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Pham GMT, Sharma A. Unregulated supplement use causing insidious lead toxicity. Proc AMIA Symp 2023; 36:226-227. [PMID: 36876278 PMCID: PMC9980634 DOI: 10.1080/08998280.2022.2139143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A woman with extensive chronic fatigue presented to the emergency department with vague abdominal complaints and was subsequently found to have microcytic anemia secondary to lead intoxication. Upon further investigation, the unlikely source of lead intoxication was found to be the supplements she procured from her frequent overseas trips to South Asia. Chelation therapy was started and lead levels dropped.
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Affiliation(s)
- Grant Manh-Tri Pham
- Texas A&M Family Medicine Residency, Baylor Scott and White Medical Center - Round Rock, Round Rock, Texas
| | - Anuj Sharma
- Texas A&M Family Medicine Residency, Baylor Scott and White Medical Center - Round Rock, Round Rock, Texas
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Hesaruiyeh FA, Rajabi S, Motamed-Jahromi M, Sarhadi M, Bell ML, Khaksefidi R, Sarhadi S, Mohammadi L, Dua K, Mohammadpour A, Martelletti P. A Pilot Study on the Association of Lead, 8-Hydroxyguanine, and Malondialdehyde Levels in Opium Addicts' Blood Serum with Illicit Drug Use and Non-Addict Persons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159110. [PMID: 35897481 PMCID: PMC9368398 DOI: 10.3390/ijerph19159110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 02/01/2023]
Abstract
While a large body of literature has shown the health problems of illicit drug use, research is needed on how substance abuse impacts DNA damage and contaminants in blood, especially given Pb-contaminated opium. This pilot study aimed to evaluate the levels of lead (Pb), 8-hydroxy di-guanine (8-oxo-Gua), and malondialdehyde (MDA) in the blood serum of opium addicts and non-addict people. The current study is a case–control study with a cross-sectional design. A sample of 50 opium-addicted and non-addict adults were chosen for this study using convenience and random sampling methods. Participants were divided into two groups: addicts and non-addicts. The atomic absorption spectroscopy method was used to measure the quantity of Pb, and the Enzyme-Linked Immunosorbent Assay (ELISA) method was used to measure the amount of 8-oxo-Gua and MDA. The data were analyzed using an independent t-test. The results show that the amount of Pb in the blood serum of addicted women and men was higher than levels in non-addict men and women, for the study participants (p-value = 0.001). Blood levels were not significantly different between addicts and non-addicts for men or women for 8-oxo-Gua (p-value = 0.647 for women and p-value = 0.785 for men) and MDA (p-value = 0.867 for women and p-value = 0.995 for men). In general, addicts’ blood Pb levels were found to be substantially higher than those of normal non-addict persons in this pilot study. As a result, testing for blood Pb levels in addicts may be informative in instances when symptoms are inconclusive.
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Affiliation(s)
- Farzaneh Allahdinian Hesaruiyeh
- Department of Toxicology, Faculty of Pharmacy, Shahreza Branch, Islamic Azad University, Shahreza P.O. Box 311-86145, Iran;
- Clinical Core Laboratory, Ali ibn Abi Talib Hospital Complex, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran
| | - Saeed Rajabi
- Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (S.R.); (R.K.)
| | | | - Mohammad Sarhadi
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran;
| | - Michelle L. Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT 06520, USA;
| | - Razieh Khaksefidi
- Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (S.R.); (R.K.)
- Cellular and Molecular Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran;
| | - Somayeh Sarhadi
- Department of Biology, Faculty of Sciences, Hamedan Branch, Islamic Azad University, Hamedan 15847-43311, Iran;
| | - Leili Mohammadi
- Environmental Health, Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan 98167-43463, Iran;
| | - Kamal Dua
- Centre for Inflammation, Centenary Institute, Sydney, NSW 2050, Australia;
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute (HMRI) & School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Amin Mohammadpour
- Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran; (S.R.); (R.K.)
- Correspondence: (A.M.); (P.M.)
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: (A.M.); (P.M.)
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Samarghandian S, Shirazi FM, Saeedi F, Roshanravan B, Pourbagher-Shahri AM, Khorasani EY, Farkhondeh T, Aaseth JO, Abdollahi M, Mehrpour O. A systematic review of clinical and laboratory findings of lead poisoning: lessons from case reports. Toxicol Appl Pharmacol 2021; 429:115681. [PMID: 34416225 DOI: 10.1016/j.taap.2021.115681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- Saeed Samarghandian
- Noncommunicable Diseases Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran.
| | - Farshad M Shirazi
- Arizona Poison & Drug Information Center, The University of Arizona, College of Pharmacy and University of Arizona, Tucson, Arizona, USA
| | - Farhad Saeedi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | | | | | - Tahereh Farkhondeh
- Faculty of Pharmacy, Birjand University of Medical Sciences (BUMS), Birjand, Iran
| | - Jan Olav Aaseth
- Elverum, and Research Department, Innlandet Hospital, Norway University of Applied Sciences, Brumunddal, Norway.
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center (PSRC), The Institute of Pharmaceutical Sciences (TIPS), Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences (BUMS), Birjand, Iran; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Tudosie MS, Caragea G, Popescu DM, Avram O, Serban D, Smarandache CG, Tudor C, Badiu CD, Socea B, Sabau AD, Comandasu M, Spataru R, Costea DO, Tanasescu C, Dascalu AM. Optimization of a GF-AAS method for lead testing in blood and urine: A useful tool in acute abdominal pain management in emergency. Exp Ther Med 2021; 22:985. [PMID: 34345267 DOI: 10.3892/etm.2021.10417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Mihail Silviu Tudosie
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,ICU II Toxicology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Genica Caragea
- Military Medical Research Center, 010919 Bucharest, Romania
| | - Dragos Marian Popescu
- Faculty of Medicine, The University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Oana Avram
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,ICU II Toxicology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Catalin Gabriel Smarandache
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Corneliu Tudor
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Cristinel Dumitru Badiu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,General Surgery, Emergency Clinical Hospital 'Prof. Dr. Bagdasar Arseni', 041915 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Alexandru Dan Sabau
- Third Department, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550169 Sibiu, Romania
| | - Meda Comandasu
- Fourth Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Radu Spataru
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Department of Pediatric Surgery, Emergency Clinic Hospital for Children 'Marie S. Curie', 077120 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University, 900470 Constanta, Romania.,First Surgery Department, Emergency County Hospital, 900591 Constanta, Romania
| | - Ciprian Tanasescu
- Third Department, Faculty of Medicine, 'Lucian Blaga' University of Sibiu, 550169 Sibiu, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020011 Bucharest, Romania.,Ophthalmology Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
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Du X, Zheng W, Ye Q. Rare cases of severe life-threatening lead poisoning due to accident or chronic occupational exposure to lead and manganese: Diagnosis, treatment, and prognosis. Toxicol Ind Health 2020; 36:951-959. [PMID: 33094697 DOI: 10.1177/0748233720958969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic long-term, low-dose environmental and occupational exposure to lead (Pb) has been extensively studied in large cohorts worldwide among general populations, miners, smelters, or battery workers. However, studies on severe life-threatening Pb poisoning due to accidental or chronic occupational exposure to Pb and manganese (Mn) were rarely reported. METHODS We present one case of acute severe Pb poisoning and compare it with another severe chronic occupational exposure case involving Pb and Mn. A 27-year-old woman mistakenly took a large quantity of pure Pb powder as an herbal remedy; she developed abdominal colic, severe nausea, vomiting, fatigue, and cutaneous and sclera icterus. Laboratory tests showed her blood lead level (BLL) of 173.5 µg dL-1 and urinary lead level (ULL) of 1240 µg dL-1. The patient was diagnosed with acute Pb poisoning and acute liver failure. In another chronic exposure case, a 56-year-old man worked in a Pb and Mn smelting factory for 15 years. He was brought to the emergency room with severe nausea, vomiting, and paroxysmal abdominal colic, which was intolerable during the onset of pain. His BLL was 64.8 µg dL-1 and ULL was 38 µg dL-1, but his blood and urinary Mn levels were normal. The patient was diagnosed with chronic Pb poisoning. Both patients received chelation therapy with calcium disodium ethylene-diamine-tetraacetate (CaNa2EDTA). The woman with acute severe Pb intoxication recovered well and was discharged from the hospital after treatment, and the man who survived severe Pb poisoning was diagnosed with lung cancer. CONCLUSION Clinical manifestations of acute and chronic severe Pb poisoning are different. Chelation therapy with CaNa2EDTA is proven to be an effective life-saving therapy in both cases by reducing BLL. Occupational exposure to both Pb and Mn does not appear to increase Mn neurotoxicity; however, the probability that co-exposure to Mn may increase Pb toxicity in the same patient cannot be excluded.
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Affiliation(s)
- Xuqin Du
- Department of Occupational Medicine and Toxicology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,138262School of Health Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Wei Zheng
- 138262School of Health Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, 74639Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Zhou JP, Wang F, Yi XQ, Wang XY, Jiang YS, Geng Y, Wang JJ. [Effects of embryonic lead exposure on food intake and bowel movement in offspring rats and possible mechanisms]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:463-469. [PMID: 28407837 PMCID: PMC7389659 DOI: 10.7499/j.issn.1008-8830.2017.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the effects of embryonic lead exposure on food intake and bowel movement in offspring rats and possible mechanisms. METHODS Sprague-Dawley rats were given 0.1% (low-dose lead exposure group) or 0.2% (high-dose lead exposure group) lead acetate freely during pregnancy to establish an animal model of embryonic lead exposure. A blank control group was also established. The male offspring rats were enrolled in the study, and 10 male offspring rats from each group were selected to observe the changes in food intake, bowel movement, gastric emptying, intestine propulsion, and pathological inflammatory response in the gastric mucosa. Eight offspring rats were selected from each group, and electron microscopy and immunohistochemistry were used to observe the changes in the ultrastructure of jejunal microvilli and cell junction and the expression of cholecystokinin-8 (CCK-8) and motilin (MTL) in the feeding center, in order to reveal the possible mechanisms for abnormal gastrointestinal motility in offspring rats induced by embryonic lead exposure. RESULTS Compared with the control group, the low- and high-dose lead exposure groups had a significant reduction in daily food intake, a significant increase in water content of feces, a significant reduction in fecal pellet weight, and a significant increase in small intestine propulsion (P<0.05). The high-dose lead exposure group had a significant reduction in gastric emptying ability compared with the control group (P<0.05). Compared with the control group, the lead exposure groups had significantly greater pathological inflammatory changes in the gastric mucosa (P<0.05), significant reductions in the number and length of the jejunal microvilli and the number of epithelial desmosome junctions (P<0.05), a significant increase in the macula densa gap (P<0.05), and significant increases in the expression of MTL and CCK-8 in the feeding center (P<0.05), in a dose-dependent manner. CONCLUSIONS The degree of gastrointestinal structural injury and expression levels of MTL and CCK-8 in the feeding center are lead dose-dependent, which may be important mechanisms for changes in food intake, bowel movement, and digestive functions in offspring rats induced by embryonic lead exposure.
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Affiliation(s)
- Jian-Ping Zhou
- Department of Pediatrics, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an 710004, China.
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