Perspective on lead toxicity, a comparison between the United States and Iran

Assessment of heavy metals among auto workers in metropolitan city: a case study

In recent decades, heavy metals (HMs) have emerged as a global health concern. Unfortunately, in Pakistan, there is a general lack of awareness regarding the potential health risks associated with HMs pollution among automobile workers. Herein, we investigated the concentration of heavy metals such as lead (Pb), cadmium (Cd), and chromium (Cr) among automobile workers who were occupationally exposed in Mingora City, Khyber Pakhtunkhwa, Pakistan. Three different automobile groups, i.e., battery recyclers, spray painters, and mechanics were studied in detail. A total of 40 blood samples were collected from automobile workers groups while 10 blood samples were collected as control individuals from different locations in the study area. We investigated heavy metals concentration with a standard method using an atomic absorption spectrometer AAS (PerkinElmer Analyst 700, United States). Based on our findings, the battery recycling group displayed the most elevated Pb levels (5.45 ± 2.11 μg/dL), exceeding those of both the spray painters' group (5.12 ± 1.98 μg/dL) and the mechanics' group (3.79 ± 2.21 μg/dL). This can be attributed to their higher exposure to Pb pollution resulting from the deterioration, dismantling, grinding, or crushing of old batteries. In the context of chromium (Cr) exposure, a similar trend was observed among the battery recycling group, as well as the spray painters and mechanics groups. However, in the case of cadmium (Cd), the mechanics' group exhibited the highest level of exposure (4.45 ± 0.65 μg/dL), surpassing the battery recycling group (1.17 ± 0.45 μg/dL) and the spray painters' group (1.35 ± 0.69 μg/dL), which was attributed to their greater exposure to welding fumes and other activities in their workplace. We believe that our findings will encourage regulatory measures to improve the health of automobile workers. However, further work is needed to determine various health-related issues associated with heavy metal exposure among automobile workers.

Lead poisoning with unusual manifestations in an opium-addicted man

One of the contributing causes of hypertension or exacerbation of ischemic heart disease (IHD) has been suggested to be environmental pollution and occupational exposure to particular metals, such as lead. Here, we describe a 43-year-old man with a history of oral opium with symptoms of IHD due to chest pain.

Bilateral Wrist Drop Due to Lead Poisoning in a Young Woman With Opium Addiction

Opium addiction can cause symptoms in the central or peripheral neurological systems, as well as gastrointestinal disorders and anemia; in such situations, lead poisoning should be considered and chelation therapy should be started as soon as possible. In adults, lead poisoning is an unusual cause of abdominal pain. A common form of lead neuropathy includes weakness of the wrist and finger extensors. We describe a 24-year-old female who developed severe lead poisoning after 3 years of opium consumption, leading to gastrointestinal complaints and bilateral wrist drops.

Modeling the impact of potentially harmful elements on the groundwater quality of a mining area (Nigeria) by integrating NSFWQI, HERisk code, and HCs

With excess potentially harmful elements (PHEs), drinking water is marked unsuitable and could pose some health risks when ingested or absorbed by humans. Different age groups are exposed to varied risk levels of PHEs. Analyzing the health risks of PHEs for several age groups could provide detailed insights for effective water resources management. No known study in Ameka Pb-Zn mine province (Nigeria) investigated the health risks of PHEs in water resources for several age groups. Therefore, in this paper, the carcinogenic and non-carcinogenic health risks (due to ingestion and dermal contact) of PHEs in groundwater resources of this area were investigated for nine age groups. To achieve its aim, this study integrated novel HERisk code, NSFWQI (national sanitation foundation water quality index), and hierarchical clusters (HCs) in modeling the groundwater quality. Standard elemental composition analysis revealed that the groundwater is polluted with PHEs. The NSFWQI indicated that 15% of the analyzed water samples have moderate water quality whereas 85% are unsuitable for drinking. The HERisk code, which considered nine age groups (1 to < 2 years, 2 to < 3 years, 3 to < 6 years, 6 to < 11 years, 11 to < 16 years, 16 to < 18 years, 18 to < 21 years, 21 to < 65 years, and > 65 years), revealed that all the samples pose high chronic and cancer risks to all the age groups due to oral ingestion. However, it was realized that age groups 1 to < 16 and > 65 are posed with higher risks than age groups 18 to < 65. Overall, it was realized that all the age groups are far more exposed to ingest or absorb Se, Co, Cd, Se, As, Ni, and Pb than Cu, Fe, and Zn. Nevertheless, the health risks due to dermal absorption are far lower than the risks due to oral ingestion. Conclusively, children and aging people are more predisposed to the health threats than middle-aged populations. HCs and geospatial maps aided the spatiotemporal analysis of the groundwater quality.

Heavy metal profile of surface and ground water samples from the Niger Delta region of Nigeria: a systematic review and meta-analysis

This systematic review and meta-analysis estimated the pooled mean levels of heavy metals in ground and surface water samples obtained from the Niger Delta region of Nigeria (NDRN). PUBMED and Google Scholar databases were searched for studies published between 2000 and 2019, which assessed the levels of heavy metals in natural water samples obtained from the NDRN. Thirty one (31) studies which had a total of 951 water samples were identified. The pooled mean estimate (PME) from the meta-analysis indicates that the levels of Ni, Cd, Cr, and Pb in the majority of the natural water bodies from the NDRN are higher than the WHO safe permissible limit for drinking water. The contributions of prevailing anthropogenic activities to the observed heavy metal profiles of natural water sources from the NDRN were discussed. Stricter enforcement of safe environmental practices is necessary to protect the lives of the over 30 million inhabitants of this oil rich region.

Treatment of opium addiction in persian medicine: A review study

Drug abuse is one of the most important threats to human beings today, leading to disability and even early death. In the past, opium had only therapeutic uses, but now, drug addiction is one of the major public health problems in Iran. Opium and its derivatives are the most commonly used illicit drugs in this country. Therefore, this study was conducted to evaluate the treatment strategies of opium addiction from the perspective of Persian medicine. In this narrative review, the search was conducted using appropriate keywords in the authoritative books of Persian medicine documentations of databases of PubMed, Google Scholar, PsycINFO, American Academy of Medical Sciences, United Nations Office on Drugs and Crimes with keywords of opioid and opium since 2000 AD. In Persian medicine books, "Afioon" means poppy plant (Papaver somniferum), which is called opium in English and "Theriac" in Persian. To quit, they should be gradually reduced and replaced with appropriate spices such as henbane (Hyoscyamus niger) seeds or mandrake (Mandragora officinarum) fruit or root or poppy (P. somniferum) seeds or poppy shell or Lettuce (Lactuca sativa) seeds, or castor testis or nutmeg (Myristans fragrans) fruit or ajwain (Trachyspermum copticum) seeds or baked bread. Opioid quit should be gradual and delayed in time of consumption and gradual reduction of opium levels, and bodies that have become lean for a long time will gradually recover with adequate nutrition over time.

Recent Advances in Nanotechnology-Based Biosensors Development for Detection of Arsenic, Lead, Mercury, and Cadmium

Heavy metals cause considerable environmental pollution due to their extent and non-degradability in the environment. Analysis and trace levels of arsenic, lead, mercury, and cadmium as the most toxic heavy metals show that they can cause various hazards in humans' health. To achieve rapid, high-sensitivity methods for analyzing ultra-trace amounts of heavy metals in different environmental and biological samples, novel biosensors have been designed with the participation of strategies applied in nanotechnology. This review attempted to investigate the novel, sensitive, efficient, cost-benefit, point of care, and user-friendly biosensors designed to detect these heavy metals based on functional mechanisms. The study's search strategies included examining the primary databases from 2015 onwards and various keywords focusing on heavy metal biosensors' performance and toxicity mechanisms. The use of aptamers and whole cells as two important bio-functional nanomaterials is remarkable in heavy metal diagnostic biosensors' bioreceptor design. The application of hybridized nanomaterials containing a specific physicochemical function in the presence of a suitable transducer can improve the sensing performance to achieve an integrated detection system. Our study showed that in addition to both labeled and label-free detection strategies, a wide range of nanoparticles and nanocomposites were used to modify the biosensor surface platform in the detection of heavy metals. The detection limit and linear dynamic range as an essential characteristic of superior biosensors for the primary toxic metals are studied. Furthermore, the perspectives and challenges facing the design of heavy metal biosensors are outlined. The development of novel biosensors and the application of nanotechnology, especially in real samples, face challenges such as the capability to simultaneously detect multiple heavy metals, the interference process in complex matrices, the efficiency and stability of nanomaterials implemented in various laboratory conditions.

Opium-Related Lead Toxicity: An Integrative Review and Case Series

BACKGROUND

Restrictive regulations and the increased price of opioids have resulted in the addition of impurities to illicit opioids by drug dealers. Among the adulterants, lead salts are optimal agents to make packages heavier. Consequently, lead toxicity has emerged in the opioid-user population.

OBJECTIVES

Our goal was to review the related literature and describe patients with common presentations of opioid-related lead poisoning to provide a basis to prepare optimal management.

METHODS

A narrative review was performed aiming to study opioid lead poisoning. PubMed and Google Scholar databases were explored with two Medical Subject Heading terms, lead poisoning and substance-related disorders to find a broad but relevant spectrum of articles. Then, the reference lists within those articles were checked to upgrade our literature pool on this issue.

RESULTS

Ultimately, among English-language articles, 16 were case series and case reports of patients with lead intoxication after opioid consumption. Data pertaining to disease characteristics, diagnosis, and treatment protocols were extracted.

CONCLUSIONS

The clinical presentation of opioid lead intoxication can vary from rather asymptomatic to severely debilitating gastrointestinal or neurologic symptoms. The diagnosis is made by checking lead blood levels after obviating other critical diagnoses and should be considered in each drug user in endemic regions of opioid addiction, such as the Middle East. Management protocols are suggested to cover both features of opioid-related complications and lead toxicity.

Lead and zinc exposure in the blood of workers in municipal waste management

Improper treating, sorting, storing, transporting, or disposing of wastes poses a potential risk to the health of humans and the environment. The workers of waste management plants are at risk of exposure to heavy metals and their toxic and hazardous effects through respiratory or cutaneous routes. Accordingly, concentrations of two heavy metals in the biological samples of workers of a municipal waste management (MSW) plant in Iraqi Kurdistan were measured in 139 persons who worked for at least 6 months. Blood and plasma samples were collected to measure lead and zinc concentrations, respectively. Their working units, occupational history, smoking habits, and the distance living from the landfill site were recorded in a predesigned questionnaire. A blood lead level (BLL) of less than 40 μg/dL was considered a safe cutoff. The lower limit of normal fasting plasma zinc was set at 70-120 μg/dL. The study showed that the mean age of the workers was 33.43, ranging from 16 to 67 years old, and they worked for the last 4.93 years. Further, 22.3% of the staff had previous experience in a job with suspected exposure to heavy metals. The mean BLL concentrations and the plasma zinc level were 31 μg/dl and 5.77 μg/dl, respectively. The study did not find a substantial difference in lead and zinc among workers with different characteristics. We did not find any predictor for lead and zinc concentrations in our sample. The study showed that the mean levels of lead and zinc were lower than the permitted ranges.

Blood Pressure and Lipid Profile in Automechanics in Relation to Lead Exposure

Context

Elevated blood pressure and alterations in lipid and lipoproteins play a major role in the development and progression of cardiovascular diseases.

Aim

This study is aimed at determining the blood pressure and lipid profile in automechanics.

Settings and Design

A total of 120 male subjects between 18 and 55 years of age comprised 60 automechanics and 60 age-matched occupationally unexposed control subjects in Emene, Enugu State, Nigeria.

Subjects and Methods

Four milliliters of fasting blood samples was collected from all subjects, 2 mL of blood was dispensed into K₂-EDTA vacutainer tube for blood lead analysis, while the other 2 mL was dispensed into plain vacutainer tube, allowed to retract, centrifuged, and the serum used for serum lipid profile analysis. Blood pressure was measured using aneroid sphygmomanometer.

Statistical Analysis

Statistical Package for Social Sciences (SPSS) version 21.0 was used for data analysis.

Results

Automechanics had significantly higher values of systolic and diastolic blood pressures compared with the controls. Serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), and triglyceride (TG) were also significantly higher in the automechanics compared with the controls (P < 0.05); serum high-density lipoprotein cholesterol (HDL-C) level, however, did not differ significantly between the two groups (P > 0.05). Blood lead level showed a significant positive correlation (P < 0.05) with systolic and diastolic blood pressures, serum TC, LDL-C, VLDL-C, and TG, with no significant correlation with serum HDL-C (P > 0.05) in the automechanics and no correlation in the controls.

Conclusion

The result of this study indicates that blood pressure is elevated and lipid profile altered in automechanics which suggests that these groups of workers are prone to increased risk of developing hypertension and cardiovascular disorders due to occupational exposure to lead.

Assessment of phytotoxicity, environmental and health risks of historical urban park soils

Urban soil areas can be contaminated with potentially dangerous heavy metals (HM), which might have got there by means of the human activity. The aim of the present study was to determine the contamination level of the city park soils and its impact on urban ecosystem. The indices assessing soil contamination such as Enrichment Factor (EF), Geoaccumulation Index (Igeo), Nemerow Pollution Index (IPI_N), and indices assessing health risks, namely Hazard Index (HI) and Carcinogenic Risk (CR), have been calculated. Furthermore, the phytotoxic effect of the soil samples has been determined. The soil contains in average 58.6 mg/kg Zn, 0.3 mg/kg Cd, 27.2 mg/kg Pb and 16.6 mg/kg Cu. Based on EF index, it has been confirmed that the increased amounts of Zn, Cd and Pb in the soil are of the anthropogenic origin. The soil may be classified as moderately to strongly polluted in the case of Zn and Pb according to Igeo. Nevertheless, soil contamination in the park is at a safe level as per IPI_N. Based on HI and CR indices, it is possible to state that the soil in the park does not pose any health risks. Subject to the outcomes of the toxicity test, the concentrations of HMs found out in the soils are not inhibitory for plants.

Association between blood lead level and blood pressure: An occupational population-based study in Jiangsu province, China

Studies about the association between lead exposure and the elevation of blood pressure and risk of hypertension are varied, while available data on blood lead levels (BLL) in workers with lead-exposure are scarce. This research aimed to evaluate associations between BLL and blood pressure in an occupational population-based study in Jiangsu province, China. We enrolled 21,688 workers in this study. Information on socioeconomic and occupational background was obtained with face-to-face interviews. BLL, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and hypertension status was confirmed. We found that workers in mini-factories had the highest average BLL (20.3 μg/dL; 95% CI, 19.0-21.6 μg/dL) for overall participants. The employees in private factories had higher BLL (9.6 μg/dL; 95% CI, 9.5-9.8 μg/dL). However, BLL was much lower (4.0 μg/dL; 95%CI, 3.7-4.2 μg/dL) in state-owned factories. Participants working in the electrical machinery and equipment manufacturing industry had higher BLL (9.1 μg/dL; 95% CI, 9.0-9.3μg/dL). Compared to those workers with ≤ 4.6 μg/dL BLL, workers with > 17.5 μg/dL BLL presented 1.34 mmHg and 0.70 mmHg average difference in SBP and DBP, respectively. The adjusted OR for hypertension was 1.11 (95%CI, 1.08-1.15) compared to the workers with > 17.5 μg/dL BLL and to those with ≤ 4.6 μg/dL BLL. In summary, we found that BLL was positively associated with SBP and DBP and with the morbidity of hypertension in occupational populations with a high concentration of lead exposure. It is important to formulate new standards of blood lead levels to screen for elevated lead exposure. In addition, a series of new systems of risk assessment should be established to further reduce and prevent lead exposure.

Lead Poisoning in Opium Abuser in Iran: A Systematic Review

Substance abuse and its consequences are major health hazards in the world. Opium addiction is a common form of substance abuse in Iran. Adulteration of illegal substances in the process of production and distribution of the drug in black market with many types of materials have been reported. One of the main goals of the adulteration of illegal substances is cutting of the substance for deal and increase of the weight for more benefit. However, adding of adulterating agents to illegal drugs could be considered as a cause of nonspecific and rare toxicity during substance abuse. Although the presence of lead in street-level heroin, marijuana, and amphetamines has been reported from some countries previously, recently, several reports suggested lead poisoning in Iranian opium addicts. Adulteration of opium with lead is a new source of lead poisoning in Iran in which the opium abuse is frequent and it could be a new health problem in the future. In this regard, evaluation of blood lead level would be important for early diagnosis of lead poisoning in opium addicts.

Clinical Aspects of Opium Adulterated with Lead in Iran: A Review

Adulteration of drugs with poisonous substances during production or consumption has caused numerous health problems. Among contaminants that have the potential of producing poisonous effects are the heavy metals lead, arsenic and thallium that make up an important group of toxic substances. The emergence of these new health problems related to opioid abuse has precipitated this MiniReview on the status of the most hazardous and common opioid adulterants. In fact, adulterated opium is a major public health problem and can threaten the health of users. In this study, we searched for information on opium, opiates, lead poisoning, toxicity, intoxication, Iran and heavy metals in the TUMS Digital Library, PubMed, Scopus, EMBASE and Google Scholar bibliographical databases. This MiniReview primarily included articles on lead poisoning, signs and symptoms, and management in opioid-dependent individuals. Exclusion criteria were articles dealing with animal studies, specific paediatric studies, adulterants other than heavy metals and substances other than opioids. Adulterated opium is one of the new sources of exposure to lead and has precipitated an increase in lead-poisoned cases owing to the widespread use of opium. The toxicology of lead and general guidelines on diagnosis and treatment of lead poisoning is briefly reviewed. The symptoms of lead toxicity mimic several diseases often leading to unnecessary diagnostic methods, misdiagnoses and even surgery. Finally, owing to the fact that lead toxicity shows non-specific signs and symptoms, screening for this disease, by taking blood samples and assessing blood lead levels in high-risk people, should be given an utmost priority. It is recommended that screening tests are adopted and applied for any drug-abusing patient with non-specific subacute signs and symptoms like abdominal pain, constipation and anaemia.

Heavy Metals and Human Health: Mechanistic Insight into Toxicity and Counter Defense System of Antioxidants

Heavy metals, which have widespread environmental distribution and originate from natural and anthropogenic sources, are common environmental pollutants. In recent decades, their contamination has increased dramatically because of continuous discharge in sewage and untreated industrial effluents. Because they are non-degradable, they persist in the environment; accordingly, they have received a great deal of attention owing to their potential health and environmental risks. Although the toxic effects of metals depend on the forms and routes of exposure, interruptions of intracellular homeostasis include damage to lipids, proteins, enzymes and DNA via the production of free radicals. Following exposure to heavy metals, their metabolism and subsequent excretion from the body depends on the presence of antioxidants (glutathione, α-tocopherol, ascorbate, etc.) associated with the quenching of free radicals by suspending the activity of enzymes (catalase, peroxidase, and superoxide dismutase). Therefore, this review was written to provide a deep understanding of the mechanisms involved in eliciting their toxicity in order to highlight the necessity for development of strategies to decrease exposure to these metals, as well as to identify substances that contribute significantly to overcome their hazardous effects within the body of living organisms.

Occupational lead toxicity in battery workers

OBJECTIVE

To estimate blood lead level (BLL) and to assess the features of lead toxicity among lead acid battery (LAB) industrial workers.

METHODS

This prospective study was carried out in the medical centre of PCSIR Laboratories, Karachi from March 2012 - March 2013. Fifty LAB industry workers, males and females between 17-65 years were included in the study. They were divided into group 1 with 40 workers- directly related and group 2 with 10 workers -indirectly related, (administration staff members) to LAB manufacture. Detailed history, complete physical examination and BLL estimation by flameless atomic absorption spectrophotometer was done.

RESULTS

Total 34 patients in group 1 and 3 patients in group 2 had elevated BLL. Comparison of group 1 and 2 revealed anemia (40v/s4), bone pain (38v/s7), abdominal pain (38 v/s 2), nausea (32v/s6), head ache & irritability (24v/s6), weakness & lethargy (21v/s6), tremors (13v/s0) insomnia (5v/s4), lead line (4v/s 0) and blood pressure above 140/90 mm of Hg (12v/s0) respectively.

CONCLUSION

High blood lead level and features attributable to lead toxicity were prevalent among LAB industry workers of Karachi.

Blood lead level in opium dependents and its association with anemia: A cross-sectional study from the capital of Iran

BACKGROUND

Opium dependence is one of the most challenging health problems in the developing countries as well as Iran. Among several health problems due to opium dependence, there are limited reports indicating the presence of lead in opium. The aim of this study is to investigate the blood lead level (BLL) in oral and inhalational opium dependents and its association with anemia.

MATERIALS AND METHODS

A cross-sectional study was done among 86 opium dependent patients who were referred to five large detoxification centers in Tehran city and 48 healthy individuals. BLL was assessed using the atomic absorption spectrometry technique. Multivariate analysis of variance and binary logistic regression analysis were performed for statistical assessment using SPSS version 18 for Windows.

RESULTS

The highest BLL was detected in oral opium dependent group (mean = 11.75, standard deviation (SD) = 6.06) in comparison to inhalational opium dependent group (mean = 7.07, SD = 3.61) and healthy control group (mean = 6.05, SD = 1.83). Anemia was detected in 38% of oral-opium dependent and 43% of inhalational-opium dependent group. Age (odds ratio (OR): 1.06, 95% confidence interval (CI): 1.03-1.09) and opium dependence (OR: 3.59, 95% CI: 1.69-7.59) were significant predictors of anemia in these patients (P < 0.001).

CONCLUSION

The results of this study confirmed the higher BLL in opium dependents, especially with an oral form of consumption.

Blood lead levels and health problems of lead acid battery workers in Bangladesh

INTRODUCTION

Use of lead acid battery (LAB) in Bangladesh has risen with sharp rise of motor vehicles. As result, manufacture of LAB is increasing. Most of the lead used by these industries comes from recycling of LAB. Workers in LAB industry are at risk of exposure lead and thus development of lead toxicity.

OBJECTIVE

The objective of this study was to measure the blood lead concentration and to assess the magnitude of health problems attributable to lead toxicity among the LAB manufacturing workers.

METHODS

A cross-sectional study was conducted among the workers of LAB manufacturing industries located in Dhaka city.

RESULT

Mean blood lead level (BLL) among the workers was found to be high. They were found to be suffering from a number of illnesses attributable to lead toxicity. The common illnesses were frequent headache, numbness of the limbs, colic pain, nausea, tremor, and lead line on the gum. High BLL was also found to be related to hypertension and anemia of the workers.

CONCLUSION

High BLL and illnesses attributable to lead toxicity were prevalent amongst workers of the LAB manufacturing industries, and this requires attention especially in terms of occupational hygiene and safety.

Cholestasis and seizure due to lead toxicity: a case report

INTRODUCTION

Lead poisoning is a major public health risk which may involve major organs. Recently, there have been reports of opioid adulteration with lead in Iran. The following case report is the first of its kind in that intrahepatic cholestasis due to lead toxicity has been described.

CASE PRESENTATION

A 65-year-old man presented to the emergency department with abdominal pain, abnormal liver function tests (cholestatic pattern), and normocytic anemia. He had been an opium user for 20 years. Clinical and preclinical findings including the bluish discoloration of periodontal tissues, or Burton's sign, and generalized ileus on abdominal x-ray led us to the possibility of lead poisoning. Lead levels were higher than normal (150 μg/dL). Magnetic resonance cholangiopancreatography (MRCP) and abdominal ultrasound were performed to rule out extra hepatic causes of cholestasis. To evaluate the possibility of lead-induced hepatotoxicity, a liver biopsy was performed. Histological features of lead-induced hepatotoxity have rarely been described in humans. In this patient, focal canalicular cholestasis and mild portal inflammation were confirmed. Thus, treatment with ethylenediaminetetraacetic acid (EDTA) and British anti-lewisite (BAL) were initiated and continued for five days. The patient's liver function tests returned to their normal values, clinical findings including nausea, vomiting, and abdominal pain subsided, and the patient was discharged from the hospital in good condition.

CONCLUSIONS

Lead toxicity should always be taken into account in cases of intrahepatic cholestasis with an unknown etiology, especially in a setting where opium abuse is common.