Attempted Self-Harm with Elemental Thallium Purchased Online: Case Report with Analytical Confirmation.

INTRODUCTION: Thallium is a highly toxic metal, with most publications demonstrating poisoning from thallium salts. We report on a patient with elevated serum and urine thallium concentrations from an intentional ingestion of elemental thallium purchased from the internet for self-harm. CASE REPORT: The regional poison center was contacted about an 18-year-old man who ingested a fragment from a 100-gram bar reported to be elemental thallium. Serial serum and urine thallium concentrations were obtained. Prussian blue was started on hospital day (HD) 2. A metal fragment was seen on abdominal x-ray and removed via colonoscopy on HD3. The ingested fragment was analyzed via inductively coupled plasma mass spectrometry (ICP-MS) and found to be 87.0% elemental thallium. The initial serum thallium concentration obtained on HD1 was 423.5 mcg/L (reference range < 5.1 mcg/L), which subsequently decreased to 4.5 mcg/L, 29 days after the ingestion. An initial random urine thallium concentration obtained on HD 3 was 1850.5 mcg/g creatinine (reference range < 0.4 mcg/g creatinine). The patient remained hospitalized for 23 days and, when seen in follow-up, had not developed any signs or symptoms of thallium toxicity. DISCUSSION: Elemental thallium ingestion is a rare toxicologic exposure, with limited published clinical and analytical experience to guide management. This case report describes a patient with ingestion of elemental thallium who developed elevated serum and urine thallium concentrations and was treated with Prussian blue. Despite having elevated serum and urine thallium concentrations consistent with previous fatal exposures, more evidence is needed to understand the differences between elemental thallium and thallium salts.

From Sphygmomanometer to Lungs: Unveiling Mercury Poisoning in Emergency Department.

Mercury, a ubiquitous heavy metal, poses a significant threat to human health. Intravenous mercury poisoning is an uncommon but critical medical emergency. The nature and severity of its toxic effects depend on the form of mercury encountered: elemental, inorganic, or organic. It can affect almost all organ systems in the body. Chelating agents are the primary treatment for symptomatic mercury poisoning. This case report is about a 27-year-old male patient who presented to the emergency department with an alleged history of intravenous injection of mercury as an attempt at suicide, followed by breathlessness, chest pain, vomiting, and high-grade fever. He was managed with chelating therapy, non-invasive ventilation, and other supportive measures and was discharged home. After five days of discharge, he presented with fever and rashes and was diagnosed with toxic epidermal necrolysis (TEN). In spite of all aggressive management, he succumbed to death after four days of re-admission. Early intervention can significantly improve the chances of recovery. However, even with successful treatment, some individuals may experience long-term complications.

Elemental Mercury Poisoning by Self-Injection - A Report of Two Cases.

Injection of mercury into the upper limb is a rare method of self-harm. We report two patients with varied clinical presentations - a 19-year-old male student who injected himself with mercury extracted from a sphygmomanometer bulb and reported to our emergency department 24 hours after the event and a 34-year-old industry worker who presented 2 years after injecting himself with elemental mercury. The management of mercury poisoning is described along with a brief review of literature. Mercury is a toxic element and adequate safety precautions must be taken by the surgical team in the management of such patients. Level of Evidence: Level V (Therapeutic).

Gas-Phase Regeneration of Metal-Poisoned V2O5-WO3/TiO2 NH3-SCR Catalysts via a Masking and Reconstruction Strategy.

Renewing metal-poisoned NH3-SCR catalysts holds great potential for mitigating environmental pollution and utilizing hazardous wastes simultaneously. Ionic compounds containing heavy metals often exhibit limited solubility due to their high polarizability, making traditional washing techniques ineffective in removing heavy metal poisons. This study presents a gas-based method for regenerating heavy-metal-poisoned V2O5-WO3/TiO2 catalysts employed in NH3-SCR techniques. The regeneration is achieved by employing a masking and reconstruction strategy, which involves the in situ formation of NO2 to mediate the production of SO3. This enables the effective bonding of Pb and triggers the reconstruction of active VOx sites. In situ spectroscopy confirms that the sulfation of PbO restores acidity, while the occupied effect resulting from the sulfation of TiO2 promotes the formation of more polymeric VOx species. Consequently, the regenerated catalyst exhibits enhanced activity and superior resistance to metal poisons compared with the fresh catalyst. The innovative method offers a promising solution for extending the lifespan of poisoned catalysts, reducing waste generation, and enhancing the efficiency of NH3-SCR systems.

Treatment of manganese and lead poisoning with sodium para-aminosalicylic acid: A contemporary update.

Sodium para-aminosalicylic acid (PAS-Na) treatment for manganese (Mn) intoxication has shown efficacy in experimental and clinical studies, giving rise to additional studies on its efficacy for lead (Pb) neurotoxicity and its associated mechanisms of neuroprotection. The difference between PAS-Na and other metal complexing agents, such as edetate calcium sodium (CaNa2-EDTA), is firstly that PAS-Na can readily pass through the blood-brain barrier (BBB), and complex and facilitate the excretion of manganese and lead. Secondly, PAS-Na has anti-inflammatory effects. Recent studies have broadened the understanding on the mechanisms associated with efficacy of PAS-Na. The latter has been shown to modulate multifarious manganese- and lead- induced neurotoxicity, via its anti-apoptotic and anti-inflammatory effects, as well as its ability to inhibit pyroptosis, and regulate abnormal autophagic processes. These observations provide novel scientific bases and new concepts for the treatment of lead, mercury, copper, thallium, as well as other toxic encephalopathies, and implicate PAS-Na as a compound with greater prospects for clinical medical application.

Plomo y mercurio en personas víctimas del conflicto armado en Bojayá, Chocó: estudio descriptivo / Lead and mercury in victims of the armed conflict in Bojayá, Chocó: a descriptive study / Chumbo e mercúrio em vítimas do conflito armado em Bojayá, Chocó: um estudo descritivo

Introducción: En los contextos del conflicto armado convergen actividades que potencialmente pueden producir toxicidad por metales pesados; inclusive, muchas víctimas de artefactos explosivos improvisados portan esquirlas residuales interiorizadas, de composición y potencial toxicidad desconocidas. Ello ha sido poco estudiado. Objetivo: Describir los niveles biológicos de plomo y mercurio en civiles supervivientes de la masacre de Bojayá, su eventual exposición actual, así como signos y síntomas compatibles con toxicidad crónica. Metodología: Estudio observacional descriptivo, tipo serie con 13 casos. Resultados: El 38.46 % de los casos tuvo niveles de plomo en sangre superiores o cercanos al valor límite superior, sin fuentes específicas identificadas. Un 46.15 % tuvo niveles mercuriales superiores o cercanos al límite de referencia, y se los considera exposición ambiental por minería aurífera regional. La valoración clínica toxicológica mostró síntomas y signos clínicos potencialmente asociados con toxicidad crónica por metales. Conclusión: Hubo presencia de residuos de artefactos explosivos en personas con hallazgos sugestivos de toxicidad por plomo o mercurio, sin que pueda afirmarse una relación directa y específica entre los dos aspectos; algunos casos sugieren exposición ambiental para mercurio, y exposición a proyectiles para el plomo, relacionadas con dinámicas del conflicto armado. Son necesarios estudios adicionales para afirmar la existencia de asociaciones causales.

Introduction: In the contexts of armed conflict, activities converge that can potentially produce heavy metal toxicity; including many victims of improvised explosive devices carry internalised residual shrapnel, of unknown composition and potential toxicity. This has been little studied. Objective: To describe the biological levels of lead and mercury in civilian survivors of the Bojayá massacre, their possible current exposure, as well as signs and symptoms compatible with chronic toxicity. Methodology: Descriptive observational study, serial type with 13 cases. Results: 38.46 % of the cases had blood lead levels above or close to the upper limit value, with no specific sources identified. 46.15 % had mercury levels above or close to the reference limit, and were considered environmental exposure from regional gold mining. Clinical toxicological assessment showed clinical signs and symptoms potentially associated with chronic metal toxicity. Conclusion: There was a presence of explosive ordnance residues in individuals with findings suggestive of lead or mercury toxicity, without a direct and specific relationship between the two; some cases suggest environmental exposure for mercury, and projectile exposure for lead, related to the dynamics of the armed conflict. Further studies are needed to affirm the existence of causal associations.

Introdução: Nos contextos de conflito armado, convergem atividades que podem potencialmente produzir toxicidade por metais pesados; Na verdade, muitas vítimas de dispositivos explosivos improvisados carregam lascas residuais internalizadas de composição desconhecida e potencial toxicidade. Isto tem sido pouco estudado. Objetivo: Descrever os níveis biológicos de chumbo e mercúrio em civis sobreviventes do massacre de Bojayá, sua eventual exposição atual, bem como sinais e sintomas compatíveis com toxicidade crônica. Metodologia: Estudo observacional descritivo, tipo série com 13 casos. Resultados: 38.46 % dos casos apresentaram níveis de chumbo no sangue superiores ou próximos ao valor limite superior, sem fontes específicas identificadas. 46.15 % apresentaram níveis de mercúrio superiores ou próximos ao limite de referência e são considerados exposição ambiental devido à mineração regional de ouro. A avaliação clínica toxicológica mostrou sintomas e sinais clínicos potencialmente associados à toxicidade crônica por metais. Conclusão: Houve presença de resíduos de artefatos explosivos em pessoas com achados sugestivos de toxicidade por chumbo ou mercúrio, sem que se pudesse afirmar uma relação direta e específica entre os dois aspectos; Alguns casos sugerem exposição ambiental ao mercúrio e exposição a projéteis de chumbo, relacionadas com a dinâmica do conflito armado. Estudos adicionais são necessários para confirmar a existência de associações causais.

Severe arsenic poisoning due to Ayurvedic supplements.

Patients that are taking Ayurvedic supplements have an increased risk of heavy metal toxicity. Lead, arsenic, and mercury are frequently identified in these supplements and can cause clinically significant toxicity. Clinicians should screen patients routinely for use of non-pharmaceutical medications and supplements.

Therapeutic Efficiency of Humic Acids in Intoxications.

Humins, humic and fulvic acids represent molecules with complex structures. These compounds comprising humic substances (HS) exist naturally in soil, brown coal, peat, and water. They are formed during the decomposition and transformation of organic matter (animal and plant remains) and their formation explains several theories. Within their chemical structures, there are numerous phenolic and carboxyl groups and their derivatives that affect their different properties, such as their solubility in water or their absorption of cations or mycotoxins. The manifold chemical structure of HS alters their polyelectrolyte character and thus their chelating efficiency. For many years, HS have been studied due to their detoxification, anti-, and pro-inflammatory or anticancer and antiviral ability. This article summarizes the antioxidant and adsorption properties of humic acids, highlighting their usefulness in intoxications.

Asymptomatic Lead Poisoning in a Pediatric Patient.

Lead poisoning is a harmful condition, potentially resulting in irreversible impairments in neurocognition and behavioral development in the pediatric population. Rarely, life-threatening complications may ensue. We report a case of an asymptomatic four-year-old patient presenting with elevated lead levels (74.7 µg/dL) detected on routine blood lead screening at a well-child examination. The patient has a history significant for atopic disease, namely atopic dermatitis, seasonal allergic rhinitis, and food allergies. Overall, the asymptomatic nature of lead poisoning warrants judicious screening in the pediatric population due to the potential for neurologic complications.

Arsenic Toxicity From the Ingestion of Terracotta Pottery.

BACKGROUND: Symptomatic arsenic toxicity has not been associated with terracotta pottery despite thousands of years of use in food storage and preparation. We describe a case of chronic arsenic toxicity from undiagnosed pica involving the ingestion of terracotta pots. CASE REPORT: A 49-year-old woman with a history of anemia and abnormal uterine bleeding presented to the Emergency Department complaining of lower extremity pain. She was also noted to have chronic lower extremity paresthesia, constipation, and fatigue. She admitted to ingesting glazed and unglazed terracotta pots for the past 5 years. This unusual craving was thought to be a manifestation of pica in the setting of chronic anemia. The patient was found to have an elevated urinary arsenic concentration of 116 µg/24 h. An abdominal radiograph showed opacifications throughout her bowel, and she received whole bowel irrigation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pica is a common behavior in certain populations. Practicing clinicians should be familiar with the complications of pica, including chronic arsenic toxicity and its associated array of nonspecific symptoms.

Intoxicación cronica por metales tóxicos en supervivientes de artefactos explosivos improvisados con fragmentos incorporados y su potencial neoplásico. Revisión sistemática exploratoria / Chronic heavy metal intoxication in survivors of improvised explosive devices with embedded fragments and its neoplastic potential. Exploratory systematic review

Resumen Introducción: Los artefactos explosivos improvisados son armas no convencionales que pueden provocar múltiples lesiones y dejar esquirlas a modo de cuerpos extraños que pueden contener metales tóxicos, con potencial afectación a la salud de las víctimas según reportes datados desde 1977, los cuales mencionan alta mortalidad por cáncer y otros síntomas compatibles con toxicidad crónica Objetivo: Describir los resultados de investigación que informen sobre la toxicidad crónica producida por metales en personas víctimas de artefactos explosivos improvisados con esquirlas internalizadas, y sus posibles relaciones con cáncer. Metodología: Revisión sistemática exploratoria de literatura publicada y gris que se realizó entre los meses de marzo a mayo de 2021 en diferentes repositorios de tesis y bases de datos (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); sin límite temporal o geográfico. Se incluyeron artículos originales de revistas indexadas o informes finales no publicados, correspondientes a investigaciones científicas con texto completo, en inglés, español y portugués. Resultados: De 56 documentos evaluados, solamente tres cumplieron criterios de inclusión. Todos estaban escritos en idioma inglés. Solo un estudio iraquí abordó población civil y los otros trabajos aludían a veteranos norteamericanos. Los niveles elevados de metales tóxicos, asociados con alteraciones tisulares circunscritas, fueron hallazgos recurrentes. No hubo reportes de patologías instauradas o manejos clínicos. Conclusión: Fue escasa la evidencia científica recabada; sin embargo, sí se han reportado cambios tisulares circundantes a esas esquirlas. Se considera necesario realizar más estudios relacionados con el tema, incluyendo seguimientos a largo plazo de las afectaciones tisulares detectadas.

Abstract Introduction: Improvised explosive devices are unconventionalweapons that can cause multiple injuries and splinters internalized containing heavy metals, potentially affecting the victim's health, according to reports dating from 1977, which mention high mortality from cancer and other symptoms suggestive of chronic metal toxicity. Objective: To describe the research results that report on the chronic toxicity produced by heavy metals in people who are victims of improvised explosive devices with internalized splinters, and its possible links with cancer. Methodology: Systematic exploratory review of published and grey literature which was carried out between march and may of 2021, in thesis repositories and different databases (Scielo, Pubmed, Academic Search Complete, JSTOR, Biblioteca Virtual en Salud, Freepdf, Google Académico, Open Grey); without time or geographical limit. Original articles from indexed scientific research journals or unpublished final reports were included, corresponding to scientific research with full text, in english, spanish and portuguese. Results: 56 documents were evaluated, three were selected fulfilling the inclusion criteria. They were all written in the english language. Only one Iraqi study addressed the civilian population and the other studies referred to North American veterans. Elevated heavy metal levels, associated with circumscribed tissue abnormalities, were recurrent findings. There were no reports of established pathologies or clinical management. Conclusion: The scientific evidence was scarce; as well as its relationship with established cancer, however, tissue changing surrounding these splinters have been reported. It is considered necessary to carry out more studies related to the subject, including long-term follow-up of detected tissue damage.

[Occupational hazard analysis of workers exposed to chromate in a steel plant].

Objective: To investigate the occupational damage to workers exposed to chromate in a steel plant. Methods: In January 2021, a retrospective analysis was used to select 850 workers exposed to chromate (observation group) and 598 workers not exposed to chromate (control group) in a steel plant in Shandong Province from 2016 to 2017 as the investigation. We collected their occupational-related information, blood routine, fasting blood sugar, nasal lesions, skin lesions, chest X-rays and other inspection results, compared the differences in the abnormal detection rate of the two groups of respondents, and analyzed the occupational hazards of chromium workers. Results: Incidence of nasal damage, skin lesion, up-regulation of ALT (Alanine aminotransferase), abnormal chest radiograph, abnormal serum biochemical index, and abnormal serum glucose level were observed higher in the exposed group than those in the control group (χ(2)=125.69, 12.25, 5.82, 10.37, 10.46, 20.66, P=0.000, 0.000, 0.016, 0.001, 0.001, 0.000). Among the symptoms, the incidence of erythra, nasal septum deviation, nasal mucosal congestion, nasal mucosal erosion and rhinitis were more frequent than those in the control group (χ(2)=101.54, 4.07, 13.20, 32.05, P=0.000, 0.044, 0.000, 0.000). There was no significant increase in the incidence of work type, age, length of work and the area of nasal mucosa erosion in the observation group compared with the control table, and the difference was not statistically significant (χ(2)=5.31、0.42、0.28, P=0.505, 0.662, 0.871) . Conclusion: Occupational hazards of long-term exposure to chromate cannot be ignored. Attention should be paid to strengthening occupational protection and health education of workers exposed to chromium, and increasing their attention.

Ayurveda intervention for brass-induced heavy metal toxicity: A report from the single-arm pilot study.

BACKGROUND: Brass is a copper-zinc alloy that also contains additional elements, including lead. Industrial operations on brass produce dust and fumes that can be harmful to an individual's health. Ayurveda recommends Dadima Svarasa and Triphala Churna for the management of symptoms caused due to brass toxicity. OBJECTIVE: To obtain preliminary evidence on the efficacy of Triphala Churna (powder mixture of three myrobalans) and Dadima Svarasa (pomegranate juice) in the management of brass-associated high serum level of copper, zinc, lead, and their harms through an open-label single-arm pilot study. MATERIALS AND METHODS: A total of 20 workers with brass toxicity and increased level of one or more of the serum ions including copper, zinc and lead were prescribed. 5gm Triphala powder once daily and Dadima Svarasa 40 ml in two divided doses were administered daily for 28 days. Changes in serum concentration of heavy metals and common health problems like anorexia, headache, dizziness, weakness, nausea, nose irritation, eye irritation, epigastric pain, abdominal distention, chest pain, dyspnea, cough, lumbar pain, body ache, numbness, and occupational dermatitis were reported at baseline and end of the trial. RESULTS: Trial drugs were found to produce significant decrease in mean values of serum copper (p < 0.001) and serum lead (p < 0.001) whereas significant increase in mean values of serum zinc (p > 0.001) was observed. Significant relief was observed in nausea (p = 0.005), anorexia (p = 0.000), epigastric pain (p = 0.001), abdominal distention (p = 0.014), weakness (p = 0.005) and body ache (p = 0.005). CONCLUSION: Triphala Churna along with Dadima Svarasa are safe and effective in the management of brass-associated high serum levels of copper and lead and their health hazards.

Parkinsonism in a Patient With Metal on Metal Total Hip Replacement Related Elevated Serum Heavy Metal Levels.

Heavy metal toxicity accounts for a rare minority of parkinsonian presentations. It is established that metal on metal total hip replacements can elevate serum cobalt and chromium levels. Here, we present an atypical parkinsonism presentation in a patient with metal on metal total hip replacement related heavy metal exposure, a picture complicated by a previous cerebral vascular accident involving the right lentiform nucleus. Initial work-up included MRI brain and dopamine transporter uptake imaging. A follow-up consultation revealed progressing parkinsonism. This case presentation reports the first parkinsonism presentation associated with metal on metal total hip replacement related heavy metal toxicity.

Nanomotor-based adsorbent for blood Lead(II) removal in vitro and in pig models.

Blood lead (Pb(II)) removal is very important but challenging. The main difficulty of blood Pb(II) removal currently lies in the fact that blood Pb(II) is mainly complexed with hemoglobin (Hb) inside the red blood cells (RBCs). Traditional blood Pb(II) removers are mostly passive particles that do not have the motion ability, thus the efficiency of the contact between the adsorbent and the Pb(II)-contaminated Hb is relatively low. Herein, a kind of magnetic nanomotor adsorbent with movement ability under alternating magnetic field based on Fe3O4 nanoparticle modified with meso-2, 3-dimercaptosuccinic acid (DMSA) was prepared and a blood Pb(II) removal strategy was further proposed. During the removal process, the nanomotor adsorbent can enter the RBCs, then the contact probability between the nanomotor adsorbent and the Pb(II)-contaminated Hb can be increased by the active movement of nanomotor. Through the strong coordination of functional groups in DMSA, the nanomotor adsorbent can adsorb Pb(II), and finally be separated from blood by permanent magnetic field. The in vivo extracorporeal blood circulation experiment verifies the ability of the adsorbent to remove blood Pb(II) in pig models, which may provide innovative ideas for blood heavy metal removal in the future.

Erythrocyte Membrane-Wrapped Magnetic Nanotherapeutic Agents for Reduction and Removal of Blood Cr(VI).

The hazard of hexavalent chromium (Cr(VI)) from environmental pollution and medical implanted metal has been recognized widely. However, removal of trace amount of Cr(VI) in the blood circumstance faces tremendous difficulties for that most of Cr(VI) located in erythrocytes, thus there is almost no literature to report the removal of Cr(VI) in blood. Herein, a removal strategy, named as reduction-adsorption-separation, is proposed to realize the removal of Cr(VI) in blood. First, magnetic core-shell mesoporous nanocomposite is fabricated by using Fe3O4 nanoparticles as magnetic core and mesoporous silica (MS) as shell, hyperbranched polyamide (HPA) as mesoporous channel modifier and ascorbic acid (ASC) as the reductant drug loaded in the mesoporous channels, which is also denoted as Fe/MS/HPA/ASC. Then, on the basis of the bionic idea, the erythrocyte membrane (EM)-wrapped Fe/MS/HPA/ASC to protect ASC from deactivation is obtained and named as the therapeutic agent (Fe/MS/HPA/ASC@EM). During removal process, the therapeutic agent can enter in erythrocytes to use ASC to reduce Cr(VI) to Cr(III) and HPA in mesoporous channels to adsorb Cr(III) and can then be recollected from blood by magnetic separation. Finally, an animal model of blood Cr(VI) poisoning is constructed and used to test the removal ability of Cr(VI) from pig blood in vivo, verifying the effectiveness of this blood Cr(VI) removal strategy, providing a possible way to design more efficient and biosafe therapeutic agents for blood purification.

Metal Levels, Genetic Instability, and Renal Markers in Electronic Waste Workers in Thailand.

BACKGROUND: Informal electronic waste (e-waste) recycling is an increasingly important industry worldwide. However, few studies have studied the health risks in this group of workers. OBJECTIVE: To assess the associations between occupational exposures to metals and genetic instability and renal markers among e-waste recycling workers. METHODS: We recruited informal e-waste recycling workers from a community in northeastern Thailand. Participants completed a questionnaire, several health measurements, and provided urine and blood samples, which we then analyzed for a number of metals including lead (Pb), cadmium (Cd), and manganese (Mn). Samples were analyzed for a marker of RNA and DNA damage (ie, oxidative stress), 8-hydroxy-2'-deoxyguanosine (8-OHdG). Glomerular filtration rate (GFR) and fractional excretion of calcium (FECa%) were measured as markers of renal function. Correlations and regression models were used to assess associations between these various factors. RESULTS: We found significantly higher levels of Cd and Pb in blood of men compared with those in women. Men who worked >48 hours/week had significantly higher levels of 8-OHdG compared with men who worked ≤48 hours/week. Smoking was significantly associated with higher blood Pb and Cd concentrations among men. CONCLUSION: Our results suggest gender differences in both blood concentrations of metals associated with e-waste recycling and smoking and highlight potentially elevated oxidative stress associated with longer work hours. Health promotion efforts are needed among informal e-waste recyclers to reduce possible risks of renal damage and cancer.

Outbreak investigation of lead neurotoxicity in children from artificial jewelry cottage industry.

BACKGROUND: Although lead neurotoxicity is a known phenomenon, it can often be missed at a primary or secondary care level especially if detailed environmental exposure history is missed. METHODS: This is an outbreak investigation where we observed 15 pediatric cases with neurologic signs and symptoms clustered in a slum area known for an unorganized artificial jewelry industry. Their clinical, biochemical, and epidemiological features were compared with 14 other children from the same region reporting with non-neurological symptoms who were considered as unmatched controls. RESULTS: Cases with neurological manifestations had a higher in-house lead smelting activity [OR 7.2 (95% CI 1.4-38.3)] as compared to controls. Toddlers below 3 years of age were more vulnerable to the effects of lead. CONCLUSION: This study emphasizes that many focal sources of lead poisoning still remain especially in the unorganized sector. In cases presenting with unexplained neurotoxicity, specific occupational and environmental inquiry for chemical poisoning, with special consideration for lead, should be actively pursued.

Outbreak investigation of lead neurotoxicity in children from artificial jewelry cottage industry

BACKGROUND@#Although lead neurotoxicity is a known phenomenon, it can often be missed at a primary or secondary care level especially if detailed environmental exposure history is missed.@*METHODS@#This is an outbreak investigation where we observed 15 pediatric cases with neurologic signs and symptoms clustered in a slum area known for an unorganized artificial jewelry industry. Their clinical, biochemical, and epidemiological features were compared with 14 other children from the same region reporting with non-neurological symptoms who were considered as unmatched controls.@*RESULTS@#Cases with neurological manifestations had a higher in-house lead smelting activity [OR 7.2 (95% CI 1.4-38.3)] as compared to controls. Toddlers below 3 years of age were more vulnerable to the effects of lead.@*CONCLUSION@#This study emphasizes that many focal sources of lead poisoning still remain especially in the unorganized sector. In cases presenting with unexplained neurotoxicity, specific occupational and environmental inquiry for chemical poisoning, with special consideration for lead, should be actively pursued.

Human exposure to mercury and its hematological effects: a systematic review / Exposição humana ao mercúrio e seus efeitos hematológicos: uma revisão sistemática / Exposición humana al mercurio y sus efectos hematológicos: una revisión sistemática

Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (β) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.

O mercúrio é um metal que pode ser encontrado naturalmente no meio ambiente e através de fontes antropogênicas. É altamente tóxico para ecossistemas e seres vivos. A maior parte da exposição humana provém da ingestão de pescados contaminados, da liberação de gases da amálgama dentária ou da exposição ocupacional (p.ex.: extração de ouro). Vastas populações são expostas ao mercúrio, tornando-se uma questão de saúde pública muito importante. Efeitos adversos à saúde são comumente observados no sistema nervoso, mas todos os órgãos são alvos em potencial, como a medula óssea. O principal objetivo do estudo foi avaliar as evidências disponíveis sobre a exposição humana ao mercúrio e seus efeitos hematológicos. Uma estratégia de busca foi realizada, incluindo termos chave (palavras-chave, palavras do texto e equivalentes), para pesquisar dois repositórios de dissertações de mestrado e teses de doutorado (Fiocruz/ARCA e Universidade de São Paulo) e quatro bases de dados eletrônicas: BVS/LILACS, MEDLINE/PubMed, Scopus e TOXLINE/NIH (artigos publicados de 1950 até fevereiro de 2018). Não houve restrições de linguagem e uma ferramenta (EPHPP) foi utilizada para avaliar a qualidade dos estudos incluídos. De acordo com os critérios pré-estabelecidos, foram encontrados 80 estudos, todos observacionais (48 relatos de caso, 24 estudos transversais, 6 séries de casos e 2 coortes), que compreendiam 9.284 pessoas. Apesar do fato de que as pessoas mais expostas (6.012) tinham contagens de células sanguíneas normais, e os efeitos hematológicos do mercúrio não pareciam muito comuns (1.914 casos, 14 graves e 29 mortes), três estudos relataram a associação de (β) anemia, linfopenia, neutrofilia e basofilia. Concluímos que as informações coletadas indicam efeitos hematotóxicos do mercúrio, alguns dos quais podem ser muito graves e até fatais.

El mercurio es un metal que se puede encontrar de forma natural en el ambiente y mediante fuentes antropogénicas. Es altamente tóxico para los ecosistemas y seres vivos. Entre otras, la mayor parte de la exposición humana, proviene de la ingestión de pescado contaminado, liberación de gases de amalgamas dentales o exposición ocupacional (p.ej. extracción de oro). Vastas poblaciones están expuestas al mercurio, convirtiéndolo en un asunto muy importante desde la perspectiva de la salud pública. Los efectos adversos para la salud se observan comúnmente en el sistema nervioso, pero cada órgano es un objetivo potencial, como la médula ósea. El objetivo principal del estudio fue evaluar las evidencias disponibles sobre la exposición humana al mercurio y sus efectos hematológicos. Se realizó una estrategia de búsqueda, incluyendo términos clave (palabras-clave, palabras del texto y equivalentes), se consultaron 2 registros de trabajos finales de máster y tesis de doctorado (Fiocruz/ARCA y Universidad de São Paulo) y 4 bases de datos electrónicas diferentes: BVS/LILACS, MEDLINE/PubMed, Scopus y TOXLINE/NIH, para artículos publicados desde el año 1950, hasta febrero de 2018. No hubo restricciones de lengua y se usó la herramienta (EPHPP) para evaluar la calidad de los estudios incluidos. De acuerdo con los criterios preestablecidos, se recopilaron 80 estudios, todos observacionales (48 informes de casos, 24 estudios transversales, 6 series de casos, y 2 cohortes), que comprendieron a 9.284 personas. A pesar de que la mayoría de los expuestos (6.012) tenían un recuento normal de células sanguíneas y los efectos hematológicos del mercurio no parecían muy comunes (1.914 casos: 14 severos y 29 muertes), tres estudios informaron de la asociación (β) para anemia, linfopenia, neutrofilia y basofilia. Concluimos que la información recabada indicaba los efectos hematotóxicos del mercurio, algunos de los cuales pueden ser muy serios e incluso fatales.