1. Dtsch Arztebl Int. 2019 May 3;116(18):311-317. doi: 10.3238/arztebl.2019.0311.
The Use of Activated Charcoal to Treat Intoxications.
Zellner T(1), Prasa D, Färber E, Hoffmann-Walbeck P, Genser D, Eyer F.
(1)Department of Internal Medicine II, SDepartment of Clinical Toxicology and
Poison Control Center Munich, Klinikum rechts der Isar, School of Medicine,
Technical University of Munich, Munich; Joint Poisons Information Center for
Mecklenburg-West Pomerania, Saxony, Saxony-Anhalt and Thuringia, Erfurt; Poisons
Information Center North for Bremen, Hamburg, Lower Saxony and
Schleswig-Holstein, Faculty of Medicine, University of Göttingen;
Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin
Institute of Health Poison Information Center; Poisons Information Center Vienna,
Gesundheit Österreich GmbH, Vienna, Austria.
BACKGROUND: In 2016, according to the German Federal Statistical Office, 178 425
cases of intoxication (poisoning) were treated in German hospitals. The poison
control centers in the German-speaking countries gave advice in a total of 268
787 instances of poisoning in that year, and use of activated charcoal was
recommended in 4.37% of cases. The application of activated charcoal plays a
major role in both primary and secondary detoxification. This article serves as
an overview of the mechanism of action, indications, contraindications, modes of
application, and dosing of activated charcoal.
METHODS: This review is based on pertinent publications retrieved by a selective
search in PubMed. The opinions of experts from the poison control centers in the
German-speaking countries were considered in the interpretation of the data.
RESULTS: The administration of activated charcoal is indicated to treat
moderately severe to life-threatening intoxication. It should be carried out as
soon as possible, within the first hour of the ingestion; timed-release
preparations can be given up to 6 hours after the ingestion. An important
contraindication is impaired consciousness with the danger of aspiration in a
patient whose air- way has not yet been secured. Activated charcoal is
ineffective or inadequately effective in cases of poisoning with acids or bases,
alcohols, organic solvents, inorganic salts, or metals. The proper dosage
consists of an amount that is 10 to 40 times as much as that of the intoxicating
substance, or else 0.5-1 g/kg body weight in children or 50 g in adults. Repeated
application is indicated for intoxications with agents that persist for a longer
time in the stomach and for intoxications with timed-release drugs or drugs with
a marked enterohepatic or entero-enteric circulation. The routine combination of
activated charcoal with a laxative is not recommended.
CONCLUSION: Even though intoxications are common, there is still no
internationally valid guideline concerning the administration of activated
charcoal. A precise analysis of the risks and benefits is needed for each
administration, and a poison control center should be consulted for this purpose.
2. Ann Transl Med. 2019 Apr;7(Suppl 2):S72. doi: 10.21037/atm.2018.10.67.
Determination of copper poisoning in Wilson's disease using laser ablation
inductively coupled plasma mass spectrometry.
Weiskirchen S(1), Kim P(1), Weiskirchen R(1).
(1)Institute of Molecular Pathobiochemistry, Experimental Gene Therapy and
Clinical Chemistry, RWTH University Hospital Aachen, Aachen, Germany.
Copper (Cu) is an essential trace element that is vital to the health of all
living organisms. As a transition metal, it is involved in a myriad of biological
processes. Balance studies estimated that the adult human requirement for copper
is in the range of 1.3 to 2 mg per day. Cu deficiency alters immune function,
neuropeptide synthesis and antioxidant defense, while the excess in Cu results in
oxidative stress and progressive structural damage of mitochondrial and
clinically in hepatic and/or neurological symptoms. This becomes particularly
visible in Wilson's disease (WD) representing a rare autosomal recessive
inherited disorder with a disease prevalence of about 1 in 30,000 people. The
affected gene, i.e., ATP7B, belongs to the class of ATP-dependent, P-type
Cu-transporting ATPases. To understand the pathomechanism in WD, several
experimental models for studying WD were established. Independent studies
performed in these models showed that the inactivation of the Atp7b gene results
in a gradual increase in Cu in many organs during life span. However, the exact
distribution of Cu and the potential impact of elevated Cu concentrations on
other metals within the tissue are only sparely analyzed. Recently, novel laser
ablation inductively coupled plasma mass spectrometry (LA-ICP-MS)-based protocols
for metal bio-imaging in liver and brain were established. In the present review,
we will discuss the methodological background of this innovative technique and
summarize our experiences using LA-ICP-MS imaging in biological monitoring, exact
measurement, and spatial assignment of metals within tissue obtained from Atp7b
null mice and clinical specimens taken from patients suffering from genetically
confirmed WD. Using WD as an example, the data discussed demonstrates that
LA-ICP-MS has multi-element capability, allowing precise measurement and
visualization of metals in the tissue with high spatial resolution, sensitivity,
quantification ability, and exceptional reproducibility.
Conflict of interest statement: Conflicts of Interest: The authors have no
conflicts of interest to declare.
3. J Trace Elem Med Biol. 2019 Jul;54:226-231. doi: 10.1016/j.jtemb.2019.05.003.
Epub 2019 May 10.
Heavy metal toxicity: An update of chelating therapeutic strategies.
Kim JJ(1), Kim YS(1), Kumar V(2).
(1)Department of Biotechnology, Yeungnam University, Gyeongbuk, Republic of
(2)Department of Biotechnology, Yeungnam University, Gyeongbuk, Republic of
Korea. Electronic address: email@example.com.
AIM: This review illustrates heavy metals toxicity, currently available therapies
and the role and efficacy of chelation therapy for its management.
SUMMARY: Heavy metals are necessary for various biological processes, but they
become harmful in excess. Specifically, they induce oxidative stress by
generating free radicals and reducing antioxidant levels. Heavy metals also alter
the confirmation of protein and DNA and inhibit their function. Chelation therapy
is commonly used to treat metals toxicity. Chelation is a chemical process that
occurs when interaction between a central metal atom/ion and ligand leads to
formation of a complex ring-like structure. The ligand has a donor ion/molecule,
which has a lone pair of electrons and may be monodentate to polydentate. Each
metal has a different reactivity with a ligand, so a specific chelation agent is
required for each metal. Combination therapy with a chelating agent and an
antioxidant led to improved outcome.
CONCLUSION: Heavy metal poisoning is a common health problem because of mining,
smelting, industrial, agricultural and sewage waste. Heavy metals can be
efficiently excreted from the body following treatment with proper chelation
Copyright © 2019 Elsevier GmbH. All rights reserved.
4. Environ Sci Pollut Res Int. 2019 Jun;26(18):18032-18052. doi:
10.1007/s11356-019-05104-2. Epub 2019 May 11.
Natural antidotes and management of metal toxicity.
Amadi CN(1), Offor SJ(2), Frazzoli C(3), Orisakwe OE(4).
(1)Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy,
University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria.
(2)Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of
Uyo, Uyo, Akwa Ibom State, Nigeria.
(3)Department of Cardiovascular and Endocrine-Metabolic Diseases, and Ageing,
Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy.
(4)Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy,
University of Port-Harcourt, Port-Harcourt, Rivers State, Nigeria.
The global burden of heavy metal especially mercury, arsenic, lead, and cadmium
toxicities remains a significant public health challenge. Developing nations are
particularly at high risk and carry the highest burden of this hazard. Chelation
therapy has been the mainstay for treatment of heavy metal poisoning where the
chelating agent binds metal ions to form complex ring-like structures called
"chelates" to enhance their elimination from the body. Metal chelators have some
drawbacks such as redistribution of some heavy metals from other tissues to the
brain thereby increasing its neurotoxicity, causing loss of essential metals such
as copper and zinc as well as some serious adverse effects, e.g., hepatotoxicity.
The use of natural antidotes, which are easily available, affordable, and with
little or no side effects compared to the classic metal chelators, is the focus
of this review and suggested as cheaper options for developing nations in the
treatment of heavy metal poisoning.
5. Environ Sci Pollut Res Int. 2019 Jun;26(16):15767-15778. doi:
10.1007/s11356-019-05023-2. Epub 2019 Apr 19.
Metals and metalloids in traditional medicines (Ayurvedic medicines,
nutraceuticals and traditional Chinese medicines).
(1)Department of Environmental Sciences, Macquarie University, Sydney, NSW, 2109,
(2)Nuclear Chemistry and Environmental Research Centre, Ghana Atomic Energy
Commission, National Nuclear Research Institute, P.O. Box LG 80, Legon, Accra,
Traditional medicine (TM) including Ayurvedic medicines, traditional Chinese
medicines and nutraceuticals are popular across the globe as dietary supplements
and traditional and alternative medicines. Health risks from these remedies
continue to present serious concerns, with occurrences of poisoning by metals and
metalloids present at concentrations above acceptable regulatory standards. This
review overviews the prevalence of TM use, cases of metal and metalloid poisoning
following TM consumption, and forms of TM contamination and adulteration. The
review summarises regulations by the World Health Organization (WHO) and other
relevant bodies. Finally, the review recommends how to protect consumers.
6. Sultan Qaboos Univ Med J. 2018 Nov;18(4):e529-e532. doi:
10.18295/squmj.2018.18.04.017. Epub 2019 Mar 28.
Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting
with Motor Neuropathy and Upper Limb Paresis: A case report.
Mirzaei SMM(1), Akbari A(2), Mehrpour O(3), Zamani N(4).
(1)Department of Neurology, Birjand University of Medical Sciences, Birjand,
(2)Department of Medical Toxicology and Drug Abuse Research Center, Birjand
University of Medical Sciences, Birjand, Iran.
(3)Rocky Mountain Poison and Drug Center, Denver Health Medical Center, Denver,
(4)Department of Clinical Toxicology, Loghman Hakim Hospital, Tehran, Iran.
Opium users may present with central or peripheral nervous system-related
symptoms, gastrointestinal complications and anaemia; in such cases, lead
poisoning should be suspected and chelation therapy initiated as soon as
possible. We report a 64-year-old male patient with a 20-year history of opium
addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with
severe motor neuropathy and paresis in both upper limbs. His primary symptoms
were generalised weakness, abdominal and bone pain, constipation and lower limb
paraesthesia that had started several months prior. In addition, he reported
severe progressive bilateral paresis of the upper limbs of one month's duration.
A diagnosis of lead poisoning was confirmed by a blood lead level of 140 μg/dL.
The patient underwent chelation therapy after which he improved significantly. At
a one-year follow-up visit, he was neurologically intact and symptom-free.
PMID: 30988975 [Indexed for MEDLINE]
7. Environ Health. 2019 Apr 11;18(1):32. doi: 10.1186/s12940-019-0472-8.
Letter to the editor re: the CDC blood lead reference value for children.
Gottesfeld P(1), Cory-Slechta DA(2).
(1)Occupational Knowledge International, 4444 Geary Boulevard, Suite 208, San
Francisco, CA, 94118, USA. firstname.lastname@example.org.
(2)Department of Environmental Medicine, Box EHSC, University of Rochester
Medical Center, Rochester, NY, 14642, USA.
Environ Health. 2019 Feb 28;18(1):16.
PMID: 30975152 [Indexed for MEDLINE]
8. J Health Pollut. 2019 Mar 14;9(21):190302. doi: 10.5696/2156-9614-9.21.190302.
eCollection 2019 Mar.
Risk of Mercury Exposure from Fish Consumption at Artisanal Small-Scale Gold
Mining Areas in West Nusa Tenggara, Indonesia.
Junaidi M(1), Krisnayanti BD(2), Juharfa(1), Anderson C(3).
(1)Department of Fish and Aquaculture, University of Mataram, Mataram, Indonesia.
(2)International Research Centre for the Management of Degraded and Mining Lands,
(3)Soil and Earth Science, Institute of Natural Resources, Massey University,
Palmerston North, New Zealand.
Background: The primary environmental risk associated with artisanal small-scale
gold mining (ASGM) activities in Sekotong and Taliwang is waste discharged
directly into the environment. This waste contains variable concentrations of
heavy metals and a high level of mercury. When these elements are released into
the environment, plants and animals can be contaminated. If mercury is methylated
to methylmercury, levels can increase in concentration at each level of the food
chain (biomagnify). Fish are a primary risk vector for methylmercury poisoning in
humans, and represent a significant source of protein for the Sekotong and
Objectives: The present study aimed to identify the concentration of mercury in
fish from ASGM sites in Sekotong and Taliwang.
Methods: Descriptive research was used to describe the mercury concentrations of
fish in the present study. The fish species collected for the samples represented
commercially available fish most commonly consumed by the community on a daily
Results: In Sekotong's ASGM area, the mercury concentration in Pilsbryoconcha
exilis tissue was 596 ppb, 721 ppb for Sephia officinalis and 50% of the
Euthynnus affinis samples had a high level of mercury, above the World Health
Organization (WHO) maximum permissable limit for the sale of fish for human
consumption of 0.5 ppb.
Conclusions: Some fish species from the studied ASGM sites had high mercury
concentrations above the maximum permissible mercury concentration in edible fish
tissue. The risks associated with mercury exposure from fish consumption threaten
Ethics Approval: All experiments were performed in accordance with relevant local
guidelines and regulations.
Competing Interests: The authors declare no competing financial interests.
9. J Mol Neurosci. 2019 Apr;67(4):511-533. doi: 10.1007/s12031-019-01274-3. Epub
2019 Mar 15.
Insights into the Potential Role of Mercury in Alzheimer's Disease.
Bjørklund G(1), Tinkov AA(2)(3)(4), Dadar M(5), Rahman MM(6)(7), Chirumbolo S(8),
Skalny AV(3)(4)(9), Skalnaya MG(3)(4), Haley BE(10), Ajsuvakova OP(2)(3)(4),
(1)Council for Nutritional and Environmental Medicine, Toften 24, 8610, Mo i
Rana, Norway. email@example.com.
(2)Yaroslavl State University, Yaroslavl, Russia.
(3)Peoples' Friendship University of Russia (RUDN University), Moscow, Russia.
(4)IM Sechenov First Moscow State Medical University, Moscow, Russia.
(5)Razi Vaccine and Serum Research Institute, Agricultural Research, Education
and Extension Organization (AREEO), Karaj, Iran.
(6)Department of Environmental Sciences, Jahangirnagar University, Dhaka,
(7)Graduate School of Environmental Science, Hokkaido University, Sapporo, Japan.
(8)Department of Neuroscience, Biomedicine and Movement Sciences, University of
Verona, Verona, Italy.
(9)Federal Research Centre of Biological Systems and Agro-technologies of the
Russian Academy of Sciences, Orenburg, Russia.
(10)University of Kentucky, Lexington, KY, USA.
(11)Research Department, Innlandet Hospital Trust, Brumunddal, Norway.
(12)Inland Norway University of Applied Sciences, Elverum, Norway.
Mercury (Hg), which is a non-essential element, is considered a highly toxic
pollutant for biological systems even when present at trace levels. Elevated Hg
exposure with the growing release of atmospheric pollutant Hg and rising
accumulations of mono-methylmercury (highly neurotoxic) in seafood products have
increased its toxic potential for humans. This review aims to highlight the
potential relationship between Hg exposure and Alzheimer's disease (AD), based on
the existing literature in the field. Recent reports have hypothesized that Hg
exposure could increase the potential risk of developing AD. Also, AD is known as
a complex neurological disorder with increased amounts of both extracellular
neuritic plaques and intracellular neurofibrillary tangles, which may also be
related to lifestyle and genetic variables. Research reports on AD and
relationships between Hg and AD indicate that neurotransmitters such as
serotonin, acetylcholine, dopamine, norepinephrine, and glutamate are
dysregulated in patients with AD. Many researchers have suggested that AD
patients should be evaluated for Hg exposure and toxicity. Some authors suggest
further exploration of the Hg concentrations in AD patients. Dysfunctional
signaling pathways in AD and Hg exposure appear to be interlinked with some
driving factors such as arachidonic acid, homocysteine, dehydroepiandrosterone
(DHEA) sulfate, hydrogen peroxide, glucosamine glycans, glutathione, acetyl-L
carnitine, melatonin, and HDL. This evidence suggests the need for a better
understanding of the relationship between AD and Hg exposure, and potential
mechanisms underlying the effects of Hg exposure on regional brain functions.
Also, further studies evaluating brain functions are needed to explore the
long-term effects of subclinical and untreated Hg toxicity on the brain function
of AD patients.
PMID: 30877448 [Indexed for MEDLINE]
10. J Vet Emerg Crit Care (San Antonio). 2019 Mar;29(2):201-207. doi:
10.1111/vec.12820. Epub 2019 Mar 12.
Acute barium poisoning in a dog after ingestion of handheld fireworks (party
Stanley MK(1), Kelers K(1), Boller E(1), Boller M(1).
(1)U-Vet Animal Hospital, Faculty of Veterinary and Agricultural Sciences,
University of Melbourne, Werribee, Australia.
OBJECTIVE: To report a case of acute barium poisoning in a dog subsequent to
ingestion of a common handheld pyrotechnic (sparkler).
CASE SUMMARY: A 5-year-old female neutered German Shorthaired Pointer presented
with acute onset of generalized flaccid muscle paralysis and fasciculations,
ptyalism, and an irregular heart rhythm. Marked hypokalemia (1.9 mmol/L [mEq/L];
reference range [3.5-5.8 mmol/L [mEq/L]), acidemia (pH 7.20; reference range
7.38-7.44), and hypoventilation (PvCO2 55 mm Hg; reference range 40-50 mm Hg)
were present on admission. Treatment consisted of fluid therapy, aggressive IV
potassium chloride supplementation, gastric lavage, and oral magnesium sulfate
administration. Based on history and clinical presentation, barium intoxication
after ingestion of handheld firework (sparklers) was suspected and a serum sample
was submitted for barium analysis. The serum barium concentration determined by
inductively coupled plasma/mass spectrometry was 2,000 μg/L, a 3 orders of
magnitude elevation above previously reported normal values in dogs. Within 18
hours of admission, the clinical signs resolved and the blood potassium
concentration normalized. The animal was discharged home 36 hours after
admission. On follow-up performed after 1 and 5 years, no health issues were
NEW INFORMATION PROVIDED: To the authors' knowledge, this is the first report of
acute, life-threatening barium toxicosis characterized by flaccid paralysis,
acidemia, and severe hypokalemia occurring in a dog after ingestion of a popular
pyrotechnic (sparkler) containing barium nitrate. Clinical signs may resolve
within 24 hours with appropriate supportive care including aggressive potassium
supplementation and chelation therapy.
© Veterinary Emergency and Critical Care Society 2019.
PMID: 30861291 [Indexed for MEDLINE]
11. Environ Health. 2019 Feb 28;18(1):16. doi: 10.1186/s12940-019-0457-7.
The CDC blood lead reference value for children: time for a change.
Paulson JA(1), Brown MJ(2).
(1)George Washington University School of Medicine & Health Sciences, and George
Washington University Milken Institute School of Public Health, 1113 N Howard St,
Alexandria, VA, 22304-1627, USA. firstname.lastname@example.org.
(2)Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA,
Environ Health. 2019 Apr 11;18(1):32.
The purpose of this article is to consider alternate uses of the blood lead
reference value for children. There are two possible approaches. Historically the
reference value has been used to guide clinical and public interventions for
individual children. As the distribution of blood lead levels in the population
has been lowered over time, the blood lead level at which interventions are
recommended has also been reduced. The use of a reference value of 3.5 μg/dL,
based on the 98 percentile of blood lead levels for children in 2011-2014
National Health and Nutrition Examination Survey is under review. For several
reasons, adopting the new reference value to guide clinical and public health
management puts practitioners in an untenable position. First, the changes in the
brain caused by lead are significant and persistent. However, these adverse
impacts are subtle and although clearly identified at the population level, not
predictive for individual children. In addition, the recommended interventions
have not been shown to reduce blood lead levels once they are elevated. Finally,
clinical laboratory and office-based blood lead testing devices are not required
to quantify blood lead levels < 4 μg/dL and in many cases cannot reliably test
for low blood lead levels. Revising the reference value also will undoubtedly
result in diversion of resources away from those population-based interventions
which have demonstrated success. We argue for second approach, in the management
of lead poisoning in the US from one of evaluation and management at the
individual level to one of population based primary prevention. This would
require a strategy directed at controlling or eliminating lead in children's
environment before they are exposed. The reference value, as a benchmark, is
essential to ensure that primary prevention efforts are successful.
PMID: 30819209 [Indexed for MEDLINE]
12. Int J Mol Sci. 2019 Feb 26;20(5). pii: E1019. doi: 10.3390/ijms20051019.
EDTA Chelation Therapy for the Treatment of Neurotoxicity.
Fulgenzi A(1), Ferrero ME(2).
(1)Department of Biomedical Sciences for Health, University of the Study of
Milan, 20133 Milan, Italy. email@example.com.
(2)Department of Biomedical Sciences for Health, University of the Study of
Milan, 20133 Milan, Italy. firstname.lastname@example.org.
Neurotoxicity can be caused by numerous direct agents, of which toxic metals,
organophosphorus pesticides, air pollution, radiation and electromagnetic fields,
neurotoxins, chemotherapeutic and anesthetic drugs, and pathogens are the most
important. Other indirect causes of neurotoxicity are cytokine and/or reactive
oxygen species production and adoptive immunotherapy. The development of
neurodegenerative diseases has been associated with neurotoxicity. Which arms are
useful to prevent or eliminate neurotoxicity? The chelating agent calcium
disodium ethylenediaminetetraacetic acid (EDTA)-previously used to treat
cardiovascular diseases-is known to be useful for the treatment of
neurodegenerative diseases. This review describes how EDTA functions as a
therapeutic agent for these diseases. Some case studies are reported to confirm
PMID: 30813622 [Indexed for MEDLINE]
13. Medicine (Baltimore). 2019 Feb;98(8):e14629. doi: 10.1097/MD.0000000000014629.
Successful treatment of a patient with severe thallium poisoning in a coma using
Prussian blue and plasma exchange: A case report.
Lin G(1), Yuan L(2), Bai L(1), Liu Y(1), Wang Y(2), Qiu Z(1).
(1)Poisoning Treatment Department, Affiliated Hospital Academy of Military
(2)State Key Laboratory of Toxicology and Medical Countermeasures, Institutes of
Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing,
People's Republic of China.
RATIONALE: This is the first reported severe thallium poisoning patient
successfully treated with Prussian blue (PB) and plasma exchange (PE).
PATIENT CONCERNS: A 42-year-old woman in a coma owing to severe thallium
poisoning was admitted to our department after day 44 of poisoning. At admission,
blood and urine thallium concentrations were 380.0 and 2580.0 ng/mL,
DIAGNOSIS: The patient was diagnosed with toxic encephalopathy induced by
thallium poisoning; in addition, she was also diagnosed with bilateral pneumonia,
respiratory failure, moderate anemia, hypoproteinemia, and electrolyte imbalance
based on her chest X-ray, blood gas analysis, Hb level, albumin levels, and serum
INTERVENTIONS: The patient was intubated and treated with PB (6600 mg/d, 15 days
in total) combined with PE (once daily, 5 days in total) as well as other
symptomatic supportive care measures.
OUTCOMES: After treatments, her blood and urinary thallium concentrations
gradually decreased and on the 13th day after admission, the blood thallium
concentration decreased to 0 ng/mL. The oxygenation index gradually improved,
meantime, the patient gradually regained consciousness, and on the 50th day of
admission, the patient's consciousness reverted to a clear-headed state. The
patient recovered mostly after 37 months of follow-up.
LESSONS: Through this case, we learned that the gradual reduction in blood and
urine thallium concentration and the patient's improved condition is correlated
with PB and PE treatment. For patients with severe thallium poisoning, this
treatment method might be effective; but the exact curative effect is
unconfirmed, requiring further research to verify.
PMID: 30813198 [Indexed for MEDLINE]
14. Sci Total Environ. 2019 Feb 25;653:748-757. doi: 10.1016/j.scitotenv.2018.10.388.
Epub 2018 Oct 30.
Heavy metal pollution and potential health risks of commercially available
Chinese herbal medicines.
Wang Z(1), Wang H(2), Wang H(1), Li Q(1), Li Y(1).
(1)Faculty of Environmental Science and Engineering, Kunming University of
Science and Technology, Kunming 650500, China.
(2)Faculty of Environmental Science and Engineering, Kunming University of
Science and Technology, Kunming 650500, China. Electronic address:
A survey was conducted to investigate the pollution and health risks of copper
(Cu), cadmium (Cd), lead (Pb), arsenic (As), mercury (Hg) and zinc (Zn) in 60
Chinese herbal medicines (CHMs) collected from a market in Kunming City, Yunnan
Province, China. Furthermore, eight CHMs (Cyathulae radix, Drynariae rhizoma,
Peucedani radix, Homalomenae rhizoma, Dryopteris setosa, Polygonati rhizoma,
Lilii bulbus, and Linderae radix) containing high Cd concentrations were selected
to further analyse their Cd chemical forms. Additionally, the dissolution rates
of six heavy metals in decoction liquid were also analysed for four CHMs
(Typhonii rhizoma, Linderae radix, Homalomenae rhizoma, and Cyathulae radix), and
the health risks of heavy metals in CHMs were evaluated. The results showed that
the Cd, Hg and Cu concentrations in the 60 CHMs exceeded the limiting values of
the "Green Trade Standards of Importing & Exporting Medicinal Plants &
Preparations" (WM2-2001), with exceedance ratios of 38.8%, 8.3% and 1.7%,
respectively. The majority of Cd was integrated with pectates and protein in
CHMs, and the other five Cd chemical forms followed the order of
water-soluble > insoluble heavy metal phosphates > oxalate > residual > inorganic
form, indicating that Cd had relatively low bioactivity and toxicity. The average
dissolution rates of Zn, Cu, Cd, Hg, As and Pb in the four CHMs were 47.4%,
33.8%, 20.5%, 6.1%, 5.4% and 4.8%, respectively. The calculation results of
hazard quotients (HQs) for Cd and Hg showed that the CHMs did not pose a threat
to human health.
Copyright © 2018 Elsevier B.V. All rights reserved.
PMID: 30759600 [Indexed for MEDLINE]
15. Rev Fac Cien Med Univ Nac Cordoba. 2018 Nov 13;75(4):310-313. doi:
[Atypical presentation of rhabdomyolysis due to hypokalaemia induced by diuretics
abuse: Case report from Sierra Leone.]
Berdaguer Ferrari FD(1), Jalloh HB, Barrie AR, Mansaray AK, Song K, Molina García
(1)Médecins Sans Frontières. email@example.com.
Rhabdomyolysis results from acute necrosis of skeletal muscle fibres and
consequent leakage of muscle constituents into the circulation. Its association
with anything different than trauma in the Emergency Room is not that frequent.
We present the case of a 47-year-old male, hypertensive, that developed weakness
and incapability to walk without help, finding on the blood biochemistry that he
had developed a rhabdomyolysis due to hipokalemia after abusing of diuretics.
Publisher: La rabdomiólisis es el resultado de la necrosis de las fibras
musculoesqueléticas y la consiguiente fuga de constituyentes musculares a la
circulación. Su asociación con algo diferente a un trauma en la sala de
emergencias no es tan frecuente. Presentamos el caso de un varón de 47 años,
hipertenso, con historia de abuso de diuréticos, desarrollando debilidad e
incapacidad para caminar por sus propios medios, encontrando en la bioquímica
sanguínea que había padecía rabdomiólisis por hipocalemia.
Revista de la Facultad de Ciencias Médicas de Córdoba
PMID: 30734712 [Indexed for MEDLINE]
Conflict of interest statement: none
16. J Vet Diagn Invest. 2019 Mar;31(2):307-310. doi: 10.1177/1040638719831413. Epub
2019 Feb 8.
Acute lead arsenate poisoning in beef cattle in Uruguay.
Schild CO(1)(2)(3)(4)(5), Giannitti F(1)(2)(3)(4)(5), Medeiros
RMT(1)(2)(3)(4)(5), da Silva Silveira C(1)(2)(3)(4)(5), Caffarena
RD(1)(2)(3)(4)(5), Poppenga RH(1)(2)(3)(4)(5), Riet-Correa F(1)(2)(3)(4)(5).
(1)Instituto Nacional de Investigación Agropecuaria (INIA), Plataforma de
Investigación en Salud Animal, Estación Experimental INIA La Estanzuela, Colonia,
Uruguay (Schild, Giannitti, da Silva Silveira, Caffarena, Riet-Correa).
(2)Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
(3)Universidade Federal de Campina Grande, Paraíba, Brazil (Medeiros).
(4)Veterinary Population Medicine Department, College of Veterinary Medicine,
University of Minnesota, Saint Paul, MN (Giannitti).
(5)California Animal Health & Food Safety Laboratory, University of California,
Davis, CA (Poppenga).
We describe and illustrate lesions in an outbreak of lead arsenate poisoning in
beef cattle that ingested pesticide residues stored in an abandoned building of a
former orange orchard. Of 70 exposed cattle, 14 had diarrhea, paresis, ataxia,
recumbency, and/or seizures. Ten of the affected animals died after a clinical
course of 12-18 h. Pathologic findings in 3 steers included extensive
necrohemorrhagic, ulcerative rumenitis, omasitis, and abomasitis; lymphocytolysis
in lymphoid organs; and nephrosis. Hepatic arsenic and lead levels in cases 1-3
were 20, 24, and 31 ppm, and 8.3, 25, and 9.4 ppm, respectively. Lesions in the
forestomachs and lymphoid tissues have been rarely reported in cases of lead
arsenate poisoning. In southern South America, these lesions are
indistinguishable from those produced by Baccharis coridifolia, a toxic plant
that contains macrocyclic trichothecenes, thus these conditions should be
considered in the differential diagnosis of necrotizing lesions in alimentary and
PMID: 30734668 [Indexed for MEDLINE]
17. Environ Health Prev Med. 2019 Jan 26;24(1):8. doi: 10.1186/s12199-019-0762-3.
Hospital-based screening to detect patients with cadmium nephropathy in
cadmium-polluted areas in Japan.
Sasaki T(1)(2), Horiguchi H(3)(4)(5), Arakawa A(6), Oguma E(7)(8)(9), Komatsuda
A(10), Sawada K(10), Murata K(8), Yokoyama K(11), Matsukawa T(11), Chiba M(11),
Omori Y(7)(11), Kamikomaki N(1)(12).
(1)Department of Internal Medicine, Akita Rosai Hospital, Japan Organization of
Occupational Health and Safe, Akita, 018-5604, Japan.
(2)Fukunaga Clinic, Akita, 018-5334, Japan.
(3)Department of Hygiene, Kitasato University School of Medicine, 1-15-1
Kitasato, Minami-ku, Sagamihara, Kanagawa, 010-8543, Japan.
(4)Department of Environmental Health Sciences, Akita University, Graduate School
of Medicine, Akita, 010-8543, Japan. firstname.lastname@example.org.
(5)Department of Environmental and Preventive Medicine, School of Medicine, Jichi
Medical University, Tochigi, 329-0498, Japan. email@example.com.
(6)Kosaka-machi Clinic, Akita, 017-0202, Japan.
(7)Department of Hygiene, Kitasato University School of Medicine, 1-15-1
Kitasato, Minami-ku, Sagamihara, Kanagawa, 010-8543, Japan.
(8)Department of Environmental Health Sciences, Akita University, Graduate School
of Medicine, Akita, 010-8543, Japan.
(9)Department of Environmental and Preventive Medicine, School of Medicine, Jichi
Medical University, Tochigi, 329-0498, Japan.
(10)Department of Hematology, Nephrology, and Rheumatology, Akita University
Graduate School of Medicine, Akita, 010-8543, Japan.
(11)Department of Epidemiology and Environmental Health, Juntendo University
Faculty of Medicine, Tokyo, 113-8421, Japan.
(12)Department of Emergency, Saiseikai Utsunomiya Hospital, Utsunomiya, 321-0974,
BACKGROUND: In health examinations for local inhabitants in cadmium-polluted
areas, only healthy people are investigated, suggesting that patients with severe
cadmium nephropathy or itai-itai disease may be overlooked. Therefore, we
performed hospital-based screening to detect patients with cadmium nephropathy in
two core medical institutes in cadmium-polluted areas in Akita prefecture, Japan.
METHODS: Subjects for this screening were selected from patients aged 60 years or
older with elevated serum creatinine levels and no definite renal diseases. We
enrolled 35 subjects from a hospital in Odate city and 22 from a clinic in Kosaka
town. Urinary ß2-microglobulin and blood and urinary cadmium levels were
RESULTS: The criteria for renal tubular dysfunction and the over-accumulation of
cadmium were set as a urinary ß2-microglobulin level higher than 10,000 μg/g cr.
and a blood cadmium level higher than 6 μg/L or urinary cadmium level higher than
10 μg/g cr., respectively. Subjects who fulfilled both criteria were diagnosed
with cadmium nephropathy. Six out of 57 patients (10.5% of all subjects) had
CONCLUSIONS: This hospital-based screening is a very effective strategy for
detecting patients with cadmium nephropathy in cadmium-polluted areas, playing a
complementary role in health examinations for local inhabitants.
REGISTRATION NUMBER: No. 6, date of registration: 6 June, 2010 (Akita Rosai
Hospital), and No. 1117, date of registration: 26 December, 2013 (Akita
PMID: 30684957 [Indexed for MEDLINE]
18. Sci Total Environ. 2019 Mar 20;657:1382-1388. doi:
10.1016/j.scitotenv.2018.12.154. Epub 2018 Dec 11.
Assessment of the prevalence of lead-based paint exposure risk in Jakarta,
Ericson B(1), Hariojati N(2), Susilorini B(2), Crampe LF(3), Fuller R(3), Taylor
MP(4), Caravanos J(5).
(1)Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA;
Department of Environmental Sciences, Faculty of Science and Engineering,
Macquarie University, North Ryde, Sydney, NSW 2109, Australia. Electronic
(2)Blacksmith Institute Indonesia, Victorian Business Park Block CC-09 2nd Floor,
Jl. Bintaro Utama 3A, Tangerang Selatan 15221, Banten, Indonesia.
(3)Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA.
(4)Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA;
Department of Environmental Sciences, Faculty of Science and Engineering,
Macquarie University, North Ryde, Sydney, NSW 2109, Australia.
(5)Pure Earth, 475 Riverside Drive, Suite 860, New York, NY 10025, USA; College
of Global Public Health, New York University, 41 East 11(th) Street, New York, NY
While lead-based paint has been banned for use in residential settings in most
high-income countries, it remains commonly available in many low- and
middle-income countries (LMICs). Despite its continued availability, little is
known about the specific exposure risk posed by lead-based paint in LMICs. To
address this knowledge gap, an assessment of home and preschool dust and paint
was carried out in Greater Jakarta, Indonesia. A team of investigators used field
portable X-ray Fluorescence (pXRF) to measure 1574 painted surfaces for the
presence of lead (mg/cm2) and collected 222 surface dust wipe samples for lead
loading (μg/m2) from 103 homes and 19 preschools across 13 different
neighborhoods of Jakarta. The assessment found that 2.7% (n = 42) of pXRF
measurements and 0.05% (n = 1) of dust wipe samples exceeded the commonly applied
USEPA guideline values for paint (1 mg/cm2) and dust (floors: 431 μg/m2; window
sills: 2691 μg/m2). Thus, contrary to expectations the locations analyzed in
Greater Jakarta showed that exposure risk to lead-based paint appears low.
Further study is required in other settings to confirm the findings here.
Precautionary measures, such as the proposed ban on lead-based paint, should be
taken to prevent the significant social and economic costs associated with lead
Copyright © 2018. Published by Elsevier B.V.
PMID: 30677904 [Indexed for MEDLINE]
19. Indian J Ophthalmol. 2019 Feb;67(2):267-268. doi: 10.4103/ijo.IJO_730_18.
Ocular argyrosis: A case with silver deposits in cornea and lens.
Dudeja L(1), Dudeja I(1), Janakiraman A(1), Babu M(1).
(1)Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Sankagiri
Main Road, Nethimedu, Salem, Tamil Nadu, India.
PMID: 30672485 [Indexed for MEDLINE]
Conflict of interest statement: None
20. BMJ Case Rep. 2019 Jan 17;12(1). pii: bcr-2018-227741. doi:
Lithium neurotoxicity presenting as dementia with therapeutic serum lithium
(1)Department of Learning Disabilities, NHS Greater Glasgow and Clyde, Glasgow,
After 25 years of continuous lithium therapy, a woman with moderate intellectual
disability and bipolar disorder developed symptoms suggestive of dementia. In
fact, she had developed lithium neurotoxicity, but this was overlooked for 18
months as serial lithium levels were in the therapeutic range.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and
permissions. Published by BMJ.
PMID: 30659009 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.
21. Am J Med Sci. 2019 Apr;357(4):338-342. doi: 10.1016/j.amjms.2018.11.014. Epub
2018 Nov 29.
The Role of Plasmapheresis in Treating Lethal Cupric Sulfate Poisoning.
Du Y(1), Mou Y(2).
(1)Emergency Department and Intensive Care Unit, West China School of Public
Health, No.4 West China Teaching Hospital, Sichuan University, Chengdu, China.
(2)Geroscience and Chronic Disease Department, The 8th Municipal People's
Hospital, Chengdu, China. Electronic address: firstname.lastname@example.org.
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.
Copyright © 2018 Southern Society for Clinical Investigation. Published by
Elsevier Inc. All rights reserved.
22. Emerg Med Australas. 2019 Feb;31(1):144-145. doi: 10.1111/1742-6723.13224. Epub
2019 Jan 12.
Two cases of lead poisoning from inhaled opium in Victoria.
Law S(1), Ackerly I(2), Scott-Rimmington B(1), Nallaratnam K(1).
(1)Department of Emergency Medicine, Western Health, Melbourne, Victoria,
(2)Department of Surgery, Western Health, Melbourne, Victoria, Australia.
PMID: 30635973 [Indexed for MEDLINE]
23. Annu Rev Pharmacol Toxicol. 2019 Jan 6;59:537-554. doi:
Metals and Mechanisms of Carcinogenesis.
Chen QY(1), DesMarais T(1), Costa M(1).
(1)Departments of Environmental Medicine, and Biochemistry and Molecular
Pharmacology, New York University School of Medicine, New York, NY 10010, USA;
Metal exposure is pervasive and not limited to sporadic poisoning events or toxic
waste sites. Hundreds of millions of people around the globe are affected by
chronic metal exposure, which is associated with serious health concerns,
including cancer, as demonstrated in a variety of studies at the molecular,
systemic, and epidemiologic levels. Metal-induced toxicity and carcinogenicity
are sophisticated and complex in nature. This review provides a broad context and
holistic view of currently available studies on the mechanisms of metal-induced
carcinogenesis. Specifically, we focus on the five most prevalent carcinogenic
metals, arsenic, nickel, cadmium, chromium, and beryllium, and their potential to
drive carcinogenesis in humans. A comprehensive understanding of the mechanisms
behind the development of metal-induced cancer can provide valuable insights for
therapeutic intervention involving molecular targets in metal-induced
24. Food Chem Toxicol. 2019 Feb;124:182-191. doi: 10.1016/j.fct.2018.12.002. Epub
2018 Dec 5.
Mechanistic insights of hepatoprotective effects of curcumin: Therapeutic updates
and future prospects.
Khan H(1), Ullah H(2), Nabavi SM(3).
(1)Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan.
Electronic address: email@example.com.
(2)Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan.
(3)Applied Biotechnology Research Center, Baqiyatallah University of Medical
Sciences, Tehran, Iran.
The liver is the most essential organ of the body performing vital functions.
Hepatic disorders affect the physiological and biochemical functions of the body.
These disorders include hepatitis B, hepatitis C, alcoholic liver disease (ALD),
nonalcoholic fatty liver disease (NAFLD), liver cirrhosis, hepatic failure and
hepatocellular carcinoma (HCC). Drugs related hepatotoxicity is one of the major
challenges facing by clinicians as it is a leading cause of liver failure. During
post-marketing surveillance studies, detection and reporting of drug-induced
hepatotoxicity may lead to drug withdrawal or warnings. Several mechanisms are
involved in hepatotoxicity such as cell membrane disruption, initiating an immune
response, alteration of cellular pathways of drug metabolism, accumulation of
reactive oxygen species (ROS), lipid peroxidation and cell death. Curcumin, the
active ingredient of turmeric and exhibits therapeutic potential for the
treatment of diabetes, cardiovascular disorders and various types of cancers.
Curcumin is strong anti-oxidant and anti-inflammatory effects and thus it
possesses hepatoprotective properties. Despite its low bioavailability, its
hepatoprotective effects have been studied in various protocols of hepatotoxicity
including acetaminophen, alcohol, lindane, carbon tetrachloride (CCL4),
diethylnitrosamine and heavy metals induced hepatotoxicities. This report reviews
the hepatoprotective effects of curcumin with a focus on its mechanistic insights
in various hepatotoxic protocols.
Copyright © 2018. Published by Elsevier Ltd.
PMID: 30529260 [Indexed for MEDLINE]
25. MMWR Morb Mortal Wkly Rep. 2018 Nov 23;67(46):1290-1294. doi:
Lead in Spices, Herbal Remedies, and Ceremonial Powders Sampled from Home
Investigations for Children with Elevated Blood Lead Levels - North Carolina,
Angelon-Gaetz KA, Klaus C, Chaudhry EA, Bean DK.
The number of pediatric cases of elevated blood lead levels (BLLs) are decreasing
in North Carolina. However, one county reported an increase in the number of
children with confirmed BLLs ≥5 μg/dL (CDC reference value,
https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm), from 27 in 2013 to
44 in 2017. Many children with elevated BLLs in this county lived in new housing,
but samples of spices, herbal remedies, and ceremonial powders from their homes
contained high levels of lead. Children with chronic lead exposure might suffer
developmental delays and behavioral problems (https://www.cdc.gov/nceh/lead/). In
1978, lead was banned from house paint in the United States (1); however,
children might consume spices and herbal remedies daily. To describe the problem
of lead in spices, herbal remedies, and ceremonial powders, the North Carolina
Childhood Lead Poisoning Prevention Program (NCCLPPP) retrospectively examined
properties where spices, herbal remedies, and ceremonial powders were sampled
that were investigated during January 2011-January 2018, in response to confirmed
elevated BLLs among children. NCCLPPP identified 59 properties (6.0% of all 983
properties where home lead investigations had been conducted) that were
investigated in response to elevated BLLs in 61 children. More than one fourth
(28.8%) of the spices, herbal remedies, and ceremonial powders sampled from these
homes contained ≥1 mg/kg lead. NCCLPPP developed a survey to measure
child-specific consumption of these products and record product details for
reporting to the Food and Drug Administration (FDA). Lead contamination of
spices, herbal remedies, and ceremonial powders might represent an important
route of childhood lead exposure, highlighting the need to increase product
safety. Setting a national maximum allowable limit for lead in spices and herbal
remedies might further reduce the risk for lead exposure from these substances.
PMID: 30462630 [Indexed for MEDLINE]
Conflict of interest statement: All authors have completed and submitted the
ICMJE form for disclosure of potential conflicts of interest. No potential
conflicts of interest were disclosed.
26. Public Health Rep. 2019 Jan/Feb;134(1):47-56. doi: 10.1177/0033354918807975. Epub
2018 Nov 14.
Elevated Blood Lead Levels in Infants and Children in Haiti, 2015.
Carpenter C(1)(2)(3), Potts B(1)(4), von Oettingen J(2)(5), Bonnell R(2)(6),
Sainvil M(2), Lorgeat V(2), Mascary MC(2), She X(1), Jean-Baptiste E(7), Palfrey
S(8), Woolf AD(1), Palfrey J(1).
(1)1 Boston Children's Hospital, Boston, MA, USA.
(2)2 Kay Mackenson Center, Pierre Payen, Artibonite, Haiti.
(3)3 Current affiliation: University of California, San Francisco Medical Center,
San Francisco, CA, USA.
(4)4 Akron's Children's Hospital, Akron, OH, USA.
(5)5 McGill University Health Center, Montreal, Quebec, Canada.
(6)6 Dell Medical School, University of Texas at Austin, Austin, TX, USA.
(7)7 Fondation Haïtienne de Diabète et de Maladies Cardio-Vasculaires, Port au
Prince, Ouest, Haiti.
(8)8 Boston Medical Center, Boston, MA, USA.
OBJECTIVE: Few studies have reported blood lead levels (BLLs) in Haitian
children, despite the known presence of lead from environmental factors such as
soil, water, leaded paint and gasoline, improperly discarded batteries, and
earthquakes. We sought to determine the prevalence of elevated blood lead levels
(EBLLs) among healthy Haitian children.
METHODS: We enrolled children aged 9 months to 6 years from 3 geographic areas in
Haiti (coastal, urban, and mountain) from March 1 through June 30, 2015. We
obtained anthropometric measurements, household income, potential sources of lead
exposure, and fingerstick BLLs from 273 children at 6 churches in Haiti. We
considered a BLL ≥5 μg/dL to be elevated.
RESULTS: Of 273 children enrolled in the study, 95 were from the coastal area, 78
from the urban area, and 100 from the mountain area. The median BLL was 5.8
μg/dL, with higher levels in the mountain area than in the other areas ( P <
.001). BLLs were elevated in 180 (65.9%) children. The prevalence of EBLL was
significantly higher in the mountain area (82 of 100, 82.0%; P < .001) than in
the urban area (42 of 78, 53.8%) and the coastal area (56 of 95, 58.9%; P <
.001). Twenty-eight (10.3%) children had EBLLs ≥10 μg/dL and 3 (1.1%) children
had EBLLs ≥20 μg/dL. Exposure to improperly discarded batteries ( P = .006) and
living in the mountain area ( P < .001) were significant risk factors for EBLLs.
CONCLUSIONS: More than half of Haitian children in our study had EBLLs. Public
health interventions are warranted to protect children in Haiti against lead
PMID: 30426830 [Indexed for MEDLINE]
27. Neurol Sci. 2019 Mar;40(3):653-654. doi: 10.1007/s10072-018-3634-5. Epub 2018 Nov
Bismuth-related acute neurotoxicity as stroke mimic: a case report.
Brigandì A(1)(2), Rizzo V(3), Ziccone V(3), Girlanda P(3)(4).
(1)Department of Clinical and Experimental Medicine, University of Messina,
Messina, Italy. firstname.lastname@example.org.
(2)Movement Disorders Unit, AOU G. Martino, University of Messina, Via Consolare
Valeria 1, 98125, Messina, Italy. email@example.com.
(3)Department of Clinical and Experimental Medicine, University of Messina,
(4)Movement Disorders Unit, AOU G. Martino, University of Messina, Via Consolare
Valeria 1, 98125, Messina, Italy.
PMID: 30414052 [Indexed for MEDLINE]
28. Forensic Sci Int. 2018 Nov;292:224-231. doi: 10.1016/j.forsciint.2018.10.002.
Epub 2018 Oct 9.
Details of a thallium poisoning case revealed by single hair analysis using laser
ablation inductively coupled plasma mass spectrometry.
Ash RD(1), He M(2).
(1)Department of Geology, University of Maryland, College Park, Maryland 20742,
(2)P.O. Box 83173, Gaithersburg, Maryland 20883, USA. Electronic address:
Heavy metals pose significant morbidity and mortality threats to humans in
connection with both acute and chronic exposure. The often-delayed manifestations
of some toxic effects and the wide-spectrum of symptoms caused by heavy metal
poisoning may perplex the clinical diagnosis and, when involved in crimes,
complicate the forensic investigation. To investigate the original intoxication
process of a thallium poisoning case, which occurred in China more than two
decades ago, laser ablation inductively coupled plasma mass spectrometry
(LA-ICP-MS) was used to analyze several hairs of the victim from before, during
and after the poisoning period. Ablation line scans of the entire length of a
∼7cm hair revealed ∼4months of repeated exposure to thallium with increased doses
and frequency toward the end, while scan of a ∼0.7cm hair revealed ∼2weeks of
constant ingestions of large doses of thallium accompanied by elevated amount of
lead. The endogenous origin of thallium was confirmed by the preservation of the
same longitudinal distribution profile in the inner part of hair, but the source
of lead could not be unambiguously determined due to the intrinsic limitation of
hair analysis to distinguish ingested lead from exogenous contaminants. The
overall thallium distribution profiles in the analyzed hairs suggested both
chronic and acute thallium exposures that correlated well with the sequential
presentation of a plethora of symptoms experienced by the victim. Aligning the
time-resolved thallium peaks with symptoms also provided clues on possible routes
of exposure at different poisoning stages. This work demonstrated the capability
of using single hair LA-ICP-MS analysis to reconstitute a prolonged and
complicated heavy metal poisoning case, and highlighted the necessity of
assessing multiple elements in the medico-legal investigation of suspicious heavy
Copyright © 2018 Elsevier B.V. All rights reserved.
PMID: 30343235 [Indexed for MEDLINE]
29. Toxicol In Vitro. 2019 Feb;54:232-236. doi: 10.1016/j.tiv.2018.10.004. Epub 2018
Protective effects of isatin and its synthetic derivatives against iron, copper
and lead toxicity.
Moghimi Benhangi H(1), Ahmadi S(2), Hakimi M(2), Molafilabi A(3), Faraji H(4),
(1)Department of Medical Toxicology, Islamic Azad University, Shahreza, Iran.
(2)Department of Chemistry, Payame Noor University, Tehran 19395-4697, Iran.
(3)Blood Transfusion Research Center, High Institute for Research and Education
in Transfusion Medicine, Tehran, Iran.
(4)Department of Laboratory Sciences, Faculty of Para-Medicine, Hormozgan
University of Medical Sciences, Bandar Abbas, Iran.
(5)Surgical Oncology Research Center, Mashhad University of Medical Sciences,
Mashhad, Iran; Department of Clinical Biochemistry, Faculty of Medicine, Mashhad
University of Medical Sciences, Mashhad, Iran. Electronic address:
INTRODUCTION: While some metals are required for physiological functions in the
form of essential trace elements, they can cause toxicity in the excessive
concentrations. Chelation therapy was used to reduce the adverse effects of acute
and chronic poisoning by metals. Isatin derivatives form complexes with copper
ions indicating that they may have protective activity against metal overload.
METHOD: In this study, four compounds (isatin and three isatin-derivatives Mj1,
TR and Mk1) were evaluated for drug-likeliness. Then their potency inhibiting
cell proliferation was determined in HEK293 cell culture assay. Finally, IC50
values for lead, copper, and iron was evaluated in the absence and also the
presence of isatin and its derivatives.
RESULTS: Isatin and its derivatives used in this study complied with the Lipinski
criteria for drug-likeliness. The greatest difference between the IC50 values and
the non-toxic dose was obtained for TR and Mj1, respectively. Pretreatment with
the Mj1 increased the IC50 values for lead, iron, and copper, by 2.1, 1.7 and 1.7
times, respectively. At non-toxic dose, TR has only increased the IC50 values for
lead and copper by 1.4 and 1.3 times without affecting iron cytotoxicity. Mk1
increased the IC50 values for lead, copper, and iron by 1.3, 1.8 and 1.7 times,
CONCLUSIONS: Mj1 is suggested as a lead compound for developing therapeutic
agents for lead (Pb) toxicity and Mk1 for copper and iron.
Copyright © 2018 Elsevier Ltd. All rights reserved.
PMID: 30296579 [Indexed for MEDLINE]
30. J Res Health Sci. 2018 Aug 4;18(3):e00419.
Bone Fracture Risk and Renal Dysfunction in a Highly Cadmium Exposed Thai
Nambunmee K(1), Nishijo M(2), Swaddiwudhipong W(3), Ruangyuttikarn W(4).
(1)Occupational Health and Safety, Major of Public Health, School of Health
Science, Mae Fah Luang University, Chiang Rai, Thailand. firstname.lastname@example.org.
(2)Department of Public Health, Kanazawa Medical University, Ishikawa, Japan.
(3)Department of Community and Social Medicine, Mae Sot General Hospital, Tak,
(4)Department of Forensic Medicine, Faculty of Medicine, Chiang Mai University,
Chiang Mai, Thailand.
BACKGROUND: Paddy fields in the Mae Sot, Tak Province of Thailand are polluted
with unsafe levels of cadmium (Cd). Elderly populations have a high Cd body
burden, putting them at elevated risk of renal dysfunction and bone fractures. We
aimed to compare bone fracture risk between glomerular dysfunction, proximal
tubular dysfunction, and calcium (Ca) handling abnormalities.
STUDY DESIGN: A cross-sectional study.
METHODS: Serum osteocalcin and cross-linked N-telopeptide of type I collagen were
used to detect bone metabolism abnormalities, whereas glomerular filtration rate,
serum cystatin C, urinary β2-microglobulin (β2-MG) and fractional excretion of
calcium (FECa) were used to indicate renal dysfunction. Urinary Cd was used as an
RESULTS: FECa >2% was associated with high bone fracture risk in both genders.
The adjusted odds of bone fracture risk were 6.029 and 3.288 in men and women,
respectively with FECa >2% relative to the FECa < 2% group. Proximal tubular
dysfunction and glomerular dysfunction did not significantly relate to the risk
of bone fracture.
CONCLUSIONS: Abnormal Ca handling is a key risk factor for bone fracture in
Cd-exposed people. Men and women were at risk of bone fracture risk at a similar
rate. FECa was a specific indicator of Ca wasting and was more cost-effective
compared to β2-MG and serum cystatin C. We recommend using FECa to monitor
abnormal Ca metabolism in individuals with FECa>2%. Reduced renal toxicant
exposure and Ca supplementation are recommended for Cd-exposed populations to
reduce bone fracture risk.
PMID: 30270212 [Indexed for MEDLINE]
31. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2018 Jun 20;36(6):474-477. doi:
[Effects of occupational cadmium exposure on workers' cardiovascular system].
[Article in Chinese; Abstract available in Chinese from the publisher]
Cao ZR(1), Cui SM, Lu XX, Chen XM, Yang X, Cui JP, Zhang GH.
(1)Xinxiang Academy of occupational health and occupational medicine, Xinxiang
Objective: To investigate the effects of cadmium exposure on cardiovascular
system of occupational workers. Methods: Cross-sectional study was applied to 992
workers in a nickel-cadmium battery plant in November, 2011, of which 749 were
cadmium exposed workers and 243 were controls without cadmium and other expose.
Urinary cadmium、electrocardiogram (ECG) and blood pressure were examined
simultaneously among 992 workers. The risk factors of ECG abnormality rate and
hypertension rate were analyzed by Logistic regression. Results: The level of
urinary cadmium in cadmium exposed workers was significantly higher than controls
(8.89±4.00 vs 1.34±1.18 μg/g creatinine, P<0.01) . Urinary cadmium level in women
was significantly higher than men in both exposure and control group (P<0.05) .
According to the group of working years, Urinary cadmium level raised with the
increase of working years (F=28.272, P<0.001) . The ECG abnormality rate and
hypertension rate of cadmium exposed workers were higher than that of control
group, the differences were all statistically significant (P<0.01) . The abnormal
rate of ECG and the hypertension rate increased with the prolonging of working
years and demonstrated dose-response relationship. With the increase of urinary
cadmium level, the abnormal rate of ECG and hypertension rate raised (OR=1.11,
P<0.01) and (OR=1.15, P<0.01) respectively. Conclusion: Occupational cadmium
exposure increased the abnormal rate of ECG and blood pressure and therefore
damaged cardiovascular system of workers. This study provided base data for
protecting health of cadmium exposed workers.
Publisher: 目的： 探讨镉职业接触对工人心血管系统的影响。 方法：
水平，并分析工人的心电图、血压等体检资料。应用Logistic回归分析心电图异常率和高血压率的危险因素。 结果： 与对照组（1.34±1.18
0.01）。 结论： 职业镉接触引起心电图异常率和高血压率升高，损害作业工人心血管系统，该研究为保护镉作业工人健康提供基础资料。.
PMID: 30248755 [Indexed for MEDLINE]
32. Public Health Rep. 2018 Nov;133(6):700-706. doi: 10.1177/0033354918795442. Epub
2018 Sep 19.
Occupational and Take-home Lead Exposure Among Lead Oxide Manufacturing
Employees, North Carolina, 2016.
Rinsky JL(1)(2), Higgins S(2), Angelon-Gaetz K(2), Hogan D(3), Lauffer P(2),
Davies M(2), Fleischauer A(2)(4), Musolin K(5), Gibbins J(5), MacFarquhar
J(2)(4), Moore Z(2).
(1)1 Epidemic Intelligence Service Program, Division of Scientific Education and
Professional Development, Centers for Disease Control and Prevention, Atlanta,
(2)2 Division of Public Health, North Carolina Department of Health and Human
Services, Raleigh, NC, USA.
(3)3 Forsyth County Department of Public Health, Winston-Salem, NC, USA.
(4)4 Office of Public Health Preparedness and Response, Centers for Disease
Control and Prevention, Atlanta, GA, USA.
(5)5 National Institute for Occupational Safety and Health, Centers for Disease
Control and Prevention, Cincinnati, OH, USA.
OBJECTIVE: In 2016, North Carolina blood lead level (BLL) surveillance activities
identified elevated BLLs among 3 children exposed to take-home lead by household
members employed at a lead oxide manufacturing facility. We characterized BLLs
among employees and associated children and identified risk factors for
occupational and take-home lead exposure.
METHODS: We reviewed BLL surveillance data for 2012-2016 to identify facility
employees and associated children. We considered a BLL ≥5 μg/dL elevated for
adults and children and compared adult BLLs with regulatory limits and
recommended health-based thresholds. We also conducted an environmental
investigation and interviewed current employees about exposure controls and
RESULTS: During 2012-2016, 5 children associated with facility employees had a
confirmed BLL ≥5 μg/dL. Among 77 people employed during 2012-2016, median BLLs
increased from 22 μg/dL (range, 4-45 μg/dL) in 2012 to 37 μg/dL (range, 16-54
μg/dL) in 2016. All employee BLLs were <60 μg/dL, the national regulatory
threshold for immediate medical removal from lead exposure; however, 55 (71%) had
a BLL ≥20 μg/dL, a recommended health-based threshold for removal from lead
exposure. Because of inadequate controls in the facility, areas considered clean
were visibly contaminated with lead dust. Employees reported bringing personal
items to work and then into their cars and homes, resulting in take-home lead
CONCLUSIONS: Integration of child and adult BLL surveillance activities
identified an occupational source of lead exposure among workers and associated
children. Our findings support recent recommendations that implementation of
updated lead standards will support better control of lead in the workplace and
prevent lead from being carried home.
PMCID: PMC6225875 [Available on 2019-11-01]
PMID: 30231234 [Indexed for MEDLINE]
33. Forensic Sci Int. 2018 Oct;291:230-233. doi: 10.1016/j.forsciint.2018.08.019.
Epub 2018 Sep 5.
Changes in thallium distribution in the scalp hair after an intoxication
Matsukawa T(1), Chiba M(2), Shinohara A(3), Matsumoto-Omori Y(4), Yokoyama K(5).
(1)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan. Electronic address: email@example.com.
(2)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan. Electronic address: firstname.lastname@example.org.
(3)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan; Seisen University, Research Institute for Cultural Studies,
3-16-21 Higashi Gotanda, Shinagawa-ku, Tokyo 141-8642, Japan. Electronic address:
(4)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan; Kitasato University School of Medicine, 1-15-1 Kitasato,
Minami-ku, Sagamihara, Kanagawa 252-0373, Japan. Electronic address:
(5)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan. Electronic address: email@example.com.
In cases of criminal thallium poisoning, forensic investigation is required to
identify the amount and time of thallium exposure. Usually, blood and urine
thallium levels are respectively used as biomarkers. Additionally, hair has the
unique potential to reveal retrospective information. Although several studies
have attempted to clarify how thallium is distributed in hair after thallium
poisoning, none have evaluated the time course of changing thallium distribution.
We investigated changes in the distribution of thallium in hair at different time
points after exposure in five criminal thallotoxicosis patients. Scalp hair
samples were collected twice, at 2.6 and 4.2-4.5months after an exposure incident
by police. Results of our segmented analysis, a considerable amount of thallium
was detected in almost all hair sample segments. The thallium exposure date
estimated from both hair sample collections matched the actual exposure date. We
found that determination of thallium amounts in hair samples divided into
consecutive segments provides valuable information about exposure period even if
a considerable time passes after exposure. Moreover, when estimating the amount
of thallium exposure from a scalp hair sample, it is necessary to pay sufficient
attention to individual differences in its decrease from hair.
Copyright © 2018 Elsevier B.V. All rights reserved.
PMID: 30227370 [Indexed for MEDLINE]
34. Int J Environ Res Public Health. 2018 Sep 13;15(9). pii: E1997. doi:
Lead Poisoning and the Dangers of Pragmatism.
(1)Department of Sociology and Anthropology, West Virginia University,
Morgantown, WV 26506-6326, USA. firstname.lastname@example.org.
Drawing from ethnographic research on lead poisoning in Uruguay and secondary
literature from lead poisoning cases around the world, the commentary argues that
public health policy guided by pragmatism presents multiple dangers to effective
PMID: 30217042 [Indexed for MEDLINE]
35. Environ Pollut. 2018 Dec;243(Pt A):292-300. doi: 10.1016/j.envpol.2018.08.065.
Epub 2018 Aug 27.
Assessment of trace metals in five most-consumed vegetables in the US:
Conventional vs. organic.
Hadayat N(1), De Oliveira LM(2), Da Silva E(2), Han L(3), Hussain M(4), Liu X(5),
(1)Research Center for Soil Contamination & Environment Remediation, South West
Forestry University, Yunnan, 650224, China; Department of Botany, University of
Agriculture, Faisalabad, 38000, Pakistan; Soil and Water Science Department,
University of Florida, Gainesville, FL, 32611, USA.
(2)Soil and Water Science Department, University of Florida, Gainesville, FL,
(3)Soil and Water Science Department, University of Florida, Gainesville, FL,
32611, USA; College of Life Sciences, Fujian Agriculture and Forestry University,
Fujian, 350002, China.
(4)Department of Botany, University of Agriculture, Faisalabad, 38000, Pakistan.
(5)Research Center for Soil Contamination & Environment Remediation, South West
Forestry University, Yunnan, 650224, China. Electronic address:
(6)Research Center for Soil Contamination & Environment Remediation, South West
Forestry University, Yunnan, 650224, China; Soil and Water Science Department,
University of Florida, Gainesville, FL, 32611, USA. Electronic address:
Metal concentrations (As, Cd, Pb, Cr, Ba, Co, Ni, Cu, and Zn) in conventional and
organic produce were assessed, specifically, five most-consumed vegetables from
the US including potato, lettuce, tomato, carrot and onion. They were from four
representative supermarkets in a college town in Florida. All vegetables
contained detectable metals, while As, Cd, Pb, Cr, and Ba are toxic metals, Co,
Ni, Cu, and Zn are nutrients for humans. The mean concentrations of As, Cd, Pb,
Cr and Ba in five vegetables were 7.86, 9.17, 12.1, 44.8 and 410 μg/kg for
organic produce, slightly lower than conventional produce at 7.29, 15.3, 17.9,
46.3 and 423 μg/kg. The mean concentrations of Co, Ni, Cu, and Zn in five
vegetables were 3.86, 58.5, 632, and 2528 μg/kg for organic produce, comparable
to conventional produce at 5.94, 68.2, 577, and 2354 μg/kg. For toxic metals, the
order followed tomato < lettuce < onion < carrot < potato, with root vegetables
being the highest. All metals in vegetables were lower than the allowable
concentrations by FAO/WHO. Health risks associated with vegetable consumption
based on daily intake and non-carcinogenic risk based on hazard quotient were
lower than allowable limits. For the five most-consumed vegetables in the US,
metal contents in conventional produce were slightly greater than organic
produce, especially for Cd and Pb.
Published by Elsevier Ltd.
PMID: 30193223 [Indexed for MEDLINE]
36. Int J Legal Med. 2019 Mar;133(2):479-481. doi: 10.1007/s00414-018-1923-4. Epub
2018 Sep 3.
Criminal mercury vapor poisoning using heated tobacco product.
Hitosugi M(1), Tojo M(2), Kane M(2)(3), Shiomi N(4), Shimizu T(5), Nomiyama T(6).
(1)Department of Legal Medicine, Shiga University of Medical Science, Otsu,
Shiga, 520-2192, Japan. email@example.com.
(2)Department of Legal Medicine, Shiga University of Medical Science, Otsu,
Shiga, 520-2192, Japan.
(3)Forensic Science Laboratory, Shiga Prefectural Police Headquarters, Otsu,
Shiga, 520-0106, Japan.
(4)Emergency and critical care medicine, Saiseikai Shiga Hospital, Ritto, Shiga,
(5)Department of Otorhinolaryngology, Shiga University of Medical Science, Otsu,
Shiga, 520-2192, Japan.
(6)Department of Preventive Medicine, Shinshu University School of Medicine,
Matsumoto, 390-8621, Japan.
We report an unusual case of mercury vapor poisoning from using a heated tobacco
product. The suspect had added grains of mercury into 20 cigarettes in a pack.
When a 36-year-old Japanese man inserted one of these cigarettes into the battery
powered holder, it was heated to a temperature of 350 °C, and he inhaled
vaporized mercury. After using 14 of the cigarettes over 16 h, he noticed he had
flu-like symptoms so he visited the hospital. Although no physical abnormalities
were revealed, 99 μg/L of mercury was detected in his serum sample. His general
condition improved gradually and his whole blood mercury level had decreased to
38 μg/L 5 days later. When the remaining six cigarettes in the pack were
examined, many metallic grains weighing a total of 1.57 g were observed. Energy
dispersive X-ray fluorescence spectrometry confirmed the grains as elemental
mercury. Accordingly, the victim was diagnosed with mercury poisoning. Because
the mercury was incorporated into cigarettes, an unusual and novel intoxication
occurred through the heating of the tobacco product. Both medical and forensic
scientific examination confirmed this event as attempted murder.
PMID: 30178086 [Indexed for MEDLINE]
37. Int J Environ Health Res. 2019 Feb;29(1):1-21. doi:
10.1080/09603123.2018.1506568. Epub 2018 Aug 7.
An insight into Cadmium poisoning and its removal from aqueous sources by
Mudila H(1)(2), Prasher P(3), Kumar M(4), Kapoor H(1), Kumar A(1), Zaidi MGH(2),
(1)a Department of Chemistry , Lovely Professional University , Phagwara , Punjab
(2)b Department of Chemistry , G.B.P.U.A. & T ., Pantnagar , Uttarakhand , India.
(3)c Department of Chemistry , U.P.E.S , Dehradun , Uttarakhand , India.
(4)d Sri Aurobindo College, Department of Chemistry , University of Delhi , Delhi
(5)e Department of Biochemistry , S. D. Agricultural University , Deesa , Gujrat
Graphene alone, in modified form or its composites had find their explicit
position in the field of adsorption technology and hence assist in detection and
removal of heavy metals like Cd (permissible limit 0.1 mg/L), which can cause
various physiological problems if entered in variety of biota. Attributed to
their unique physiognomies graphene-based adsorbent had classed themselves
superior as compared to other carbonaceous adsorbent like CNT's or activated
carbon, etc. This assessment summarizes the validity of graphene and its
composite as a superior adsorbent for decontamination of Cd from aqueous
environment; in addition, this evaluation also pronounces the toxicity profile of
trace graphene and necessity of regeneration of the adsorbent.
PMID: 30084259 [Indexed for MEDLINE]
38. J Neurosci Rural Pract. 2018 Jul-Sep;9(3):431-433. doi: 10.4103/jnrp.jnrp_555_17.
A Case of Morvan's Syndrome Associated with Heavy Metal Poisoning after Ayurvedic
Mohanakkannan S(1), Perumal SR(1), Velayudham S(1), Jeyaraj KM(1), Arunan S(1).
(1)Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil
Morvan's syndrome is an autoimmune disorder of peripheral and central nervous
system mediated by VGKC antibody. Here we report a case of Morvans syndrome who
presented 1 month after ayurvedic drug intake. She presented with symptoms of
peripheral nerve hyperexcitablity and autoimmune testing revealed positive result
for VGKC antibody. Heavy metals level was also significantly raised. She improved
after a course of steroids. This case report tries to highlight the association
of VGKC mediated Morvans syndrome with heavy metal poisoning and its incidental
occurence after Ayurvedic drug intake.
Conflict of interest statement: There are no conflicts of interest.
39. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Jul;30(7):695-698. doi:
[Efficacy analysis of prussian blue or its combination with hemoperfusion in the
treatment of acute thallium poisoning].
[Article in Chinese]
Zhao J(1), Peng X, Wang C, Bai L, Dong J, Lu X, Liu Y, Feng S, Long J, Qiu Z.
(1)Department of Poisoning Treatment, the 307th Hospital of PLA, Poisoning
Treatment Center of the Army, Beijing 100071, China. Corresponding author: Qiu
Zewu, Email: firstname.lastname@example.org.
OBJECTIVE: To investigate the efficacy of prussian blue (PB) or its combination
with hemoperfusion (HP) in the treatment of acute thallium poisoning.
METHODS: Forty-seven patients with acute thallium poisoning with complete data
hospitalized in the 307th Hospital of PLA from September 2002 to December 2017
were enrolled, and they were divided into mild poisoning group (blood thallium <
150 μg/L, urinary thallium < 1 000 μg/L) and moderate-severe poisoning group
(blood thallium ≥ 150 μg/L, urinary thallium ≥ 1 000 μg/L) according to the toxic
degrees. All patients were given symptomatic supportive treatments such as
potassium supplementation, catharsis, vital organ protections, neurotrophic
drugs, and circulation support. The mild poisoning patients were given PB with an
oral dose of 250 mg×kg-1×d-1, while moderate-severe poisoning patients were given
PB combined HP continued 2-4 hours each time. The PB dose or frequency of HP
application was adjusted according to the monitoring results of blood and urine
thallium. Data of gender, age, pain grading (numeric rating scale NRS), clinical
manifestations, blood and urine thallium before and after treatment, length of
hospitalization and prognosis were collected.
RESULTS: Of the 47 patients, patients with incomplete blood and urine test
results, and used non-single HP treatment such as plasmapheresis and hemodialysis
for treatment were excluded, and a total of 29 patients were enrolled in the
analysis. (1) Among 29 patients, there were 20 males and 9 females, median age of
40.0 (34.0, 49.0) years old; the main clinical manifestations were nervous system
and alopecia, some patients had digestive system symptoms. There were 13 patients
(44.8%) in the mild poisoning group with painless (grade 0) or mild pain (grade
1-3) with mild clinical symptoms, the length of hospitalization was 17.0 (14.2,
21.5) days. There were 16 patients (55.2%) in the moderate-severe poisoning group
with moderate pain (grade 4-6) or severe pain (grade 7-10) with severe clinical
symptoms, the length of hospitalization was 24.0 (18.0, 29.0) days. (2) After
treatment, the thallium concentrations in blood and urine in the mild poisoning
group were significantly lower than those before treatment [μg/L: blood thallium
was 0.80 (0, 8.83) vs. 60.00 (40.00, 120.00), urine thallium was 11.30 (0, 70.10)
vs. 370.00 (168.30, 610.00), both P < 0.01], the thallium concentrations in blood
and urine in the moderate-severe poisoning group were also significantly lower
than those before treatment [μg/L: blood thallium was 6.95 (0, 50.50) vs. 614.50
(245.00, 922.00), urinary thallium was 20.70 (1.95, 283.00) vs. 5 434.00 (4
077.20, 10 273.00), both P < 0.01]. None of the 29 patients died, and their
clinical symptoms were improved significantly. All the 27 patients had good
prognosis without sequela in half a year follow-up, and 2 patients with severe
acute thallium poisoning suffered from nervous system injury.
CONCLUSIONS: In the acute thallium poisoning patients, on the basis of general
treatment, additional PB in mild poisoning group and PB combined with HP in
moderate-severe poisoning group can obtain satisfactory curative effects.
PMID: 30045801 [Indexed for MEDLINE]
40. Food Addit Contam Part B Surveill. 2018 Sep;11(3):223-228. doi:
10.1080/19393210.2018.1491644. Epub 2018 Jul 23.
Estimation of weekly intake of cadmium and lead by consumption of commercial
ready-to-feed infant foods.
Winiarska-Mieczan A(1), Kwiecień M(1), Kwiatkowska K(1), Kowalczuk-Vasilev E(1),
(1)a Department of Bromatology and Food Physiology , University of Life Sciences
in Lublin , Poland.
The purpose of this survey was to estimate the safety of ready-to-eat infant
foods in terms of Pb and Cd content. The studied samples were ready-to-eat infant
products: dinners (n = 74), soups (n = 27) and desserts (n = 82) containing
components of animal origin: meat and/or milk. Cd and Pb content was determined
using a GF-AAS method. The analysed products contained 1.82-3.54 µg Pb and
1.32-1.50 µg Cd per kg. The content of Pb per kg of the product can be
represented as dinners > soups > desserts, whereas the content of Cd was dinners
> desserts > soups. The analysed ready-to-eat products could be regarded as safe,
because they supply 12-month-old infants with Pb in an amount accounting for
nearly 22% BMDL01 and Cd accounting for ca. 8.6% of the total weekly intake.
PMID: 29962292 [Indexed for MEDLINE]
41. BMJ Case Rep. 2018 Jun 29;2018. pii: bcr-2018-225590. doi:
Ayurveda metallic-mineral 'Bhasma'-associated severe liver injury.
Philips CA(1), Paramaguru R(2), Augustine P(1).
(1)The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre,
Kochi, Kerala, India.
(2)Department of Pathology, PVS Memorial Hospital Ltd, Kochi, Kerala, India.
Ayurveda Bhasma is a metallic-mineral preparation homogenised with herbal juices
or decoctions and modified with heat treatment to apparently detoxify the heavy
metals. It is widely recommended for the treatment of many disease conditions by
practitioners of complementary and alternative medicine in the absence of good
quality clinical trial evidence on its safety and efficacy. Heavy metal-induced
liver injury is widely reported in the literature, and heavy metal adulteration
of non-Bhasma-related Ayurveda and herbal products has been well described. We
report a patient who developed severe liver injury requiring listing for liver
transplantation for improved survival, after consumption of Bhasma for dyspepsia.
This case describes the first documented case and toxicology analysis of Ayurveda
Bhasma associated with severe drug-induced liver injury. Physicians must be alert
regarding patient's use of supposedly safe Ayurveda Bhasma that may promote acute
severe liver injury in the absence of other known aetiologies.
© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and
permissions. Published by BMJ.
PMID: 29960971 [Indexed for MEDLINE]
Conflict of interest statement: Competing interests: None declared.