Mercury exposure: evaluation and intervention the inappropriate use of chelating agents in the diagnosis and treatment of putative mercury poisoning

Tissue Culture Innovations for Propagation and Conservation of Myrteae-A Globally Important Myrtaceae Tribe

Myrteae is the most species-rich tribe in the Myrtaceae family, represented by a range of socioeconomically and ecologically significant species. Many of these species, including commercially relevant ones, have become increasingly threatened in the wild, and now require conservation actions. Tissue culture presents an appropriate in vitro tool to facilitate medium-term and long-term wild germplasm conservation, as well as for commercial propagation to maintain desirable traits of commercial cultivars. So far, tissue culture has not been extensively achieved for Myrteae. Here, tissue culture for Eugenia, one of the most species-rich genera in Myrteae, is reviewed, giving directions for other related Myrteae. This review also focuses on ex situ conservation of Australian Myrteae, including using seed banking and field banking. Despite some progress, challenges to conserve these species remain, mostly due to the increasing threats in the wild and limited research. Research into in vitro methods (tissue culture and cryopreservation) is paramount given that at least some of the species are 'non-orthodox'. There is an urgent need to develop long-term in vitro conservation for capturing the remaining germplasm of threatened Myrteae.

The safety of magnetic resonance imaging contrast agents

Gadolinium-based contrast agents are increasingly used in clinical practice. While these pharmaceuticals are verified causal agents in nephrogenic systemic fibrosis, there is a growing body of literature supporting their role as causal agents in symptoms associated with gadolinium exposure after intravenous use and encephalopathy following intrathecal administration. Gadolinium-based contrast agents are multidentate organic ligands that strongly bind the metal ion to reduce the toxicity of the metal. The notion that cationic gadolinium dissociates from these chelates and causes the disease is prevalent among patients and providers. We hypothesize that non-ligand-bound (soluble) gadolinium will be exceedingly low in patients. Soluble, ionic gadolinium is not likely to be the initial step in mediating any disease. The Kidney Institute of New Mexico was the first to identify gadolinium-rich nanoparticles in skin and kidney tissues from magnetic resonance imaging contrast agents in rodents. In 2023, they found similar nanoparticles in the kidney cells of humans with normal renal function, likely from contrast agents. We suspect these nanoparticles are the mediators of chronic toxicity from magnetic resonance imaging contrast agents. This article explores associations between gadolinium contrast and adverse health outcomes supported by clinical reports and rodent models.

Diagnostic and Therapeutic Challenges in Intravenous Mercury Poisoning: A Case Report

Intravenous mercury poisoning is a rare but severe medical emergency, often resulting from accidental exposure or intentional self-harm. We present the case of a 30-year-old male with a history of sickle cell anemia who presented with high-grade fever, vomiting, giddiness, and breathlessness following intravenous mercury self-administration. Diagnostic challenges included distinguishing symptoms of acute mercury toxicity from those of his chronic condition of sickle cell trait. Markedly elevated serum mercury levels confirmed the diagnosis, with high-resolution computed tomography (HRCT) imaging studies revealing mercury deposits and alveolar lung injury. Management involved antidote of mercury poisoning, including non-invasive ventilation and transfusions, with consultations from multiple specialties. The patient demonstrated significant clinical improvement and was discharged with scheduled follow-ups. This case underscores the complexity of diagnosing and managing intravenous mercury poisoning, highlighting the importance of a comprehensive multidisciplinary approach for optimal patient outcomes.

Microfluidics in environmental analysis: advancements, challenges, and future prospects for rapid and efficient monitoring

Microfluidic devices have emerged as advantageous tools for detecting environmental contaminants due to their portability, ease of use, cost-effectiveness, and rapid response capabilities. These devices have wide-ranging applications in environmental monitoring of air, water, and soil matrices, and have also been applied to agricultural monitoring. Although several previous reviews have explored microfluidic devices' utility, this paper presents an up-to-date account of the latest advancements in this field for environmental monitoring, looking back at the past five years. In this review, we discuss devices for prominent contaminants such as heavy metals, pesticides, nutrients, microorganisms, per- and polyfluoroalkyl substances (PFAS), etc. We cover numerous detection methods (electrochemical, colorimetric, fluorescent, etc.) and critically assess the current state of microfluidic devices for environmental monitoring, highlighting both their successes and limitations. Moreover, we propose potential strategies to mitigate these limitations and offer valuable insights into future research and development directions.

Total body burden of neurotoxicant Hg in Chinese mitten crab (Eriocheir sinensis) - Considerations of distribution and human risk assessment

The Chinese mitten crab (Eriocheir sinensis) is considered one of the 100 most invasive alien species in the world. Despite this, its role in ecosystems, among others, in the trophodynamics of pollutants including mercury, is still not fully understood. Becoming an increasingly important and widespread element of the trophic chain in new areas arouses interest from humans as consumers. Hence it is important to determine the level of contaminants (including Hg) in alien species. In the present study, great attention was paid separately to the soft tissues and hard tissues of the exoskeleton, which may play an important role in the detoxification of the crab's body from toxic Hg. The study was conducted on crabs collected in 2011-2021 in the Vistula Lagoon. Concentrations of total mercury and its forms were carried out using a Direct Mercury Analyzer, DMA-80 (Milestone, Italy). The present study showed that mercury accumulation of the crab's body largely occurred through the gills, followed by the oral route. The distribution of Hg in the crab's organs was related to the trophic origin of the mercury, while halide-bound mercury and semilabile forms from the respiration (filtration) process were redistributed into the crab's exoskeleton. Male crabs, compared to females, had a higher Hg burden on internal organs such as their hepatopancreas and gonads. Hg concentration in hard tissues was closely related to the type of mineralization of the carapace. The elimination of Hg from the muscles and from the hepatopancreas into the carapace was one of the important detoxification processes of the crab's body. Thus, moulting crabs effectively remove Hg protecting its body from the neurotoxin. As a result, a smaller Hg load is biomagnified, making the crab's muscle tissue fit for human consumption. The observed decrease in Hg concentrations from 2011 to 2021, as well as the spatial variability of Hg in the crab's muscles, testify that the crab can serve as a biomonitor for ecosystem changes.

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Several heavy metals and other chemical elements are natural components of the Earth's crust and their properties and toxicity have been recognized for thousands of years. Moreover, their use in industries presents a major source of environmental and occupational pollution. Therefore, this ubiquity in daily life may result in several potential exposures coming from natural sources (e.g., through food and water contamination), industrial processes, and commercial products, among others. The toxicity of most chemical elements of the periodic table accrues from their highly reactive nature, resulting in the formation of complexes with intracellular compounds that impair cellular pathways, leading to dysfunction, necrosis, and apoptosis. Nervous, gastrointestinal, hematopoietic, renal, and dermatological systems are the main targets. This manuscript aims to collect the clinical and forensic signs related to poisoning from heavy metals, such as thallium, lead, copper, mercury, iron, cadmium, and bismuth, as well as other chemical elements such as arsenic, selenium, and fluorine. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could rapidly initiate treatment even before the toxicological results are available, which can make a huge difference in these patients' outcomes.

Study of the mechanism of embolism removal in xylem vessels by using microfluidic devices

Determining the mechanism that effects embolism repair in the xylem vessels of plants is of great significance in predicting plant distribution and the screening of drought-resistant plants. However, the mechanism of perforation plates of xylem vessels in the acceleration of embolism repair is still not clear by using conventional methods of anatomy and visualization technology. Microfluidic devices have shown their ability to simulate physiological environments and conduct quantitative experiments. This work proposes a biomimetic microfluidic device to study the mechanism of perforation plates of xylem vessels in the acceleration of embolism repair. The results proffered that the perforation plates increase the rate of embolism removal by increasing the pressure differential through the vessel, and the rate of embolism removal is related to the structural parameters of the perforation plate. A combination of the perforation size, the vessel diameter and the perforation plate angle can be optimised to generate higher pressure differentials, which can accelerate the process of embolism repair. This work provides a new method for studying the mechanism of microstructures of natural plants. Furthermore, the mechanism that perforation plates accelerate embolism repair was applied to an electrochemical flow sensor for online determination of heavy metal ions. Test results of this application indicate that the mechanism can be applied in the engineering field to solve the problems of reduced sensitivity of devices, inaccuracy of analysis results and poor reaction performance caused by bubbles that are generated or introduced easily in microdevices, which paves the way for applying the theory to engineering.

Rational synthesis and characterization of highly water stable MOF@GO composite for efficient removal of mercury (Hg2+) from water

The present study is aimed at adsorptive removal of Mercury (Hg²⁺) using highly functionalized nanomaterials based on Graphene Oxide Zeolitic Imidazolate Framework composite (ZIF-67@GO). Solvothermal methodology was used to synthesize ZIF-67@GO composite. Synthesized compounds were confirmed by FTIR, SEM, PXRD and EDX analysis. The as-prepared ZIF-67@GO was tested as efficient adsorbent for effective removal of Mercury (Hg²⁺) from aquatic environment. The atomic adsorption spectrophotometer was used to monitor the process of adsorption of Hg⁺² on ZIF-67@GO. From the adsorption data, the maximum removal efficiency achieved was 91.1% using 10 mg amount of composite for 50 mL using 20 ppm Mercury (Hg²⁺) solution. Different parameters like pH, contact time, concentration, adsorption kinetics and isotherm were also examined to explore adsorption process. Adsorption data fitted well for Freundlich Model having R² value of 0.9925 than Langmuir Isotherm with R² value of 0.9238. Kinetics were rapid and excellently described via 2nd order model with R² = 0.99946 than 1st order model with R² value of 0.8836. Freundlich and pseudo 2nd order models validated that multilayer chemisorption occurs during adsorption process due to the presence of highly functionalized sites on ZIF-67@GO composite. The synthesized composite material has shown excellent reusability. Thus, water stable ZIF-67@GO composites can efficiently be used for Mercury (Hg²⁺) confiscation from water.

Mercury Exposure in Artisanal Mining: Assessing the Effect of Occupational Activities on Blood Mercury Levels Among Artisanal and Small-Scale Goldminers in Ghana

A cross-sectional survey of 425 male artisanal and small-scale goldminers (ASGM) was conducted to examine the relationship between the occupational activities of the miners and their blood mercury levels while controlling for relevant biosocial and socio-cultural factors. The data was subjected to descriptive and inferential statistics. Initial findings showed that 43.29% of the ASGM miners had blood mercury levels above the occupational exposure threshold. Among the occupational factors, ASGM miners who amalgamate gold, burn amalgam, and ASGM miners who smelt gold were 2.260, 1.881, and 2.094 times respectively more likely to have high blood mercury levels as compared to ASGM miners who did not carry out these activities. Also, ASGM miners who suck excess mercury with their mouth (OR = 0.197, p < 0.001) were less likely to have high blood mercury levels. For the biosocial and socio-cultural attributes, high blood mercury levels was less likely among older ASGM miners (OR = 0.507, p < 0.05). Inversely, high blood mercury levels was more likely among ASGM miners who are married (OR = 1.627, p < 0.05), ASGM miners with junior (OR = 2.240, p < 0.001) and senior (OR = 1.575, p < 0.05) high school education, and ASGM miners who have 6-10 years (OR = 3.802, p < 0.001) and above 10 years (OR = 2.591, p < 0.001) work experience. ASGM miners who amalgamate gold, burn amalgam, and smelt gold are exposed to mercury and are at risk of mercury poisoning. This could, however, be minimized with the right capturing devices and personal protective equipment. This notwithstanding, unsafe, and unsustainable occupational practices such as working in mercury contaminated water and sucking excess mercury with the mouth should be discouraged.

Synthesis and characterization of poly (styrene-co-acrylamide)-graft-polyanilines as new sorbents for mercuric present in aqueous hydrocarbon liquids

Background

The unprocessing hydrocarbon oil often contains high concentrations of mercury, which damages the metallic processing components and have health risk on workers and environment. Mercuric removal unit associated with natural gas processing plant is failed to complete mercury removal and then mercury distributed in most places of removal unit. Most of unremoved mercury are found in polar solutions.

Results

Styrene-co-acrylamide-graft-polyanilines were synthesized and characterized. The copolymer formed by free radical emulsion copolymerization of styrene-acrylamide (14:1) using ammonium persulphate (APS) at 60 °C. In addition, the grafting process was also achieved by oxidation chemical polymerization of the above copolymer with both aniline and 2-chloroaniline using APS. The synthetic polymeric samples were characterized using infrared (IR), x-ray diffraction (XRD), scan electron microscope (SEM), transition electron microscope (TEM), thermogravimetric analysis (TGA) and Brunauer–Emmett–Teller (BET) to confirm the polymerization process and investigate the polymeric samples as new sorbents for Hg (II). Both adsorption kinetics and isotherm models were checked.

Conclusions

In most cases Hg (II) was adsorbed as multi-layer on the obtained mesopores materials. The grafting process enhances the copolymer activity towards Hg (II) removal. The complete removal of mercury from water solution portion of mercuric removal unit was achieved by introduction of synthetic polymeric mesopores material based on styrene-co-acrylamide-graft-polyanilines. The removal efficiency closed to 100% in case of grafting with poly (2-chloroaniline).

Feather mercury levels in beached Magellanic penguin (Spheniscus magellanicus) in northern Argentina during the non-breeding season

Mercury (Hg) is a great concern for marine environments. Bird feathers have been widely used to assess Hg pollution. In this study, we determine mercury concentrations in body feathers of juvenile Magellanic penguins (Spheniscus magellanicus) from the southeastern sector of Buenos Aires province, Argentina, during a non-breeding season, considering both sexes. Hg levels, considering both females and males together, ranged between 265.5 and 1515.52 ng/g. These levels are well below the concentrations in feathers suggested for taking actions focused on the protection of seabirds. Non-significant differences between sexes regarding Hg levels were found, probably because juveniles were sexually immature and females did not excrete Hg by egg laying yet. Hg concentrations found in this study were an order of magnitude higher than those reported 10 years ago for the species in breeding areas on the Argentine coast. Thus, the present study provides relevant information indicating a possible increase of Hg pollution in the southwestern region of the Atlantic Ocean and thus trigger for the development of monitoring programs and regional strategies to improve the conservation status of this species.

To Love and to Kill: Accurate and Selective Colorimetry for Both Chloride and Mercury Ions Regulated by Electro-Synthesized Oxidase-like SnTe Nanobelts

Herein, SnTe nanobelts (NBs) with efficient oxidase-mimetic activity were synthesized by the simple electrochemical exfoliation method. A specific inhibition effect of Cl^- on the enzymatic behavior of the pure SnTe NBs was discovered, which was accordingly used for establishing a highly feasible, sensitive, selective, and stable Cl^- colorimetric assay. The detection concentration range was 50 nM to 1 mM, and the lowest detection limit was 20 nM for Cl^-. In addition, a signal on-off-on route based on the SnTe NB nanozyme was designed to realize the reliable and specific detection of Hg²⁺. Therein, the SnTe NBs were grafted with gold nanoparticles to form a hybrid of SnTe/Au, resulting in the depression of the oxidase-like activity, which can then be recovered in the presence of the Hg²⁺ due to the formation of a gold amalgam. Especially, it was found that the high concentration of Cl^- over 3 mM could again exert suppression influence toward the enzymatic activity of the SnTe/Au-Hg system. Based on the to-love-and-to-kill interaction between Cl^- and Hg²⁺, the detection range for Cl^- can be extended to 40 to 250 mM. In return, the assays of Cl^- could avoid in advance its interference toward the accurate Hg²⁺ assays. We systematically clarified the oxidase-like catalytic mechanism of the SnTe-derived nanozyme systems. The as-proposed colorimetry can be successfully applied in practical samples including the sweat, human serum, or seawater/tap water, relating to cystic fibrosis, hyper-/hypochloremia, or environmental control, respectively.

Failure of chelator-provoked urine testing results to predict heavy metal toxicity in a prospective cohort of patients referred for medical toxicology evaluation

INTRODUCTION

Provoked urine testing (PUT), involving chelating agent administration prior to measuring urine metal excretion levels, is used by some alternative health care practitioners to diagnose patients with heavy metal poisoning. Multiple medical societies have advised against this practice due to its presumed unreliability, expense, and lack of validation. However, no prospective study of the predictive value of PUT for heavy metal poisoning has been undertaken.

METHODS

This study utilized the Toxicology Consortium's prospective case registry to evaluate the reliability of PUT for diagnosing heavy metal poisoning. Inclusion criteria were toxicology clinic patients with PUT results who were subsequently evaluated by a board-certified medical toxicologist and had a determination made regarding whether their signs and symptoms were likely related or unrelated to toxicologic exposures. The primary outcome was the positive predictive value of PUT for heavy metal toxicity as diagnosed by the evaluating medical toxicologist. Patients presenting to participating toxicology clinics without PUT served as a comparison group.

RESULTS

74 of 106 cases presenting with PUT results met inclusion criteria and were analyzed. 15 cases were determined by the examining toxicologist to be likely related to a toxicologic exposure. Only three cases were found to be related to heavy metal exposure, giving a positive predictive value of 4.3%. 20.2% of patients with PUT were found to have signs or symptoms related to any toxicologic exposure, compared to 14.3% of clinic patients without PUT. Demographics of toxicology clinic patients with and without PUT results were not significantly different except for age.

DISCUSSION

Our results provide empiric support that PUT is an inaccurate predictor of a diagnosis of heavy metal poisoning by a board-certified medical toxicologist. Given the inability to properly interpret PUT results along with the increased cost burden and risk of false positives, PUT should not be performed.

A Review of Microfluidic Detection Strategies for Heavy Metals in Water

Heavy metal pollution of water has become a global issue and is especially problematic in some developing countries. Heavy metals are toxic to living organisms, even at very low concentrations. Therefore, effective and reliable heavy metal detection in environmental water is very important. Current laboratory-based methods used for analysis of heavy metals in water require sophisticated instrumentation and highly trained technicians, making them unsuitable for routine heavy metal monitoring in the environment. Consequently, there is a growing demand for autonomous detection systems that could perform in situ or point-of-use measurements. Microfluidic detection systems, which are defined by their small size, have many characteristics that make them suitable for environmental analysis. Some of these advantages include portability, high sample throughput, reduced reagent consumption and waste generation, and reduced production cost. This review focusses on developments in the application of microfluidic detection systems to heavy metal detection in water. Microfluidic detection strategies based on optical techniques, electrochemical techniques, and quartz crystal microbalance are discussed.

Brain delivery of antidotes by polymeric nanoparticles

Accidental intoxications from environmental pollutants, as well as intentional self- and chemical warfare-related poisonings affect millions of people worldwide each year. While many toxic agents can readily enter the central nervous system (CNS), the blood-brain barrier (BBB) prevents the brain uptake of most pharmaceuticals. Consequently, poisoning antidotes usually cannot reach their site of action in the CNS in therapeutically relevant concentrations, and thus only provide effective protection to the peripheral nervous system. This limitation can be overcome by encapsulating the antidotes in nanoparticles (NP), which can enhance their CNS accumulation without damaging the integrity of the BBB. Among nanocarriers, polymer-based drug delivery systems exhibit remarkable benefits, such as bioavailability, cell uptake and tissue retention. Furthermore, due to their capacity to mask unfavorable physicochemical properties of cargo drugs, polymeric NPs were able to improve BBB transport of various pharmaceuticals. However, while polymer NP-mediated treatment of various pathological brain conditions, such as glioma and Alzheimer's disease were exhaustively studied, the application of polymeric nanocarriers for brain-targeted delivery of antidote molecules has not been adequately examined. To display its therapeutic potential, we review the state of the art of polymer NP-assisted CNS delivery of antidotes for various poisonings, including heavy metal and organophosphorus intoxications.

Neuropsychological effects of long-term occupational exposure to mercury among chloralkali workers

BACKGROUND

Mercury is one of the most well-known toxic metals for humans. Chloralkali workers are exposed to mercury vapours extensively, which may be associated with neurotoxicity.

OBJECTIVE

The aim of this study was to determine the associations between mercury concentration in blood and air samples, and mercury's neuropsychological effects among chloralkali workers.

METHODS

This study was conducted on 50 chloralkali workers as the exposed group and 50 non-industrial office workers as the unexposed group. All subjects were assessed using the Hamilton Depression Rating Scale, Piper Chronic Fatigue Scale and Essential Tremor Rating Scale. Mercury concentration was measured in blood and air samples using cold vapour atomic absorption spectrometry.

RESULTS

There was significantly more severe fatigue, depression and tremor in the exposed group compared with the unexposed group. The mean concentration of blood mercury in the exposed group was 22.59±12.5μgL-1 which was significantly higher than the unexposed group (1.28±1.05μg L-1). Based on multiple linear regression, shift work, smoking, fatigue, depression and tremor were predictor variables for blood mercury concentration.

CONCLUSIONS

This study indicated that this sample of chloralkali workers suffered from neuropsychological problems such as fatigue, depression and tremor, which is probably related to mercury exposure.

Interventions of aqueous extract of Solanum melongena fruits (garden eggs) on mercury chloride induced testicular toxicity in adult male Wistar rats

BACKGROUND

Solanum melongena (SM) is commonly known as the garden egg fruit or eggplant. It can be eaten fresh or cooked and has a large history of consumption in West Africa. This study focused on interventions of aqueous extract of SM (garden eggs) fruits on Mercury chloride (HgCl2) induced testicular toxicity in adult male Wistar rats.

METHODS

Thirty-two adult male Wistar rats were randomly divided into four groups (A-D) of eight (n = 8) rats each. Group A Served as control and was given 10 ml/kg/day of distilled water, Group B- 500 mg/kg B.W of SM, Group C received 40 mg/kg B.W HgCl2 and Group D- 500 mg/kg B.W of SM and 40 mg/kg B.W HgCl2). The administration was done by gastric gavage once a day, for twenty-eight consecutive days. Testicular weight, semen analysis revealing the sperm count and sperm motility were assessed, gross parameters of the testis and testicular histology were assessed. Testicular oxidative stress markers viz a viz malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and reduced glutathione (GSH) were also assessed.

RESULTS

assessment of the histological profiles of the testes showed a derangement of the cytoarchitecture and deterioration of sperm quality after HgCl2 administration and a marked improvement was observed after SM administration. Similarly, SM was associated with increased antioxidant parameters (SOD, CAT, GPx, and GSH) and decreased MDA in SM + HgCl2 rats.

CONCLUSION

It was concluded that S. melongena offers protection against free radical mediated oxidative stress of rats with mercury chloride induced testicular toxicity.

The Clinical Importance of the Mercury Problem in Artisanal Small-Scale Gold Mining

Artisanal small-scale mining is widely operated in various countries serving as a livelihood to many rural communities. However, it is a significant source of environmental mercury contamination which affects human health. Amalgamation and amalgam smelting, two significant steps in the artisanal small-scale mining operations generate lots of mercury vapors, leading to chronic exposure among miners. Thus, this article seeks to provide a topical review of recent findings on organ damage and metabolic disorders among mercury-exposed artisanal small-scale miners with emphasis on the contributing factors such as personal protective equipment usage and artisanal small-scale gold mining-specific occupational activities. Also, insights into the effect of mercury intoxication and mechanisms of action on organ and metabolic systems among exposed individuals are provided.

Leaf extracts from Dendropanax morbifera Léveille mitigate mercury-induced reduction of spatial memory, as well as cell proliferation, and neuroblast differentiation in rat dentate gyrus

Background

The brain is susceptible to methylmercury toxicity, which causes irreversible damage to neurons and glia and the leaf extract Dendropanax morbifera Léveille (DML) has various biological functions in the nervous system. In this study, we examined the effects of DML on mercury-induced proliferating cells and differentiated neuroblasts.

Methods

Dimethylmercury (5 μg/kg) and galantamine (5 mg/kg) was administered intraperitoneally and/or DML (100 mg/kg) was orally to 7-week-old rats every day for 36 days. One hour after the treatment, novel object recognition test was examined. In addition, spatial probe tests were conducted on the 6th day after 5 days of continuous training in the Morris swim maze. Thereafter, the rats were euthanized for immunohistochemical staining analysis with Ki67 and doublecortin and measurement for acetylcholinesterase (AChE) activity.

Results

Dimethylmercury-treated rats showed reduced discrimination index in novel object recognition test and took longer to find the platform than did control group. Compared with dimethylmercury treatment alone, supplementation with DML or galatamine significantly ameliorated the reduction of discrimination index and reduced the time spent to find the platform. In addition, the number of platform crossings was lower in the dimethylmercury-treated group than in controls, while the administration of DML or galantamine significantly increased the number of crossings than did dimethylmercury treatment alone. Proliferating cells and differentiated neuroblasts, assessed by Ki67 and doublecortin immunohistochemical staining was significantly decreased in the dimethylmercury treated group versus controls. Supplementation with DML or galantamine significantly increased the number of proliferating cells and differentiated neuroblasts in the dentate gyrus. In addition, treatment with dimethylmercury significantly increased AChE activity in hippocampal homogenates, while treatment with dimethylmercury+DML or dimethylmercury+galantamine significantly ameliorated this increase.

Conclusions

These results suggest that DML may be a functional food that improves dimethylmercury-induced memory impairment and ameliorates dimethylmercury-induced reduction in proliferating cells and differentiated neuroblasts, and demonstrates corresponding activation of AChE activity in the dentate gyrus.

Oxidative Stress: A Key Modulator in Neurodegenerative Diseases

Oxidative stress is proposed as a regulatory element in ageing and various neurological disorders. The excess of oxidants causes a reduction of antioxidants, which in turn produce an oxidation-reduction imbalance in organisms. Paucity of the antioxidant system generates oxidative-stress, characterized by elevated levels of reactive species (oxygen, hydroxyl free radical, and so on). Mitochondria play a key role in ATP supply to cells via oxidative phosphorylation, as well as synthesis of essential biological molecules. Various redox reactions catalyzed by enzymes take place in the oxidative phosphorylation process. An inefficient oxidative phosphorylation may generate reactive oxygen species (ROS), leading to mitochondrial dysfunction. Mitochondrial redox metabolism, phospholipid metabolism, and proteolytic pathways are found to be the major and potential source of free radicals. A lower concentration of ROS is essential for normal cellular signaling, whereas the higher concentration and long-time exposure of ROS cause damage to cellular macromolecules such as DNA, lipids and proteins, ultimately resulting in necrosis and apoptotic cell death. Normal and proper functioning of the central nervous system (CNS) is entirely dependent on the chemical integrity of brain. It is well established that the brain consumes a large amount of oxygen and is highly rich in lipid content, becoming prone to oxidative stress. A high consumption of oxygen leads to excessive production of ROS. Apart from this, the neuronal membranes are found to be rich in polyunsaturated fatty acids, which are highly susceptible to ROS. Various neurodegenerative diseases such as Parkinson's disease (PD), Alzheimer's disease (AD), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS), among others, can be the result of biochemical alteration (due to oxidative stress) in bimolecular components. There is a need to understand the processes and role of oxidative stress in neurodegenerative diseases. This review is an effort towards improving our understanding of the pivotal role played by OS in neurodegenerative disorders.

Variation in thyroid hormone levels is associated with elevated blood mercury levels among artisanal small-scale miners in Ghana

Background

Mercury can be very toxic to human health even at low dose of exposure. Artisanal small-scale miners (ASGMs) use mercury in gold production, hence are at risk of mercury-induced organ dysfunction.

Aim

We determined the association between mercury exposure, thyroid function and work-related factors among artisanal small-scale gold miners in Bibiani- Ghana.

Method

We conveniently recruited 137 consenting male gold miners at their work site in Bibiani-Ghana, in a comparative cross-sectional study. Occupational activities and socio-demographic data of participants were collected using a questionnaire. Blood sample was analysed for total mercury and thyroid hormones.

Results

Overall, 58.4% (80/137) of the participants had blood mercury exceeding the occupational exposure threshold (blood mercury ≥5μg/L). T3(P<0.0001) and T4(P<0.0001) were significantly reduced among the exposed group compared to the non-exposed. TSH showed no significant variation between the exposed and non-exposed groups. Longer work duration (≥5years), gold amalgamation, gold smelting and sucking of excess mercury with the mouth were associated with increased odds of mercury exposure. Blood mercury showed negative correlation with T3(r = -0.29, P<0.0001), and T4(r = -0.69, P<0.0001) and positive correlation with work duration (r = 0.88, P<0.001). Even though a positive trend of association between blood mercury and TSH levels was recorded, it was not significant (r = 0.07, P = 0.4121)

Conclusion

Small scale miners in Bibiani are exposed to mercury above the occupational threshold which may affect thyroid hormone levels.

Validation of Total Mercury in Marine Sediment and Biological Samples, Using Cold Vapour Atomic Absorption Spectrometry

A method for the measurement of total mercury (T-Hg) in environmental samples using cold vapour atomic absorption spectrometry (CV AAS) has been validated yielding a dynamic range (0.04–10.00 μg/kg) and high certified reference material (CRM) recovery (>90%). The validation was carried out according to International Union of Pure and Applied Chemistry (IUPAC) validation and Eurachem Guides. A freeze-dried and homogenised sample was weighed and then digested using Suprapur acids (HNO₃, H₂SO₄, and HF) with potassium dichromate solution in a hot block digestion system. A calibration curve was constructed (R² > 0.999). Two CRMs (Marine Sediment Reference Material (PACS-3) and Trace Elements in Muscle Tissue (Trace Elements and Methylmercury in Mussel Tissue (NIST2976)) were utilised for quality assurance and control. The limit of quantification (LOQ) calculated as 0.04 µg/kg, and uncertainty (U) calculated as 2%. The obtained results showed the suitability of this method for direct mercury measurement in environmental samples. Additionally, the proficiency of this method was recognised by accreditation under the standard of International Organization for Standardization (ISO/IEC 17025:2017) for competence of testing and calibration laboratories.

Natural Phytotherapeutic Antioxidants in the Treatment of Mercury Intoxication-A Review

Heavy metals taken into the organism can make the toxic effects on the metabolism in various ways. For example, they may interact with proteins to alter and inhibit their enzymatic and structural functions. Mercury is one of the toxic elements that are widely distributed in nature. Mercury toxicity poses a serious threat to human health. It is an element that causes oxidative stress to increase in individuals, leading to tissue damage. Oxidative stress is the result of the imbalance between the production of oxidative species and cellular antioxidant defense. Phytotherapy continues to play an important role in health care. Natural phytotherapeutic antioxidants, exhibit a broad sequence of biological impacts, including anti-oxidative stress, anti-aging, anti-toxicicity and anticancer. Many studies have also shown that the phytotherapeutic agents play an important role in the removal of mercury from the tissue and in reducing oxidative stress. Our goal in this review was to investigate alternative ways of extracting the mercury in the tissue.

Copper attenuates early and late biochemical alterations induced by inorganic mercury in young rats

Mercury (Hg), a divalent metal, produces adverse effects predominantly in the renal and central nervous systems. The aim of this study was to determine the effectiveness of copper (Cu) in prevention of mercuric mercury (Hg²⁺)-mediated toxic effects as well as the role metallothioneins (MT) play in this protective mechanism in young rats. Wistar rats were treated subcutaneously with saline (Sal) or CuCl₂.2H₂O (Cu 2.6 mg/kg/day) from 3 to 7 days old and with saline or HgCl₂ (Hg 3.7 mg/kg/day) from 8 to 12 days old. The experimental groups were (1) Sal-Sal, (2) Cu-Sal, (3) Sal-Hg, and (4) Cu-Hg. MTs and metal contents were determined at 13 and 33 days of age. Porphobilinogen synthase (PBG-synthase) activity as well as renal and hepatic parameters were measured at 33 days. At 13 day, Hg²⁺ exposure increased hepatic MT, Hg, zinc (Zn) and iron (Fe) levels, in kidney elevated Cu and Hg and decreased renal Fe concentrations, accompanied by elevated blood Hg levels. At 33 days, Hg²⁺ exposure inhibited renal PBG-synthase activity, increased serum urea levels and lowered Fe and Mg levels. Copper partially prevented the rise in blood Hg and liver Fe noted at 13 days; and completely blocked urea rise and diminished renal PBG-synthase activity inhibition at 33 days. In 13-day-old rats, Cu exposure redistributed the Hg in the body, decreasing hepatic and blood levels while increasing renal levels, accompanied by elevated renal and hepatic MT levels in Hg²⁺-exposed animals. These results suggest that hepatic MT might bind to hepatic and blood Hg for transport to the kidney in order to be excreted.

ABBREVIATIONS

MT: metallothioneins; PBG-synthase: porphobilinogen synthase.

A Challenging Case of Acute Mercury Toxicity

Background

Mercury exists in multiple forms: elemental, organic, and inorganic. Its toxic manifestations depend on the type and magnitude of exposure. The role of colonoscopic decompression in acute mercury toxicity is still unclear. We present a case of acute elemental mercury toxicity secondary to mercury ingestion, which markedly improved with colonoscopic decompression.

Clinical Case

A 54-year-old male presented to the ED five days after ingesting five ounces (148 cubic centimeters) of elemental mercury. Examination was only significant for a distended abdomen. Labs showed elevated serum and urine mercury levels. An abdominal radiograph showed radiopaque material throughout the colon. Succimer and laxatives were initiated. The patient had recurrent bowel movements, and serial radiographs showed interval decrease of mercury in the descending colon with interval increase in the cecum and ascending colon. Colonoscopic decompression was done successfully. The colon was evacuated, and a repeat radiograph showed decreased hyperdense material in the colon. Three months later, a repeat radiograph showed no hyperdense material in the colon.

Conclusion

Ingested elemental mercury can be retained in the colon. Although there are no established guidelines for colonoscopic decompression, our patient showed significant improvement. We believe further studies on this subject are needed to guide management practices.

Protective Effect of Leaf Ethanolic Extract Etlingera hemisphaerica Blume Against Mercuric Chloride Toxicity in Blood of Mice

This research was intended to investigate the protective effect of leaf ethanolic extract Etlingera hemisphaerica Blume (LE3H) against mercuric chloride (HgCl₂) toxicity in blood of mice (Mus musculus). The experimental animals, 95 male M. musculus, received drink and food ad libitum. Three materials were tested: LE3H (0.13, 0.26, 0.39 mg/g body weight [bw]) was administered by gavage; HgCl₂ (5 mg/kg bw) was administrated by gavage or intraperitoneal injection; and Imunos (the nutritional supplement to stimulate the immune system; 0.2 mg/g bw), as a positive control for LE3H treatment, was given by gavage. Blood samples were taken from the tails for determining number of blood cells. The animals were killed by cervical dislocation (CD), and then blood samples were collected from the hearts for protein electrophoresis. Results revealed the same number of leukocytes with LE3H (0.39 mg/g bw) treatment as with the Imunos treatment. HgCl₂ administration increased leukocytes and decreased erythrocytes; HgCl₂ administration followed by LE3H (0.39 mg/g bw) treatment protected the amount of blood cells as well as the control. HgCl₂ administration showed a new 125 kDa protein and caused overexpression of 48 kDa protein; this protein profile could be protected by LE3H (0.39 mg/g bw) treatment as in the control condition. We conclude that LE3H provides a protective effect against HgCl₂ toxicity in blood of M. musculus.

A scanner-based colorimetric mercuric ion detection using Tween-20-stabilized AuNPs solution in 96-well plates

This paper reports the development of a sensitive, high-throughput colorimetric method for the detection of trace mercuric ions (Hg²⁺). The method is based on the binding of the analyte to gold nanoparticles (AuNPs) modified with Tween-20. Tween-20 was used as a nonionic stabilizer to allow a good dispersion of AuNPs in solution. When mercuric ions were added to the solution, they replaced the Tween-20 stabilizer on the surface of the AuNPs due to their stronger binding affinity. This caused the NPs to aggregate and the color of the solution to change from red to blue. The quantitative analysis of Hg²⁺ was achieved by plotting the Red Green Blue (RGB) values of the scanned images of the analyte samples in the AuNP solution against concentrations of Hg²⁺. Since the reaction was carried out in 96-well plates, ninety-six samples were analyzed simultaneously, reducing the cost and time of analysis. The experimental parameters optimized were the concentrations of Tween-20 and NaCl, the reactants ratio, and the incubation time. Under the optimum conditions, the calibration plot of the assay was linear over an Hg²⁺ concentration range of 0.10-2.00 mg L^-1, and the detection limit was 0.050 mg L^-1 (S/N  =  3). The selectivity of the technique was high with no significant colorimetric responses to the presence of 100-fold excesses of other metal ions. Quantification was validated with Hg²⁺ standard solutions and spiked tap and waste water samples, and the accuracy of the technique was confirmed. The developed technique is simple and cost effective because it requires no complicated instruments, yet the results demonstrate it to be a very powerful technique with the potential to be developed for on-site mercury detection.

Reduced egfr, elevated urine protein and low level of personal protective equipment compliance among artisanal small scale gold miners at Bibiani-Ghana: a cross-sectional study

BACKGROUND

Mercury is a toxic metal with its effects on human health ranging from acute to chronic in a very short time of exposure. Artisanal and small-scale gold mining (ASGM) is the main source of direct human exposure to mercury.

AIM

To access the effect of mercury exposure on the renal function and level of personal protective equipment (PPE) compliance among small-scale gold miners in Bibiani District of the Western Region of Ghana METHOD: 110 consenting male gold miners were purposively recruited for this study. A structured questionnaire was used to collect socio-demographic information from the participants. Work place assessment and interviews were conducted. Urine samples were analysed for protein; blood was analysed for mercury and creatinine. Estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation.

RESULTS

Of the 110 participants, 61(55.5%) exceeded the occupational exposure threshold (blood mercury <5μg/L). Urine protein (41.72±68.34, P<0.0001), serum creatinine (2.24±1.19, P<0.0001) and blood mercury (18.37±10.47, P<0.0001) were significantly elevated among the exposed group compared to the non-exposed group. However, the exposed group had a significantly reduced eGFR (P<0.0001). There was a significant correlation (r=0.7338, p<0.0001) between blood mercury concentration and urine protein concentration. An increase in blood mercury correlated negatively (r = -0.8233, P<0.0001) with eGFR among the exposed group. High urine protein (P< 0.0001) and high serum creatinine (P< 0.0001) were significantly associated with increased mercury exposure. Increased mercury exposure was significantly associated with burning of amalgam (P=0.0196), sucking of excess mercury (P=0.0336), longer work duration (P=0.0314) and low educational background (P=0.0473).

CONCLUSION

Small scale miners at the Bibiani work site are exposed to excess mercury. Proteinuria and reduced eGFR is common in mine workers exposed to excess mercury. We found poor PPE compliance among the study population.

Reduced egfr, elevated urine protein and low level of personal protective equipment compliance among artisanal small scale gold miners at Bibiani-Ghana: a cross-sectional study

Background

Mercury is a toxic metal with its effects on human health ranging from acute to chronic in a very short time of exposure. Artisanal and small-scale gold mining (ASGM) is the main source of direct human exposure to mercury.

Aim

To access the effect of mercury exposure on the renal function and level of personal protective equipment (PPE) compliance among small-scale gold miners in Bibiani District of the Western Region of Ghana

Method

110 consenting male gold miners were purposively recruited for this study. A structured questionnaire was used to collect socio-demographic information from the participants. Work place assessment and interviews were conducted. Urine samples were analysed for protein; blood was analysed for mercury and creatinine. Estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation.

Results

Of the 110 participants, 61(55.5%) exceeded the occupational exposure threshold (blood mercury <5μg/L). Urine protein (41.72±68.34, P<0.0001), serum creatinine (2.24±1.19, P<0.0001) and blood mercury (18.37±10.47, P<0.0001) were significantly elevated among the exposed group compared to the non-exposed group. However, the exposed group had a significantly reduced eGFR (P<0.0001). There was a significant correlation (r=0.7338, p<0.0001) between blood mercury concentration and urine protein concentration. An increase in blood mercury correlated negatively (r = −0.8233, P<0.0001) with eGFR among the exposed group. High urine protein (P< 0.0001) and high serum creatinine (P< 0.0001) were significantly associated with increased mercury exposure. Increased mercury exposure was significantly associated with burning of amalgam (P=0.0196), sucking of excess mercury (P=0.0336), longer work duration (P=0.0314) and low educational background (P=0.0473).

Conclusion

Small scale miners at the Bibiani work site are exposed to excess mercury. Proteinuria and reduced eGFR is common in mine workers exposed to excess mercury. We found poor PPE compliance among the study population.

Cases of acute mercury poisoning by mercury vapor exposure during the demolition of a fluorescent lamp factory

Background

In 2015, workers dismantling a fluorescent lamp factory in Korea were affected by mercury poisoning from exposure to mercury vapor.

Case presentation

Eighteen out of the 21 workers who participated in the demolition project presented with symptoms of poisoning and, of these, 10 had persistent symptoms even at 18 months after the initial exposure to mercury vapor. Early symptoms of 18 workers included a general skin rash, pruritus, myalgia, sleep disturbance, and cough and sputum production. Following alleviation of these initial symptoms, late symptoms, such as easy fatigue, insomnia, bad dreams, and anxiety disorder, began to manifest in 10 out of 18 patients. Seven workers underwent psychiatric care owing to sleep disturbance, anxiety disorder, and depression, and three workers underwent dermatologic treatment for hyperpigmentation, erythematous skin eruption, and chloracne-like skin lesions. Furthermore, three workers developed a coarse jerky movement, two had swan neck deformity of the fingers, and two received care at an anesthesiology clinic for paresthesia, such as burning sensation, cold sensation, and pain. Two workers underwent urologic treatment for dysfunction of the urologic system and impotence. However, symptomatic treatment did not result in satisfactory relief of these symptoms.

Conclusion

Awareness of the perils of mercury and prevention of mercury exposure are critical for preventing health hazards caused by mercury vapor. Chelation therapy should be performed promptly following mercury poisoning to minimize damage.

Occupational Metallic Mercury Poisoning in Gilders

Occupational exposure to elemental mercury vapor usually occurs through inhalation during its utilizations. This leads to a variety of adverse health effects. In some Islamic cities, this type of poisoning may occur during gilding of shrines using elemental mercury with gold. Herein, we report on three male patients aged 20-53 years, who were diagnosed with occupational metallic mercury poisoning due to gilding of a shrine. All patients presented with neuro-psychiatric disorders such as anxiety, loss of memory and concentration, and sleep disorders with high urinary mercury concentrations of 326-760 μg/L upon referring, 3-10 days after cessation of elemental mercury exposure. Following chelating therapy, the patients recovered clinically and their mercury concentrations declined to non-toxic level (<25 μg/L). Health, environmental and labor authorities, as well as the gilders should be aware of the toxicity risk of exposure to metalic mercury during gilding in closed environments and act accordingly.

Consensus document on the prevention of methylmercury exposure in Spain: Study group for the prevention of Me-Hg exposure in Spain (GEPREM-Hg)

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet.

Polymer antidotes for toxin sequestration

Toxins delivered by envenomation, secreted by microorganisms, or unintentionally ingested can pose an immediate threat to life. Rapid intervention coupled with the appropriate antidote is required to mitigate the threat. Many antidotes are biological products and their cost, methods of production, potential for eliciting immunogenic responses, the time needed to generate them, and stability issues contribute to their limited availability and effectiveness. These factors exacerbate a world-wide challenge for providing treatment. In this review we evaluate a number of polymer constructs that may serve as alternative antidotes. The range of toxins investigated includes those from sources such as plants, animals and bacteria. The development of polymeric heavy metal sequestrants for use as antidotes to heavy metal poisoning faces similar challenges, thus recent findings in this area have also been included. Two general strategies have emerged for the development of polymeric antidotes. In one, the polymer acts as a scaffold for the presentation of ligands with a known affinity for the toxin. A second strategy is to generate polymers with an intrinsic affinity, and in some cases selectivity, to a range of toxins. Importantly, in vivo efficacy has been demonstrated for each of these strategies, which suggests that these approaches hold promise as an alternative to biological or small molecule based treatments.

Antioxidant effects of Dendropanax morbifera Léveille extract in the hippocampus of mercury-exposed rats

Background

Dendropanax morbifera Léveille has been employed for the treatment of infectious diseases using folk medicine. In this study, we evaluated the antioxidant effects of a leaf extract of Dendropanax morbifera Léveille in the hippocampus of mercury-exposed rats.

Methods

Seven-week-old Sprague–Dawley rats received a daily intraperitoneal injection of 5 μg/kg dimethylmercury and/or oral Dendropanax morbifera Léveille leaf extract (100 mg/kg) for 4 weeks. Animals were sacrificed 2 h after the last dimethylmercury and/or leaf extract treatment. Mercury levels were measured in homogenates of hippocampal tissue, a brain region that is vulnerable to mercury toxicity. In addition, we measured reactive oxygen species production, lipid peroxidation levels, and antioxidant levels in these hippocampal homogenates.

Results

Treatment with Dendropanax morbifera Léveille leaf extract significantly reduced mercury levels in hippocampal homogenates and attenuated the dimethylmercury-induced increase in the production of reactive oxygen species and formation of malondialdehyde. In addition, this leaf extract treatment significantly reversed the dimethylmercury-induced reduction in the hippocampal activities of Cu, Zn-superoxide dismutase, catalase, glutathione peroxidase, and glutathione-S-transferase.

Conclusion

These results suggest that a leaf extract of Dendropanax morbifera Léveille had strong antioxidant effects in the hippocampus of mercury-exposed rats.

Removal of toxic mercury from petroleum oil by newly synthesized molecularly-imprinted polymer

In recent years, molecularly-imprinted polymers (MIPs) have attracted the attention of several researchers due to their capability for molecular recognition, easiness of preparation, stability and cost-effective production. By taking advantage of these facts, Hg(II) imprinted and non-imprinted copolymers were prepared by polymerizing mercury nitrate stock solution (or without it) with methacrylic acid (MAA), 2-hydroxyl ethyl methacrylate (HEMA), methanol and ethylene glycol dimethacrylate (EGDMA) as the monomer, co-monomer solvent (porogen) and cross-linker, respectively. Thus, the formed Hg(II) imprinted polymer was characterized by using Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscopy (FESEM), Brunauer, Emmett and Teller (BET) and thermal gravimetric analysis (TGA). The separation and preconcentration characteristics of Hg(II) imprinted polymer were investigated by solid phase extraction (SPE) procedures, and an optimal pH of 7 was investigated as ideal. The specific surface area of the Hg(II) imprinted polymer was found to be 19.45 m²/g with a size range from 100 to 140 µm in diameter. The maximum adsorption capacity was observed to be 1.11 mg/g of Hg(II) imprinted beads with 87.54% removal of Hg(II) ions within the first 5 min. The results of the study therefore confirm that the Hg(II) imprinted polymer can be used multiple times without significantly losing its adsorption capacity.

Complementary and Alternative Therapies for Autism Spectrum Disorder

Background. Complementary and alternative medicine (CAM) represents a popular therapeutic option for patients with autism spectrum disorder (ASD). Unfortunately, there is a paucity of data regarding the efficacy of CAM in ASD. The aim of the present systematic review is to investigate trials of CAM in ASD. Material and Methods. We searched the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CINAHL, Psychology and Behavioral Sciences Collection, Agricola, and Food Science Source. Results. Our literature search identified 2687 clinical publications. After the title/abstract screening, 139 publications were obtained for detailed evaluation. After detailed evaluation 67 studies were included, from hand search of references we retrieved 13 additional studies for a total of 80. Conclusion. There is no conclusive evidence supporting the efficacy of CAM therapies in ASD. Promising results are reported for music therapy, sensory integration therapy, acupuncture, and massage.

Mercury poisoning as a cause of intracranial hypertension

Mercury poisoning is a rare but fatal toxicologic emergency. Neurologic manifestations involving the central nervous system are seen usually with chronic mercury intoxication. The most commonly seen complaints are headache, tremor, impaired cognitive skills, weakness, muscle atrophy, and paresthesia. Here, we present a male patient who was chronically exposed to elemental mercury and had papilledema and intracranial hypertension without parenchymal lesion in the central nervous system. A 12-year-old male patient was referred to our emergency room because of severe fatigue, generalized muscle pain and weakness, which was present for a month. Physical examination revealed painful extremities, decreased motor strength and the lack of deep tendon reflexes in lower extremities. He had mixed type polyneuropathy in his electromyography. Whole blood and 24-hour urinary mercury concentrations were high. A chelation therapy with succimer (dimercaptosuccinic acid) was started on the fourth day of his admission. On the seventh day of his admission, he developed headache and nausea, and bilateral papilledema and intracranial hypertension were detected on physical examination. Acetazolamide was started and after 1 month of treatment, the fundi examination was normal. The patient stayed in the hospital for 35 days and was then discharged with acetazolamide, vitamin B6, gabapentin, and followed as an outpatient. His clinical findings were relieving day by day. Although headache is the most common symptom in mercury poisoning, the clinician should evaluate the fundus in terms of intracranial hypertension.

Biomedical implications of heavy metals induced imbalances in redox systems

Several workers have extensively worked out the metal induced toxicity and have reported the toxic and carcinogenic effects of metals in human and animals. It is well known that these metals play a crucial role in facilitating normal biological functions of cells as well. One of the major mechanisms associated with heavy metal toxicity has been attributed to generation of reactive oxygen and nitrogen species, which develops imbalance between the prooxidant elements and the antioxidants (reducing elements) in the body. In this process, a shift to the former is termed as oxidative stress. The oxidative stress mediated toxicity of heavy metals involves damage primarily to liver (hepatotoxicity), central nervous system (neurotoxicity), DNA (genotoxicity), and kidney (nephrotoxicity) in animals and humans. Heavy metals are reported to impact signaling cascade and associated factors leading to apoptosis. The present review illustrates an account of the current knowledge about the effects of heavy metals (mainly arsenic, lead, mercury, and cadmium) induced oxidative stress as well as the possible remedies of metal(s) toxicity through natural/synthetic antioxidants, which may render their effects by reducing the concentration of toxic metal(s). This paper primarily concerns the clinicopathological and biomedical implications of heavy metals induced oxidative stress and their toxicity management in mammals.

Current use of chelation in American health care

The National Center for Health Statistics estimates that more than 100,000 Americans receive chelation each year, although far fewer than 1 % of these cases are managed by medical toxicologists. Unfortunately, fatalities have been reported after inappropriate chelation use. There are currently 11 FDA-approved chelators available by prescription although chelation products may also be obtained through compounding pharmacies and directly over the internet. Promotion of chelation training is prominent on some alternative and complementary medicine websites.