Lead Poisoning Can Be Easily Misdiagnosed as Acute Porphyria and Nonspecific Abdominal Pain. Case Rep Emerg Med. 2017;2017:9050713. [PMID: 28630774 PMCID: PMC5467293 DOI: 10.1155/2017/9050713]

Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women

Traditional and alternative medicines are widely used around the world and include for example herbal medicine, Ayurveda, traditional Chinese medicine, and indigenous therapies. Due to the long history and the mostly natural origin of traditional remedies, it is often assumed that they are harmless, but in recent decades more and more case reports have been published in which traditional medicine has caused metal poisoning. This paper provides an analysis of published cases in which patients have suffered metal poisoning due to traditional or alternative medicines. A systematic literature search was performed on PubMed, whereby 210 patient cases from a total of 102 case reports and 30 case series were identified and then analyzed about various aspects. Most of the traditional medicines involved come from Asia and are mainly contaminated with lead and arsenic. The analyzed patient cases show a high degree of heterogeneity with regard to age, sex, intake reason, symptoms, and severity of intoxication. The metal intoxication itself and the cause of the poisoning often remained unrecognized for a long time, which resulted in many patients undergoing unnecessary diagnostic methods and ineffective therapeutic approaches before the correct diagnosis was made. The evaluation of the available patient cases revealed a higher sensitivity to metal poisoning in children compared to adults and a higher sensitivity in men compared to women. Anemia and basophilic stippling were frequently observed and became more common as the metal content in the blood increased. Hopefully, this paper raises awareness of the potential dangers of traditional and alternative medicines, both from the patient's and the doctor's perspective, so that in case of intoxication, treatment can be initiated quickly using the correct diagnostic methods. As ingested metals do not only circulate in the blood but also accumulate in soft tissues and bones, long-term monitoring is necessary to ensure that patients make a full recovery. Doctors should be aware that, in contrast to common belief, men are more sensitive to this type of intoxication than women, necessitating particular attention for diagnosis and treatment.

Abnormal Porphyrin Metabolism in Autism Spectrum Disorder and Therapeutic Implications

Autism spectrum disorder (ASD) is a mosaic of neurodevelopmental conditions composed of early-onset social interaction and communication deficits, along with repetitive and/or restricted patterns of activities, behavior, and interests. ASD affects around 1% of children worldwide, with a male predominance. Energy, porphyrin, and neurotransmitter homeostasis are the key metabolic pathways affected by heavy metal exposure, potentially implicated in the pathogenesis of ASD. Exposure to heavy metals can lead to an altered porphyrin metabolism due to enzyme inhibition by heavy metals. Heavy metal exposure, inborn genetic susceptibility, and abnormal thiol and selenol metabolism may play a significant role in the urinary porphyrin profile anomalies observed in ASD. Altered porphyrin metabolism in ASD may also be associated with, vitamin B6 deficiency, hyperoxalemia, hyperhomocysteinemia, and hypomagnesemia. The present review considers the abnormal porphyrin metabolism in ASD in relation to the potential pathogenic mechanism and discusses the possible metabolic therapies such as vitamins, minerals, cofactors, and antioxidants that need to be explored in future research. Such targeted therapeutic therapies would bring about favorable outcomes such as improvements in core and co-occurring symptoms.

Heavy metal poisoning caused by Chinese folk remedies in psoriasis patients: a retrospective analysis

Psoriasis, characterized as a chronic relapsing disease with a protracted course, often drives patients to seek relief through Chinese folk remedies (CFR). Nonetheless, the complex compositions of these remedies frequently result in unintended adverse effects, notably various types of heavy metal poisoning. Our study involved an exhaustive collection and analysis of clinical data from psoriasis patients who developed heavy metal poisoning due to CFR usage, admitted to Beijing Chao-Yang Hospital from January 2011 to October 2023. Our analysis identified 44 cases of mercury poisoning, 17 of lead poisoning, 21 of arsenic poisoning, and 4 instances of mixed heavy metal poisoning. The folk remedies used ranged from fumigation and inhalation to skin application and oral administration. Distinct pathogenic characteristics were observed in each poisoning type. After treatment with metal chelating agents, all patients experienced a reduction in heavy metal levels in their bodies, accompanied by varying degrees of symptom alleviation. This study underscores the vital necessity of opting for formal, medically approved treatments for psoriasis, thereby avoiding the hazardous consequences of unregulated folk remedies that may lead to severe heavy metal poisoning.

Health risk assessment of potentially toxic elements (PTEs) concentrations in soil and fruits of selected perennial economic trees growing naturally in the vicinity of the abandoned mining ponds in Kuba, Bokkos Local Government Area (LGA) Plateau State, Nigeria

This study was designed to determine the level of potentially toxic elements (PTEs) contamination in soil and selected fruits and assesses the health risk of inhabitants in the abandoned tin mining community in Kuba, Bokkos LGA. Samples of the abandoned mine soil and selected fruits mango (Magnifera indica), guava (Psidium guajava), avocado pear (Persea americana), and banana (Musa spp)) from the vicinity of the abandoned mine were analyzed for the presence of arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), manganese (Mn), nickel (Ni), lead (Pb), and zinc (Zn) using inductively coupled plasma mass spectrometry (ICP-MS). The results showed that the levels of all the PTEs analysed in the abandoned mine soil samples were significantly (p < 0.05) higher than their corresponding values in the control soil from the non-mining area. Except for Cd, the mean concentrations of As, Cr, Cu, Mn, Ni, and Pb were significantly higher than the FAO/WHO maximum permissible limit. Except for Zn in guava fruits and Cd in avocado fruits, the mean concentration of PTEs in fruits from abandoned mines was significantly (p < 0.05) higher than their corresponding control values. In contrast, the mean levels of As, Cr, Cu, Mn, Ni, and Pb in the investigated fruits were significantly (p < 0.05) higher than FAO/WHO maximum permissible limits established for fruits. The studied fruits remarkably took up and bioaccumulated PTEs from the abandoned mine soil. Mango fruit significantly bioaccumulated As (5.40), Cd (3.40), and Zn (2.81). Guava fruit bioaccumulated As (1.50) and Cd (4.60), while avocado bioaccumulated As (3.53), Cd (3.80), and Zn (6.48). Banana bioaccumulated As (0.96), Cd (0.80), and Zn (6.78). The hazard quotient values for PTEs investigated in fruits for adults, and children were several folds greater than 1. The hazard index (HI) for the PTEs through consuming fruits for children and adults was greater than 1, indicating that possible health risks exist for both local children and adults. However, the HI values for the children were higher than those for adults, implying that children were exposed to more potential noncarcinogenic health risks from PTEs than adults. The total cancer risk (TCR) values for Cr and Ni for all the fruits studied were within 10-3-10-1, which is several-fold higher than the permissible limits (10-6 and < 10-4), indicating high carcinogenic risk. TCR values for Cd and Pb in all the fruits, except for Cd in guava and avocado fruits for children, were within the range of 10-5-10-4, indicating that they are associated with moderate risk. The CR values for all the PTEs in all the fruits for adults and children except for mango fruit adults were within 10-2-10-1, indicating high carcinogenic risk. In conclusion, the results and risk assessment provided by this study indicate that human exposure to fruits from abandoned mines suggests a high vulnerability of the local community to PTE toxicity. Long-term preventive measures to safeguard the health of the residents need to be put in place.

Lead (Pb) and cadmium (Cd) blood levels and potential hematological health risk among inhabitants of the claimed hazardous region around Qaroun Lake in Egypt

BACKGROUND

Lead (Pb) and cadmium (Cd) heavy metals are considered potentially hazardous toxins which cause serious health problems. Many studies reported that the water of Qaroun Lake in Fayoum, Egypt with its fish farms was contaminated with Pb and Cd above permissible levels. However, there is a lack of studies addressing levels of these toxic metals among inhabitants.

OBJECTIVES

We aimed to evaluate blood levels of Pb and Cd and their potential health risk among inhabitants around Qaroun Lake.

MATERIALS AND METHODS

This case-control study estimated Pb and Cd blood levels among 190 individuals from two destinations (near and far away) of Qaroun Lack using an atomic absorption spectrometer after full history taking and routine checkup investigations; Full blood count, serum ferritin, liver enzyme (ALT), and creatinine levels.

RESULTS

There was a significant difference between blood levels of Pb and Cd heavy metals of inhabitants from near and far away Qaroun Lake destinations (p-value < 0.001). The majority of inhabitants around Qaroun Lake had Pb and Cd blood levels above permissible levels (100% and 60% respectively). Critical levels out of them were 12.1% and 30.3% respectively. In comparison to inhabitants faraway Qaroun Lake, three individuals (2.4%) had Cd above the permissible level, while all of them (100%) had Pb level within the permissible level. There were no statistically significant differences between the two sampled populations as regards hemoglobin level, ALT, creatinine, and ferritin serum levels (p-value > 0.05). The difference between studied populations regarding types of anemia was not statistically significant. Subclinical leucopenia was higher in the population near Qaroun Lake when compare to inhabitants far from the lake (13.6% vs. 4.8%, p-value 0.032).

CONCLUSION

Bio-monitoring of populations exposed to Pb and Cd hazardous substances could help in generating an early warning system to reduce the disease burden associated with their toxicity.

Exceptional Sorption of Heavy Metals from Natural Water by Halloysite Particles: A New Prospect of Highly Efficient Water Remediation

Halloysite particles, with their unique multilayer nanostructure, are demonstrated here as highly efficient and readily available sorbent of heavy metals that can be easily scaled up and used in large-scale water remediation facilities. The various methods of raw material purification were applied, and their effects were verified using techniques such as BET isotherm (determination of specific surface area and size of pores), XRF analysis (composition), and SEM imaging (determination of morphology). A series of adsorption experiments for aqueous solutions of metal ions (i.e., lead, cadmium) were carried out to quantify the sorption capacity of halloysite particles for selected heavy metals. The ability of adequately activated halloysite to efficiently remove heavy metal ions from water solutions was confirmed. The value of the zeta potential of raw and purified halloysite particles in water was determined. This enables us to understand its importance for the sorption of positively charged ions (metal, organics) at various pH values. The adsorption process conducted in the pH range of 6.0-6.5 showed significant improvement compared to the acidic conditions (pH value 3.0-3.5) and resulted in a high sorption capacity of lead ions-above 24.3 mg/g for the sulphuric acid-treated sample. The atomic scale ab initio calculations revealed a significant difference in adsorption energy between the external siloxane surface and cross-sectional interlayer surface, resulting in pronounced adsorption anisotropy. A low energy barrier was calculated for the interlayer migration of heavy metals into the halloysite interior, facilitating access to the active sites in these regions, thus significantly increasing the sorption capacity and kinetics. DFT (density functional theory) calculations supporting this study allowed for predicting the sorption potential of pure halloysite structure towards heavy metals. To confront it with experimental results, it was crucial to determine proper purification conditions to obtain such a developed structure from the mineral ore. The results show a massive increase in the BET area and confirm a high sorption potential of modified halloysite towards heavy metals.

Design, implementation, and evaluation of the computer-aided clinical decision support system based on learning-to-rank: collaboration between physicians and machine learning in the differential diagnosis process

BACKGROUND

We are researching, developing, and publishing the clinical decision support system based on learning-to-rank. The main objectives are (1) To support for differential diagnoses performed by internists and general practitioners and (2) To prevent diagnostic errors made by physicians. The main features are that "A physician inputs a patient's symptoms, findings, and test results to the system, and the system outputs a ranking list of possible diseases".

METHOD

The software libraries for machine learning and artificial intelligence are TensorFlow and TensorFlow Ranking. The prediction algorithm is Learning-to-Rank with the listwise approach. The ranking metric is normalized discounted cumulative gain (NDCG). The loss functions are Approximate NDCG (A-NDCG). We evaluated the machine learning performance on k-fold cross-validation. We evaluated the differential diagnosis performance with validated cases.

RESULTS

The machine learning performance of our system was much higher than that of the conventional system. The differential diagnosis performance of our system was much higher than that of the conventional system. We have shown that the clinical decision support system prevents physicians' diagnostic errors due to confirmation bias.

CONCLUSIONS

We have demonstrated that the clinical decision support system is useful for supporting differential diagnoses and preventing diagnostic errors. We propose that differential diagnosis by physicians and learning-to-rank by machine has a high affinity. We found that information retrieval and clinical decision support systems have much in common (Target data, learning-to-rank, etc.). We propose that Clinical Decision Support Systems have the potential to support: (1) recall of rare diseases, (2) differential diagnoses for difficult-to-diagnoses cases, and (3) prevention of diagnostic errors. Our system can potentially evolve into an explainable clinical decision support system.

Challenges and opportunities in the application of bioinspired engineered nanomaterials for the recovery of metal ions from mining industry wastewater

Heavy-metal-bearing wastewater is among the most formidable challenges the mining industry currently faces in maintaining its social license to operate. Amongst the technologies available for metal ion adsorption, bioinspired engineering nanomaterials have emerged as one which exhibits great promise. However, current processes used for the preparation of adsorbents (including nanoscale activated carbon and biochar) represent a source of adverse impacts on the environment. In contrast, the application of biogenic-nanoparticles, i.e., those derived from processes catalysed by microbiota, has received significant attention in the last few years. Coupled with this, the use of naturally occurring reagents is of major importance for the sustainability of this emerging industry. This paper analyses the life cycle assessment (LCA) of the synthesis of adsorbents derived from agricultural wastes. Moreover, rather than simply recovering the ecotoxic metals from wastewater, the potential to valorise dissolved metals into high-value metallic nanoparticle products is discussed. LCA analysis revealed that the adsorbent had some adverse impact on the environment. The agricultural wastes contributed 27.86% to global warming, 54.64% to ozone formation, 33.06% to fine particles, and 98.24% to marine eutrophication. Mining wastewater is an important, and largely currently unexploited, source of metal value. However, the often-low concentration of such metals dictates that their conversion into high-value products (such as engineered nanoparticles) is an important new research frontier. Within this the use of biosynthesis methods has emerged as having great potential due to a range of beneficial attributes, including low cost, high efficacy and/or environmental compatibility.

Health Risks for a Rural Community in Bokkos, Plateau State, Nigeria, Exposed to Potentially Toxic Elements from an Abandoned Tin Mine

The past mining activities in Bokkos Local Government Area (LGA) were performed in an uncontrolled way and gave rise to many abandoned ponds now serving as domestic and irrigation water sources. Past research focused mainly on the environmental impact, and we show for the first time what the human health risk through consumption of contaminated food crops is in these communities. This study was designed to determine the level of Potentially Toxic Elements (PTEs) contamination in pond water, soil, and food crops and assess the health risk of inhabitants in the abandoned tin mining community in Bokkos LGA. Samples of the mining pond water, soil, and selected food crops from farms irrigated with the pond water: bitter leaf (Vernonia amygdalina), pepper (Piper nigrum), okra (Albelmoschus esculentus), maize (Zea mays), sweet potato (Ipomoea batatas), and Irish potato (Solanum tuberosum) were analyzed for each of the eight PTEs (viz. Cu, Cr, Fe, Mn, Ni, Zn, Cd, and Pb) using inductively coupled plasma optical emission spectrometry (ICP-OES). The results obtained showed that the levels of all the PTEs analyzed in the soil, pond water, and selected food crops except for Fe and Mn in soil and Cd in sweet potato were greater than their corresponding background area values (p < 0.05). Also, the mean concentrations of all the PTEs except for Cu in pond water were significantly (p < 0.05) higher than the WHO maximum permissible limit. With the exception of Fe, Ni, and Zn for pepper and okra, Cu and Fe for maize grains as well as Cu, Ni, and Zn for sweet and Irish potatoes and Fe and Cd for sweet potato, the mean concentrations of PTEs in the food crops were significantly higher than WHO maximum permissible limit. The EF values of Cd (0.39); Cu (3.59) and Ni (2.81); Cr (9.38) and Pb (17.84); and Mn (178.13) and Zn (83.22) classified the soil as minimally, moderately, significantly, and extremely highly enriched, respectively. The PI values of all the PTEs in the soil studied were all greater than 5, indicating that the soils were severely contaminated. There was evidence that food crops significantly bioaccumulated PTEs either as a result of contaminated soil and/or irrigation water. The bioaccumulation was not uniform and was dominated by transfer from the polluted irrigation water. The bitter leaf, okra, and to some extent maize had the highest transfer of PTEs, and Mn, Cu, and Zn had the highest bioaccumulation in the food crops investigated. The hazardous index (HI) for the eight PTEs through the consumption of food crops was 107 for children and 33 for adults which greatly exceeded the recommended limit of 1, thus indicating that possible health risks exist for both local children and adults. For every PTE, the values of HI for children are many-fold higher than those for adults, which is of particular concern due to the high HI values for Pb found for maize consumption, a typical staple food. The cancer risk values for Cr and Ni for all the food crops were within 10^-3-10^-1 which is several fold higher than the permissible limits (10^-6 and < 10^-4) indicating the high carcinogenic risk. It can be concluded based on the results and risk assessment provided by this study that human exposure to mining pond water and soil in farms around the mining pond through the food chain suggests the high vulnerability of the local community to PTE toxicity. Long-term preventive measures to safeguard the health of the residents need to be put in place.

Residence in an Area with Environmental Exposure to Heavy Metals and Neurobehavioral Performance in Children 9-11 Years Old: An Explorative Study

We explored the association between residence in an area polluted with metals and neurobehavioral performance in children aged 9 to 11. A cross-sectional study was conducted with thirty boys and thirty girls aged 9 to 11 from public schools in a heavily industrialized area, matched by age (±4 months) and gender with 15 boys and 15 girls from public schools in cities without relevant industrial activity. Neurobehavioral performance was assessed with the Behavioral Assessment and Research System. Linear regression models were used, adjusting for age, sex, social class and multimedia activities to predict each of the neurobehavioral outcome variables. No differences in neurobehavioral performance were found when all children with residence in areas with environmental exposure to metals were classified as exposed and the children from the other provinces as unexposed. However, when we compared children living <1 km from an industrial area with respect to those living more than 1 km away, significant differences were found. Children living <1 km away had lower scores on Finger Tapping (p = 0.03), Symbol-Digit (p = 0.07) and Continuous Performance (p = 0.02) than those living farther away. Our results support the hypothesis that residing close to an area with industrial activity (<1 km) is associated with deficits in neurobehavioral performance among children aged 9 to 11.

A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports

Lead is one of the most toxic heavy metals in the environment. The present review aimed to highlight hazardous pollution sources, management, and review symptoms of lead poisonings in various parts of the world. The present study summarized the information available from case reports and case series studies from 2009 to March 2020 on the lead pollution sources and clinical symptoms. All are along with detoxification methods in infants, children, and adults. Our literature compilation includes results from 126 studies on lead poisoning. We found that traditional medication, occupational exposure, and substance abuse are as common as previously reported sources of lead exposure for children and adults. Ayurvedic medications and gunshot wounds have been identified as the most common source of exposure in the United States. However, opium and occupational exposure to the batteries were primarily seen in Iran and India. Furthermore, neurological, gastrointestinal, and hematological disorders were the most frequently occurring symptoms in lead-poisoned patients. As for therapeutic strategies, our findings confirm the safety and efficacy of chelating agents, even for infants. Our results suggest that treatment with chelating agents combined with the prevention of environmental exposure may be an excellent strategy to reduce the rate of lead poisoning. Besides, more clinical studies and long-term follow-ups are necessary to address all questions about lead poisoning management.

Optimization of a GF-AAS method for lead testing in blood and urine: A useful tool in acute abdominal pain management in emergency

Suspicion of lead poisoning is confirmed by its concentration in blood and protoporphyrin red blood cells. At low concentrations, lead influences the synthesis of the heme in the sense of lowering it. Acute and chronic lead intoxication is extremely polymorphic in regards to its clinical manifestations, with digestive, hematological, cardiovascular, renal hepatic and neurological features. The aim of the study was to evaluate the presence of lead in human whole blood and urine harvested before and during chelation treatment in the case of lead poisoning. An atomic absorption spectroscopic method for the analysis of lead was developed using graphite furnace atomic absorption spectrophotometer (GF-AAS), Varian Spectra AA-880 with a hollow cathode lead lamp and a deuterium lamp for background correction, coupled to a GTA-100 atomizer and a programmable sample dispenser. Standard calibration solutions were used for the range 10-100 µg/l. The linearity range was 10.0 to 100.0 µg/l with the correlation coefficient of 0.999. We established that the method can be applied for the determination of lead in whole blood and urine, and the results obtained are useful for monitoring chelation therapy in cases of acute lead poisoning, a neglected cause of abdominal colic pain in an emergency situation.

Investigation of toxic heavy metals content and estimation of potential health risks in Chinese herbal medicine

The content of toxic heavy metals (THMs), including lead (Pb), arsenic (As), cadmium (Cd), and mercury (Hg), was determined in a total of 10,245 samples for 279 types of Chinese herbal medicine (CHM) using a validated inductively coupled plasma mass spectrometry method. The exceeding rate (ER) for the four THMs were calculated based on diverse permissible limits (PLs) established by different organizations and national pharmacopeias. Cluster analysis was used to classify the degree risk of THMs contamination according to the calculated ER. Results revealed that Cibotii rhizome, Selaginellae herba, Morindae officinalis radix, Asprellae ilicis radix, and Toxicodendri resina exhibited high-degree risk of Pb contamination. Eckloniae/Laminariae thallus, Spirodelae herba, and Naturalis indigo possessed high-degree risk of As contamination. Tetrapanacis medulla, Centipedae herba, Cyathulae radix, Linderae radix, Meretricis/Cyclinae concha, and Tabanus displayed high-degree risk of Cd contamination. Toxicodendri resina has high-degree risk of Hg contamination. In addition, six types of CHM, including Asprellae ilicis radix, Toxicodendri resina, Eckloniae/Laminariae thallus, Fossilia Ossis Mastodi, Haematitum, and Hedyotidis diffusae herba, may have non-carcinogenic health risk after consumption of raw materials because the calculated hazard quotient and hazard index were over 1.0. In summary, these data provide useful information about THMs contamination in CHM.

Toxic Mechanisms of Five Heavy Metals: Mercury, Lead, Chromium, Cadmium, and Arsenic

The industrial activities of the last century have caused massive increases in human exposure to heavy metals. Mercury, lead, chromium, cadmium, and arsenic have been the most common heavy metals that induced human poisonings. Here, we reviewed the mechanistic action of these heavy metals according to the available animal and human studies. Acute or chronic poisonings may occur following exposure through water, air, and food. Bioaccumulation of these heavy metals leads to a diversity of toxic effects on a variety of body tissues and organs. Heavy metals disrupt cellular events including growth, proliferation, differentiation, damage-repairing processes, and apoptosis. Comparison of the mechanisms of action reveals similar pathways for these metals to induce toxicity including ROS generation, weakening of the antioxidant defense, enzyme inactivation, and oxidative stress. On the other hand, some of them have selective binding to specific macromolecules. The interaction of lead with aminolevulinic acid dehydratase and ferrochelatase is within this context. Reactions of other heavy metals with certain proteins were discussed as well. Some toxic metals including chromium, cadmium, and arsenic cause genomic instability. Defects in DNA repair following the induction of oxidative stress and DNA damage by the three metals have been considered as the cause of their carcinogenicity. Even with the current knowledge of hazards of heavy metals, the incidence of poisoning remains considerable and requires preventive and effective treatment. The application of chelation therapy for the management of metal poisoning could be another aspect of heavy metals to be reviewed in the future.

Abdominal pain related to adulterated opium: An emerging issue in drug addicts

Lead may contaminate opium, heroin and illicit opiates and is particularly observed in Iran. Lead, a natural heavy metal is able to interfere with several organ functions after ingestion or inhalation. Lead poisoning manifestations are non-specific and thus lead poisoning remains difficult to diagnose. Among the manifestations, abdominal pain is almost the most frequent symptom causing patients to seek medical care. In patients with a history of opium addiction presenting with moderate-to-severe abdominal pain, lack of diagnosis of lead toxicity may thus result in time-consuming and unnecessary medical work-ups that can end up in invasive surgery. This paper aims to briefly review abdominal pain as an emergency issue and the leading symptom of lead poisoning that brings most of the patients to healthcare facilities. All published adult cases and case series of opium addicts admitted with abdominal pain due to lead-adulterated opium consumption have been reviewed. A trend of increasing numbers of lead poisoning cases has recently emerged among opium addicts in Iran. Due to the non-specific manifestations and hazardous effects, psychiatrists and emergency physicians should consider lead poisoning in patients with a past or present history of opium addiction referred for acute abdominal pain, particularly in case of colicky abdominal pain.

Occupational Lead Poisoning in a Patient with Acute Abdomen and Normocytic Anemia

We herein report a 24-year-old male construction worker with occupational lead poisoning who presented with acute abdomen and normocytic anemia. The levels of urinary delta-aminolevulinic acid and free erythrocyte protoporphyrin were elevated without any increase in the level of urine porphobilinogen. Detection of an elevated blood lead level of 100 μg/dL confirmed a diagnosis of lead poisoning. Chelation therapy with calcium disodium ethylenediaminetetraacetate resulted in prompt improvement of the clinical symptoms and the blood lead level. Clinicians should be aware that lead poisoning caused by occupational exposure can still occur sporadically in construction workers in Japan.

The association between chemical-induced porphyria and hepatic cancer

The haem biosynthetic pathway is of fundamental importance for cellular metabolism both for the erythroid and nonerythroid tissues. There are several genetic variants of the pathway in the human population that cause dysfunction of one or other of the enzymes resulting in porphyrias of varying severity. Serious chronic hepatic and systemic diseases may result. Some of these can be precipitated by exposure to drugs including hormones, barbiturates and antibiotics, as well as alcohol and particular chlorinated aromatic chemicals. In experimental animals some of the steps of this pathway can also be severely disrupted by a variety of environmental chemicals, potential drugs and pesticides, especially in the liver, leading to the accumulation of uroporphyrins derived from the intermediate uroporphyrinogens or protoporphyrin IX, the immediate precursor of haem. With some of these chemicals this also leads to cholestasis and liver cell injury and eventually hepatic tumours. The review evaluates the available evidence linking hepatic porphyria with carcinogenesis in naturally occurring human genetic conditions and in chemically-induced porphyrias in laboratory animals. The existing data showing gender, strain, and species differences in sensitivity to the chemical-induced porphyrias, liver injury and liver tumours are discussed and the role that transgenically altered mouse models have played in defining the varying mechanisms. Finally, the review proposes a novel, unifying hypothesis linking the hepatotoxicity induced by the accumulation of various porphyrins, with the increased risk of developing hepatic cancer as a long term consequence.

Lead Poisoning Caused by Traditional Chinese Medicine: A Case Report and Literature Review

Traditional Chinese herbal medicine is widely used for primary health care worldwide as it mostly consists of herbs or herbal extracts known to be safe. However, owing to the intentional or unintentional addition to herbs of lead-containing bases or pastes, lead poisoning from traditional Chinese medicine (TCM) remains a serious issue. We report here a case of lead poisoning caused by long-term use of homemade TCM. A 66-year-old man was admitted for periumbilical pain and constipation. A detailed medication history revealed that the patient had been using homemade TCM for the past 8 months. Screening for heavy metals showed that the patient had a blood lead level of 657 μg/L and his wife, who was asymptomatic, had a blood lead level of 488 μg/L. Chemical analysis confirmed a lead concentration of more than 4,000 mg/kg in the TCM. Both individuals were advised to discontinue the medications and chelation treatment was immediately initiated for the husband. The patient's periumbilical pain was noticeably relieved after treatment, and blood lead levels returned to normal after three treatment rounds. We also review here the literature to summarize the usual reasons for taking TCM and common features of lead poisoning. Our findings suggest that potential exposure to lead from TCM treatment must be considered when diagnosing unexplained cases of abdominal colic in China. The Chinese health authority should speed up legislation to improve the regulatory framework of TCM, especially regarding small private clinics.