Blood lead concentrations among pediatric patients with abdominal pain: a prospective cross-sectional study

Chemical Components in the Breast Milk of Passive Smoker Women: A Systematic Review and Health Risks Assessment

Breast milk from passive smokers may contain various harmful chemical components, primarily due to exposure to tobacco smoke. This systematic review was conducted on the chemical components of breast milk in women who were exposed to environmental tobacco smoke (ETS). English language-published papers were advanced searched without time limitation until April, 2024 in Web of Science, PubMed, and Scopus databases. A total of 1156 papers were recorded in the initial search of these databases. Finally, 18 articles met the inclusion criteria and were included. Our results showed that metals (n = 10) and heterocyclic compounds (n = 9) (cotinine, nicotine, and nornicotine) were the most commonly reported compounds in the included studies. Cotinine was the most frequently reported compound in mature milk (n = 9) and colostrum (n = 3). Among metals in mature milk, cadmium (n = 8) and lead (n = 6) are the most common compounds. Metals in colostrum were just reported in one study. The cancer risk (CR) values showed a decreasing pattern in the order of Sr > Mn > U > Co > Pb > Cr > As > Cd > Be for both aged infant groups. Parents should be encouraged to not smoke, as well as must be advised of the potential risks of ETS exposure to their babies. It is recommended that routine and continuous monitoring of probable sources of chemical contamination of breast milk due to environmental exposures should be done to discover the influencing factors and develop suitable interventions for decreasing the exposure/contamination.

Lead poisoning as a differential diagnosis in pediatric patients with chronic abdominal pain: a case-control study in Tehran-Iran

BACKGROUND

Chronic abdominal pain is a potential symptom of lead poisoning, which is often challenging to diagnose. This case-control study aimed to evaluate blood lead levels in pediatric patients with chronic abdominal pain.

METHODS

The case-control study was conducted on 190 pediatrics who presented to the Children's Medical Center Hospital clinics, Tehran between April 2021- 2023. The children were divided into two groups: the case group, consisting of 81 patients with chronic abdominal pain, and the matched control group; 109 children without any gastrointestinal symptoms. The statistical analysis of the data was performed using STATA 16. A multiple logistic regression model was used to assess the association of different independent variables with chronic abdominal pain.

RESULTS

There was no significant difference between mean (± standard deviation [SD]) of age (8.80(2.7) years vs. control group: 9.23(3.9) years), sex, and BMI (16.55(4.6) vs. 17.32(4.7)) of the patients with chronic abdominal pain (case group) and the control group, whereas the mean weight was remarkably low in patients with chronic abdominal pain: 27.25(± 12.1) kg vs. 31.70(± 14.7) kg (P value = 0.028). Fifty-nine percent of children with chronic abdominal pain had serum lead levels ≥ 10 µg/dL. The mean (SD) of blood lead levels was statistically high in the case group: 11.09 (± 5.35) µg/dL vs. control group: 8.26 (± 5.01) µg/dL) (P value ≤ 0.05). The appetite level was significantly low in the case group: 3.8 (± 2.5) vs. control group 5.4 (± 1.3).

CONCLUSIONS

Lead poisoning could be a possible cause of children's chronic abdominal pain. Regarding the high rate of lead poisoning in children exerting appropriate measures to reduce their exposure to lead is necessary.

The effects of active and passive smoking on selected trace element levels in human milk

Our study aimed to compare levels of six micro-elements and six potentially toxic elements in the breast milk of non-smoking women compared to those found in women who smoke tobacco and women exposed to second-hand smoke during pregnancy and lactation. This was a cross-sectional study conducted on 100 lactating women in western Iran. The studied subjects were in three groups: passive smokers, active smokers, and a control group. Concentrations of selected trace elements in breast milk (essential and non-essential metals) were determined using ICP-MS. Our results indicated that the parameters of education, fruit consumption, and cosmetics usage had a significant difference among the groups (p < 0.05). Moreover, for trace elements, the Kruskal-Wallis test was statistically significant for arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) (p < 0.05). The post hoc Dunn test revealed a significant difference in the levels of As, Cd, Hg, and Pb between non-smoker and passive/active smoker groups (p < 0.05). Our findings illustrate that exposure to cigarette smoke can cause an increase in the level of potentially toxic elements in human milk, which is dangerous for the consumption of premature newborns, but more research is needed to evaluate the potential toxic mechanisms of toxic metals.

Blood lead level evaluation in children presenting with chronic constipation in Tehran-Iran: a cross-sectional study

Constipation is a common reason for children seeking medical care worldwide. Abdominal complaints and constipation are also common in lead-poisoned children. This study evaluates the prevalence of abnormal blood lead levels (BLL) among pediatric and adolescent patients and examines the association of constipation with elevated BLL. This was a prospective data collection of patients younger than 18 years old with the chief complaint of constipation seen in the Mofid Children's Hospital gastroenterology clinic and Loghman Hakim pediatric and pediatric gastroenterology clinics were eligible for enrollment in this study. Constipation was defined as infrequent or difficult defecation according to ROME IV criteria lasting 2 months or more. BLL was measured with a fresh capillary whole blood capillary sample. The LeadCare II device assays BLL using an electrochemical technique (anodic stripping voltammetry). A total of 237 patients were enrolled in the study. 122 (51.48%) were female and 115 (48.52%) were male. About one fifth of patients (49; 20.67%) had BLL ≥ 5 µg/dL. The mean BLL in the sample was 3.51 µg/dL. Abdominal pain was the most common symptom accompanying constipation (134; 56%). Multivariate analysis found endoscopic evaluation (P values 0.024, OR 3.646, 95% CI 1.189-11.178), muscle pain (P values 0.020, OR 24.74, 95% CI 1.67-365.83), and maternal education (P values 0.02, OR 4.45, 95% CI 1.27-15.57) with significant differences in groups of patients with normal and elevated BLL. Elevated BLL necessitates an assessment and plans to reduce childhood lead exposure. BLL screening in childhood constipation with refractory chronic abdominal pain may also eradicate the need for invasive procedures like endoscopic evaluation.