Associations between urinary heavy metal concentrations and blood pressure in residents of Asian countries

BACKGROUND@#Previous studies have suggested that exposures to heavy metals (arsenic, cadmium, lead, and selenium) may be associated with differences in blood pressure. However, the findings of these studies have been inconsistent. This study was performed to examine the associations between urinary heavy metal concentrations and blood pressure among residents of four Asian countries (Bangladesh, Indonesia, Nepal, and Vietnam).@*METHODS@#This cross-sectional study examined 1899 adults in four Asian countries. Urinary concentrations of heavy metals were measured by inductively coupled plasma mass spectrometry. A questionnaire survey was administered regarding individual characteristics. Anthropometric measurements (height and weight) were performed. Systolic and diastolic blood pressures were measured after a short rest. Multiple linear regression models were applied to investigate associations between urinary heavy metal concentrations and blood pressure after adjustments for age, sex, and body mass index.@*RESULTS@#The geometric means of the urinary concentrations of arsenic, cadmium, lead, and selenium were 84.6, 0.885, 2.09, and 16.5 μg/g creatinine, respectively. The urinary arsenic concentrations were slightly higher than those typically reported in non-polluted populations, while urinary cadmium, lead, and selenium concentrations were equivalent or slightly lower. The urinary lead concentrations were positively associated with both systolic and diastolic blood pressure, but urinary selenium concentrations were negatively associated with them.@*CONCLUSIONS@#Variations in the urinary concentrations of lead and selenium were associated with blood pressure at low levels of exposure/intake.

Comparative study of the role of D- pencillamine and garlic extract in treatment of lead poisoning in adult albino rats

Lead is one of the most useful materials in the world. The aim of this study was to compare the curative role of D-penicillamine and garlic extract in treatment of lead poisoning in adult albino rats. The study included 80 adult albino rats consisted of 7 groups. The period of lead intoxication extended for 3 months followed by either 1 month treatment [penicillamine or garlic extract] or 1 month of no treatment. Group I: consisted of 20 rats divided equally into the negative and positive control subgroups. Each of groups 11- VII consisted into 10 rats. Group [I: [P] Pencillamine alone in a dose of 25 mg/kg 6 days/ week for 1 month. Group III: [G] garlic extract alone in a dose of 20 mg/kg 6 days/ wk for I month. Group IV: [Pb] lead poisoning in a dose of 20 mg/kg 6 days/ wk for 3 months. Group V: [Pb-P] treatment with penicillamine in Pb poisoning. Group VI: [Pb-G] treatment with garlic extract in Pb poisoning. Group VII: [Pb-F] follow up of Pb poisoning without treatment. The results of this study revealed that lead poisoning significantly elevated blood lead level [BLL] and testicular lead level [TLL] when compared with the negative control rats. Lead was testicular toxicant as it produced atrophic germinal epithelium and arrested spermatogenesis. Treatment of Pb poisoning by penicillamine or garlic extract resulted in significant decrease in BLL and TLL with significant increase in urinary lead level [ULL] when compared with the Pb treated rats. Also, P and G treatment resulted in improvement of testicular structure. [n follow up group, BLL, ULL and TLL were significantly increased when compared with the negative control rats. Also, BLL was significantly decreased when compared with lead treated group. There was minimal improvement in testicular structure in Pb-F group. It was concluded that both penicillamine and garlic can treat lead poisoning. Moreover, garlic curative effect is better than that of penicillamine. garlic can be considered as a chelating agent in treatment of lead poisoning

Avaliação da exposição a metais numa oficina de recuperação de armamento de uma organização militar / Exposure assessment to metals in an armament repair shop of a military organization

O objetivo deste estudo foi a avaliação da exposição ocupacional ao chumbo e manganês dos trabalhadores de uma oficina de recuperação de armamento de uma organização militar. O ar do ambiente de trabalho foi avaliado no monitoramento ambiental e os indicadores biológicos de dose interna, para chumbo e manganês, em sangue e na urina, foram utilizados no monitoramento biológico. A concentração de manganês e chumbo nos filtros e fluidos biológicos foi determinada por espectrometria de absorção atômica eletrotérmica. Os resultados do monitoramento ambiental indicaram níveis de Pb e Mn acima do TLV-TWA durante o processo de pintura (313,33 μg m-3) e solda (951 μg m-3). Os indicadores biológicos revelaram que cinco dos nove trabalhadores apresentam níveis de Pb-S que sugerem exposição ambiental ao chumbo (valores entre 5 e 10 μg dL-1). Pode-se concluir que existe uma pequena exposição ocupacional ao chumbo e ao manganês na oficina de tratamento superficial. Tal exposição é influenciada pelas condições meteorológicas e pela demanda variável de trabalho.

The aim of this study was the occupational exposure assessment to lead and manganese of workers in an armament repair shop of a military organization. The air of the working environment was assessed in the environmental monitoring while the internal dose biological indicators for lead and manganese, in blood and urine, were used in biological monitoring. Metals concentration in filters and biological fluids were determined by electrothermal atomic absorption spectrometry. The results of the environmental monitoring showed lead and manganese levels above the TLV-TWA during the process of painting (313.33 g m-3) and solder (951 μg m-3). The biological indicators revealed that five of the nine employees presented Pb-S levels that suggested an environmental exposure to lead (values between 5 and 10 μg dL-1). It can be concluded that there is a small occupational exposure to lead and manganese in the superficial treatment repair shop. This exposure is influenced by weather conditions and the variable demand of work.

Lead-induced peripheral neuropathy following ayurvedic medication.

Lead poisoning following intake of Ayurvedic medication is one of the recent areas of concern. We report a case of a 58-year-old type II diabetic man who was stable with diet control and 30 mg pioglitazone per day. He took Ayurvedic medication for generalized weakness and developed peripheral neuropathy following its intake. He was found to have high blood and urinary lead levels and was diagnosed to have subacute lead poisoning. He was treated with d-Penicillamine for 8 weeks, following which his lead levels became normal. The use of d-Penicillamine was proved highly effective in treating a case of lead poisoning.

Uso do chumbo em urina como indicador de exposição e sua relação com chumbo no sangue / Use of urine lead level as an exposure indicator and its relationship to blood lead

O objetivo deste trabalho foi verificar se há correlação estatisticamente significativa entre as concentrações de chumbo no sangue (Pb-S) e urina (Pb-U). A espectrometria de absorção atômica eletrotérmica foi utilizada na determinação da concentração de chumbo no material biológico. As amostras de sangue e de urina foram coletadas entre trabalhadores expostos ocupacionalmente (95) e entre adultos (130) e crianças até 15 anos (22) expostos ambientalmente. Após um teste que mostrou diferenças significativas entre Pb-U e as três categorias previamente determinadas, pontos de corte em Pb-U puderam ser fixados para a predição dos valores de Pb-S pela curva ROC. Assim, para Pb-U até 0,55 µg.dL-1, pode-se esperar que Pb-S seja menor do que 10 µg.dL-1, ao passo que níveis de chumbo no sangue até 27,6 µg.dL-1 são esperados quando o teor do metal na urina é menor do que 2,05 µg.dL-1. Logo, a urina pode ser utilizada em substituição ao sangue para avaliação da exposição ocupacional ao chumbo. Contudo, recomenda-se cautela no caso da exposição ambiental, devendo-se utilizar o chumbo urinário como uma estimativa do conteúdo do metal no sangue.

The aim of this work was to verify whether there are statistically significant correlation between the concentrations of lead in blood (Pb-B) and urine (Pb-U). Electrothermal atomic absorption spectrometry was used in the determination of lead concentration in biological material. Venous blood and spot urine were collected from workers occupationally exposed (95), adults (130) and children up to 15 years old (22) environmentally exposed. After a test showing significant differences between Pb-U and the three categories previously determined, cutting points for Pb-U were established to predict Pb-B values by the ROC curve. Thus, it is expected that Pb-B is lower than 10 µg.dL-¹ with Pb-U up to 0.55 µg. dL-¹, whereas lead levels in blood below 27.6 µg. dL-¹ are expected when the amount of the metal in urine is lower than 2.05 µg.dL-¹. So, urine can be used to replace blood for the assessment of the occupational exposure to lead. However, caution is advised in the case of environmental exposure, since urinary lead should be used just as an estimation of the metal content in blood.

"Kohl" use for infants

Kohl is still being used for the eyes of infants. The habit is of concern to paediatritians because of the serious toxic effects. 1. To determine how frequent kohl was being used for infants eyes, the reasons for its use and the method of application. 2. To estimate the blood and urine level of lead in infants, and in kohl samples from the local market. 3. To document kohl induced encephalopathy. Mothers of 150 children under a year of age were interviewed and samples of 40 infants' blood and urine were analyzed for their lead content. Kohl was used for 47% of infants. Forty percent of town mothers and 57% of rural mothers were applying it to their infants eyes. Fifty percent of illiterate mothers and 33% of college graduates were applying it. The habit started in the neonatal period: 40% of which on the third day after birth. The reasons for the use were: cosmetic 54%, improving vision 41% and prevention of eye infection 4%. The mean blood and urine levels of lead were higher among kohl user, but it did not reach statistical significance. The lead contents of kohl samples varied from 0.4% to 54%. In two infants encephalitis was present, the most likely cause was kohl use. Kohl use is common during infancy. Its lead content could be high. It was usually applied to the conjunctival side of the eyelid where a higher chance of absorption into the blood stream was expected. Kohl use for infants could lead to encephalopathy. Active means should be adopted to educate mothers about the hazards of kohl use for infants, and possibly banning the sales of lead containing kohl

Can dietary intervention reduce heavy metals load and improve neurobehavioral problems in children?

Heavy metal exposure is a threatening health hazard especially among children. It is reported to affect physical and neurobehavioral health status. Cairo is reported to have high levels of heavy metal pollution specially lead and cadmium. Foods, mainly proteins, milk, vegetables and fruits with its high content of calcium, iron, zinc, vitamins C, A and B complex are reported to have a protective role against heavy metal absorption and intoxication. Children with inadequate intake of these food items are at higher risk for heavy metals load with its associated health hazards. Egyptian children specially those from lower social and economical levels were reported to receive unbalanced inadequate diet resulting in several nutritional deficiencies including iron, zinc, vitamin A, C, B complex and calcium deficiencies. Is to test the hypothesis that dietary intervention supplying diet rich in protein, milk, vegetables and fruits to children with unhealthy nutritional habits can reduce the heavy metal load in their body and hence improve the associated neurobehavioral problems. 30 children [18 boys and 12 girls] were selected from the obesity clinic, NRC, age range was 11-14 years. They all reported to receive unbalanced diet that consists mainly of fats, sugars and carbohydrates. Full clinical examination, 24-hour dietary recall, BMI, neurobehavioral assessment and urine analysis for determination of lead, cadmium and aluminum levels using the atomic absorption spectrophotometer, were performed for all children, at the beginning and 2 months after following a healthy diet rich in protein, milk, fresh vegetables and fruits. Mean urine levels for lead, cadmium and aluminum levels were, 47.2 +/- 6.5, 12.8 +/- 1.4, 9.8 +/- 1.5 microgram/liter respectively at the beginning of the study. After 2 months of changing the diet the levels were 38 +/- 6.9, 9.4 +/- 1.2 and 9.6 +/- 1.6 microgram/Liter. p value was significant at [0.001] level for lead and cadmium, but non significant for aluminum. Our recorded levels are considered higher than recorded reference values. As for the neurobehavioral variables mean scores for aggression, mood, lethargy and concentration were 12.8 +/- 2.1, 8,3 +/- 1.2, 13.5 +/- 1.6 and 7.7 +/- 1.2 before the diet change. While after 2 months of diet change the scores were 10.1 +/- 1.19, 11.6 +/- 1.3, 9.4 +/- 1.7 and 12.6 +/- 1.4. Significant changes were recorded [p<0.001] for all neurobehavioral variables. Significant correlation was found between lead level, and aggression, mood and concentration scores, between cadmium level, and lethargy and concentration, and between aluminum levels, and concentration scores. Changing the dietary pattern to be rich in milk, protein, fresh vegetables and fruits helps to reduce heavy metals burden and improve neurobehavioral symptoms

Prevalence of lead toxicity among secondary school students in Sohag city and its impact on cognitive functions

Lead is an extremely toxic metal. Lead intoxication in children has been associated with cognitive impairments. This study was designed to determine the prevalence rate of lead toxicity among secondary school children in Sohag City [Upper Egypt], sources of lead toxicity and the impact of lead toxicity on cognitive function of studied student. The studied students [600] were recruited from three schools, 200 students from Elaskaria school [main stream school] and 400 students from two technical schools [200 from industry and 200 from Elzekhrofia]. A control group was selected from the same sample of studied school, who proved to have normal urinary lead level [<50 micro g/L]. All studied students were subjected to body measurements, clinical evaluation, soft neurological signs, social level, psychometric tests [WAIS, CASI and WMS]. Urine sample were collected for assessment of lead level. The study revealed that the prevalence rate of lead toxicity was 50.5% and the highest rate among studied schools was reported in Elzekhrofia school [62%]. Sources of lead toxicity in this community were old houses [77.9%], presence of repair shops [60.8%], and garbage combustion 60.3%, and smoking [62.1%]. Soft neurological signs were significant abnormal among student with toxic urinary lead level [> 80 micro g/L] in comparison to student with normal lead level [<50 micro g/L] except in one test [standing on one foot]. Student with toxic urinary lead level [> 80 micro g/L] had inverse proportion with social level. There were statistically significant lower scores among students with pre clinical toxicity [>50-80 micro g/L] and toxic level than students with normal urinary lead [<50 micro g/L] in total, verbal and performance Wechsler adult intelligence scale [WAIS], in all Wechsler memory scale [WMS] subitems and in all cognitive abilities screening instrument [CASI] subitems

Saturnismo ocupacional / Occupational poisoning

Avaliação da exposição ocupacional ao chumbo, passando pelos meios de prevenção, manifestações clínicas, normas técnicas vigentes em lei até o seu tratamento e correlação das profissões de maior risco com avaliações dos níveis de concentração no organismo.

Evaluation of intercellular adhesion molecule - 1 [ICAM-1] and other risk factors in tobacco smokers with chronic H C V. infection

Based on the idea that the adhesion molecules have becoming one of the most important therapeutic strategies in the medicine, our aim in this study was to elucidate the role played by these molecules in pathogenesis of chronic HCV infection and on the other hand, this work is a trial to find to what extent can the bad habits of smoking aggravate the disease state, and finally to find a hope how modulation of adhesion molecules expression can aid in treating or controlling the wide spread of HCV infection in Egypt. In trial to assess the state of ICAM-1 in chronic hepatitis C, we were not able to neglect the deleterious effects of heavy elements cadmium and lead which are added to the body among other thousands of toxic materials contained in tobacco smoker. Eighty subjects enrolled in this study were properly selected from tropical medicine department and those attending the outpatient clinic between December 1999 and September 200I, they were classified into 4 groups: group I [control group] comprised 20 apparently healthy persons, non smoker with negative tests throughout for any viral hepatitis; group II included 20 non smoker, with chronic hepatitis C infection [positive anti-HCV by ELISA and positive PCR for HCV-RNA]; group III included 20 healthy normal smokers show no evidence for any viral hepatitis tests; and group IV included 20 smoker with chronic hepatitis C infection. All subjects were subjected to full history taking especially that concerning the smoking burden, clinical examinations and abdominal ultrasonography and routine laboratory investigations e.g. liver function test and complete blood picture and HBs antigen to exclude hepatitis B infection for all the patients ICAM-1 was assayed in plasma using ELISA technique also cadmium and lead were assayed in whole blood and urine using atomic absorption spectrophotometer and urine cotinine was measured by radioimmunoassay. Significant rise was recorded in the level of ICAM-1 in hepatitis C patients as compared to control. The effects of cadmium and lead were obvious, in the fact that they evoked more rise in the level of ICAM-1 in smoking hepatitis patients as compared to controls or non-smokers. Levels of ICAM-1, were significantly correlated with serum enzymes and urinary cotinine. Also the concentration of heavy elements in urine and blood correlated significantly with urinary cotinine. Urinary cotinine was chosen as a marker of smoking burden Finally, the idea of advent of specific mono clonal antibodies against adhesion molecules for purposes of control of their mediating inflammatory and metastatic effects, was discussed. To our opinion, this procedure, would be associated with deleterious systemic unavoidable effect, but the idea needs be considered and tried employing more advanced and sophisticated techniques

Oligoelementos en clínica-II-plomo / Trace elements in clinic-II-lead

Se presenta una actualización de los efectos del plomo sobre la salud. Se describen los síntomas de la intoxicación aguda y crónica en adultos y niños alertando sobre la importancia de efectos mal llamados "subclínicos" que afectan especialmente el SNC. Se explican los efectos neurotóxicos del plomo y la importancia de considerar la carga corporal real medible por análisis de cabellos dándose los valores máximos tolerables. Se presentan las propiedades geno y teratotóxicas del metal que tienen importancia en neonatología. Se menciona su importancia en toxicología conductual destacando los efectos sobre el C.I. de niños desde dosis bajas y el posible desarrollo de conducta violenta, destacando la muy posible falta de umbral en estos efectos. Se dan datos sobre la ingesta y excreción del metal enfatizando su ingreso por el agua y en las ciudades por el aire en zonas de alto tránsito automotor. Se da una suscinta idea sobre modos de prevención y tratamiento y la importancia de la eliminación del plomo en las naftas. Se informa sobre las investigaciones a efectuar para detectar la contaminación y posibles sinergias, y los nuevos intervalos de referencia a considerar, hasta 300 µg/l en sangre de adultos hasta 200 µg/l en niños.

Recomendaciones en el manejo de intoxicación por plomo / Recommendations in the management of lead poisoning

Se presentan las recomendaciones en el manejo del niño intoxicado por plomo, que se utilizan en los grandes centros de concentración de intoxicaciones. Se habla de la prueba provocadora que se emplea para conocer la cantidad de plomo que puede ser removido y el tratamiento que se deben utilizar con las diferentes concentraciones de plomo en sangre, así como las recomendaciones en el uso de agentes quelantes

Alteraçöes hematológicas e urinárias em indivíduos expostos ocupacionalmente ao chumbo inorgânico / Hematological and urinary changes in subjects exposed occupationally to inorganic lead

Foram examinadas 15 amostras de sangue e de urina, provenientes de indivíduos ocupacionalmente expostos ao chumbo inorgânico, com finalidade de determinar os níveis deste metal no sangue e observar as alteraçöes por ele produzidas no sangue e na urina. Para tanto, procedeu-se a execuçäo de hemogramas completos, pesquisa semi-quantitativa das coproporfirinas e exame qualitativo de urina. Os resultados mostraram valores de chumbo sanguíneos, em alguns casos, superiores a 50 *g/100ml, hemáceas com pontilhadas basófilos, policromatofilia e reticulocitose. Na maioria dos indivíduos envolvidos foi detectada a presença de coproporfirinas, näo sendo observadas alteraçöes no exame qualitativo de urina

Hemoglobina AS em trabalhadores expostos ao chumbo inorgânico / Hemoglobin AS in workers exposed to inorganic lead

Realizou-se um estudo entre trabalhadores de metalúrgica de chumbo no município de Santo Amaro da Purificaçäo, na Bahia, para se verificar o grau de suscetibilidade de indivíduos portadores de hemoglobina anormal em relaçäo aos efeitos tóxicos do chumbo inorganico

Intoxicaçäo saturnínica em mecânicos de veículos auto-motores da cidade de Ribeiräo Preto - SP / Lead poisoning among automobile mechanics in garages in the city of Ribeiräo Preto - SP

Os autores estudam a intoxicaçäo saturnínica entre os mecânicos de oficinas da cidade de Ribeiräo Preto. De um total de quinhentas e vinte e duas oficinas, foram sorteadas aleatoriamente cinquenta e duas e todos os cento e oitenta e um trabalhadores dessa amostra foram submetidos ao teste de dosagem da coproporfirina urinária, segundo a técnica modificada por Ribeiro & Stettiner. Para grupo controle foi sorteada aleatoriamente uma amostra de oito serrarias da mesma cidade e os trinta e nove trabalhadores dessa amostra foram submetidos ao mesmo teste (trabalhadores näo expostos ao chumbo). Enquanto trinta e três (18,2%) dos mecânicos apresentaram exames de urina positivos, nenhum serrador apresentou positividade. Há portanto, uma clara evidência de que os mecânicos se intoxicam pelo chumbo. Os autores discutem ainda alguns aspectos gerais da prevençäo do saturnismo

Chronic industrial exposure to lead in 63 subjects. I. Clinical and erythrokinetic findings.

Clinical, biochemical, haematological and erythrokinetic studies were performed on 63 adult males with prolonged lead exposure. Their most common symptoms and findings were abdominal pain (62%), gingival lead lines (48%), headache and/or dizziness (33%), muscle cramps (32%), anaemia (19%), and fatigue (18%). Colicky abdominal pain (27%) and gingival lead lines correlated with urinary lead excretion. Anaemia was mild, but more frequent in the subjects with the greatest urinary lead excretion. Other associated findings were: higher reticulocyte counts and more basophilic stippling of the RBCs, more sideroblasts and greater erythroid hyperplasia of the bone marrow, more reduction in 51Cr-tagged RBC survival time, smaller RBC mass, a more rapid plasma iron clearance, a greater plasma iron turnover and greater utilization of 59Fe in subjects with urinary lead excretion of greater than 100 microng/day in comparison with the remainder and normal controls. These findings suggest that minimal chronic exposure to lead causes an increased haemolysis with resulting increased production of erythrocytes.

Chronic industrial exposure to lead in 63 subjects. II. Evaluation of chelation therapy.

Efficacy of chelation therapy with intravenous calcium disodium edetate, oral Ca EDTA, and oral penicillamine was tested in 63 subjects with chronic minimal industrial exposure to lead. All three agents increased the urinary lead excretion. The effect was greatest with intravenous Ca EDTA, next with oral penicillamine and least with oral Ca EDTA. Symptoms, particularly colicky abdominal pain, improved during the period of chelation therapy. Anaemic subjects showed improvements in haematological parameters. It is recommended that subjects with chronic minimal industrial exposure to lead receive chelation therapy. The relative merits of the three agents are discussed.