that methamphetamine toxicity and bowel obstruction can present similarly in children and the reported opinion that accidental drug ingestion is uncommon in children over the age of five. This case emphasizes that the age range for suspected accidental drug ingestion should be expanded for those with pica, as these patients, despite being older, may not be able to differentiate between what they should and should not ingest. Furthermore, when treating a pediatric patient with pica that appears to present with bowel obstruction, unintentional drug ingestion should also be considered, particularly if there is a suspicion that the child lives in a household where drugs are abused, given the prospect that drug toxicity can present similarly.

A study to access the hemoglobin level and sociodemographic profile of underfive children having Pica

Introduction: Pica is a disorder that occurs when children persistently eat one or more non-food substances over the course of at least one month. Pica may result in serious medical problems, such as intestinal blockage, poisoning, parasitic infection, and sometimes death. The typical non-food substances that children with pica ingest tend to vary with age. Method: This prospective study was undertaken at a pediatric outdoor department Career Institute of Medical Sciences Lucknow since Jan 2019 to Mar 2019. All the under five years children visiting pediatric clinic with direct or indirect history of pica were enrolled for the study. The mothers were interviewed in depth regarding their sociodemographic profile and Hemoglobin level of all the children done. Results: In our study most of the children belongs to the age group 12-24 months 66(36.67%). Most of the parents were educated upto secondary education only and belong to joint families.Children belongs to rural area 111(61.6%) were more in number and Only 87(48.33%) of the children were exclusive breast fed. In our study only 20.56% children have normal hemoglobin level while 79.44% children have hemoglobin level below 12.0gm/dl and classified as anemic children, out of which 35.56% children have mild anemia, 25.00% children have moderate anemia and 18.89% children had severe anemia. Conclusion: Pica is mostly related with micronutrient deficiencies. Because of lower breastfeeding rate and delayed starting of complementary feeding the children are prone for micronutrient deficiencies leading to pica behavior in children. Knowledge of pica is the key for prevention.

Evaluation of Blood Lead Level as a Risk Factor in Children with Autism Spectrum Disorder: A Case Control Study

The present study deals with the Evaluation of Blood lead (Pb) level as a risk factor in Autistic Children and to determine the association between blood lead level (BLL) and Autism Spectrum Disorder (ASD). It was a casecontrol study. Blood samples were collected from both case (25 of 3-16 years) and control (25 of 3-16 years) groups by vein puncture for the determination of blood lead levels using Energy Dispersive X-ray Fluorescence (EDXRF) technique. Predesigned questionnaires were completed for each case and control group by interviewing the parents or care-givers. The present study revealed that there was a significant difference between mean ages of mother at child’s birth in both case and control group. Significantly more children in case group had parents with higher educational levels and came from families with higher socioeconomic status. Significantly more children in ASD group came from urban areas than rural area. The risk of exposure to air pollution in case group was 14 times more than the control group which is represented by the proximity of child’s residence to high traffic roads. History of pica was exclusively present in case group (p value 0.001) indicating that children in ASD group had more exposure to lead than those of control group. The mean blood levels were 44.18 and 29.22 μg/dl for case and control group respectively. In case group 48% of the children had blood lead level ≥ 10 μg/dl compared to 24% in the control group.

Rapunzel Syndrome and Small Bowel Intussusceptions Due to a Cotton Thread Bezoar: A Case Report

AbstractRapunzel syndrome is a rare disease in which a trichobezoar extends into the duodenum or distal small intestine. It is associated with compulsive eating of indigestible substances or pica and is more common in cases of underlying psychiatric disturbances. If left untreated, gastrointestinal bezoars with or without the Rapunzel syndrome may lead to several complications such as ulceration, perforation, peritonitis, pancreatitis, biliary obstruction, severe nutritional disturbances, and rarely intestinal obstruction. We present an exceptionally rare case of Rapunzel syndrome caused by a large cotton thread bezoar in an adolescent girl, associated with multiple jejunal intussusceptions. Further, we present a literature review of this entity. An interesting association of bezoar with intussusception is explained. Since a history of pica may not be forthcoming in all cases, it is important to be familiar with the imaging characteristics, complications, and management of bezoars.

Clinical profile, sociodemographic and biochemical determinants of PICA among 1 to 5 aged children attending a tertiary care hospital

Background: The term PICA has been derived from the Latin word “MAGPIE” which is a bird that has omnivorous habit and is known for its indiscriminate preference for foods and non-foods. The aim of this study was to study the clinical profile and to determine the relationship between pica and various socio demographic determinants, serum levels of iron, zinc and calcium.Methods: This study was conducted in 51 children with PICA belonging to 1-5 years and 51 controls of same age and sex who were attending pediatrics department in SRM medical college hospital and research centre. The data regarding clinical manifestations and sociodemographic determinants were collected by questionnaires to mother. The blood samples were collected from each child involved in the study after getting consent. Then the data was analyzed by using chi-square, unpaired ‘t’ test and ANOVA analysis.Results: This study shows that PICA is commonly seen in males, bottle fed children and those belonging to nuclear family. Family history of PICA had significant association with PICA in children (p=0.05). Soil is the most common type of pica (49%) followed by paper and stone. The most common presentation is poor appetite (43.1%). The serum levels of iron and zinc were significantly low when compared to controls (P &lt;0.001). The serum levels of iron in anemic children with pica are also significantly lower than pica children with no anemia. No significant association is seen between serum iron and zinc with number of substances or duration of ingestion or frequency of ingestion (P &gt;0.05).Conclusions: Family history of PICA, bottle feeding, joint family has significant association with pica. Soil is the most common type of PICA. Poor appetite is the most common clinical manifestation. There is significant association between low serum levels of iron and zinc with PICA.

Assessment of Prevalence and Risk Factors for Anemia Among Pregnant Mothers Attending Anc Clinic at Adama Hospital Medical Collage, Adama, Ethiopia, 2017

<i>Background</i>: Anemia is a significant public health problem in developing countries, particularly in pregnant women. It refers to a condition in which the hemoglobin content of the blood is lower than normal. In developing countries, the cause of anemia during pregnancy is multifactorial and includes nutritional deficiencies. It is associated with an increased risk of maternal and perinatal morbidity and mortality. In order to design an intervention for prevention of anemia in pregnancy, determination of its magnitude and identifying associated risk factors for anemia are paramount importance. <i>Objectives</i>: To determine the magnitude and factors associated with anemia during pregnancy among mothers attending antenatal care at Adama Hospital Medical College antenatal care clinic from November to December 2017. <i>Methods</i>: Institution based cross sectional study design was used in Adama Hospital Medical College from November to December 2017. The study participants were selected using systematic sampling technique from their sequence of antenatal care visit in the period of study, and associated risk factors data were collected using structured questionnaire by trained antenatal care service providers. Level of haemoglobin was determined. Descriptive and analytical statistics were computed using SPSS version 20. Odds Ratios, P-values and 95% CIs - the analytical statistics from bivariate and multi variate logstic regression were used to identify predictor variables associated with the dependent variable - anaemia. <i>Result</i>: A total of 329 participants completed the study making the response rate of 97.0%. The mean age of the participants was (26.5 ± 4.03). The prevalence of anaemia was found to be 14.9%. Pregnant women who had pica during pregnancy had 33.6(13.92 -81.48) times more likely to be anemic compared with those had no history of pica. Pregnant women who didn’t take iron supplementation during their pregnancy were 0.196(.085-.445) times more likely to be affected by anemia when they compared with those who took iron supplementation. <i>Conclusion</i>: The prevalence of anaemia was found to be 14.9%. Iron supplementation during pregnancy and presence of pica were significantly associated with anaemia in the study population. Therefore, long term and short term strategies helpful in alleviating these predisposing factors need to be developed so as to reduce the number of mothers affected by anaemia.

A study of pica in cattle in Iran

Abstract Pica is often considered a nutritional disorder of cattle and other farm animals, but the etiology is controversial. Roles for the shortage or imbalance of some nutritional elements have been debated. This study was conducted to evaluate serum variations of some electrolyte, mineral, and protein factors in cattle with pica. After history taking and clinical examination, of the 285 referred native cows, 15 with an ongoing history of pica were included as the pica group. Fifteen healthy-looking cows without pica were randomly chosen as the control. Serum levels of Ca, P, Mg, Na, Cl, K, Cu, Zn, Fe, total protein, albumin, urea, and ferritin were quantified. Body condition score and any deformity of the legs of the cows in the study were visually determined. The prevalence rate of pica was 5.96%. Six out of 15 of the cows with pica (40%) had deformation of the legs associated with hypophosphatemia (1.82 ± 0.7 mg/dL). Profound hypophosphatemia and hypochloremia were seen in all diseased cattle. There was no significant difference between serum values of copper, zinc, total protein, albumin, and urea between the 2 groups. The serum ferritin and iron concentration of pica group was also lower than those of control group ( P

Case Report of Foreign Body Stuck in Esophagus with Failure of Endoscopic Management in a Man with a History of Pica

This is a case report of foreign body ingestion in a 55-year-old intellectually disabled man with a history of pica and previous removal of ten plastic gloves from his rectum four months prior to this presentation. The patient presented after ingesting plastic gloves which formed large, rigid esophageal and gastric bezoars that were not amenable to endoscopic removal. An exploratory laparotomy and gastrostomy was performed, and a 10 × 4.5 × 2 cm gastric bezoar consisting of rigid plastic gloves was removed without complication. Special considerations must be taken when considering the ingestion of nonfood items in the intellectually disabled population as these cases may not present classically with symptoms of a gastric bezoar.

Association of Lead Levels and Cerebral Palsy.

Background: Cerebral palsy is a common motor disability in childhood. Raised lead levels affect cognition. Children with cerebral palsy may have raised lead levels, further impairing their residual cognitive motor and behavioral abilities. Environmental exposure and abnormal eating habits may lead to increased lead levels. Aims and Objectives: To measure blood lead levels in children with cerebral palsy and compare them with healthy neurologically normal children. To correlate blood lead levels with environmental factors. Material and Methods: Design: Prospective case-control study. Setting: Tertiary care hospital. Participants: Cases comprised 34 children with cerebral palsy, and controls comprised 34 neurologically normal, age- and sex-matched children. Methods: Clinical and demographic details were recorded as per proforma. Detailed environmental history was recorded to know the source of exposure to lead. These children were investigated and treated as per protocol. Venous blood was collected in ethylenediaminetetraacetic acid vials for analysis of blood lead levels. Lead levels were estimated by Schimadzu Flame AA-6800 (atomic absorption spectrophotometer). Data were analyzed using SPSS version 17. P < .05 was taken as significant. Results: Mean blood lead levels were 9.20 ± 8.31 µg/dL in cerebral palsy cases and 2.89 ± 3.04 µg/dL in their controls (P < .001). Among children with cerebral palsy, 19 (55.88%) children had blood lead levels ≥5 µg/dL. Lead levels in children with pica were 12.33 ± 10.02 µg/dL in comparison to children with no history of pica, 6.70 ± 4.60 µg/dL (P = .029). No correlation was found between hemoglobin and blood lead levels in cases and controls. Conclusion: In our study, blood lead levels are raised in children with cerebral palsy. However, further studies are required to show effects of raised levels in these children.