Exploring the link between toxic metal exposure and ADHD: a systematic review of pb and hg.

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) is a recognized neurodevelopmental disorder with a complex, multifactorial origin. Lead (Pb) and mercury (Hg) are highly toxic substances that can potentially impair brain development and have been implicated in the development of ADHD. This systematic review aims to analyze the epidemiological literature regarding the association between Pb and Hg exposure and the diagnosis of ADHD. METHODS: From November 1983 to June 2, 2023, a comprehensive search was conducted in multiple databases and search engines, including PubMed, Web of Science, Scopus, and Google Scholar. Observational studies (case-control, cohort, and cross-sectional) measuring Pb and Hg levels in various biological samples (blood, hair, urine, nail, saliva, teeth, and bone) of children with ADHD or their parents and their association with ADHD symptoms were included. RESULTS: Out of 2059 studies, 87 met the inclusion criteria and were included in this systematic review. Approximately two-thirds of the 74 studies investigating Pb levels in different biological samples reported associations with at least one subtype of ADHD. However, most studies examining Hg levels in various biological samples found no significant association with any ADHD subtype, although there were variations in exposure periods and diagnostic criteria. CONCLUSION: The evidence gathered from the included studies supports an association between Pb exposure and the diagnosis of ADHD, while no significant association was found with Hg exposure. Importantly, even low levels of Pb were found to elevate the risk of ADHD. Further research is needed to explore the comprehensive range of risk factors for ADHD in children, considering its significance as a neurodevelopmental disorder.

Unusual and very rare presentation of wrist pain in a man with acute anterior myocardial infarction, a case report and literature of review.

BACKGROUND: As acute myocardial infarction (AMI) prevalence is increasing because of lifestyle changes, the incidence of atypical symptoms in acute coronary syndrome (ACS) is rising and making misdiagnosing of this fatal event more probable. To better approach the patients with atypical symptoms, we tend to present a rare case of AMI with wrist pain. CASE REPORT: A 41-year-old man presented to the emergency room (ER) with severe both-hand wrist pain and mild epigastric pain. His electrocardiogram (ECG) showed anterior ST-elevation myocardial infarction (MI) with an ejection fraction of 35-40%. His angiography showed severe left anterior descending artery (LAD), and first obtuse marginal artery (OM1) artery stenosis. He underwent Primary percutaneous coronary intervention (PCI). The patient recovered without serious complications and was discharged the day after PCI. DISCUSSION: In this rare case of AMI with wrist pain, it is important to know that atypical symptoms can be present at various levels of symptoms, which prevents future misdiagnosis.

Alzheimer's Disease and Circulatory Imbalance of Toxic Heavy Metals: A Systematic Review and Meta-analysis of Clinical Studies.

The role of heavy metals on human health has often been discussed regarding disease pathogenesis and risk factors. Alzheimer's disease (AD), a prevalent neurodegenerative disease, is no exception. We conducted a comprehensive examination to assess the concentrations of lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg) in biological samples of AD patients in comparison with a group of individuals without AD, with the objective of our study being to perform a systematic review on this topic. We performed this systematic review by searching various databases/search engines, including Web of Science, Scopus, PubMed, and Google Scholar, until December 7, 2022. Relevant studies were scrutinized for eligibility. Meta-analysis was performed on studies with sufficient data using STATA software. Twenty-seven out of 3349 studies met pre-defined eligibility criteria and were included in our systematic review. For the meta-analysis, 22 studies with 3346 participants (1291 AD patients and 2055 healthy controls) had sufficient data for inclusion in the analysis. Using a random-effects model, we found that pooled data indicated patients with AD had significantly higher levels of Cd in their biological samples compared to controls (Hedges' g, 0.83; 95% CI, 0.11, 1.54; p = 0.023). However, other heavy metals were not significantly different in circulatory samples of AD patients compared to healthy controls (p > 0.05). This systematic review and meta-analysis indicated that Cd concentrations in AD patients were significantly higher than in healthy controls. Other included heavy metals may not be directly associated with increased risk of AD.