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.

Author information:

(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.

DOI: 10.3238/arztebl.2019.0311

PMID: 31219028

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).

Author information:

(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.

DOI: 10.21037/atm.2018.10.67

PMCID: PMC6531650

PMID: 31179309

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).

Author information:

(1)Department of Biotechnology, Yeungnam University, Gyeongbuk, Republic of


(2)Department of Biotechnology, Yeungnam University, Gyeongbuk, Republic of

Korea. Electronic address: vijaykumarcbt@ynu.ac.kr.

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.

DOI: 10.1016/j.jtemb.2019.05.003

PMID: 31109617

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).

Author information:

(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.

DOI: 10.1007/s11356-019-05104-2

PMID: 31079302

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).

Gyamfi ET(1)(2).

Author information:

(1)Department of Environmental Sciences, Macquarie University, Sydney, NSW, 2109,

Australia. eva.gyamfi@students.mq.edu.au.

(2)Nuclear Chemistry and Environmental Research Centre, Ghana Atomic Energy

Commission, National Nuclear Research Institute, P.O. Box LG 80, Legon, Accra,

Ghana. eva.gyamfi@students.mq.edu.au.

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.

DOI: 10.1007/s11356-019-05023-2

PMID: 31004267

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).

Author information:

(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,

Colorado, USA.

(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.

DOI: 10.18295/squmj.2018.18.04.017

PMCID: PMC6443289

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).

Author information:

(1)Occupational Knowledge International, 4444 Geary Boulevard, Suite 208, San

Francisco, CA, 94118, USA. pgottesfeld@okinternational.org.

(2)Department of Environmental Medicine, Box EHSC, University of Rochester

Medical Center, Rochester, NY, 14642, USA.

Comment on

Environ Health. 2019 Feb 28;18(1):16.

DOI: 10.1186/s12940-019-0472-8

PMCID: PMC6458603

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).

Author information:

(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

Taliwang communities.

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

community health.

Ethics Approval: All experiments were performed in accordance with relevant local

guidelines and regulations.

Competing Interests: The authors declare no competing financial interests.

DOI: 10.5696/2156-9614-9.21.190302

PMCID: PMC6421955

PMID: 30931162

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),

Aaseth J(11)(12).

Author information:

(1)Council for Nutritional and Environmental Medicine, Toften 24, 8610, Mo i

Rana, Norway. bjorklund@conem.org.

(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.

DOI: 10.1007/s12031-019-01274-3

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).

Author information:

(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.

DOI: 10.1111/vec.12820

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).

Author information:

(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. jerry@envirohealthdoctor.com.

(2)Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA,

02115, USA.

Comment in

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.

DOI: 10.1186/s12940-019-0457-7

PMCID: PMC6396537

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).

Author information:

(1)Department of Biomedical Sciences for Health, University of the Study of

Milan, 20133 Milan, Italy. alessandro.fulgenzi@unimi.it.

(2)Department of Biomedical Sciences for Health, University of the Study of

Milan, 20133 Milan, Italy. mariaelena.ferrero@unimi.it.

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

our findings.

DOI: 10.3390/ijms20051019

PMCID: PMC6429616

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).

Author information:

(1)Poisoning Treatment Department, Affiliated Hospital Academy of Military

Medical Sciences.

(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

electrolyte results.

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.

DOI: 10.1097/MD.0000000000014629

PMCID: PMC6407929

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).

Author information:

(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.

DOI: 10.1016/j.scitotenv.2018.10.388

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


Author information:

(1)Médecins Sans Frontières. fdberdaguer@hotmail.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

DOI: 10.31053/1853.0605.v75.n4.20398

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).

Author information:

(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

(Schild, Caffarena).

(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

lymphoid organs.

DOI: 10.1177/1040638719831413

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).

Author information:

(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. hhyogo@med.kitasato-u.ac.jp.

(5)Department of Environmental and Preventive Medicine, School of Medicine, Jichi

Medical University, Tochigi, 329-0498, Japan. hhyogo@med.kitasato-u.ac.jp.

(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

cadmium nephropathy.

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


DOI: 10.1186/s12199-019-0762-3

PMCID: PMC6347770

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).

Author information:

(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

address: bret@pureearth.org.

(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

10003, USA.

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.

DOI: 10.1016/j.scitotenv.2018.12.154

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).

Author information:

(1)Department of Cornea and Refractive Surgery, Aravind Eye Hospital, Sankagiri

Main Road, Nethimedu, Salem, Tamil Nadu, India.

DOI: 10.4103/ijo.IJO_730_18

PMCID: PMC6376824

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


Soni S(1).

Author information:

(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.

DOI: 10.1136/bcr-2018-227741

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).

Author information:

(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: 18982180702@msn.cn.

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.

DOI: 10.1016/j.amjms.2018.11.014

PMID: 30638603

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).

Author information:

(1)Department of Emergency Medicine, Western Health, Melbourne, Victoria,


(2)Department of Surgery, Western Health, Melbourne, Victoria, Australia.

DOI: 10.1111/1742-6723.13224

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).

Author information:

(1)Departments of Environmental Medicine, and Biochemistry and Molecular

Pharmacology, New York University School of Medicine, New York, NY 10010, USA;

email: Max.Costa@nyumc.org.

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


DOI: 10.1146/annurev-pharmtox-010818-021031

PMCID: PMC6348465

PMID: 30625284

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).

Author information:

(1)Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan.

Electronic address: hkdr2006@gmail.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.

DOI: 10.1016/j.fct.2018.12.002

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.

DOI: 10.15585/mmwr.mm6746a2

PMCID: PMC6289082

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).

Author information:

(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


DOI: 10.1177/0033354918807975

PMCID: PMC6304722

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).

Author information:

(1)Department of Clinical and Experimental Medicine, University of Messina,

Messina, Italy. amelia.briga@hotmail.it.

(2)Movement Disorders Unit, AOU G. Martino, University of Messina, Via Consolare

Valeria 1, 98125, Messina, Italy. amelia.briga@hotmail.it.

(3)Department of Clinical and Experimental Medicine, University of Messina,

Messina, Italy.

(4)Movement Disorders Unit, AOU G. Martino, University of Messina, Via Consolare

Valeria 1, 98125, Messina, Italy.

DOI: 10.1007/s10072-018-3634-5

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).

Author information:

(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

metal poisonings.

Copyright © 2018 Elsevier B.V. All rights reserved.

DOI: 10.1016/j.forsciint.2018.10.002

PMID: 30343235 [Indexed for MEDLINE]

29. Toxicol In Vitro. 2019 Feb;54:232-236. doi: 10.1016/j.tiv.2018.10.004. Epub 2018

Oct 5.

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),

Mashkani B(5).

Author information:

(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.

DOI: 10.1016/j.tiv.2018.10.004

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).

Author information:

(1)Occupational Health and Safety, Major of Public Health, School of Health

Science, Mae Fah Luang University, Chiang Rai, Thailand. kowit.nam@mfu.ac.th.

(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

exposure marker.

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.

Author information:

(1)Xinxiang Academy of occupational health and occupational medicine, Xinxiang

453003, China.

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。.

DOI: 10.3760/cma.j.issn.1001-9391.2018.06.025

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).

Author information:

(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

cleanup procedures.

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.

DOI: 10.1177/0033354918795442

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).

Author information:

(1)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo

113-8421, Japan. Electronic address: tmatsuka@juntendo.ac.jp.

(2)Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo

113-8421, Japan. Electronic address: mmchiba@juntendo.ac.jp.

(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: kyokoya@juntendo.ac.jp.

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.

DOI: 10.1016/j.forsciint.2018.08.019

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.

Renfrew D(1).

Author information:

(1)Department of Sociology and Anthropology, West Virginia University,

Morgantown, WV 26506-6326, USA. daniel.renfrew@mail.wvu.edu.

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

health intervention.

DOI: 10.3390/ijerph15091997

PMCID: PMC6164330

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),

Ma LQ(6).

Author information:

(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,

32611, USA.

(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.

DOI: 10.1016/j.envpol.2018.08.065

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).

Author information:

(1)Department of Legal Medicine, Shiga University of Medical Science, Otsu,

Shiga, 520-2192, Japan. hitosugi@belle.shiga-med.ac.jp.

(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,

520-3046, Japan.

(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.

DOI: 10.1007/s00414-018-1923-4

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

Graphene Adsorbents.

Mudila H(1)(2), Prasher P(3), Kumar M(4), Kapoor H(1), Kumar A(1), Zaidi MGH(2),

Verma A(5).

Author information:

(1)a Department of Chemistry , Lovely Professional University , Phagwara , Punjab

, India.

(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

, India.

(5)e Department of Biochemistry , S. D. Agricultural University , Deesa , Gujrat

, India.

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.

DOI: 10.1080/09603123.2018.1506568

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

Drug Intake.

Mohanakkannan S(1), Perumal SR(1), Velayudham S(1), Jeyaraj KM(1), Arunan S(1).

Author information:

(1)Department of Neurology, Stanley Medical College and Hospital, Chennai, Tamil

Nadu, India.

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.

DOI: 10.4103/jnrp.jnrp_555_17

PMCID: PMC6050783

PMID: 30069108

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.

Author information:

(1)Department of Poisoning Treatment, the 307th Hospital of PLA, Poisoning

Treatment Center of the Army, Beijing 100071, China. Corresponding author: Qiu

Zewu, Email: qiuzw828@163.com.

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.

DOI: 10.3760/cma.j.issn.2095-4352.2018.07.016

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),

Kiczorowska B(1).

Author information:

(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.

DOI: 10.1080/19393210.2018.1491644

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).

Author information:

(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.

DOI: 10.1136/bcr-2018-225590

PMID: 29960971 [Indexed for MEDLINE]

Conflict of interest statement: Competing interests: None declared.