Lead toxicity and chelation therapy

Lead Encephalopathy in a 73-year-old Man Manifesting as Acute Disturbance of Consciousness with a Unique Magnetic Resonance Imaging Appearance

A 73-year-old man was admitted with Cheyne-Stokes respiration and progressive disturbance of consciousness over the course of a month. Cranial magnetic resonance imaging (MRI) revealed signs suggestive of angioedema in the posterior limb of the internal capsule, external capsule, and subcortical white matter. Acute lead encephalopathy was diagnosed based on abnormally high plasma lead levels. After methylprednisolone pulse therapy followed by chelation therapy, the patient fully recovered. In this case, the angioedema with a distinctive magnetic resonance imaging appearance was attributed to the cytotoxic effects of lead on the nervous system, which responded well to methylprednisolone pulse therapy.

Synthesis, characterization, and environmental applications of graphene-coated sand: A review

Global water quality has deteriorated, leaving over 844 million individuals without access to clean drinking water. While sand filters (SF) offer a solution, their limited surface area and adsorption capacity for emerging contaminants remain a challenge. This has prompted the development of new materials such as graphene-coated sand (GCS) to enhance the sand's adsorptive properties. Notably, GCS also possesses inherent anti-bacterial properties and can function as a photocatalyst when exposed to UV and visible light, offering enhanced water purification. This manuscript 1) reviews the synthesis of GCS, detailing the characterization techniques employed to understand its structure, composition, and multifunctional properties and 2) highlights the superior efficacy of GCS in removing contaminants, including metals (>95 % removal of Cd2+, Pb2+, Zn2+, and Cu2+ in low pH environment), sulfides (full removal compared to 26 % removal by raw sand), antibiotics (98 % removal of tetracycline), and bacteria (complete cell membrane destruction), compared to traditional SF. Due to its enhanced performance and multifaceted purification capabilities, GCS presents a promising alternative to SFs, especially in developing countries, aiming to improve water quality and ensure safe drinking water access. To the best of our knowledge, no other work groups the available research on GCS. Furthermore, future research directions should focus on reducing the overall production cost of GCS, exploring surface modification techniques, and expanding the range of contaminants tested by GCS, to fully realize its potential in water purification.

Effect of Lactiplantibacillus plantarum CCFM8661 on serum metabolites and gut microbiota in a lead-exposed population

In this study, we investigated the impact of Lactiplantibacillus plantarum (L. plantarum) CCFM8661 on the gut microbiota, and the serum and fecal metabolomes in lead (Pb)-exposed individuals. The volunteers recruited for this study were divided into two treatment groups, (i) the placebo (control) and (ii) the L. plantarum CCFM8661 treatment groups. The analysis revealed that probiotic intervention reversed some of the changes in Pb exposure-induced intestinal bacterial abundance, including the abundance of Parabacteroides, Bacteroides, Clostridiaceae, and Erysipelotrichaceae. An analysis of the fecal metabolome identified 26 differential metabolites involved in purine metabolism, unsaturated fatty acid metabolism, and other pathways. Serum metabolite analysis showed that L. plantarum CCFM8661 treatment altered the serum metabolite levels of various metabolic pathways, such as the glycerophospholipid, amino acid, and glutathione metabolism pathways. These results suggest that L. plantarum CCFM8661 may have beneficial effects on Pb-exposed populations by modulating the gut microbiota, host serum metabolism, and the metabolism of the gut microbiota.

Environmentally relevant lead alters nuclear integrity in erythrocytes and generates oxidative stress in liver of Anabas testudineus: Involvement of Nrf2-Keap1 regulation and expression of biomarker genes

Genotoxic and hepatotoxic effects of lead (Pb) on a freshwater fish, climbing perch (Anabas testudineus) were studied at an environmentally relevant concentration (43.3 ppm). The genotoxic potential of Pb was confirmed by micronucleus study, with increased frequencies of erythrocytic nuclear alterations like lobed, blebbed, notched, fragmented, and micronuclei were observed in erythrocytes in treated groups as compared to control. Inorganic Pb induces oxidative stress which is a consequence of elevated level of Reactive Oxygen Species. Hepatotoxicity was assessed both by the oxidative stress and cellular responses that emerged due to the toxic assault of Pb in the liver, the most important detoxifying organ. Upregulation of xenobiotic metabolizing enzyme like catalase was evident after 15, 30, and 90 days of exposure, and a profound effect was observed on 30th days. The level of lipid peroxidation and reduced glutathione was increased after Pb exposure. Histoarchitectural damages of liver were distinctly evident in treated fish. Western blot analysis confirmed the expressional alterations of stress-responsive marker proteins like Nrf2, Keap1, Hsp70, and Nqo1. Pb exposure resulted in increased expression of Hsp70, Nrf2, and Nqo1, whereas Keap1 was downregulated, suggesting the involvement of Nrf2-Keap1 regulation as a cytoprotective mechanism against Pb toxicity.

Unmasking herbal medication-induced lead poisoning in a geriatric patient with gastrointestinal symptoms

Lead poisoning, often associated with occupational exposure, can also arise from intake of traditional and herbal medicines with high lead content. Geriatric patients displaying gastrointestinal symptoms from such sources are frequently misdiagnosed. An individual in his 70s reported to our geriatric clinic with vomiting, constipation and anaemia. A meticulous history unveiled his recent intake of herbal remedies. Heavy metal assay indicated elevated lead levels in his blood and urine, consistent with the high lead content we measured in the herbal medication. Following supportive treatment, nutritional supplementation and chelation therapy with calcium disodium EDTA, he improved. Follow-up tests indicated a decrease in lead levels and resolution of anaemia. This case emphasises the importance of considering lead poisoning as a potential diagnosis in patients with unexplained symptoms, particularly when there is a history of herbal or alternative medication intake. Timely recognition and appropriate management can lead to better outcome.

Succimer chelation does not produce lasting reductions of blood lead levels in a rodent model of retained lead fragments

Retained lead fragments from nonfatal firearm injuries pose a risk of lead poisoning. While chelation is well-established as a lead poisoning treatment, it remains unclear whether chelation mobilizes lead from embedded lead fragments. Here, we tested whether 1) DMSA/succimer or CaNa2EDTA increases mobilization of lead from fragments in vitro, and 2) succimer is efficacious in chelating fragment lead in vivo, using stable lead isotope tracer methods in a rodent model of embedded fragments. DMSA was > 10-times more effective than CaNa2EDTA in mobilizing fragment lead in vitro. In the rodent model, succimer chelation on day 1 produced the greatest blood lead reductions, and fragment lead was not mobilized into blood. However, with continued chelation and over 3-weeks post-chelation, blood lead levels rebounded with mobilization of lead from the fragments. These findings suggest prolonged chelation will increase fragment lead mobilization post-chelation, supporting the need for long-term surveillance in patients with retained fragments.

Possible implementation of salicylate anions in lead detoxification

The water-soluble coordination polymer of formula {[Pb(Sal)₂(H₂O)]_n} (SaLead), was obtained from the reaction between Pb(NO₃)₂ and the potassium salt of salicylic acid (SalH), an anti-inflammatory drug, which is also use as food preservation, in cosmetics etc. The compound was characterized by melting point, Attenuated Total Reflectance-Fourier Transform Infra-Red (ATR-FTIR) spectroscopy and X-ray diffraction crystallography (XRD) in solid state and in solution by Ultra Violet (UV) and ¹H NMR spectroscopies. The binding affinity of SalK to Pb(II) ions towards SaLead was determined in order to examine its possible implementation in lead detoxification. The in vitro non-toxic behaviour of SalK and its complex SaLead was evaluated against normal human fetal lung fibroblast cells (MRC-5). The corresponding IC₅₀ values are 260 ± 13 and > 1600 μM respectively. The non-genotoxic in vitro activity of SaLead was confirmed with the micronucleus (MN) assay, while its in vivo non-toxicity behaviour was evaluated with Allium cepa and Artemia salina assays.

A comprehensive review on pollution status and associated health risk assessment of human exposure to selected heavy metals in road dust across different cities of the world

In order to expound on the present situation and potential risk of road dust heavy metals in major cities, a total of 114 literatures mainly over the past two decades, involving more than 5000 sampling sites in 61 cities of 21 countries, were screened through the collection and analysis of research papers. The concentration, sources, distribution, health risk, sample collection, and analytical methods of heavy metal research on road dust in cities around the world are summarized. The results show that Cd, Zn, and Cu in many urban road dusts in the world are higher than the grade II of the Chinese maximum allowable concentration of potentially toxic elements in the soil. Geo-accumulation index values show that Pb > Cd > Zn > Cu had the highest contamination levels. Hazard index assessment indicates Pb and Cr had the highest potential health risk, especially for children in which ingestion was found as the main exposure pathway. Moreover, through comparative analysis, it is found that some pollutants are higher in developed and industrialized cities and transport (53%) followed by industrial emissions (35%) provide the major contributions to the sources of heavy metals.

Severe Abdominal Pain as a Presentation of Lead Poisoning: A Case Presentation

Background

Lead poisoning is a rare but serious disease. The clinical manifestations of lead poisoning are various and nonspecific, such as abdominal pain, headache, dizziness, nightmare, fatigue and so on. Rapid diagnosis of lead poisoning is challenging because it does not have special symptoms and the morbidity is very low.

Case Presentation

A 31-year-old woman presented with epigastric discomfort without any obvious cause. The patient was diagnosed with lead poisoning, as the blood levels of heavy metals were detected and the lead was 463.17 µg/L, which was very high (normal value was less than 100 µg/L). The patient was treated with intravenous drip of calcium sodium edentate and got better. The patient achieved good recovery and there was no recurrence.

Conclusion

Lead poisoning is a rare disease and easy to be misdiagnosed as acute abdomen disease when present with abdominal pain. Lead poisoning should be considered when common causes of abdominal pain are excluded, especially patients with anemia and abnormal liver function. The diagnosis of lead poisoning is mainly replied on the blood or urine lead concentrations. Then we should firstly cut off the contact with lead and use metal complexing agent to facilitate lead excretion.

Exposure Sources Among Veterans With Elevated Blood Lead Levels, United States, 2015‒2021

Objectives. To determine characteristics and sources of exposure in veterans with elevated blood lead levels (BLLs). Methods. We included users of US Veterans Health Administration care aged 18 years or older tested for BLL from October 2015 to September 2021. Prevalence of BLL 10 micrograms per deciliter (µg/dL) or higher and 25 µg/dL or higher was determined within demographic groups. Logistic regression analysis measured association of International Classification of Diseases, Tenth Revision, Clinical Modification‒coded conditions with elevated BLL. Electronic notes were reviewed for exposure sources. Results. Among 1007 unique veterans with BLL 10 µg/dL or higher, prevalence of BLL 10 µg/dL or higher and 25 µg/dL or higher peaked at 4.9 and 1.3 per 100 000 veterans, respectively (fiscal year 2019), and was highest in non-Hispanic White men and those aged 25 to 34 years. Conditions predicted by elevated BLL were attention-deficit/hyperactivity disorder (ADHD) and nausea or vomiting. Firearms represented 70.1% of occupational and 85.9% of nonoccupational exposures. Toxicology consults occurred in 17 of 298 (6%) with BLL 25 µg/dL or higher. Conclusions. Firearms were the largest exposure source among veterans with elevated BLL. Clinicians should be alert for potential conditions (including ADHD and nausea or vomiting in our study) associated with lead exposure. Standardization of care regarding toxicology referral practices is warranted. (Am J Public Health. 2022;112(S7):S670-S678. https://doi.org/10.2105/AJPH.2022.306936).

Sodium para-aminosalicylic acid ameliorates lead-induced hippocampal neuronal apoptosis by suppressing the activation of the IP3R-Ca2+-ASK1-p38 signaling pathway

Lead (Pb) is a naturally occurring heavy metal, which can damage the brain and affect learning and memory. Sodium para-aminosalicylic acid (PAS-Na), a non-steroidal anti-inflammatory drug, can readily cross the blood-brain barrier. Our previous studies have found that PAS-Na alleviated Pb-induced hippocampal ultrastructural damage and neurodegeneration, but the mechanism has yet to be defined. Here, we investigated the molecular mechanisms that mediate Pb-induced apoptosis in hippocampal neurons, and the efficacy of PAS-Na in alleviating its effects. This work showed that juvenile developmental Pb exposure impaired rats cognitive ability by inducing apoptotic cell death in hippocampal neurons. Pb-induced neuronal apoptosis was accompanied by increased inositol 1,4,5-trisphosphate receptor (IP₃R) expression and enhanced intracellular calcium [Ca²⁺]_i levels, which resulted in increased phosphorylation of neuronal apoptosis signal-regulating kinase 1 (ASK1) and p38. Activation of ASK1 and p38 was blocked by IP₃R inhibitor and a Ca²⁺ chelator. Importantly, PAS-Na treatment improved the Pb-induced effects on cognitive deficits in rats, concomitant with rescued neuronal apoptosis. In addition, PAS-Na reduced the expression of IP₃R and the ensuing increase in intracellular Ca²⁺ and decreased the phosphorylation of ASK1 and p38 in Pb-exposed neurons. Taken together, this study demonstrates that the IP₃R-Ca²⁺-ASK1-p38 signaling pathway mediates Pb-induced apoptosis in hippocampal neurons, and that PAS-Na, at a specific dose-range, ameliorates these changes. Collectively, this study sheds novel light on the cellular mechanisms that mediate PAS-Na efficacy, laying the groundwork for future research to examine the treatment potential of PAS-Na upon Pb poisoning.

Two cases of lead poisoning associated with occupational exposure presented as intestinal obstruction: a case report

Lead exposure in India is common in industries that may present with nonspecific signs and symptoms or symptoms of toxicity, depending on the amount of lead absorbed. We are presenting two case reports of occupational lead exposure in a lead-based battery manufacturing unit, which were presented as intestinal obstruction. Both the patients aged 28 and 24-year old presented with complaints of pain in the abdomen with blood lead levels of 61.1 and 85 μg/dl, respectively. The diagnosis was made clinically before any other radiological investigation or intervention. Both the patients were treated conservatively with D-Penicillamine, following which, both the patients improved symptomatically and the blood lead level also decreased. The importance of a detailed history of occupation & clinically diagnosing such patient will avoid unnecessary investigation and intervention. This will help to reach the correct diagnosis in such cases.

Children's exposure to environmental lead: A review of potential sources, blood levels, and methods used to reduce exposure

Lead has been used for thousands of years in different anthropogenic activities thanks to its unique properties that allow for many applications such as the manufacturing of drinking water pipes and its use as additives to gasoline and paint. However, knowledge of the adverse impacts of lead on human health has led to its banning from several of its applications, with the main goal of reducing environmental pollution and protecting human health. Human exposure to lead has been linked to different sources of contamination, resulting in high blood lead levels (BLLs) and adverse health implications, primarily in exposed children. Here, we present a summary of a literature review on potential lead sources affecting blood levels and on the different approaches used to reduce human exposure. The findings show a combination of different research approaches, which include the use of inspectors to identify problematic areas in homes, collection and analysis of environmental samples, different lead detection methods (e.g. smart phone applications to identify the presence of lead and mass spectrometry techniques). Although not always the most effective way to predict BLLs in children, linear and non-linear regression models have been used to link BLLs and environmental lead. However, multiple regressions and complex modelling systems would be ideal, especially when seeking results in support of decision-making processes. Overall, lead remains a pollutant of concern and many children are still exposed to it through environmental and drinking water sources. To reduce exposure to lead through source apportionment methods, recent technological advances using high-precision lead stable isotope ratios measured on multi-collector induced coupled plasma mass spectrometry (MC-ICP-MS) instruments have created a new direction for identifying and then eliminating prevalent lead sources associated with high BLLs.

Tb3+ luminescence cholate hydrogel-based multi-functionalized platform for Hg2+ and NO2 detection

In this paper, Tb3+ luminescence cholate hydrogel (Tb3+/hydrogel) was selected as a multi-functionalized platform, and PS-BD@Tb3+/hydrogel or PS-BS@Tb3+/hydrogel systems were fabricated respectively for selective detecting of Hg2+ in water and...

Temporal changes in arsenic and lead pools in a contaminated sediment amended with biochar pyrolyzed at different temperatures

Globally, tons of soils and sediments are experiencing degradation due to the presence of high concentrations of potentially toxic elements (PTEs), such as arsenic (As) and lead (Pb), in areas in the vicinity of metal mining activities. The addition of biochar to contaminated sediments is a promising in situ remediation approach, and the effects of pyrolysis temperature and biochar aging are important factors for the immobilization and fate of PTEs. In this study, we evaluated the temporal changes in pools of As and Pb in sediment amended with biochars produced from sugarcane (Saccharum officinarum) pyrolyzed at 350 (BC350), 550 (BC550), and 750 °C (BC750). Biochars were aged by natural process (without additional acid or heat), and changes in As and Pb pools were evaluated every 45 days until completing 180 days of incubation. Changes in the As and Pb pools were extracted with water (bioavailable), magnesium chloride (exchangeable), nitric acid (active geochemical fraction), and exchangeable Mehlich-3 (associated with organic matter). As and Pb available contents have increased over time. BC750 was more effective in reducing the bioavailable and exchangeable As contents, while BC550 and BC350 were more effective in reducing the contents of bioavailable and exchangeable Pb.

On the Quantum Chemical Nature of Lead(II) “Lone Pair”

We study the quantum chemical nature of the Lead(II) valence basins, sometimes called the lead “lone pair”. Using various chemical interpretation tools, such as molecular orbital analysis, natural bond orbitals (NBO), natural population analysis (NPA) and electron localization function (ELF) topological analysis, we study a variety of Lead(II) complexes. A careful analysis of the results shows that the optimal structures of the lead complexes are only governed by the 6s and 6p subshells, whereas no involvement of the 5d orbitals is found. Similarly, we do not find any significant contribution of the 6d. Therefore, the Pb(II) complexation with its ligand can be explained through the interaction of the 6s² electrons and the accepting 6p orbitals. We detail the potential structural and dynamical consequences of such electronic structure organization of the Pb (II) valence domain.

Adult Lead Poisoning Caused by Contaminated Opium: A Two-Year Longitudinal Follow-Up Study

Background:

A major episode of lead poisoning caused by lead-adulterated opium occurred in Iran in 2016. Patients were removed from exposure and treated with chelating agents. A subset of those patients was evaluated in this follow-up study to evaluate treatment efficacy in relation to patient outcome.

Methods:

Between March 2016 and December 2017, thirty-five male cases of lead poisoning due to ingestion of lead-adulterated opium were followed for two years. There are three patient groups: 1) those who abstained from opium use; 2) those who continued to use potentially contaminated opium; and 3) those who abstained from opium and were placed on maintenance therapy. Maintenance therapy included: methadone and opium tincture, offered by the Opioid Maintenance Therapy (OMT) clinics. Amongst the three patient groups Blood Lead Levels (BLL), complete blood count, and kidney and liver function tests were compared.

Findings:

The results of BLL, hemoglobin, hematocrit, and aspartate aminotransferase were significantly different between the admission time and follow-up. Of the three patient groups, no difference was detected in these measures.

Conclusions:

Treatment of lead poisoning combined with OMT proved an effective method to prevent recurrent lead poisoning.

N,N'bis-(2-mercaptoethyl) isophthalamide (NBMI) exerts neuroprotection against lead-induced toxicity in U-87 MG cells

N,N'-bis(2-mercaptoethyl)isophthalamide (NBMI) is a novel lipophilic heavy metal chelator and thiol redox antioxidant. This study was designed to investigate the neuroprotective activity of NBMI in U-87 MG cells exposed to lead acetate (PbAc). Cells were pretreated with NBMI for 24 h prior to a 48 h exposure to PbAc. Cell death (55%, p < 0.0001) and reduction of intracellular GSH levels (0.70-fold, p < 0.005) induced by 250 µM Pb were successfully attenuated by NBMI pretreatment at concentrations as low as 10 µM. A similar pretreatment with the FDA-approved Pb chelator dimercaptosuccinic acid (DMSA) proved ineffective, indicating a superior PKPD profile for NBMI. Pretreatment with NBMI successfully counteracted Pb-induced neuroinflammation by reducing IL-1β (0.59-fold, p < 0.05) and GFAP expression levels. NBMI alone was also found to significantly increase ferroportin expression (1.97-fold, p < 0.05) thereby enhancing cellular ability to efflux heavy metals. While no response was observed on the apoptotic pathway, this study demonstrated for the first time that necrotic cell death induced by Pb in U-87 MG cells is successfully attenuated by NBMI. Collectively these data demonstrate NBMI to be a promising neuroprotective compound in the realm of Pb poisoning.

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.

Potent Cyclic Tetrapeptide for Lead Detoxification

Lead (Pb) is a ubiquitous poisonous metal, affecting the health of vast populations worldwide. Medications to treat Pb poisoning suffer from various limitations and are often toxic owing to insufficient metal selectivity. Here, we report a cyclic tetrapeptide that selectively binds Pb and eradicates its toxic effect on the cellular level, with superior potency than state-of-the-art drugs. The Pb-peptide complex is remarkably strong and was characterized experimentally and computationally. Accompanied by the lack of toxicity and enhanced stability of this peptide, these qualities indicate its merit as a potential remedy for Pb poisoning.

Effect of chelation therapy on arrhythmogenic and basal ECG parameters of lead exposed workers

Lead exposure has etiological role on cardiovascular system diseases as hypertension, atherosclerosis, stroke, and arrhythmic events. In this study, we aimed to compare the basal and arrhythmogenic ECG parameters of lead exposed workers before and after chelation therapy and to evaluate the effect of acute change of blood lead levels on ECG. Fourty consecutive occupationally lead exposed workers were enrolled, demographic, blood, echocardiographic, and electrocardiographic data's were analyzed before and after chelation therapy. Pmax, P min, P Wave Dispersion, and QT Dispersion values which are arrhythmia predictors were significantly lower after chelation therapy compared to values before chelation therapy. Lead exposed workers are under the risk of ventricular and atrial arrythmias and chelation treatment has a positive effect on these parameters.

Sustainability in Perovskite Solar Cells

At a current value of 25.5%, perovskites have reached some of the highest power conversion efficiencies of all single-junction solar cell devices. Researchers, however, are questioning their readiness for the commercial market, citing reasons of the toxicity of the lead-based active layer and instability. Closer examination of the life cycle of perovskite solar cells reveals that there are more areas than just these which should be addressed in order to bring an environmentally friendly and sustainable technology to global use. In this review, we discuss these issues. Life cycle analyses show that high temperature processes, heavy use of organic solvents, and extensive use of certain materials can have high up and downstream consequences in terms of emissions, human and ecotoxicity. We further bring attention to the toxicity of the perovskites themselves, where the most direct analyses suggest that the lead cannot be considered totally safe, despite its small quantity and that replacements such as tin may be more toxic in certain scenarios. As a way to reduce the negative environmental impact, we highlight ways in which researchers have used encapsulation and recycling to extend the life of the entire unit and its components and to prevent lead leakage. We hope this review directs researchers toward new strategies to introduce a clean solar technology to the world.

Potentiometric extractive sensing of lead ions over a nickel oxide intercalated chitosan-grafted-polyaniline composite

The present research paper reports the extractive potentiometric sensing of lead ions over a chemically functionalized ternary nanocomposite of nickel oxide intercalated chitosan grafted polyaniline (NiO-in-CHIT-g-PANI) prepared by the in situ chemical polymerization and composite formation technique under optimized conditions. The structural, morphological, and physical properties of the composite material were investigated by Fourier transform infrared (FT-IR) spectroscopy, X-ray diffraction (XRD), scanning electron microscopy (SEM), and other suitable ASTM methods. The obtained analytical result suggests the formation of a porous hybrid composite matrix with better electrical conductivity ∼ 5.25 × 10^-3 S cm^-1, free interactive carbonyl sites, and evolved aligned crystallinity. Furthermore, a film of the synthesized composite was cast on ITO coated glass by the spin coating technique for potentiometric sensing and the recovery of adsorbed Pb²⁺ ions from natural and artificial water solutions. Under optimum conditions of ∼pH = 7.0 and a temperature of 25 °C, the electrode exhibited potential responses for Pb²⁺ ions in concentrations ranging from 1.0 × 10^-6 M to 1 × 10^-3 M along with a sensitivity of 0.2379 mV μM^-1 cm^-2, response time of 40 s, recovery time of 10 s, and stability for 64 days. The adsorbed Pb²⁺ ions were recovered at a rate of 84% after applying an optimized reverse voltage on the above-used electrodes. The adsorption and desorption mechanism has been explained based on the induced potential due to the electrochemical surface interaction between Pb²⁺ and the NiO-in-CHIT-g-PANI based electrode. The analytical application of the fabricated electrode in the real sample was also explored for the sensing and recovery of the respective metal ions in wastewater samples along with the possibility of optimization of the required metal concentrations.

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 poisoning; a neglected potential diagnosis in abdominal pain

Background

Abdominal pain may be a presenting symptom of lead poisoning and is often difficult to diagnose. This study aimed to determine the prevalence of abdominal pain in patients seen in the Laghman Hakim Hospital ED and GI clinic who were lead-intoxicated, with or without opiate use disorder.

Methods

Between July 2017 and January 2018, patients seen in the ED and GI clinic of Loghman Hakim Hospital with unexplained abdominal pain or abdominal pain resistant to treatment were enrolled. Informed consent was obtained from potential enrollees. For standardization, a pre-designed data collection tool was developed for uniform data acquisition. Opiate use was determined historically. For this study, lead poisoning was defined as a blood lead level (BLL) greater than or equal to 30 μg/dL (1.45 μmol/L) with concomitant GI symptoms.

Results

Of 125 patients admitted, 28 (22.4%) had BLLs higher than 30 μg/dL. None of the patients had signs and symptoms of opioid withdrawal syndrome during evaluation. Elevated BLLs were significantly correlated with oral opium use/abuse, history of addiction for over the preceding 12 years. The daily opium use was more than 2.75 g. There was a statistical correlation between lead toxicity and abdominal pain consistency and intensity, constipation, and paresthesias. Anemia, leukocytosis, and abnormal liver enzyme tests were laboratory findings associated with lead toxicity. Four patients died, one of whom was diagnosed with lead toxicity.

Conclusion

Lead toxicity should be considered in the potential differential diagnosis of severe and resistant abdominal pain in patients referring to general EDs or GI clinics if a positive history of opium abuse exists.

Medical Devices for Low- and Middle-Income Countries: A Review and Directions for Development

The development of diagnostics and medical devices has historically been concentrated in high-income countries, despite a significant need to expand healthcare services to low- and middle-income countries (LMIC). Poor quality healthcare extends beyond LMIC to underserved communities in developed countries. This paper reviews diseases and conditions that have not received much attention in the past despite imposing a significant burden on healthcare systems in these circumstances. We review the underlying mechanism of action of these conditions and current technology in use for diagnosis or surgical intervention. We aim to identify areas for technological development and review policy considerations that will enable real-world adoption. Specifically, this review focuses on diseases prevalent in sub-Saharan Africa and south Asia: melioidosis, infant and maternal mortality, schistosomiasis, and heavy metal and pesticide poisoning. Our aim with this review is to identify problems facing the world that require the attention of the medical device community and provide recommendations for research directions for groups interested in this field.

New effective 3-aminopropyltrimethoxysilane functionalized magnetic sporopollenin-based silica coated graphene oxide adsorbent for removal of Pb(II) from aqueous environment

A new effective adsorbent, 3-aminopropyltrimethoxysilane functionalized magnetic sporopollenin (MSp@SiO₂NH₂) based silica-coated graphene oxide (GO), (GO@SiO₂-MSp@SiO₂NH₂) was successfully synthesized and applied for the first time in the removal of hazardous Pb(II) ions from aqueous solution. The properties of the composite were characterized using Fourier-transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), field emission scanning electron microscopy (FESEM), energy-dispersive X-ray spectroscopy (EDX) and vibrating-sample magnetometery (VSM). Evaluation of GO@SiO₂-MSp@SiO₂NH₂ adsorption performance at optimum conditions revealed that the adsorbent has a maximum adsorption capacity of 323.5 mg/g for Pb(II) using 50-200 mg/L initial Pb(II) ions concentrations. Initial and final concentrations of Pb(II) ions in aqueous solution were analyzed using graphite furnace atomic absorption spectroscopy (GF-ASS). The adsorption behavior of Pb(II) ions onto GO@SiO₂-MSp@SiO₂NH₂ was studied using Langmuir, Freundlich and Temkin isotherms models. The values of coefficient of determination showed that the adsorption best fitted the Langmuir model (R² = 0.9994). Kinetic studies suggested that the adsorption of Pb(II) ion followed a pseudo-second-order rate model (R² = 1.00) and thermodynamic studies revealed that the adsorption process is endothermic and spontaneous. The effect of co-existing ions on Pb(II) ion adsorption were also studied and found to have considerable effects only at higher matrix concentration. The adsorbent can be reused up to ten times and retain its good adsorption capacity. In addition, GO@SiO₂-MSp@SiO₂NH₂ showed great potential for Pb(II)removal from industrial wastewater samples.

Novel formation of Au/Ag bimetallic nanoparticles from a mixture of monometallic nanoparticles and their application for the rapid detection of lead in onion samples

Characterization of gold, silver and gold/silver bimetallic nanoparticles for colorimetric detection of lead in onion samples.

Formation and Stability of Nontoxic Perovskite Precursor

Strontium, calcium, and magnesium silicate hydrate phases are synthesized by the reaction between silica and solution of metal hydroxides. The kinetics of the reaction is recorded using a quartz crystal microbalance (QCM), continuously monitoring the change in frequency and dissipation energy. Based on QCM results, it is shown that properties of solutions like the pH-value or the type of ions play a pivotal function on the rate-determining stage of the reaction, the thickness of the diffuse layer, the formation of carbonates, as well as the kinetics of the formed phases. Further properties of the reaction products are investigated using X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and infrared spectroscopy (IR). With the help of thermogravimetric analysis (TGA) and temperature-dependent X-ray diffraction (XRD), we investigate how our synthesized phases can be turned into MSiO₃ structures. Finally, the Goldschmidt rules for perovskites structures show that this might be an attractive way for new and nontoxic phases in the future.

Rebalancing metal dyshomeostasis for Alzheimer's disease therapy

Alzheimer's disease (AD) is a type of neurodegenerative malady that is associated with the accumulation of amyloid plaques. Metal ions are critical for the development and upkeep of brain activity, but metal dyshomeostasis can contribute to the development of neurodegenerative diseases, including AD. This review highlights the association between metal dyshomeostasis and AD pathology, the feasibility of rebalancing metal homeostasis as a therapeutic strategy for AD, and a survey of current drugs that action via rebalancing metal homeostasis. Finally, we discuss the challenges that should be overcome by researchers in the future to enable the practical use of metal homeostasis rebalancing agents for clinical application.

Heavy metal toxicity: An update of chelating therapeutic strategies

AIM

This review illustrates heavy metals toxicity, currently available therapies and the role and efficacy of chelation therapy for its management.

SUMMARY

Heavy metals are necessary for various biological processes, but they become harmful in excess. Specifically, they induce oxidative stress by generating free radicals and reducing antioxidant levels. Heavy metals also alter the confirmation of protein and DNA and inhibit their function. Chelation therapy is commonly used to treat metals toxicity. Chelation is a chemical process that occurs when interaction between a central metal atom/ion and ligand leads to formation of a complex ring-like structure. The ligand has a donor ion/molecule, which has a lone pair of electrons and may be monodentate to polydentate. Each metal has a different reactivity with a ligand, so a specific chelation agent is required for each metal. Combination therapy with a chelating agent and an antioxidant led to improved outcome.

CONCLUSION

Heavy metal poisoning is a common health problem because of mining, smelting, industrial, agricultural and sewage waste. Heavy metals can be efficiently excreted from the body following treatment with proper chelation agents.

Reflective Fiber Surface Plasmon Resonance Sensor for High-Sensitive Mercury Ion Detection

This paper proposes a reflective fiber mercury ion sensor based on the surface plasmon resonance (SPR) principle and chitosan (CS)/polyacrylic acid (PAA) multilayer sensitive film. By optimizing the coating parameters of the gold film, the refractive index (RI) sensitivity of the reflective SPR sensor is demonstrated to be 2110.33 nm/RIU. Then, a multi-layer CS/PAA film is fixed on the surface of the gold film as a mercury ion sensitive film to form a reflective SPR fiber mercury ion sensor. Experimental results demonstrate that the sensor can be used to detect different concentrations of mercury ions with a high sensitivity of 0.5586 nm/μM and good specificity and repeatability. Therefore, the reflective SPR fiber mercury ion sensor shows great promise for future applications of environmental monitoring and drinking water safety.

Reversing the adverse biochemical effects in lead-intoxicated rats by N,N`- bis[(1,2-didehydro-1-hydroxy-2-thioxopyrid-4-yl)-carbonyl]- L-lysine

N,N`-Bis[(1,2-didehydro-1-hydroxy-2-thioxopyrid-4-yl)-carbonyl]- L-lysine (HTPL) is a novel newly synthesized compound intended to be used for the chelation of lead in intoxicated animals. Subchronic lead intoxication experiments were carried out on Wistar male rats; these rats were intoxicated with lead and then treated with HTPL. Results were compared with those obtained with known compounds used for lead chelation therapy, such as disodium ethylnediaminetetraacetic acid (CaNa₂EDTA) and meso-2,3-dimercaptosuccininc acid (DMSA), using different routes of administration. Biological samples of whole blood and urine were collected and analyzed for urinary proporphyrins, δ-aminolevulinic acid dehydratase, and zinc protoporphyrin. Results revealed that HTPL can remarkably reverse the toxic effects of lead intoxication at biochemical levels. Additionally, results showed that this agent is as good or even more potent than calcium disodium ethylnediaminetetraacetic acid (CaNa₂EDTA) and meso-2,3-dimercaptosuccininc acid (DMSA) in reversing the toxic effect of lead. More importantly, HTPL was found effective when administrated intraperitoneally and orally.

Immobilization of cadmium and lead by Lactobacillus rhamnosus GR-1 mitigates apical-to-basolateral heavy metal translocation in a Caco-2 model of the intestinal epithelium

Heavy metals are highly toxic elements that contaminate the global food supply and affect human and wildlife health. Purification technologies are often too expensive or not practically applicable for large-scale implementation, especially in impoverished nations where heavy metal contamination is widespread. Lactobacillus rhamnosus GR-1 (LGR-1) was shown in previous work to reduce heavy metal bioaccumulation in a Tanzanian cohort of women and children through indeterminant mechanisms. Here, it was hypothesized that LGR-1 could sequester the heavy metals lead (Pb) and cadmium (Cd), thereby reducing their absorption across intestinal epithelium. LGR-1 and other lactobacilli significantly reduced the amount of Pb and Cd in solution at all concentrations tested (0.5 mg/L - 50 mg/L) and exhibited sustained binding profiles over a 48-hour period. Relative binding efficiency of LGR-1 decreased as Pb concentration increased, with an absolute minimum binding threshold apparent at concentrations of 2 mg/L and above. Electron microscopy revealed that Pb formed irregular cell-surface clusters on LGR-1, while Cd appeared to form intracellular polymeric clusters. Additionally, LGR-1 was able to significantly reduce apical-to-basolateral translocation of Pb and Cd in a Caco-2 model of the intestinal epithelium. These findings demonstrate the absorbent properties of LGR-1 can immobilize Pb and Cd, effectively reducing their translocation across the intestinal epithelium in vitro. Oral administration of heavy metal-binding Lactobacillus spp. (many of which are known human symbionts and strains of established probiotics) may offer a simple and effective means to reduce the amount of heavy metals absorbed from foods in contaminated regions of the world.

Chronic exposure to low concentrations of lead induces metabolic disorder and dysbiosis of the gut microbiota in mice

Lead (Pb) is one of the most prevalent toxic, nonessential heavy metals that can contaminate food and water. In this study, effects of chronic exposure to low concentrations of Pb on metabolism and gut microbiota were evaluated in mice. It was observed that exposure of mice to 0.1mg/L Pb, supplied via drinking water, for 15weeks increased hepatic TG and TCH levels. The levels of some key genes related to lipid metabolism in the liver increased significantly in Pb-treated mice. For the gut microbiota, at the phylum level, the relative abundance of Firmicutes and Bacteroidetes changed obviously in the feces and the cecal contents of mice exposed to 0.1mg/L Pb for 15weeks. In addition, 16s rRNA gene sequencing further discovered that Pb exposure affected the structure and richness of the gut microbiota. Moreover, a ¹H NMR metabolic analysis unambiguously identified 31 metabolites, and 15 metabolites were noticeably altered in 0.1mg/L Pb-treated mice. Taken together, the data indicate that chronic Pb exposure induces dysbiosis of the gut microbiota and metabolic disorder in mice.

CAPSULE

Chronic Pb exposure induces metabolic disorder, dysbiosis of the gut microbiota and hepatic lipid metabolism disorder in mice.

Environmental Lead and Wild Birds: A Review

Lead is a persistent inorganic environmental pollutant that affects humans and animals worldwide. Avian species are especially susceptible to lead exposure through consumption of lead ammunition, lead fishing tackle, and other contaminated food sources such as aquatic species ingesting lead contaminated sediments in mining areas. Even with government regulations on the use of lead ammunition in many countries, including the United States, terrestrial, aquatic, predatory, and scavenger avian species are still at risk of exposure to potentially lethal concentrations of lead. The toxicities seen in these avian species include increased oxidative stress and decreased anti-oxidant enzymes in hepatic and renal tissue. The avian immune system is also a target of lead and displays a number of altered functions suggestive of immune suppression; however, studies in wildlife and laboratory species remain too limited for definitive statements with regard to population risk. In contrast, lead clearly inhibits reproductive capabilities in adult birds, and alters growth and development of hatchlings. Environmental remediation for lead removal, which would lower toxic exposure in wildlife, presently is a monumental and prohibitively expensive effort. Wildlife exposure will therefore continue in contaminated areas, necessitating development of new remediation practices. These plans should aim toward limiting more widespread or heavier contamination of wildlife habitats. This chapter reviews presently available information of lead toxicity in wild bird species, and suggests continued monitoring and reduction strategies to reduce lead exposure for at-risk avian populations.

Synthesis and characterization of new 1-hydroxy-2-pyridinethione derivatives: Their lead complexes and efficacy in the treatment of acute lead poisoning in rats

A number of new mono- and dihydroxypyridinethione ligands have been synthesized via reaction of dimethylamine and amino acid esters with the active amide obtained from the reaction of 1-hydroxy-2-pyridinethione-4-carboxylic acid (1) and 1,1'-carbonyldiimidazole in DMF. Moreover, the lead complexes of these new ligands were also prepared. Structures of the newly synthesized compounds have been confirmed by different spectroscopic methods such as IR, ¹H NMR, and ¹³C NMR, and by elemental analysis. The effect of these synthesized ligands on the excretion of lead, iron, and zinc, and their distribution in kidneys, liver, and bones in acutely intoxicated rats was investigated and results, for lead, were compared with those of the known drug meso-2,3-dimercaptosuccinic acid (DMSA). Results obtained revealed that compound 5 exhibits remarkable ability in total fecal and urinary excretion of lead and was superior to DMSA. In addition, results show that the concentration of lead in soft tissues and bones was lower in rats treated with HTPL than those treated with DMSA. Furthermore, the concentration of lead in liver tissues obtained from sub-chronic lead-intoxicated rats treated with HTPL was lower than those treated with DMSA and calcium disodium ethylenediaminetetraacetic acid (CaNa₂EDTA).

Milk and Dairy Products Intake Is Associated with Low Levels of Lead (Pb) in Workers highly Exposed to the Metal

Lead (Pb) is a toxic metal, frequently associated with occupational exposure, due to its widespread use in industry and several studies have shown high Pb levels in workers occupationally exposed to the metal. The aim of this study was to evaluate the influence of milk and dairy products (MDP) on Pb levels in blood (B-Pb), plasma (P-Pb), and urine (U-Pb), in workers from automotive battery industries in Brazil. The study included 237 male workers; information concerning diet and lifestyle were gathered through a questionnaire, and B-Pb, P-Pb, and U-Pb were determined by ICP-MS. Mean B-Pb, P-Pb, and U-Pb were 21 ± 12, 0.62 ± 0.73 μg/dL, and 39 ± 47 μg/g creatinine, respectively. Forty three percent of participants declared consuming ≤3 portions/week of MDP (classified as low-MDP intake), while 57% of individuals had >3portions/week of MDP (high-MDP intake). B-Pb and P-Pb were correlated with working time (r _s  = 0.21; r _s  = 0.20; p < 0.010). Multivariable linear regressions showed a significant influence of MDP intake on B-Pb (β = -0.10; p = 0.012) and P-Pb (β = -0.16; p < 0.010), while no significance was seen on U-Pb. Our results suggest that MDP consumption may modulate Pb levels in individuals highly exposed to the metal; these findings may be due to the Pb-Ca interactions, since the adverse effects of Pb are partially based on its interference with Ca metabolism and proper Ca supplementation may help to reduce the adverse health effects induced by Pb exposure.

A miniaturized bismuth-based sensor to evaluate the marine organism Styela plicata bioremediation capacity toward heavy metal polluted seawater

Cadmium and lead are highly toxic heavy metals which cause a severe worldwide pollution. In addition to the toxic effect produced by the direct exposure, they can be bioconcentrated and accumulated in living organisms, including humans. Herein, a miniaturized and disposable electrochemical sensor was improved for the simultaneous detection of cadmium and lead ions to study the bioremediation of polluted seawater in presence of the filter-feeding marine organism Styela plicata. A screen-printed electrode modified in situ with a bismuth film was selected using the anodic stripping analysis as detection technique. This sensor was coupled with a portable potentiostat and the detection of cadmium and lead ions was carried out by Square Wave Anodic Stripping Voltammetry, allowing the simultaneous detection of both heavy metals at ppb level (LOD=0.3ppb for lead, 1.5ppb for cadmium). This analytical tool was then applied to assess the bioremediation capacity of S. plicata through a bioremediation experiment, in which the organism has been exposed to seawater artificially polluted with 1000ppb of Cd²⁺ and Pb²⁺. The matrix effect of both seawater and acid digested biological samples was evaluated. A bioconcentration phenomenon was observed for both heavy metals through the analysis of S. plicata tissues. In details, Pb²⁺ resulted to be about 2.5 times more bioconcentrated than Cd²⁺, giving an effective bioremediation level in seawater of 13% and 40% for Cd²⁺ and Pb²⁺, respectively. Thus, our results demonstrate the capability of S. plicata to bioremediate Cd²⁺ and Pb²⁺ polluted seawater as well as the suitability of the electrochemical sensor for contaminated marine environment monitoring and bioremediation evaluation.

Lead-Induced ERK Activation Is Mediated by GluR2 Non-containing AMPA Receptor in Cortical Neurons

Lead is a persistent environmental pollutant and exposure to high environmental levels causes various deleterious toxicities, especially to the central nervous system (CNS). The α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor that is devoid of the glutamate receptor 2 (GluR2) subunit is Ca²⁺-permeable, which increases the neuronal vulnerability to excitotoxicity. We have previously reported that long-term exposure of rat cortical neurons to lead acetate induces decrease of GluR2 expression. However, it is not clarified whether lead-induced GluR2 decrease is involved in neurotoxicity. Therefore, we investigated the contribution of GluR2 non-containing AMPA receptor to lead-induced neurotoxic events. Although the expression of four AMPA receptor subunits (GluR1, GluR2, GluR3, and GluR4) was decreased by lead exposure, the decrease in GluR2 expression was remarkable among four subunits. Lead-induced neuronal cell death was rescued by three glutamate receptor antagonists, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX, a non-selective AMPA receptor blocker), MK-801 (N-methyl-D-aspartate (NMDA) receptor blocker), and 1-naphthyl acetyl spermine (NAS, a specific Ca²⁺-permeable AMPA receptor blocker). Lead exposure activated extracellular signal-regulated protein kinase (ERK) 1/2, which was significantly ameliorated by CNQX. In addition, lead exposure activated p38 mitogen-activated protein kinase (MAPK p38), and protein kinase C (PKC), which was partially ameliorated by CNQX. Our findings indicate that Ca²⁺-permeable AMPA receptors resulting from GluR2 decrease may be involved in lead-induced neurotoxicity.