Mudar Dalloul

Human Fetal Exposure to Triclosan and Triclocarban in an Urban Population from Brooklyn, New York

Triclosan (TCS) and triclocarban (TCC) are antimicrobial agents formulated in a wide variety of consumer products (including soaps, toothpaste, medical devices, plastics, and fabrics) that are regulated by the U.S. Food and Drug Administration (FDA) and U.S. Environmental Protection Agency. In late 2014, the FDA will consider regulating the use of both chemicals, which are under scrutiny regarding lack of effectiveness, potential for endocrine disruption, and potential contribution to bacterial resistance to antibiotics. Here, we report on body burdens of TCS and TCC resulting from real-world exposures during pregnancy. Using liquid chromatography tandem mass spectrometry, we determined the concentrations of TCS, TCC, and its human metabolites (2′-hydroxy-TCC and 3′-hydroxy-TCC) as well as the manufacturing byproduct (3′-chloro-TCC) as total concentrations (Σ−) after conjugate hydrolysis in maternal urine and cord blood plasma from a cohort of 181 expecting mother/infant pairs in an urban multiethnic population from Brooklyn, NY recruited in 2007–09. TCS was detected in 100% of urine and 51% of cord blood samples after conjugate hydrolysis. The interquartile range (IQR) of detected TCS concentrations in urine was highly similar to the IQR reported previously for the age-matched population of the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2004, but typically higher than the IQR reported previously for the general population (detection frequency = 74.6%). Urinary levels of TCC are reported here for the first time from real-world exposures during pregnancy, showing a median concentration of 0.21 μg/L. Urinary concentrations of TCC correlated well with its phase-I metabolite ∑-2′-hydroxy-TCC (r = 0.49) and the manufacturing byproduct ∑-3′-chloro-TCC C (r = 0.79), and ∑-2′-hydroxy-TCC correlated strongly with ∑-3′-hydroxy-TCC (r = 0.99). This human biomonitoring study presents the first body burden data for TCC from exposures occurring during pregnancy and provides additional data on composite exposure to TCS (i.e., from both consumer-product use and environmental sources) in the maternal–fetal unit for an urban population in the United States.

Assessment of prenatal mercury exposure in a predominately Caribbean immigrant community in Brooklyn, NY

Prenatal mercury exposure and its fetotoxic effects may be of particular concern in urban immigrant communities as a result of possible contributing cultural factors. The most common source of exposure in these communities is ingestion of fish and shellfish contaminated with methylmercury. Other sources of exposure may occur in ritualistic practices associated with Hispanic and Caribbean-based religions. This study 1) assessed total mercury levels in both random urine specimens from pregnant women, and in cord blood; and 2) examined environmental sources of exposure from a convenience sample in a predominantly Caribbean immigrant population in Brooklyn, New York. A questionnaire designed in collaboration with health professionals from the Caribbean community assessed the frequency of fish consumption, ritualistic practices, occupational exposures, and use of dental amalgams and mercury-containing skin and household products. The geometric mean for total mercury in cord blood was 2.14 μg L(-1) (95%CI: 1.76-2.60) (n = 78), and 0.45 μg L(-1) (95%CI: 0.37-0.55) (n = 183) in maternal urine corrected for creatinine (μg g(-1)). Sixteen percent of cord blood mercury levels exceeded the estimated equivalent of U.S. Environmental Protection Agencys Reference Dose (5.8 μg L(-1) blood). Predictors of cord blood mercury included maternal fish consumption and foreign birth of the mother. Predictors of urine mercury included foreign birth of the mother, number of dental amalgams, and special product use. There were no reports of mercury use in ritualistic practices or in cosmetics; however some women reported use of religious medals and charms. This study characterized risk factors for mercury exposure in a sample of urban, predominantly Caribbean-born blacks. Findings may help target interventions in this population, which might include appropriate fish selection and consumption frequency during pregnancy, and safe handling of mercury-containing products in the home.

Maternal Mercury Exposure, Season of Conception and Adverse Birth Outcomes in an Urban Immigrant Community in Brooklyn, New York, U.S.A.

Adverse birth outcomes including preterm birth (PTB: <37 weeks gestation) and low birth weight (LBW: <2500 g) can result in severe infant morbidity and mortality. In the United States, there are racial and ethnic differences in the prevalence of PTB and LBW. We investigated the association between PTB and LBW with prenatal mercury (Hg) exposure and season of conception in an urban immigrant community in Brooklyn, New York. We recruited 191 pregnant women aged 18–45 in a Brooklyn Prenatal Clinic and followed them until delivery. Urine specimens were collected from the participants during the 6th to 9th month of pregnancy. Cord blood specimens and neonate anthropometric data were collected at birth. We used multivariate logistic regression models to investigate the odds of LBW or PTB with either maternal urinary mercury or neonate cord blood mercury. We used linear regression models to investigate the association between continuous anthropometric outcomes and maternal urinary mercury or neonate cord blood mercury. We also examined the association between LBW and PTB and the season that pregnancy began. Results showed higher rates of PTB and LBW in this cohort of women compared to other studies. Pregnancies beginning in winter (December, January, February) were at increased odds of LBW births compared with births from pregnancies that began in all other months (OR7.52 [95% CI 1.65, 34.29]). We observed no association between maternal exposure to Hg, and either LBW or PTB. The apparent lack of association is consistent with other studies. Further examination of seasonal association with LBW is warranted.

Maternal and fetal exposure to parabens in a multiethnic urban U.S. population

Fetal exposure to five parabens was investigated due to their endocrine-disrupting potential and possible impact on fetal development. Body burdens occurring from real-world exposures were determined typically as total concentrations after conjugate hydrolysis in 181 maternal urine and 38 umbilical cord blood plasma samples from a multiethnic cohort of 185 predominantly-black, pregnant women recruited in Brooklyn, New York between 2007/9. For 33 participants, both sample types (maternal urine and cord blood) were available. Methyl- (MePB), ethyl- (EtPB), propyl- (PrPB), butyl- (BuPB), and benzylparaben (BePB) were detected in 100, 73.5, 100, 66.3 and 0.0% of the urine samples at median concentrations of 279, 1.44, 75.3, 0.39, and <0.02μg/L, respectively. Median concentrations of MePB and PrPB were, respectively 4.4- and 8.7-fold higher compared to those reported previously for the general U.S. population (NHANES, 2005/6). Listed in the order above, the five parabens were detected in 97.4, 94.7, 47.4, 47.4, and 44.7% of cord blood plasma samples at median total concentrations of 25.0, 0.36, <0.27, <0.09, and <0.10μg/L, respectively. Free MePB, EtPB, and PrPB were detected in a subset of cord blood plasma samples at, respectively, 3.9, 71.7, and 6.4% of their total concentrations, whereas free BuPB and BePB were not detected. Literature data and those reported here show the urban community studied here to rank highest in the world for MePB and PrPB exposure in pregnant women, whereas it ranks among the lowest for EtPB and BuPB. This study is the first to report the occurrence of parabens in human umbilical cord blood. Maternal exposure to parabens is widespread, and substantial differences were found to exist between communities and countries both in the spectrum and degree of paraben exposures.

Methicillin-Resistant Staphylococcus aureus Bacteremia and Chorioamnionitis After Recurrent Marsupialization of a Bartholin Abscess

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an extremely rare etiology of chorioamnionitis. CASE: A young primigravida, with sickle cell (Hb SS) disease and &bgr; thalassemia presented at 37 weeks of gestation with fever, chills, and lower abdominal pain in the presence of intact fetal membranes, 10 days after recurrent marsupialization of a Bartholin abscess. Overt clinical chorioamnionitis was diagnosed. The patient received intravenous triple antibiotics and delivered by immediate cesarean. Maternal blood, uterine, placental and neonatal nares, external auditory canal, and umbilical cord stump cultures all yielded MRSA. Both the mother and infant received intravenous vancomycin and did well. CONCLUSION: Our case and the literature suggest that it may be prudent to consider MRSA when contemplating the possibility of chorioamnionitis in the presence of intact fetal membranes, especially in gravidas with recurrent admissions or minor surgical procedures or who are hospital staff.

Serum ionized magnesium and calcium and sex hormones in healthy young men: importance of serum progesterone level.

OBJECTIVE To determine the serum concentrations of the sex hormones with respect to the concentrations of the biologically active fractions of magnesium (Mg) and calcium (Ca) in healthy young men and to compare them with those in young and older women. DESIGN Controlled clinical study. SETTING An academic research environment. PATIENT(S) Twenty-five healthy young male volunteers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Concentrations of the sex steroid hormones testosterone, estrogen, and progesterone, and levels of ionized Ca (Ca2+) and Mg (Mg2+) were measured in the serum of healthy young men. These levels were compared with those in young women at different phases of the menstrual cycle and with those in older women. RESULT(S) The Mg2+ and total Mg concentrations in young men were not different from those during the follicular phase in young women or from the mean concentrations in menopausal women. The Ca2+ levels in young men were similar to the levels in young women during the follicular phase but significantly lower than the levels in older women. The Mg2+ concentration in the young men was directly and significantly related to the progesterone level, and the Ca2+/Mg2+ ratio was inversely related to the progesterone level. CONCLUSION(S) Progesterone may be a more important steroid hormone in men than previously believed.

Prenatal sonographic findings of congenital adrenal cortical adenoma.

The differential diagnosis of prenatally diagnosed adrenal masses includes neuroblastoma, adrenal hemorrhage, adrenal and cortical renal cysts, adrenal adenoma and carcinoma, subdiaphragmatic pulmonary sequestration, Beckwith-Wiedemann syndrome, duplication of the renal system, Wilms tumors, congenital mesoblastic nephroma, and mesenteric and enteric duplication cysts. The worldwide annual incidence of childhood adrenal cortical neoplasms ranges between 0.3 and 0.38 per 1 million children younger than 15 years. These neoplasms are even more unusual among infants, with only 23 cases reported in the literature.

Gestational diabetes leading to diagnosis and management of multiple endocrine neoplasia type 2a.

BACKGROUND: Multiple endocrine neoplasia (MEN) type 2a is an autosomal dominant syndrome caused by specific proto-oncogene mutations characterized by medullary carcinoma of the thyroid, pheochromocytoma, and, occasionally, multiglandular parathyroid hyperplasia, which rarely complicates pregnancy. Secondary diabetes rarely has been reported in association with principal endocrinopathies complicating pregnancy. CASE: A 34-year-old primiparous woman with recently diagnosed gestational diabetes had repeated episodes of dizziness at 30 weeks of gestation, initially attributed to glyburide. Continued episodes of dizziness and later-appearing bouts of severe headache, palpitations, diaphoresis, severe hypertension, and marked tachycardia led to diagnosis and management of MEN type 2a complicating pregnancy. CONCLUSION: Patients with MEN type 2a complicating pregnancy may present with gestational diabetes.

Nomograms of the fetal neck circumference and area throughout gestation.

The purpose of this study was to create reference range nomograms of the axial fetal neck circumference (FNC) and fetal neck area (FNA) throughout gestation.

Acquired hematometra and hematotrachelos in an adolescent with dysfunctional uterine bleeding

Obstruction of the lower female genital tract leading to proximal dilatation and development of hematocolpos, hematotrachelos, and hematometra is most commonly a result of congenital abnormalities. 1-3 These conditions include an imperforate hymen, a complete transverse vaginal septum, and vaginal and, rarely, cervical atresia. 1-3 Acquired obstruction of the lower female genital tract is rare. Etiologies of such acquired lesions include iatrogenic trauma to the uterine cervix such as cone biopsies, loop electrosurgical procedures, dilation and curettage, obstetric lacerations, cervical or endometrial carcinoma, and radiation therapy. 4-8 Spontaneous obstruction is extremely rare yet has been reported recently. 9 We describe an unusual case in which sonographic findings of marked spontaneous hematometra and hematotrachelos were depicted in an adolescent with dysfunctional uterine bleeding.