Navigating the complexity of spinal cord injuries with retained foreign bodies and the diagnostic challenge of lead toxicity-a case reportaaa.

INTRODUCTION: Retained shrapnel from gunshots is a common occurrence; however, retained shrapnel within the spinal canal is exceedingly uncommon. Guidelines for removal and treatment of these cases are a difficult topic, as surgical removal is not necessarily without consequence, and retention can lead to possible further injury or a secondary disease process of plumbism, which can be difficult to diagnose in this population. CASE PRESENTATION: This case report provides a unique example of a young patient with retained shrapnel from a gunshot. This patient suffered an initial spinal cord injury due to a gunshot and secondarily presented with abdominal pain, fatigue, elevated blood lead levels, and was diagnosed with plumbism. This was addressed with operative removal of shrapnel and posterior instrumented spinal fusion, resulting in decreased lead levels and symptom resolution postoperatively. DISCUSSION: Lead toxicity risk in patients with retained shrapnel, particularly in the spine, warrants vigilant monitoring. While management guidelines lack consensus, symptomatic lead toxicity may necessitate intervention. Residual neurological deficits complicate evaluation, emphasizing individualized management decisions.

The Contribution of Declines in Blood Lead Levels to Reductions in Blood Pressure Levels: Longitudinal Evidence in the Strong Heart Family Study.

BACKGROUND: Chronic lead exposure is associated with both subclinical and clinical cardiovascular disease. We evaluated whether declines in blood lead were associated with changes in systolic and diastolic blood pressure in adult American Indian participants from the SHFS (Strong Heart Family Study). METHODS AND RESULTS: Lead in whole blood was measured in 285 SHFS participants in 1997 to 1999 and 2006 to 2009. Blood pressure and measures of cardiac geometry and function were obtained in 2001 to 2003 and 2006 to 2009. We used generalized estimating equations to evaluate the association of declines in blood lead with changes in blood pressure; cardiac function and geometry measures were considered secondary. Mean blood lead was 2.04 µg/dL at baseline. After ≈10 years, mean decline in blood lead was 0.67 µg/dL. In fully adjusted models, the mean difference in systolic blood pressure comparing the highest to lowest tertile of decline (>0.91 versus <0.27 µg/dL) in blood lead was -7.08 mm Hg (95% CI, -13.16 to -1.00). A significant nonlinear association between declines in blood lead and declines in systolic blood pressure was detected, with significant linear associations where blood lead decline was 0.1 µg/dL or higher. Declines in blood lead were nonsignificantly associated with declines in diastolic blood pressure and significantly associated with declines in interventricular septum thickness. CONCLUSIONS: Declines in blood lead levels in American Indian adults, even when small (0.1-1.0 µg/dL), were associated with reductions in systolic blood pressure. These findings suggest the need to further study the cardiovascular impacts of reducing lead exposures and the importance of lead exposure prevention.

Exploring the association of metal mixture in blood to the kidney function and tumor necrosis factor alpha using machine learning methods.

This research aimed to approach relationships between metal mixture in blood and kidney function, tumor necrosis factor alpha (TNF-α) by machine learning. Metals levels were measured by Inductively Couple Plasma Mass Spectrometry in blood from 421 participants. We applied K Nearest Neighbor (KNN), Naive Bayes classifier (NB), Support Vector Machines (SVM), random forest (RF), Gradient Boosting Decision Tree (GBDT), Categorical boosting (CatBoost), eXtreme Gradient Boosting (XGBoost), Whale Optimization-based XGBoost (WXGBoost) to identify the effect of plasma metals, TNF-α, and estimated glomerular filtration rate (eGFR by CKD-EPI equation). We conducted not only toxic metals, lead (Pb), arsenic (As), cadmium (Cd) but also included trace essential metals, selenium (Se), copper (Cu), zinc (Zn), cobalt (Co), to predict the interaction of TNF-α, TNF-α/white blood count, and eGFR. The high average TNF-α level group was observed among subjects with higher Pb, As, Cd, Cu, and Zn levels in blood. No associations were shown between the low and high TNF-α level group in blood Se and Co levels. Those with lower eGFR group had high Pb, As, Cd, Co, Cu, and Zn levels. The crucial predictor of TNF-α level in metals was blood Pb, and then Cd, As, Cu, Se, Zn and Co. The machine learning revealed that As was the major role among predictors of eGFR after feature selection. The levels of kidney function and TNF-α were modified by co-exposure metals. We were able to acquire highest accuracy of over 85% in the multi-metals exposure model. The higher Pb and Zn levels had strongest interaction with declined eGFR. In addition, As and Cd had synergistic with prediction model of TNF-α. We explored the potential of machine learning approaches for predicting health outcomes with multi-metal exposure. XGBoost model added SHAP could give an explicit explanation of individualized and precision risk prediction and insight of the interaction of key features in the multi-metal exposure.

Segregation and Childhood Blood Lead Levels in North Carolina.

BACKGROUND AND OBJECTIVES: Using a local measure of racial residential segregation, estimate the association between racial residential segregation and childhood blood lead levels between the early 1990s and 2015 in North Carolina. METHODS: This population-based observational study uses individual-level blood lead testing records obtained from the NC Department of Health and Human Services for 320 916 children aged <7 years who were tested between 1992 and 1996 or 2013 and 2015. NC childhood blood lead levels were georeferenced to the census tract. Neighborhood racial residential segregation, assessed using a local, spatial measure of the racial isolation of non-Hispanic Blacks (RINHB), was calculated at the census tract level. RESULTS: From 1990 to 2015, RINHB increased in 50% of 2195 NC census tracts, although the degree of change varied by geographic region. In 1992 to 1996 blood lead testing data, a 1-standard-deviation increase in tract-level RINHB was associated with a 2.86% (95% confidence interval: 0.96%-4.81%) and 2.44% (1.34%-3.56%) increase in BLL among non-Hispanic Black and non-Hispanic White children, respectively. In 2013 to 2015 blood lead testing data, this association was attenuated but persisted with a 1-standard-deviation increase in tract-level RINHB associated with a 1.59% (0.50%-2.70%) and 0.76% (0.08%-1.45%) increase in BLL among non-Hispanic Black and non-Hispanic White children, respectively. In the supplemental information, we show the change in racial residential segregation across the entire United States, demonstrating that RINHB increased in 69% of 72 899 US census tracts. CONCLUSIONS: Racially isolated neighborhoods are associated with higher childhood lead levels, demonstrating the disproportionate environmental burdens borne by segregated communities and warranting attention to providing whole child health care.

Comparison of the accumulation of toxic metal biomarkers in Asian subgroups and other races in the United States: NHANES 2015-2016.

Toxic metals such as lead (Pb), cadmium (Cd), mercury (Hg) and arsenic (As) that lead to many visceral organ and nervous system diseases have attracted global attention due to their gradual accumulation in human bodies. The tolerance levels of exposure to toxic metals among race/ethnic groups are different due to the variance of sociodemographic, dietary, and behavioral characteristics. Few studies focused on investigating the biomarker levels of toxic metals in different race/ethnic groups and the potential mechanisms for controlling the accumulation in human bodies. Therefore, we selected eight biomarkers for four toxic metals from the National Health and Nutrition and Examination Survey (NHANES) in the 2-year data cycle of 2015-2016 to reveal the accumulation levels in different races. According to the NHANES rules, we applied probability sampling weights. The geometric mean levels of these biomarkers were calculated in all five race/ethnic groups (Mexican American, white, black, Asian, and other Hispanic) and two Asian subgroups (U.S.-born Asian, and other-born Asian), and compared with each other. The results showed that all the biomarkers in other-born Asians were 1.1-6.7 times in blood and 1.1-3.6 times in urine higher than other race/ethnic groups. Except Hg and As, the lowest biomarker levels were recorded in U.S.-born Asians, only 0.6-0.9 times of lead and 0.3-0.8 times of cadmium than other race/ethnic groups. Furthermore, the major factors of higher Hg and As biomarker levels in Asians were dietary intake of seafood and rice, indicating different accumulation mechanisms among Asians and other race/ethnic groups, especially for U.S.-born Asians. These findings provided new insight into a deeper understanding the accumulation of toxic metals and human health.

Metal Exposure and Risk of Parkinson Disease: A Systematic Review and Meta-Analysis.

Metal exposure has been suggested as a possible environmental risk factor for Parkinson disease (PD). We searched the PubMed, EMBASE, and Cochrane databases to systematically review the literature on the relationship between metal exposure and PD risk and to examine the overall quality of each study and the exposure assessment method. A total of 83 case-control studies and 5 cohort studies published during the period 1963-July 2021 were included, of which 73 were graded as being of low or moderate overall quality. Investigators in 69 studies adopted self-reported exposure and biomonitoring after disease diagnosis for exposure assessment approaches. The meta-analyses showed that concentrations of copper and iron in serum and concentrations of zinc in either serum or plasma were lower, while concentrations of magnesium in CSF and zinc in hair were higher, among PD cases as compared with controls. Cumulative lead levels in bone were found to be associated with increased risk of PD. We did not find associations between other metals and PD. The current level of evidence for associations between metals and PD risk is limited, as biases from methodological limitations cannot be ruled out. High-quality studies assessing metal levels before disease onset are needed to improve our understanding of the role of metals in the etiology of PD.

Using blood lead concentrations of wildlife sentinels to identify environmental risk factors of lead exposure for public health and wildlife rehabilitation efforts.

Lead poisoning remains a persistent health issue for both humans and wildlife, despite strides to reduce lead contamination in the environment. Using Geographic Information Systems (GIS), this study explores the associations between blood lead levels (BLLs) in wildlife sentinels and possible built environment lead exposure risk factors in the Minneapolis-Saint Paul, Minnesota urban area. Results show a high-level of heterogeneity in animal BLLs (n = 472) across our urban environment and suggest that each kilometer increase in road density is associated with a 17.07% (95% CI: 1.48%, 35.05%) increase in BLL in our study species of Virginia opossums and Eastern gray squirrels, and a 14.28% (95% CI: 1.16%, 29.09%) increase in BLL of rock pigeons. For squirrels and opossums, we see an additional 5.72% (95% CI: 0.59%, 10.85%) increased risk of BLL for every 1000 people per square-mile. The relationship between animal sentinels and environmental hazards can give us an insight into the potential lead exposure risks for humans. The use of wildlife sentinel data to explore environmental risk factors supports a One Health approach to better address public health questions and aid in wildlife rehabilitation related to residual lead poisoning from ambient environmental exposures.

The Time Trend of Blood Lead and Cadmium Levels in Rural Chinese Children: China Nutrition and Health Survey 2002 and 2012.

This study was to investigate blood lead (Pb) and cadmium (Cd) levels and time trend in rural Chinese children derived from the China Nutrition and Health Survey 2002 and 2012 (CNHS 2002, CNHS 2012). In total, 1698 and 1581 of rural Chinese children were selected from the CNHS 2002 and the CNHS 2012 databases, respectively. The blood Pb and Cd levels were determined by inductively coupled plasma mass spectrometer (ICP-MS), whilst the prevalence of blood Pb levels >5 µg/dL and blood Cd levels >0.5 µg/L and the corresponding reference values (RV95s: the upper limit of 95% confidence interval of 95th percentile) were together calculated. From the CNHS 2002 to the CNHS 2012, median concentrations in blood were severally decreased from 6.3 to 3.1 µg/dL for Pb and from 0.64 to 0.39 µg/L for Cd. The prevalence of blood Pb levels >5 µg/dL had decreased from 63.6 to 14.2%, together with blood Cd levels >0.5 µg/L prevalence from 62.7 to 33.5%, respectively. The RV95s of blood Pb and Cd levels were 15.2 µg/dL and 1.54 µg/L in the CNHS 2002, as well as 6.3 µg/dL and 1.12 µg/L in the CNHS 2012. In conclusion, blood Pb and Cd levels had been obviously improved in rural Chinese children during the past 10 years. However, the risks of Pb and Cd exposure are still serious and required to have continuous health monitoring and evaluation, even call for greater collaboration of the government and society.

Comparison of monoamine oxidase and selected heavy metal levels in the blood and the workplace among e-waste sorting workers in Ubon Ratchathani Province, Thailand.

Background: E-waste sorting workers usually separate electronic waste. Therefore, they can be exposed to heavy metals. Objectives: This study compared monoamine oxidase (MAO) levels affected by the levels of lead (Pb), cadmium (Cd), and nickel (Ni) in the blood and their workplace among e-waste sorting workers (EWSW). Material and methods: The exposed group included 76 EWSW, and the non-exposed group included 49 village health volunteers. An interview form was used to assess the risk factors. We measured Pb, Cd, and Ni on the work surfaces and in the blood, and MAO levels as a neurological enzymes. Results: Among the EWSW, 42 were males (55.3%), and the mean age (SD) 48.0 (12.64) years, and income were 156.37 ± 88.08 USD. In the work areas of the exposed group, the concentration of Pb, Cd, and Ni were 245.042 (± 613.910), 0.375 (± 0.662), and 46.115 (± 75.740) µg/100 cm2, respectively, while the non-exposed group, the concentration of Pb, Cd, and Ni were 0.609 (± 0.934), 0.167 (± 1.171) and 1.020 (± 0.142) µg/100 cm2. Pb and Ni concentrations in the workplace of the exposed groups were statistically different from that of the non-exposed group. Pb, Cd, and Ni concentrations in serum were 6.411 ± 1.492 µg/dL, 0.9480 ± 0.350 µg/L, 2.568 ± 0.468 µg/L, respectively, while in the non-exposed group, the heavy metal concentrations were 6.411 ± 1.620 µg/dL, 0.909 ± 0.277 µg/L, 2.527 ± 0.457 µg/L. The MAO in the exposed group was 362.060 ± 97.981 U/L, while that in the non-exposed group was 369.771 ± 86.752 U/L. Moreover, MAO concentration was significantly different from Ni concentration (p < 0.05). Conclusion: The electronic waste sorting workers should clean their work areas to reduce the Pb, Cd, and Ni levels on the working surfaces, and health surveillance should be performed.

Blood cadmium, lead, manganese, mercury, and selenium levels in American Indian populations: The Strong Heart Study.

BACKGROUND: Many American Indian (AI) communities are in areas affected by environmental contamination, such as toxic metals. However, studies assessing exposures in AI communities are limited. We measured blood metals in AI communities to assess historical exposure and identify participant characteristics associated with these levels in the Strong Heart Study (SHS) cohort. METHOD: Archived blood specimens collected from participants (n = 2014, all participants were 50 years of age and older) in Arizona, Oklahoma, and North and South Dakota during SHS Phase-III (1998-1999) were analyzed for cadmium, lead, manganese, mercury, and selenium using inductively coupled plasma triple quadrupole mass spectrometry. We conducted descriptive analyses for the entire cohort and stratified by selected subgroups, including selected demographics, health behaviors, income, waist circumference, and body mass index. Bivariate associations were conducted to examine associations between blood metal levels and selected socio-demographic and behavioral covariates. Finally, multivariate regression models were used to assess the best model fit that predicted blood metal levels. FINDINGS: All elements were detected in 100% of study participants, with the exception of mercury (detected in 73% of participants). The SHS population had higher levels of blood cadmium and manganese than the general U.S. population 50 years and older. The median blood mercury in the SHS cohort was at about 30% of the U.S. reference population, potentially due to low fish consumption. Participants in North Dakota and South Dakota had the highest blood cadmium, lead, manganese, and selenium, and the lowest total mercury levels, even after adjusting for covariates. In addition, each of the blood metals was associated with selected demographic, behavioral, income, and/or weight-related factors in multivariate models. These findings will help guide the tribes to develop education, outreach, and strategies to reduce harmful exposures and increase beneficial nutrient intake in these AI communities.

Detoxification Role of Metabolic Glutathione S-Transferase (GST) Genes in Blood Lead Concentrations of Jamaican Children with and without Autism Spectrum Disorder.

Glutathione S-transferases (GST) are involved in the detoxification of exogenous chemicals including lead (Pb). Using data from 344 pairs of autism spectrum disorder (ASD) cases and age- and sex-matched typically developing (TD) controls (2−8 years old) from Jamaica, we investigated the interaction between three GST genes and ASD status as determinants of blood Pb concentrations (BPbCs). We found that ASD cases had lower geometric mean BPbCs than TD children (1.74 vs. 2.27 µg/dL, p < 0.01). Using a co-dominant genetic model, ASD cases with the Ile/Val genotype for the GSTP1 Ile105Val polymorphism had lower GM BPbCs than TD controls, after adjusting for a known interaction between GSTP1 and GSTT1, child's parish, socioeconomic status, consumption of lettuce, fried plantains, and canned fish (Ile/Val: 1.78 vs. 2.13 µg/dL, p = 0.03). Similarly, among carriers of the I/I or I/D (I*) genotype for GSTT1 and GSTM1, ASD cases had lower adjusted GM BPbCs than TD controls (GSTT1 I*: 1.61 vs. 1.91 µg/dL, p = 0.01; GSTM1 I*: 1.71 vs. 2.04 µg/dL, p = 0.01). Our findings suggest that genetic polymorphisms in GST genes may influence detoxification of Pb by the enzymes they encode in Jamaican children with and without ASD.

Possible role of lead in breast cancer - a case-control study.

Numerous risk factors have been associated with breast cancer (BC), exposure to metalloestrogen, like lead, being such. Since lead involvement in BC is still equivocal, we focused on lead levels in three compartments of BC patients, blood, healthy, and malignant tissues. Also, as the cholesterol role in cancer development was recognized at the beginning of the twentieth century and led to involvement in lipid profile impairment, we further extend our research on lipid profile and enzymes responsible for maintaining lipid balance in BC patients. Fifty-five women diagnosed with BC were enrolled in the study. Forty-one healthy women represented the control group. Lead levels in blood, healthy surrounding and malignant tissue, and lipid profile parameters in serum, were determined. Higher lead levels were obtained in surrounding healthy tissue samples compared to cancerous tissue samples, while blood lead levels of BC women did not differ significantly from the control group. The altered lipid profile scheme in women diagnosed with breast cancer contained significantly higher triglycerides levels (P < 0.001). Moreover, logistic regression analysis revealed triglycerides as a significant predictor of BC (OR = 2.6; P < 0.01). Although statistical significance was missing for lower paraoxonase-1 (PON-1) activities observed in BC women, multivariate logistic regression singled out PON-1 activities as significant BC predictors. The result of the present study further indicated oxidative status imbalance and tissue levels bioelements perturbation. Obtained results in the present study propose possible lead involvement in BC onset accompanied with bioelements redistribution and oxidative stress occurrence.

Effects of heavy metals in acute ischemic stroke patients: A cross-sectional study.

ABSTRACT: Cerebrovascular disease is the second commonest cause of mortality globally and among the commonest causes of disability. However, research executed to probe the heavy metal exposure-stroke incidence relationship is scarce. Accordingly, we executed our study to probe the relationship of heavy metal concentrations (ie, concentrations of lead [Pb], mercury [Hg], cadmium [Cd], and arsenic) in the serum and urine of acute ischemic stroke (AIS) patients with several patient variables.For enrollment, we chose patients who had a first AIS within 7 days after the onset of a stroke. Thus, 33 newly diagnosed patients with AIS were recruited. We determined the aforementioned metals' concentrations by executing inductively coupled plasma mass spectrometry. We also gauged the association between such metal concentrations and patient variables by employing Spearman correlation coefficient. To examine the differences in metal concentrations between the different variables, we implemented an independent Mann-Whitney U test.In our cohort analysis, we noted serum Pb and Cd concentrations to be positively correlated with serum creatinine and hemoglobin. Serum and urine Cd concentrations had a negative correlation with impaired HbA1c in AIS patients. Urine Hg had a positive correlation with C-reactive protein in the participants. Participants who smoked or consumed alcohol had significantly higher Pb and Cd levels in serum than did those who neither smoked nor drank. Patients with AIS who smoked or consumed alcohol had high levels of serum Pb and serum Cd than did those who did not. Patients with AIS who consumed alcohol had significantly higher Pb and Hg urine concentrations than did those who did not.Our study indicated that serum Cd and Pb elevation increased the AIS risk in southern Taiwan patients.

Association between blood lead levels and markers of calcium homeostasis: a systematic review and meta-analysis.

Chronic Pb exposure associated systemic illness are partly posited to involve calcium homeostasis. Present systematic review aims to comprehensively evaluate the association between chronic lead exposure and markers of calcium homeostasis. Observational studies documenting the changes in calcium homeostasis markers (i.e. serum calcium, parathyroid hormone, vitamin D & calcitonin) between occupationally Pb exposed group and control group were systematically searched from pubmed-Medline, Scopus, and Embase digital databases since inception to September 24, 2021. The protocol was earlier registered at PROSPERO (ID: CRD42020199503) and executed adhering to PRISMA 2020 guidelines. Mean differences of calcium homeostasis markers between the groups were analysed using random-effects model. Conventional I2 statistics was employed to assess heterogeneity, while the risk for various biases were assessed using Newcastle Ottawa Scale. Sub-group, sensitivity and meta-regression analyses were performed where data permitted. Eleven studies including 837 Pb exposed and 739 controls were part of the present study. Pb exposed group exhibited higher mean blood lead level [i.e. 36.13 (with 95% CI 25.88-46.38) µg/dl] significantly lower serum calcium (i.e. - 0.72 mg/dl with 95% CI - 0.36 to - 1.07) and trend of higher parathyroid levels and lower vitamin D levels than controls. Heterogeneity was high (I2 > 90%) among the studies. Considering the cardinal role of calcium in multiple biological functions, present observations emphasis the need for periodic evaluation of calcium levels and its markers among those with known cumulative Pb exposure.

Protective Effects of Green Tea Supplementation against Lead-Induced Neurotoxicity in Mice.

The use of natural products as therapeutic agents is rapidly growing recently. In the current study, we investigated the protective effects of green tea supplementation on lead-induced toxicity in mice. Forty albino mice were divided into four groups as follows: A: control group; B: green tea receiving group; C: lead-intoxicated group; and D: lead-intoxicated group supplemented with green tea. At the end of the experiment, the animals were tested for neurobehavioral and biochemical alterations. Green tea was analyzed through Gas Chromatography-Mass Spectrometry (GC/MS) analysis. We found that supplementation with green tea ameliorated the lead-associated increase in body weight and blood glucose. Green tea supplementation also changed the blood picture that was affected due to lead toxicity and ameliorated lead-induced dyslipidemia. The group of mice that were supplemented with green tea has shown positive alterations in locomotory, anxiety, memory, and learning behaviors. The GC/MS analysis revealed many active ingredients among which the two most abundant were caffeine and 1,2-benzenedicarboxylic acid, mono(2-ethylhexyl) ester. We concluded that green tea supplementation has several positive effects on the lead-induced neurotoxicity in mice and that these effects may be attributed to its main two active ingredients.

Blood lead levels and lead toxicity in children aged 1-5 years of Cinangka Village, Bogor Regency.

Lead is one of ten hazardous chemicals of public health concern and is used in more than 900 occupations, including the battery, smelting, and mining industries. Lead toxicity accounts for 1.5% (900,000) of deaths annually in the world. In Indonesia, reports of high Blood Lead Level (BLL) were associated with residency in Used Lead Acid Battery (ULAB) recycling sites. The present study aims to investigate the BLL and the evidence of lead toxicity of children living in an ULAB recycling site in Bogor Regency, Indonesia. A cross-sectional study involving 128 children aged 1-5 years was conducted in September-October 2019. The socio-economic factors, BLL, nutritional status, and hematological parameters, were evaluated. Data were analyzed by univariate and bivariate using the Chi-Square test. Socio-economic factors revealed only 2.3% children have pica and 10.9% children have hand-to-mouth habits. Majority of parents had low income, education, and have stayed in the village for years. Analysis on BLL revealed that 69.5% children had BLL of >10 µg/dL, 25% had abnormal BMI, 23.4% had underweight, 53.9% had stunting, 33.6% had anemia, and 22.6% had basophilic stippling. The average BLL and hemoglobin levels of respondents were 17.03 µg/dL and 11.48 g/dL, respectively. Bivariate analysis revealed that children with high BLL had double risk of having underweight and protected from stunting. Analysis on the association between BLL and BMI for age revealed a higher risk to have abnormal BMI. The high BLL also had 1.017 times risk of developing anemia, and almost doubled risk of having basophilic stippling, although they were not statistically significant. In conclusion, the high BLL of children living in the ULAB recycling indicates that lead exposure as well as lead toxicity are still occurring in Cinangka Village, and alerts to the need for a systematic action to mitigate the exposure.

Effects of lead and cadmium co-exposure on liver function in residents near a mining and smelting area in northwestern China.

Chronic exposure to environmental cadmium (Cd) and lead (Pb) may have adverse effects on the human health. In this study, we aimed to determine the primary and interactive effects of Cd and Pb exposure on liver function in residents near a mining and smelting area in northwestern China. A total of 451 subjects were recruited, from which blood samples were collected to determine the levels of Cd, Pb, and liver function indices. Additionally, the association between the levels of exposure markers and liver function indices was analysed. Cd and Pb levels were significantly higher in subjects living in the polluted area than in those living in the non-polluted reference area. The liver function levels of subjects in the polluted area were poor compared with those in the reference area. In addition, Cd and Pb levels in the blood were positively associated with gamma glutamyl transpeptidase (GGT) levels and negatively associated with direct bilirubin (DBil) levels. Cd and Pb may be risk factors for abnormal liver function. The risk of abnormal liver function was higher in subjects with moderate Cd and Pb levels, high Cd levels, high Pb levels, and high Cd and Pb levels than in those with low Cd and Pb levels. Our data show that exposure to Cd and/or Pb can cause abnormal liver function. Cd and Pb may have an antagonistic effect on liver function, and high Cd exposure alone has a more profound effect on abnormal liver function compared with co-exposure to Pb and Cd.

Niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales / Blood and faecal lead levels in children with various functional gastrointestinal disorders

Introducción: El objetivo del estudio fue determinar los niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales (TDF) en comparación con controles sanos. Pacientes y métodos: La muestra incluyó a 102 niños de 4-18 años con TDF definidos mediante los criterios de Roma IV y a 102 controles sanos emparejados por edad y sexo. Los niños con TDF se dividieron en 3 subgrupos: estreñimiento funcional (EF) (n=36), dolor abdominal funcional (DAF) (n=36) y náuseas funcionales (NF) (n=30). Los niveles de plomo se midieron mediante espectrometría de absorción atómica. Resultados: El nivel de plomo en sangre (NPS) mediano fue significativamente mayor en niños con TDF en comparación con controles (5,12 vs. 1,77μg/dl). Los NPS superaron los 5μg/dl en el 51,9% del grupo TDF. Se observó una diferencia estadísticamente significativa en los NPS entre el subgrupo con EF y los otros 2subgrupos (DAF y NF) (p=0,003 y p<0,001, respectivamente). Los niveles de plomo en heces (NPH) fueron significativamente mayores en niños con TDF en comparación con controles (28,08 vs. 0,01μg/g). No hubo diferencias significativas en los NPH entre el subgrupo de EF y los otros subgrupos (p=0,992 y p=0,989). No se encontró una correlación significativa entre los NPS y los NPH en niños con TDF (p=0,123). Conclusión: El presente estudio demostró que los niveles séricos y fecales de plomo eran superiores en niños con TDF en comparación con controles y que más de la mitad de los niños con TDF tenían NPS ≥ 5μg/dl, que se consideran tóxicos. A la vista de estos resultados, cabe replantearse si los clínicos han de determinar los NPS de manera rutinaria en niños con TDF.(AU)

Introduction: To investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. Patients and methods: One hundred and 2children with FGIDs defined by the Rome IV criteria, aged 4 -18 years, and one hundred and 2sex matched healthy children were enrolled in the study. Children with FGIDs were divided into 3subgroups as functional constipation (FC) (n=36), functional abdominal pain (FAP) (n=36) and functional náusea (FN) (n=30). The lead levels were measured using atomic absorption spectrometer. Results: The median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77μg/dL, respectively). The BLLs were above 5μg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (P=.003, P<.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01μg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (P=.992, P=.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (P =.123). Conclusion: This study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5μg/dL which is toxic level. These results might revive the question of whether or not clinician need to evaluate routine BLLs in children with FGIDs.(AU)