Multimetal exposure: Challenges in diagnostics, prevention, and treatment.

Extensive use of heavy metals has posed a serious concern for ecosystem and human too. Heavy metals are toxic in nature and their accumulation in human body causes serious disorders such as neurological disease, cardiac disease, gastrointestinal problems, skin disorders, reproductive disease, lungs diseases, and so on. Furthermore, heavy metals not only affect the human health but also have a negative impact on the economy. In the current review, we have elaborated the impact of heavy metal exposure on human health and socioeconomics. We have discussed the molecular mechanism involved in the heavy metal-induced human disorders such as oxidative stress, neuroinflammation, and protein misfolding. Finally, we discussed the preventive measure and treatment strategy that could counter the negative effects of heavy metal intoxications. In conclusion, there is a substantial correlation between heavy metals and the onset and advancement of several health issues. Chelation treatment could be a useful tactic to lessen the toxic metal load and the difficulties that come with it.

Investigation and monitoring of heavy metal poisoning.

Historically, heavy metal measurement and interpretation has been a highly specialised area performed only in a handful of centres within the UK. However, recent years have seen a move to more local testing due to the repatriation of referred work into pathology networks and the increased availability of inductively coupled plasma mass spectrometry technology. While management of significant poisoning is still overseen by tertiary care poisoning specialists, management of milder cases may be undertaken locally.Non-specialist clinical scientists and clinicians need to know when heavy metal testing is appropriate, which samples are required (and any specific requirements around collection) and how to interpret and act on the results.This Best Practice article provides guidance on the investigation and monitoring of the toxic elements most frequently encountered in general medical practice; lead, mercury and arsenic. It is intended as a reference guide for the non-specialist and as a comprehensive summary for clinical toxicologists and clinical scientists.

Complexions therapy and severe intoxication by Thallium salts.

The aim of this paper is to study the clinical features of severe intoxications with thallium salts and developing effective care schemes for the application of potassium hexacyanoferrate (II) and deferasirox for correction of detected disorders. A total of 39 patients diagnosed with severe thallium salt poisoning were examined in two groups. Group I comprised 20 patients with severe thallium salt poisoning, who were prescribed with potassium-iron hexacyanoferrate in a dose of 250 mg/kg/day per os, intravenous potassium infusions, furosemide intravenously in amount of 40 mg three times per, and hemodialysis until the thallium level in the blood dropped below 10 mg/L, lactulose 30 mL two times per day per os. Group II consisted of 19 people with severe thallium salt poisoning, which in addition to the above treatment, received Deferasirox in a dosage of 500 mg two times per day per os. The clinical picture of severe poisoning with thallium salts is characterized by lesions of the gastrointestinal tract, nervous system (central and peripheral), alopecia, heart rhythm disorders, and myocardial ischemia zones. Extension of standard therapy with potassium-iron by adding hexacyanoferrate deferasirox showed better effect on thallium elimination rate and improved functional state of liver and kidneys in patients with severe thallium salt poisoning.

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.

Clinical characteristics and treatment of thallium poisoning in patients with delayed admission in China.

Thallium is highly toxic and its effects are cumulative. The clinical symptoms of thallium poisoning are non-specific, thereby delaying admission and treatment. This study aimed to summarize the clinical features and treatment experience of patients with delayed admission who experience thallium poisoning.We conducted a retrospective descriptive analysis of patients in our hospital from 2008 to 2018 who had thallium poisoning and experienced a delay in hospital admission. The time from symptom onset to admission was assessed. The patients were divided into 3 groups and descriptive analyses of their clinical characteristics, including basic patient information, symptoms, laboratory test results, examination findings, treatment methods, outcomes, and follow-up information, were conducted.A total of 34 patients with thallium poisoning were included: 8 were admitted to the hospital early or with mild delay, 9 had a moderate delay, and 17 had a severely delayed admission. The time from illness onset to admission was 13 (interquartile range, 7.5-26) days. Some patients with delayed admission had significant symptoms associated with central nervous system damage, and changes in magnetic resonance images and electroencephalograms were also noted. After admission, all patients received Prussian blue treatment, and some patients with relatively high blood concentration received blood purification treatments. Following treatment, the blood and urine thallium concentrations of all patients decreased significantly, and their symptoms were alleviated.Our results show that delayed patient admission in cases of thallium poisoning is associated with greater risk of central nervous system damage. Use of Prussian blue combined with blood purification treatments might improve patients' conditions.

Impact of extra-corporeal membrane oxygenation on outcome of aluminium phosphide poisoning complicated with myocardial dysfunction.

Background: Aluminium phosphide (AlP) poisoning is associated with a high mortality rate when patients are complicated with myocardial dysfunction and refractory shock or severe metabolic acidosis. We studied the role of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) in patients of AlP poisoning induced myocardial dysfunction. Methods and results: This is a tertiary care, single-centre, retrospective study. Between January 2011 and June 2016, total of 107 patients with AlP poisoning were identified and of those 67 were categorised in high-risk category as per the criteria. The in-hospital mortality of patients who received ECMO (n = 35) was compared to those who received conventional treatment (n = 32) only. The use of ECMO in addition to conventional treatment has reduced the in-hospital mortality from 84.4% to 40% (odds ratio: 0.47; 95% confidence interval 0.31-0.73). Among survivors, the ECMO group had a significantly lower baseline left ventricular ejection fraction (LVEF; median: 24%; IQR: 22-29 vs. median: 32%; IQR: 32-33.5; p < .003) but a non-significantly higher LVEF at the time of discharge (median: 52%; IQR: 48-60 vs. median: 48%; IQR: 47-49; p: .064) than did the conventional group. On logistic regression analysis the higher sequential organ failure assessment (SOFA) score, lower pH and the non-usage of ECMO were found to be the independent predictors of mortality. Conclusion: The use of ECMO in high-risk patient of AlP poisoning has resulted in a significant reduction in the mortality. A high baseline SOFA score has been found to be the independent predictor of mortality.

The Role of Plasmapheresis in Treating Lethal Cupric Sulfate Poisoning.

The mortality rate of cupric sulfate is relatively high in contrast to that of other heavy metals. Cases of orally ingested cupric sulfate poisoning are very rare, with a reported half lethal dose of 10 g. Cupric sulfate poisoning leads to gastrointestinal corrosion, intravascular hemolysis, hemolytic anemia, methemoglobinemia and acute renal and hepatic impairment. Without proper and prompt treatment, multiple organ failure and death occur. Here, we present the first report that removal of the excessive intravascular copper ions by plasmapheresis was accompanied by complete recovery.

Gut remediation: a potential approach to reducing chromium accumulation using Lactobacillus plantarum TW1-1.

Some lactobacilli have protective effects against some heavy metals in mammals, but the underlying mechanism is not fully understood. To evaluate the remediation potency and the mechanism of Lactobacillus against chromium (Cr) in mice, Lactobacillus plantarum TW1-1 was orally administrated to Kunming mice for 7 weeks during exposure to 1 mM K2Cr2O7 in drinking water. Results showed that TW1-1 helped to decrease Cr accumulation in tissues and increase Cr excretion in feces, and may also attenuate alterations in oxidative stress and histopathological changes caused by Cr exposure. Moreover, the chromate reduction ability of fecal bacteria doubled after administration of TW1-1 upon Cr induction. MiSeq sequencing of fecal bacterial 16S rRNA genes revealed that the overall structures of gut microbiota was shifted by Cr exposure and partially restored by TW1-1. The abundances of 49 of the 79 operational taxonomic units altered by Cr were reversed by TW1-1. Based on these, we proposed a working model of TW1-1 against Cr: TW1-1 helps to remove Cr from the host and meanwhile acts as a regulator of gut microbiota, which aids in chromate reduction and provide protection against Cr. We call this process of remediation of heavy metal in the gut "gut remediation".

Neuroprotective potential of Aloe arborescens against copper induced neurobehavioral features of Parkinson's disease in rat.

Copper (Cu) is an important trace element for the organism survival, which ensures the normal functioning of different biosystems. However, excessive levels of this heavy metal are responsible for profound physiological alterations including the central nervous system. Numerous findings sustain the involvement of heavy metals, as an environmental risk factor such as copper (Cu), in the neuropathology of Parkinson's disease (PD) which is a chronic neurodegenerative disorder that principally affects the motor system. The classic and evident symptoms of PD namely rigidity, tardiness of movement, and difficulty with walking, result from progressive dopaminergic neurons death within substantia nigra. Whereas, few pharmacological trials have shown a beneficial role against Cu neurotoxicity, Aloe arborescens is one of the powerful medicinal plants with an array of therapeutic effects. Thus, we aimed through the present study, to evaluate the impact of acute Cu intoxication (10µg/g B.W. i.p) for 3days on the dopaminergic system and locomotor performance, together with the possible restorative effect of oral administration of aqueous extract of Aloe arborescens gel (AEAAG) (200mg/kg B.W.). By means of immunohistochemistry, we noted, in the Cu intoxicated rats, a significant loss of TH (tyrosine hydroxylase) expression within substantia nigra compacta (SNc), ventral tegmental area (VTA) and the subsequent striatal outputs, those alterations were correlated to behavioral abnormalities such as a severe drop of locomotor performance. While AEAAG administration to Cu intoxicated rats showed a noticeable beneficial effect; this potential was featured by a complete recovery of the TH expression and locomotor behavior deficiencies in the intoxicated rats. The present investigation have brought, on the one hand, an experimental evidence of an altered dopaminergic innervations following Cu intoxication and on the other hand, a new pharmacological property of Aloe arborescens that may be used as a neuroprotective plant for neurodegenerative disorders, such as PD, touching the dopaminergic system trigged by heavy metals.

Chemical Hand Warmer Packet Ingestion: A Case of Elemental Iron Exposure.

For individuals who work outdoors in the winter or play winter sports, chemical hand warmers are becoming increasingly more commonplace because of their convenience and effectiveness. A 32-year-old woman with a history of chronic pain and bipolar disorder presented to the emergency department complaining of a "warm sensation" in her mouth and epigastrium after reportedly ingesting the partial contents of a chemical hand warmer packet containing between 5 and 8 g of elemental iron. She had been complaining of abdominal pain for approximately 1 month and was prescribed unknown antibiotics the previous day. The patient denied ingestion of any other product or medication other than what was prescribed. A serum iron level obtained approximately 6 hours after ingestion measured 235 micrograms/dL (reference range 40-180 micrograms/dL). As the patient demonstrated no new abdominal complaints and no evidence of systemic iron toxicity, she was discharged uneventfully after education. However, the potential for significant iron toxicity exists depending on the extent of exposure to this or similar products. Treatment for severe iron toxicity may include fluid resuscitation, whole bowel irrigation, and iron chelation therapy with deferoxamine. Physicians should become aware of the toxicity associated with ingestion of commercially available hand warmers. Consultation with a medical toxicologist is recommended.