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Environmental arsenic epidemiology in the Mekong river basin of Cambodia

Phan K, Kim KW, Hashim JH

Environ Res, 2014 Nov;135:37-41.
PMID: 25262072 DOI: 10.1016/j.envres.2014.07.031

We investigated relationship of arsenicosis symptoms with total blood arsenic (BAs) and serum albumin (SAlb) of residents in the Mekong River basin of Cambodia. We found that arsenicosis patients had significantly higher BAs and lower SAlb than asymptomatic villagers (Mann-Whitney U test, p<0.01). Arsenicosis symptoms were found to be 76.4% (1.764 times) more likely to develop among individuals having an SAlb≤44.3gL(-1) than among those who had an SAlb>44.3gL(-1) (OR=1.764, 95% CI=0.999-3.114) and 117.6% (2.176 times) as likely to occur among those with BAs>5.73µgL(-1) than for those having BAs≤5.73µgL(-1) (OR=2.176, 95% CI=1.223-3.872). Furthermore, a significant negative correlation was also found between BAs and SAlb (rs (199)=-0.354, p<0.0001). As such, this study suggests that people with low SAlb and/or high BAs are likely to rapidly develop arsenicosis symptoms.
Current status of arsenic exposure and social implication in the Mekong River basin of Cambodia

Phan K, Kim KW, Huoy L, Phan S, Se S, Capon AG, et al.

Environ Geochem Health, 2016 Jun;38(3):763-72.
PMID: 26298061 DOI: 10.1007/s10653-015-9759-z

To evaluate the current status of arsenic exposure in the Mekong River basin of Cambodia, field interview along with urine sample collection was conducted in the arsenic-affected area of Kandal Province, Cambodia. Urine samples were analyzed for total arsenic concentrations by inductively coupled plasma mass spectrometry. As a result, arsenicosis patients (n = 127) had As in urine (UAs) ranging from 3.76 to 373 µg L(-1) (mean = 78.7 ± 69.8 µg L(-1); median = 60.2 µg L(-1)). Asymptomatic villagers (n = 108) had UAs ranging from 5.93 to 312 µg L(-1) (mean = 73.0 ± 52.2 µg L(-1); median = 60.5 µg L(-1)). About 24.7 % of all participants had UAs greater than 100 µg L(-1) which indicated a recent arsenic exposure. A survey found that females and adults were more likely to be diagnosed with skin sign of arsenicosis than males and children, respectively. Education level, age, gender, groundwater drinking period, residence time in the village and amount of water drunk per day may influence the incidence of skin signs of arsenicosis. This study suggests that residents in Kandal study area are currently at risk of arsenic although some mitigation has been implemented. More commitment should be made to address this public health concern in rural Cambodia.
Fulltext Annular closure device for disc herniation: meta-analysis of clinical outcome and complications

Choy WJ, Phan K, Diwan AD, Ong CS, Mobbs RJ

BMC Musculoskelet Disord, 2018 Aug 16;19(1):290.
PMID: 30115053 DOI: 10.1186/s12891-018-2213-5

BACKGROUND: Lumbar intervertebral disc herniation is a common cause of lower back and leg pain, with surgical intervention (e.g. discectomy to remove the herniated disc) recommended after an appropriate period of conservative management, however the existing or increased breach of the annulus fibrosus persists with the potential of reherniation. Several prosthesis and techniques to reduce re-herniation have been proposed including implantation of an annular closure device (ACD) - Barricaid™ and an annular tissue repair system (AR) - Anulex-Xclose™. The aim of this meta-analysis is to assist surgeons determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications.
METHODS: Four electronic full-text databases were systematically searched through September 2017. Data including outcomes of annular closure device/annular repair were extracted. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics.
RESULTS: Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P
Hair arsenic levels and prevalence of arsenicosis in three Cambodian provinces

Hashim JH, Radzi RS, Aljunid SM, Nur AM, Ismail A, Baguma D, et al.

Sci Total Environ, 2013 Oct 1;463-464:1210-6.
PMID: 23759330 DOI: 10.1016/j.scitotenv.2013.04.084

Natural, inorganic arsenic contamination of groundwater threatens the health of more than 100 million people worldwide, including residents of the densely populated river deltas of South and Southeast Asia. Contaminated groundwater from tube wells in Cambodia was discovered in 2001 leading to the detection of the first cases of arsenicosis in 2006. The most affected area was the Kandal Province. The main objective of this study was to determine the prevalence of arsenicosis in Cambodia based on acceptable criteria, and to investigate the use of hair arsenic as a biomarker not only for arsenicosis-related signs but also for associated symptoms. A cross-sectional epidemiological study of 616 respondents from 3 purposely selected provinces within the Mekong River basin of Cambodia was conducted. The Kandal Province was chosen as a high arsenic-contaminated area, while the Kratie Province and Kampong Cham Province were chosen as moderate and low arsenic-contaminated areas, respectively. The most prevalent sign of arsenicosis was hypomelanosis with a prevalence of 14.5% among all respondents and 32.4% among respondents with a hair arsenic level of ≥1 μg/g. This was followed by hyperkeratosis, hyperpigmentation and mee's lines. Results also suggest a 1.0 μg/g hair arsenic level to be a practical cut off point for an indication of an arsenic contaminated individual. This hair arsenic level, together with the presence of one or more of the classical signs of arsenicosis, seems to be a practical criteria for a confirmed diagnosis. Based on these criteria, the overall prevalence of arsenicosis for all provinces was found to be 16.1%, with Kandal Province recording the highest prevalence of 35.5%. This prevalence is comparatively high when compared to that of other affected countries. The association between arsenicosis and the use of Chinese traditional medicine also needs further investigation.