Eco-Pap: The Ecological Modification of the Papanicolaou Stain for Sustainable Cervical Cancer Diagnosis.

OBJECTIVES: To validate the ecological modification of the Papanicolaou stain (Eco-Pap) for the diagnosis of cervical cancer. STUDY DESIGN: A prospective study was performed at the Mother and Child "San Bartolomé" Hospital, Lima, Peru. Reagent handling strategies were divided into three phases: we used (1) Harris progressive hematoxylin (for nuclear staining), (2) a polychromatic solution (a mix of EA-36/Orange G-6 to suppress the use of several alcohol baths), and (3) direct mounting (with Entellan® solution). The cellular details were analyzed by the staining quality index, an external quality control, and the Bethesda System 2014. RESULTS: We evaluated 72,901 cervical smears stained with the Eco-Pap. The validation of the Eco-Pap against the conventional Pap stain was optimal (κ = 0.89; 95% CI: 0.87-0.92), showing a sensibility and specificity of 88.3% (95% CI: 85.1-90.0) and 98.7% (95% CI: 98-99.2), respectively. The Eco-Pap dramatically reduced the environmental pollution caused by 72 L of xylene, hydrochloric acid, and ammonia (6 L each) and mercury oxide. CONCLUSION: The Eco-Pap is an innovative and efficient staining method reducing the use of toxic reagents with carcinogenic potential during cervical cancer screening by exfoliative cytology.

The chemical speciation, spatial distribution and toxicity of mercury from Tibetan medicine Zuotai，ß-HgS and HgCl2 in mouse kidney.

Zuotai, a famous Tibetan medicinal mixture containing ß-HgS, has been used to combine with herbal remedies for treating diseases for more than 1 300 years. The target organ for inorganic mercury toxicity is generally considered to be the kidney. Therefore, it is crucial to reveal the chemical speciation, spatial distribution and potential nephrotoxicity of mercury from Zuotai in kidney. To date, this remains poorly understood. We used X-ray absorption spectroscopy (XAS) and micro X-ray fluorescence (µ-XRF) imaging based on synchrotron radiation to study mercury chemical forms and mercury special distribution in kidney after mice were treated orally with Zuotai, ß-HgS or HgCl2. Meanwhile, the histopathology of kidney was observed. Mice exposed with Zuotai showed kidney with significant proportion of mercury ions bound to sulfydryl biomolecules (e.g. Cys-S-Hg-S-Cys) plus some of unknown species, but without methylmercury cysteine, which is the same as ß-HgS and HgCl2. The mercury is mainly deposited in renal cortex in mouse treated with Zuotai, ß-HgS or HgCl2, but with a low level of mercury in medulla. The total mercury in kidney of mice treated with HgCl2 was much higher than that of ß-HgS, and the later was higher than that of Zuotai. And, HgCl2 cause severe impairments in mouse kidney, but that was not observed in the Zuotai and ß-HgS groups. Meanwhile, the bio-metals (Ca, Zn, Fe and Cu) micro-distributions in kidney were also revealed. These findings elucidated the chemical nature, spatial distribution and toxicity difference of mercury from Zuotai, ß-HgS and HgCl2 in mouse kidney, and provide new insights into the appropriate methods for biological monitoring.

Nephrotic syndrome of minimal change disease following exposure to mercury-containing skin-lightening cream.

A 28-year-old female suffered from nephrotic syndrome after a long-term use of mercury-containing, skin-lightening cream. The blood and urinary mercury content of this patient increased with use. Renal biopsy showed minimal change disease. Her symptoms were relieved 6 months after discontinuing use of the cream and receiving sodium dimercaptosulfonate and glucocorticosteroid treatments. Proteinuria disappeared, and blood and urinary mercury levels returned to normal. Previous reports of nephrotic syndrome caused by mercury-containing, skin-lightening creams have mostly been identified as be.ing due to membranous nephropathy. Minimal change disease has been reported in a few case reports published in the English language. Here we report a case of nephrotic syndrome with minimal change disease following exposure to a mercury-containing, skin-lightening cream. We also reviewed relevant published reports to summarize clinical features and treatments and to explore the possible mechanisms involved.

Evidence supporting a link between dental amalgams and chronic illness, fatigue, depression, anxiety, and suicide.

The purpose of this review is to examine the evidence for a relationship between mercury (Hg) exposure from dental amalgams and certain idiopathic chronic illnesses--chronic fatigue syndrome (CFS), fibromyalgia (FM), depression, anxiety, and suicide. Dental amalgam is a commonly used dental restorative material that contains approximately 50% elemental mercury (Hg0) by weight and releases Hg0 vapor. Studies have shown that chronic Hg exposure from various sources including dental amalgams is associated with numerous health complaints, including fatigue, anxiety, and depression--and these are among the main symptoms that are associated with CFS and FM. In addition, several studies have shown that the removal of amalgams is associated with improvement in these symptoms. Although the issue of amalgam safety is still under debate, the preponderance of evidence suggests that Hg exposure from dental amalgams may cause or contribute to many chronic conditions. Thus, consideration of Hg toxicity may be central to the effective clinical investigation of many chronic illnesses, particularly those involving fatigue and depression.

Effects of methylmercury on electric organ discharges in the weak electric fish Gymnotus sylvius

Methylmercury (MeHg) is present in the environment because of natural and anthropogenic causes. MeHg can reach the central nervous system (CNS) and cause neurological damage in humans and animals. Electric organ discharges (EODs) in the weak electric fish Gymnotus sylvius are produced by the electric organ and modulated by the CNS. These discharges are used for electrolocation and communication. The purpose of the present study was to investigate the effects of dietary MeHg exposure on EOD rate in G. sylvius. An oscilloscope was used to record the EOD rate. Two treatments were investigated: chronic MeHg administration (4 µg/kg MeHg every 2 days, with a total of nine dietary exposures to MeHg) and acute MeHg administration (a single dose of 20 µg/kg MeHg). The control data for both treatments were collected every 2 days for 18 days, with a total of nine sessions (day 1 until day 18). Data of fish exposed to MeHg were collected every 2 days, totaling nine sessions (day 19 until day 36). Chronic treatment significantly increased the EOD rate in G. sylvius (p < .05), especially with the final treatment (day 32 until day 36). Acute treatment resulted in an initial increase in the EOD rate, which was maintained midway through the experiment (day 26 until day 30; p < .05). The present study provides the first insights into the effects of MeHg on EODs in weak electric fish. The EOD rate is a novel response of the fish to MeHg administration.

Toxic risks and nutritional benefits of traditional diet on near visual contrast sensitivity and color vision in the Brazilian Amazon.

BACKGROUND: Visual functions are known to be sensitive to toxins such as mercury (Hg) and lead (Pb), while omega-3 fatty acids (FA) and selenium (Se) may be protective. In the Tapajós region of the Brazilian Amazon, all of these elements are present in the local diet. OBJECTIVE: Examine how near visual contrast sensitivity and acquired color vision loss vary with biomarkers of toxic exposures (Hg and Pb) and the nutrients Se and omega-3 FA in riverside communities of the Tapajós. METHODS: Complete visuo-ocular examinations were performed. Near visual contrast sensitivity and color vision were assessed in 228 participants (≥15 years) without diagnosed age-related cataracts or ocular pathologies and with near visual acuity refracted to at least 20/40. Biomarkers of Hg (hair), Pb (blood), Se (plasma), and the omega-3 FAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in plasma phospholipids were measured. Multiple linear regressions were used to examine the relations between visual outcomes and biomarkers, taking into account age, sex, drinking and smoking. RESULTS: Reduced contrast sensitivity at all spatial frequencies was associated with hair Hg, while %EPA, and to a lesser extent %EPA+DHA, were associated with better visual function. The intermediate spatial frequency of contrast sensitivity (12 cycles/degree) was negatively related to blood Pb and positively associated with plasma Se. Acquired color vision loss increased with hair Hg and decreased with plasma Se and %EPA. CONCLUSIONS: These findings suggest that the local diet of riverside communities of the Amazon contain toxic substances that can have deleterious effects on vision as well as nutrients that are beneficial for visual function. Since remediation at the source is a long process, a better knowledge of the nutrient content and health effects of traditional foods would be useful to minimize harmful effects of Hg and Pb exposure.

Minimal change disease caused by exposure to mercury-containing skin lightening cream: a report of 4 cases.

Mercury is a known cause of nephrotic syndrome and the underlying renal pathology in most of the reported cases was membranous nephropathy. We describe here 4 cases of minimal change disease following exposure to mercury-containing skin lightening cream for 2 - 6 months. The mercury content of the facial creams was very high (7,420 - 30,000 parts per million). All patients were female and presented with nephrotic syndrome and heavy proteinuria (8.35 - 20.69 g/d). The blood and urine mercury levels were 26 - 129 nmol/l and 316 - 2,521 nmol/d, respectively. Renal biopsy revealed minimal change disease (MCD) in all patients. The use of cosmetic cream was stopped and chelation therapy with D-penicillamine was given. Two patients were also given steroids. The time for blood mercury level to normalize was 1 - 7 months, whereas it took longer for urine mercury level to normalize (9 - 16 months). All patients had complete remission of proteinuria and the time to normalization of proteinuria was 1 - 9 months. Mercury-containing skin lightening cream is hazardous because skin absorption of mercury can cause minimal change disease. The public should be warned of the danger of using such products. In patients presenting with nephrotic syndrome, a detailed history should be taken, including the use of skin lightening cream. With regard to renal pathology, apart from membranous nephropathy, minimal change disease should be included as another pathological entity caused by mercury exposure or intoxication.

Elemental mercury poisoning presenting as hypertension in a young child.

Mercury intoxication is an uncommon cause of hypertension in children and can mimic several other diseases, such as pheochromocytoma and vasculitis. Mercury intoxication can present as a diagnostic challenge because levels of catecholamines may be elevated, suggesting that the etiology is a catecholamine-secreting tumor. Once acrodynia is identified as a primary symptom, a 24-hour urine mercury level can confirm the diagnosis. Inclusion of mercury intoxication in the differential diagnosis early on can help avoid unnecessary and invasive diagnostic tests and therapeutic interventions. We discuss a case of mercury intoxication in a 3-year-old girl presenting with hypertension and acrodynia, without a known history of exposure. Chelation therapy successfully treated our patient's mercury intoxication. However, it was also necessary to concurrently treat her hypertension and the pain associated with her acrodynia. Because there were no known risk factors for mercury poisoning in this case, and because ritual use of mercury is common in much of the United States, we recommend high clinical suspicion and subsequent testing in all cases of acrodynia.

[Overview of studies on detoxification effect of smilacis glabrae rhizoma on mercury poisoning].

Mercury-containing preparations are widely used in surgery department of traditional Chinese medicine and have made remarkable achievements. But they are toxic to human kidney, nerve, immune, etc. Smilacis Glabrae Rhizoma is sweet, tasteless and neutral in nature and able to enter liver and stomach channels and detoxify mercury poisoning. This article summarizes the mercury poisoning and the detoxification effect of Smilacis Glabrae Rhizoma in ancient records, pharmaceutical studies and clinical application, in order to provide ideas and methods for the safe use of mercury-containing preparations in surgery department of traditional Chinese medicine.

Cutaneous pseudolymphoma following tattoo application: report of two new cases of a potential lymphoma mimicker.

The authors report 2 cases of cutaneous pseudolymphoma that occurred in 2 young adult patients who referred for relentlessly growing nodules that appeared within 4 to 5 months after the application of a mercury-based tattoo. Systemic symptoms were not present and there was no evidence of lymph node enlargement. Clinically, both lesions were limited to the red, mercury-based areas of the tattoo. Microscopic examination featured a dense cellular infiltrate composed of polytypic T cells in the upper to mid-dermis, coupled with focal interface tissue reaction. Scattered macrophages contained finely granular particles in their cytoplasm. In addition, extracellular pigment particles were also recognized. Collections of epithelioid macrophages were present in both cases and were reminiscent of epithelioid granulomas. This study confirms evidence that, among skin diseases featuring a dense lymphoid infiltrate, cutaneous pseudolymphoma secondary to tattooing is a rare but not exceptional source of diagnostic challenges.

Mercury exposure and oxidative stress in communities of the Brazilian Amazon.

This study was designed to assess possible associations between biomarkers of mercury (Hg) exposure and oxidative stress in fish-eating Amazonian communities. Clinical samples were obtained from riparians living in the Brazilian Amazon. Biomarkers of oxidative stress (glutathione - GSH, glutathione peroxidase - GSH-Px, catalase - CAT, activity and reactivation index of delta-aminolevulinate dehydratase - ALA-D (R%) were determined in blood. Total Hg was measured in whole blood (B-Hg), plasma (P-Hg) and hair (H-Hg). Association between biomarkers of Hg exposure and oxidative stress were examined using multiple regression models, including age, gender, alcohol consumption, smoking status, fish consumption and then stratified for gender. Significant inverse relations were observed between GSH-Px, GSH, CAT, ALA-D activity and B-Hg or H-Hg (p<0.05). ALA-D reactivation index was positively related to B-Hg (p<0.0001). P-Hg was directly related to ALA-D reactivation index and inversely associated with GSH-Px, GSH, and ALA-D activity (p<0.05). When stratified for gender, women showed significant inverse associations between all biomarkers of Hg exposure and CAT (p<0.05) or GSH (p<0.05), while for men only P-Hg showed a significant inverse relation with GSH (p<0.001). Our results clearly demonstrated an association between Hg exposure and oxidative stress. Moreover, for B-Hg, P-Hg and H-Hg gender differences were present.

Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review.

OBJECTIVE: We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations. STUDY DESIGN: Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes. RESULTS: Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam. CONCLUSIONS: Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.

Contact orofacial granulomatosis caused by delayed hypersensitivity to gold and mercury.

Orofacial granulomatosis, an entity with characteristic clinicopathologic features, is thought to be a reactive process. The authors describe orofacial granulomatosis associated with contact allergy to gold in dental crowns in one patient and a possible allergic contact reaction to mercury from dental fillings in another one. Thus allergic contact dermatitis to the metals gold and mercury should be considered as a possible etiologic agent of orofacial granulomatosis.

Red ink tattoo reactions: successful treatment with the Q-switched 532 nm Nd:YAG laser.

BACKGROUND: In the South-west Thames region there were an unprecedented number of lichenoid tattoo reactions to red ink in patients who had visited a local tattoo parlour. The red ink was found to contain mercuric sulphide, a compound known to cause allergic reactions. Topical Dermovate (clobetasol propionate 0.05%, GlaxoWellcome) ointment alone had little impact. OBJECTIVES: To investigate whether the Q-switched 532 nm Nd:YAG laser could produce permanent flattening of the reaction. METHODS: This was an open nonrandomized clinical trial. Biopsies were taken from the lichenoid areas within the tattoos. Subjects were patch tested to 1% ammoniated mercury in petrolatum prior to treatment with the Q-switched 532 nm Nd:YAG laser. Laser treatments were delivered at 6-weekly intervals by a single operator. Patients also applied topical Dermovate between treatments. Therapy was discontinued when the lesions flattened. Clinical photographs were assessed at baseline and prior to each laser treatment. RESULTS: Seven patients with Fitzpatrick skin types I-III were enrolled in the study (four females, three males, mean age 39 years). All patients completed the trial. Patch testing to mercury was universally negative at 48 and 96 h. Substantial flattening and depigmentation of the red ink within the tattoos was noted after six laser treatments. No adverse effects were recorded. CONCLUSIONS: The Q-switched 532 nm Nd:YAG laser in combination with topical Dermovate ointment is a safe and effective method of treating red ink tattoo reactions.

[Methodological aspects of gas-mercury monitoring of non-industrial areas]. / Metodicheskie aspekty gazortutnogo monitoringa neproizvodstvennykh ob"ektov.

The paper presents new methodological approaches to gaseous mercury monitoring whose key link is to record the territorial background level of air pollution, which is calculated by using the frequency distribution diagrams of single measurements for uniform objects within an area by comparing them with logarithmically normal random distribution. The methodological approach has been used during surveys of schools and preschool children establishments in Moscow, Kaluga, and the Kaluga Region.

Mercury exposure and early effects: an overview.

OBJECTIVES: This paper was given as a keynote address at the conference on The Assessment of the Effects Due to Low Doses of Inorganic Mercury following Environmental and Occupational Exposures: Human and in vitro Studies on the Specific Mechanisms of Toxicity in Gargnano, Italy, in September 2001. METHODS: The most relevant literature over the past 40 years has been reviewed, and in particular, the proceedings of the World Health Organisation conferences on the health effects of inorganic and organic mercury exposure have been considered. RESULTS: In an uncontaminated environment the general population is exposed to mercury vapour from the atmosphere and from dental amalgam, while the diet, mainly from fish, is the principal source for methyl mercury absorption. Mercury vapour release from amalgam fillings increases with chewing, with absorption and uptake by the brain and kidneys. Infants exposed to phenyl mercury from treated diapers and young children ingesting mercurous chloride in teething powders have developed acrodynia (pink disease), and Kawasaki disease and the use of mercurial skin lightening creams has been followed by the development of the nephrotic syndrome. Both mercury compounds and mercury vapour have given rise to contact dermatitis in the general population. Epidemics of mercury poisoning have followed release of mercury into the environment from industrial activity, with uptake of methyl mercury from fish eating in Minamata Bay and uptake of both inorganic and methyl mercury following release of mercury vapour and deposition into waterways from gold recovery procedures in the Amazon basin. The ingestion of wheat and barley seed treated with an alkyl mercury fungicide for sowing, by a largely illiterate population in Iraq, led to a major outbreak of poisoning with a high fatality rate. Following exposure to mercury vapour, the earliest clinically observed adverse effects at urine mercury levels of the order of 30-100 mg/g creatinine, are objectively detectable tremor, psychological disorder and impaired nerve conduction velocity in sensitive subjects, with subjective symptoms of irritability, fatigue and anorexia. At these and at lower levels, proteinuria has also been observed. Both glomerular and tubular damage may occur at exposure levels lower than those giving rise to central nervous system effects. An immunological effect has also been observed in studies on clinically asymptomatic workers with low level exposure. CONCLUSIONS: As mercury can give rise to allergic and immunotoxic reactions which may be genetically regulated, in the absence of adequate dose-response studies for immunologically sensitive individuals, it has not been possible to set a level for mercury in blood or urine below which mercury related symptoms will not occur.