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Akhgarandouz S, Moshiri M, Etemad L, Dadpour B, Khadem-Rezaiyan M, Vahdati-Mashhadian N. Effect of oral naloxone on opioid-induced constipation in methadone maintenance treatment patients, a double-blind, placebo-control, clinical trial. Ir J Med Sci 2024; 193:1807-1815. [PMID: 38502432 DOI: 10.1007/s11845-024-03652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Opioid-induced constipation (OIC) is the most prevalent side effect of methadone maintenance therapy (MMT). Naloxone could reduce the OIC. METHOD Fifty-six MMT cases (< 75 mg/day methadone, > 3 months) were entered randomly into four groups of a trial. They received placebo or naloxone tablets (0.5, 2, or 4 mg/day) once a day for 2 weeks. They continued their conventional laxative. Their constipation and opiate withdrawal (OWS) were evaluated by the Bristol Stool Form Scale (stool consistency and frequency), Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire, Constipation Scoring System (CSS), and the Subjective Opiate Withdrawal Scale (SOWS) before starting treatment and at the end of the first and second weeks. RESULTS The dose of 4 mg/day naloxone was excluded from the study due to severe OWS. The precipitants of groups had similar ages, methadone dose and duration, laxative use, and constipation scores at the start of the trial. However, 2 mg of naloxone could change the stool consistency (PV = 0.0052) and frequency (P = 0.0133), 0.5 mg/day dose only improved the stool consistency (P = 0.0016). The patients' CSS and PAC-SYM scores were reduced by naloxone after the 1st week of treatment. However, there was no significant difference in the mean score of SOWS at different assessment times and groups. Also, 3 and 4 cases of 0.5 and 2 mg/day groups, respectively, withdrew from the study due to OWS. CONCLUSION Oral naloxone at doses of 0.5 and 2 mg/day was significantly more effective than placebo on OIC in MMT. However, the dose of 4 mg induced intolerable OWS.
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Affiliation(s)
| | - Mohammad Moshiri
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Etemad
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Dadpour
- Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Community medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasser Vahdati-Mashhadian
- Department of Pharmacodynamics and Toxicology, Mashhad University of Medical Sciences, Mashhad, Iran.
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2
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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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3
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Jing H, Zhang Q, Li S, Gao XJ. Pb exposure triggers MAPK-dependent inflammation by activating oxidative stress and miRNA-155 expression in carp head kidney. FISH & SHELLFISH IMMUNOLOGY 2020; 106:219-227. [PMID: 32781208 DOI: 10.1016/j.fsi.2020.08.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
Lead (Pb) is a toxic heavy metal and an aquatic pollutant. Various amounts of heavy metals are released into the environment through industrial discharge, causing excessive contamination of aquatic ecosystems. The head kidney is a unique immune organ of the bony fish and plays an important role in the metabolism of heavy metals. Studies of toxic Pb exposure that have investigated the head kidney of carp are limited. This study was carried out to explore the potential immunotoxicity effects of Pb and the specific related mechanisms in the carp head kidney. Pb poisoning was shown to induce the production of reactive oxygen species (ROS) and increase the expression levels of phosphorylated proteins related to the MAPK pathway, including p38, extracellular signal-regulated protein kinase (ERK), and c-Jun N-terminal kinase (JNK). We also found that microRNA-155 played a key role in regulating the production of inflammatory factors TNF-α, IL-1β, and IL-6, and the pre-miRNA-155 inhibitor reversed the Pb-induced inflammation. In conclusion, these in vitro and in vivo findings suggest that oxidative stress and the MAPKs are involved in the Pb-induced inflammasome response, and the production of microRNA-155 aggravated the occurrence of inflammation in carp head kidney.
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Affiliation(s)
- Hongyuan Jing
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, People's Republic of China
| | - Qirui Zhang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, People's Republic of China
| | - Shu Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, People's Republic of China
| | - Xue-Jiao Gao
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, 150030, People's Republic of China.
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4
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Zamani N, Mehrpour O, Hassanian-Moghaddam H, Jalali M, Amirabadizadeh A, Samie S, Sabeti S, Kolahi AA. A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran. Sci Rep 2020; 10:11797. [PMID: 32678122 PMCID: PMC7367297 DOI: 10.1038/s41598-020-64859-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/23/2020] [Indexed: 11/09/2022] Open
Abstract
No countrywide data exists on the patients' characteristics of lead exposure in Iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45- to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by Opioid Maintenance Therapy (OMT)-prescribed opium tincture is recommended.
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Affiliation(s)
- Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.,Rocky Mountain Poison and Drug Center, Denver, Colorado, USA
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Department of Clinical Toxicology, Loghman Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Jalali
- Clinical Biochemistry Founder and Director of Noor Pathobiology Lab, Tehran, Iran
| | | | - Saeed Samie
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Sabeti
- Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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5
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Amirabadizadeh A, Nakhaee S, Mehrpour O. Risk assessment of elevated blood lead concentrations in the adult population using a decision tree approach. Drug Chem Toxicol 2020; 45:878-885. [DOI: 10.1080/01480545.2020.1783286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
- Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, Denver, CO, USA
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6
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Nakhaee S, Amirabadizadeh A, Zarban A, Nasirizade M, Salmani Mood M, Ataei H, Shariatmadari MR, Brent J, Mehrpour O. The reference value of blood lead level among the general adult population of eastern Iran. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2019; 54:1287-1292. [PMID: 31328627 DOI: 10.1080/10934529.2019.1640580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/23/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study to the estimate the lead concentrations in the blood of the adult population in South Khorasan Province, evaluate factors related to high lead blood concentrations and establish lead reference values (RVs) in our study population. In cross-sectional study, 400 people who lived in the province of South Khorasan in 2017 were selected. Demographic information was collected and clinical examinations were performed. As the geometric means, blood lead concentration (BLC) was expressed, 10th, 50th, 90th, and 95th percentiles, and 95% confidence intervals (CI) of the 95th percentile. The upper limits rounded values of the 95% CI with the 95th percentile were applied to calculate RVs. Mean BLC was 6.02 ± 7.41 µg dL-1, median of BLC was 4.4 µg dL-1 (IQR: 2.9-6.5; range 0.9-54.7 µg dL-1). One hundred and twenty-five (31.2%) participants had BLCs between 5 and 10.0 µg dL-1, 40 (10.0%) between 10 and 20.0 µg dL-1, and 15 (3.8%%) over 20 µg dL-1. The RVs for BLC for men and women were 16 [95% CI: 10.13-15.96] µg dL-1 and 15 [95% CI: 9.81-14.45] µg dL-1, respectively. Higher BLCs were significantly associated with age, gender, hemoglobin, white blood cell count, and serum phosphorus concentration. This bio-monitoring study of BLCs in the general population of South Khorasan Province offers important demographic and lifestyle factors-stratified reference data. It is essential to continue efforts to reduce lead exposure.
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Affiliation(s)
- Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences , Birjand , Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences , Birjand , Iran
| | - Asghar Zarban
- Department of Clinical Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences , Birjand , Iran
| | - Manizhe Nasirizade
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences , Birjand , Iran
| | - Maryam Salmani Mood
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences , Birjand , Iran
| | - Homeira Ataei
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences , Birjand , Iran
| | | | - Jeffery Brent
- School of medicine, University of Colorado , Aurora , CO , USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences , Birjand , Iran
- Rocky Mountain Poison & Drug Safety (RMPDS) , Denver , CO , USA
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7
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Mirzaei SMM, Akbari A, Mehrpour O, Zamani N. Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report. Sultan Qaboos Univ Med J 2019; 18:e529-e532. [PMID: 30988975 DOI: 10.18295/squmj.2018.18.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/22/2018] [Accepted: 07/19/2018] [Indexed: 11/16/2022] Open
Abstract
Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month's duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 μg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.
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Affiliation(s)
- Seyed M M Mirzaei
- Department of Neurology, Birjand University of Medical Sciences, Birjand, Iran
| | - Ayob Akbari
- Department of Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Rocky Mountain Poison and Drug Center, Denver Health Medical Center, Denver, Colorado, USA
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Tehran, Iran
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8
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Blood lead levels and multiple sclerosis: A case-control study. Mult Scler Relat Disord 2018; 27:151-155. [PMID: 30384201 DOI: 10.1016/j.msard.2018.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/09/2018] [Accepted: 10/13/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a debilitating disease of the central nervous system, with disseminating demyelination of nerve fibers and spinal cord. Exposure to heavy metals seems to be associated with a higher incidence of MS. Few studies have assessed the correlation of the incidence of MS with heavy metal concentrations. The present study aimed to assess the relationship between blood lead levels and MS. METHODS This case-control study was conducted on 29 MS patients and 29 healthy control persons. The controls were age, gender and occupation matched at the time of blood sampling. Blood lead levels were measured using the atomic absorption spectrometry method. Data were analyzed using Student t-test, Mann-Whitney U, and multiple logistic regression, using a significance level of p ˂ 0.05. RESULTS According to the result of this study, the mean blood lead level (BLL) was 75.6 ± 9.35and33.8 ± 28.8 µg/L in patients with MS and control group, respectively. Median blood lead levels were significantly higher in MS patients (38 µg/L, range: 27-67), compared to the controls (30 µg/L, range: 11-49) (p = 0.03). The risk of MS increased 1.17 times per one µg/L increment of blood lead level, using the multiple logistic regression analysis on the present results. CONCLUSION In conclusion, based on our results, BLL was higher in MS patients, compared with healthy individuals. The risk of MS increased 1.17 times per one µg/L increment of blood lead level.
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9
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Mahmoudi N, Latifi AM, Amani MA, Masoumbeigi H, Ghanizadeh G. Data on the environmental exposure to lead in Iran. Data Brief 2018; 20:1133-1141. [PMID: 30225326 PMCID: PMC6139886 DOI: 10.1016/j.dib.2018.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022] Open
Abstract
The data was obtained to present the environmental and occupational exposure to lead in Iranian populations based on the published articles. To acquire the data, online resources including Google Scholar, Magiran, SID, Iranmedex, PubMed, and Science Direct were searched and 104 articles were found out of which 70 that focused on the level of lead in blood, urine, milk, and hair of different Iranian populations were selected. Since the results of the studies were not homogenous, it was not possible to carry out a meta-analysis. The average blood lead level (BLL) among workers, ordinary people, patients with specific diseases, addicts, and pregnant women, women in labor, infants, and children are presented in this article. The average BLL was compared to the standards.
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Affiliation(s)
- Norouz Mahmoudi
- Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.,Health Research Center, Life style Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Ali Mohammad Latifi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Amani
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Masoumbeigi
- Health Research Center, Life style Institute, Baqiyatallah University of Medical Sciences, Tehran
| | - Ghader Ghanizadeh
- Health Research Center, Life style Institute, Baqiyatallah University of Medical Sciences, Tehran
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Alinejad S, Aaseth J, Abdollahi M, Hassanian-Moghaddam H, Mehrpour O. Clinical Aspects of Opium Adulterated with Lead in Iran: A Review. Basic Clin Pharmacol Toxicol 2017; 122:56-64. [PMID: 28802093 DOI: 10.1111/bcpt.12855] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Samira Alinejad
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Jan Aaseth
- Norway University of Applied Sciences, Elverum and Research Department, Innlandet Hospital, Brumunddal, Norway
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
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11
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Hayatbakhsh MM, Oghabian Z, Conlon E, Nakhaee S, Amirabadizadeh AR, Zahedi MJ, Darvish Moghadam S, Ahmadi B, Soroush S, Aaseth J, Mehrpour O. Lead poisoning among opium users in Iran: an emerging health hazard. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:43. [PMID: 28982369 PMCID: PMC5629748 DOI: 10.1186/s13011-017-0127-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/26/2017] [Indexed: 11/18/2022]
Abstract
Background Lead (Pb) poisoning among people using opium has been an increasing problem in Iran. The present study highlights the clinical effects of lead toxicity associated with opium use in Iran, Kerman province. Methods Between January 2016 and June 2016, patients with signs and symptoms of Pb poisoning were questioned to assess whether they had a history of opium dependency. In total, 249 patients were enrolled onto this cross-sectional study, all were opium dependent. Para-clinical data including blood lead level (BLL), demographic information, user preferences, and symptoms were obtained. Results The patients used either opium (83.9%), refined opium (6.4%) or a combination of both (9.7%) via ingestion (71.9%), smoking (8.4%) or a combination of both (19.7%). The overall median BLL was 80.0 μg/dL [IQR: 51.7–119.0]. The median BLL did not differ significantly between opium and refined opium users. Further, BLL was not significantly affected by the type of substance, route of use, duration of use, or daily quantity consumed. Common symptoms included abdominal pain (86.9%), constipation (75.8%), anorexia (71.5%) and nausea (54.7%). Linear regression analysis showed log of BLL was significantly associated with abdominal pain, myalgia and anorexia. Conclusions The study unravelled an increase in opium-related Pb poisoning in the Kerman province. Raised awareness of this emerging Pb source and investigation of its aetiology is recommended. Pb poisoning should be considered among the primary differential diagnosis of opium users with gastrointestinal symptoms.
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Affiliation(s)
- Mohammad Mahdi Hayatbakhsh
- Department of Gastroenterology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Zohreh Oghabian
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran.,Department of Clinical Toxicology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Endocrinology and Metabolism Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Samaneh Nakhaee
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.,Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138, Iran
| | - Ali Reza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138, Iran
| | - Mohammad Javad Zahedi
- Department of Gastroenterology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sodief Darvish Moghadam
- Department of Gastroenterology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Bighan Ahmadi
- Department of Gastroenterology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Soroush
- Department of Gastroenterology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.,Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Jan Aaseth
- Inland Norway University of Applied Sciences, Elverum, and Research Department, Innlandet Hospital, Brumunddal, Norway
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138, Iran.
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Ansarihadipour H, Bayatiani M. Influence of Electromagnetic Fields on Lead Toxicity: A Study of Conformational Changes in Human Blood Proteins. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e28050. [PMID: 27651951 PMCID: PMC5022290 DOI: 10.5812/ircmj.28050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/04/2015] [Accepted: 04/13/2015] [Indexed: 11/23/2022]
Abstract
Background Electromagnetic fields (EMF) are associated with oxidative stress, which is in turn associated with reactive oxygen species (ROS), anemia, and hypoxia. Objectives This study focused on the synergistic effects of lead ions and EMF on oxidative modifications in hemoglobin (Hb) and plasma proteins. Patients and Methods In this experimental study, the blood samples were obtained from age- and sex-matched healthy subjects at Arak University of Medical Sciences, Arak, Iran. The collected bloods were prepared as 55 samples and then divided into different groups for incubating with 0 to 100 uM of lead ions in 2 mT and 50 Hz of EMF for 120 minutes. The carbonyl group was determined to be an oxidative biomarker in plasma proteins. The ferric reducing ability of plasma (FRAP) was considered to be an antioxidant power of human plasma. The conformational changes in hemoglobin, met-Hb, and hemichrome were considered to be oxidative markers in red blood cells. To predict the factors affecting the oxyHb, the artificial neural network (MLP: 11,2,2,1) in SPSS software was applied. Results The test subjects showed increased concentrations of metHb (1.8 ± 0.19 vs. 1.36 ± 0.25) and hemichrome (6.01 ± 0.57) in relation to the control subjects. The decreased absorbance at 340 nm (0.88 ± 0.09 vs. 1.07 ± 0.08) demonstrated the reduced interaction between the globin chain and the heme ring. The decreased absorbance at 420 nm (Soret band) (2.96 ± 0.13) and the increased absorbance at 630 nm (0.07 ± 0.002 vs. 0.064 ± 0.005) indicated the conversion of oxyHb to metHb, which confirmed the oxidative damage to the erythrocytes. The linear regression analysis showed significant positive correlations between lead concentration and the percentage of plasma carbonyl content (R2 = 0.96), the relation of plasma carbonyl content to Hb absorbance at 630 nm (R2 = 0.97), and the relation of plasma carbonyl content to metHb concentration (R2 = 0.95) after 120 minutes incubation with lead ions in 20 millitesla and 50 hertz EMF. The artificial neural network analysis showed the significant importance of hemichrome, PCO, metHb, and lead concentration to the oxyHb content of erythrocytes. Conclusions Lead contamination in the presence of an EMF exacerbates the oxidative damage to plasma proteins as well as the conformational changes in Hb. An artificial neural network can be used as a predictive tool for the oxidative danger posed to workers in industrial fields, battery manufacturing companies, and power plants.
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Affiliation(s)
- Hadi Ansarihadipour
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, IR Iran
- Corresponding Author: Hadi Ansarihadipour, Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, IR Iran. Tel: +98-8634173502, Fax: +98-8634173529, E-mail:
| | - Mohamadreza Bayatiani
- Department of Radiotherapy, Faculty of Paramedicine, Arak University of Medical Sciences, Arak, IR Iran
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