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Medicina (Kaunas, Lithuania) May 2021HIV has been a serious global health concern since its discovery, with about 37.9 million people living with HIV worldwide as of 2018. Sub-Saharan Africa (SSA) accounts... (Review)
Review
HIV has been a serious global health concern since its discovery, with about 37.9 million people living with HIV worldwide as of 2018. Sub-Saharan Africa (SSA) accounts for 68% of the infection and contributed 74% of the 1.5 million deaths in 2013 despite having only 12% of the total world population residing in the region. This systematic review has attempted to determine the association between heavy metal toxicity and the occurrence of non-communicable diseases in the HIV/AIDS population. Three databases were systematically searched: PubMed, Scopus, and Google Scholar for studies written in English and published between 1 April 2000 and 12 April 2020. Studies were excluded if the main outcomes were not measured or did not meet the inclusion criteria. All the six included studies are cross-sectional in design, and therefore were evaluated using the STROBE checklist. The data extraction was done using an extraction table; the ratio of female to male participants included in the study was 1.09:1. Qualitative analysis was used due to the heterogeneity in the heavy metal biomarkers and the outcome measured by the included studies. Two studies compared the concentration of heavy metals in HIV-positive and HIV-negative participants while one compared the levels between HAART-naïve and HAART-treated participants, and three determined the association between heavy metal toxicity and non-communicable diseases (liver fibrosis, anaemia, and reproductive parameters, respectively) in HIV-positive patients. Blood lead, cadmium, and mercury levels were higher in HIV-seropositive than -seronegative subjects, whereas serum zinc level was lower in HIV-seropositive than -seronegative subjects, but the causal association between heavy metals and non-communicable diseases in HIV subjects is largely unknown. Interdisciplinary research between nutrition, toxicology, and human health is envisaged for primary and secondary prevention and treatment.
Topics: Africa South of the Sahara; Cross-Sectional Studies; Female; HIV Infections; Humans; Male; Metals, Heavy; Noncommunicable Diseases
PubMed: 34068196
DOI: 10.3390/medicina57050492 -
Environmental Health Perspectives Aug 2023Neural tube defects (NTDs) affect pregnancies worldwide annually. Few nongenetic factors, other than folate deficiency, have been identified that may provide... (Review)
Review
BACKGROUND
Neural tube defects (NTDs) affect pregnancies worldwide annually. Few nongenetic factors, other than folate deficiency, have been identified that may provide intervenable solutions to reduce the burden of NTDs. Prenatal exposure to toxic metals [arsenic (As), cadmium (Cd), mercury (Hg), manganese (Mn) and lead (Pb)] may increase the risk of NTDs. Although a growing epidemiologic literature has examined associations, to our knowledge no systematic review has been conducted to date.
OBJECTIVE
Through adaptation of the Navigation Guide systematic review methodology, we aimed to answer the question "does exposure to As, Cd, Hg, Mn, or Pb during gestation increase the risk of NTDs?" and to assess challenges to evaluating this question given the current evidence.
METHODS
We selected available evidence on prenatal As, Cd, Hg, Mn, or Pb exposure and risk of specific NTDs (e.g., spina bifida, anencephaly) or all NTDs via a comprehensive search across MEDLINE, Embase, Web of Science, and TOXLINE databases and applied inclusion/exclusion criteria. We rated the quality and strength of the evidence for each metal. We applied a customized risk of bias protocol and evaluated the sufficiency of evidence of an effect of each metal on NTDs.
RESULTS
We identified 30 studies that met our criteria. Risk of bias for confounding and selection was high in most studies, but low for missing data. We determined that, although the evidence was limited, the literature supported an association between prenatal exposure to Hg or Mn and increased risk of NTDs. For the remaining metals, the evidence was inadequate to establish or rule out an effect.
CONCLUSION
The role of gestational As, Cd, or Pb exposure in the etiology of NTDs remains unclear and warrants further investigation in high-quality studies, with a particular focus on controlling confounding, mitigating selection bias, and improving exposure assessment. https://doi.org/10.1289/EHP11872.
Topics: Female; Pregnancy; Humans; Cadmium; Lead; Prenatal Exposure Delayed Effects; Neural Tube Defects; Mercury; Manganese; Arsenic
PubMed: 37647124
DOI: 10.1289/EHP11872 -
European Journal of Pediatrics Jan 2022With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric... (Meta-Analysis)
Meta-Analysis Review
Blood pressure measurement in pediatric population: comparison between automated oscillometric devices and mercury sphygmomanometers-a systematic review and meta-analysis.
With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric devices provide a replacement without mercury, are fully automated, and have excellent reliability among evaluators. Here, the goal was to test the accuracy of automatic blood pressure monitor devices compared to the mercury sphygmomanometer for BP measurement in children and adolescents. Electronic databases are EMBASE, MEDLINE (PubMed), SCOPUS, and Web of Science. We selected 8974 potentially eligible articles and two authors independently. We separately reviewed 370 full papers. Potentially eligible articles were selected according to the following criteria: (a) articles published in Portuguese, English, and Spanish; (b) screening of titles; (c) screening of abstracts; and (d) retrieval and screening of the full article to determine whether it met the inclusion criteria. We included 45 articles for analysis, 28 of which were selected for meta-analysis. The systolic BP measured by automatic blood pressure monitors presents 1.17 mmHg on average (95% CI 0.85; 1.48); for diastolic BP, it produced -0.08 mmHg (95% CI -0.69; 0.54) compared with a mercury sphygmomanometer. There is high heterogeneity between studies (> 90%) in the meta-analysis, partly explained by the device model, study environment, and observer training. Only articles that reported BP measurement by both methods were included.Conclusion: Automatic blood pressure monitors have strong measurement validity when compared with the mercury column. Thus, these can be safely used in blood pressure measurements of children and adolescents in clinical and epidemiological studies. What is Known: •The "gold standard" for indirect BP measurement is the mercury sphygmomanometer. •The accuracy of the automatic device is critical to any blood pressure measurement method. What is New: •Oscillometric or automatic devices can be a suitable alternative to auscultation for initial screening, consistent with current pediatric guidelines. •The automatic devices compared to the mercury column have a good validity of measurements, which can be used in blood pressure measurements of children and adolescents in clinical and epidemiological settings, provided that international protocols are followed.
Topics: Adolescent; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitors; Child; Humans; Hypertension; Mercury; Reproducibility of Results; Sphygmomanometers
PubMed: 34272985
DOI: 10.1007/s00431-021-04171-3 -
Journal of Diabetes and Metabolic... Jun 2024Obesity and metabolic syndrome are global health concerns associated with development of different types of diseases and serious health threats in the long term. Their... (Review)
Review
BACKGROUND
Obesity and metabolic syndrome are global health concerns associated with development of different types of diseases and serious health threats in the long term. Their metabolic imbalance can be attributable to inherited and environmental factors. As a considerable environmental agent, heavy metals exposure can predispose individuals to diseases like obesity. This systematic review and meta-analysis aimed to evaluate the association between heavy metals exposure and the risk of obesity.
METHODS
PubMed/MEDLINE, EMBASE and Web of Science were systematically searched until December 17, 2022. Only observational studies that evaluated heavy metals exposure and obesity were included. Studies were excluded if they assessed maternal or prenatal exposure, the mixture of heavy metals and other chemicals, reported the association with overweight or other diseases, and undesirable study designs. The Joanna Briggs Institute checklist was used for quality assessment. The pooled adjusted odds ratio (aOR) and the pooled standardized mean difference (SMD) with their 95% confidence intervals (CIs) were calculated, respectively. The publication bias was evaluated using Egger's and Begg's tests.
RESULTS
Twenty studies (n = 127755), four case-control and sixteen analytical cross-sectional studies, were included. Lead exposure was significantly associated with a lower risk of obesity (aOR: 0.705, 95% CI: 0.498-0.997), while mercury (aOR: 1.458, 95% CI: 1.048-2.031) and barium (aOR: 1.439, 95% CI: 1.142-1.813) exposure increased the risk of obesity. No significant publication bias was found and the studies had a low risk of bias.
CONCLUSION
Overall, lead exposure reduced obesity risk, while mercury and barium exposure raised it. Further large-scale observational studies are recommended to determine the roles of heavy metals in obesity.Study registration ID: CRD42023394865.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40200-023-01307-0.
PubMed: 38932800
DOI: 10.1007/s40200-023-01307-0 -
Chemosphere Feb 2023The various ingredients and impurities that can be detected within tattoo inks have been associated with a myriad of dermatologic complications. Legislation regarding... (Meta-Analysis)
Meta-Analysis Review
The various ingredients and impurities that can be detected within tattoo inks have been associated with a myriad of dermatologic complications. Legislation regarding these antigenic substances varies widely around the world, with Europe serving as both the research and regulatory center on these intradermal formulations. Although industry is said to be moving away from metallic and metalloid pigments in exchange for organic or organometallic dyes, surveys of commercially available inks continue to detect these elements at concentrations considered unsafe for application into the dermis. In order to better assess the formulation and safety of tattoo ink, we present a systematic review and meta-analysis of studies quantifying restricted metals and metalloids in commercially available tattoo ink products. Among the papers selected, inconsistencies were noted in the degree of specificity by which ink products were identified and the elements sampled for. In addition, the analytical targets' valency and/or solubility were not always considered in accordance with regulation criteria. Of note, chromium, by total content and that of its regulated +6 valency, exceeded its maximum allowed concentration in nearly every sample tested. Total copper content exceeded the limit for soluble copper in half of inks sampled. In descending order, concentrations of cadmium, barium, mercury, soluble copper, arsenic, zinc, antimony, and lead violated regulations in one-sixth or fewer of samples tested. Cobalt and tin levels never violated regulation. Overall, our findings indicate that unsafe levels of restricted elements continue to be detected across studies, warranting further investigation under a regulatory lens.
Topics: Tattooing; Ink; Copper; Metalloids; Metals; Coloring Agents
PubMed: 36436582
DOI: 10.1016/j.chemosphere.2022.137291 -
Circulation. Cardiovascular Quality and... Apr 2023Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease.
METHODS
Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk.
RESULTS
One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results.
CONCLUSIONS
Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years.
REGISTRATION
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.
Topics: Adult; Humans; Middle Aged; Diabetes Mellitus, Type 2; Cardiovascular Diseases; Incidence; Weight Reduction Programs; Weight Gain
PubMed: 36974678
DOI: 10.1161/CIRCOUTCOMES.122.009348 -
The Science of the Total Environment Sep 2023Heavy metals are defined by their long biological half-life and non-biodegradability in the environment and the human body. Thus, they can accumulate in considerable... (Meta-Analysis)
Meta-Analysis Review
Heavy metals are defined by their long biological half-life and non-biodegradability in the environment and the human body. Thus, they can accumulate in considerable amounts within soil-plant-food chains, presenting a potential health risk to humans. This systematic review and meta-analysis aimed to investigate the prevalence and mean levels of heavy metals (As, Cd, Hg, and Pb) in red meat globally. Studies describing the heavy metal contamination of meat were retrieved by searching international general and specific databases between 2000 and 2021. According to the findings, there is a low level of contamination of meat with arsenic (As) and mercury (Hg). In contrast, the lead (Pb) and cadmium (Cd) levels exceed the Codex permissible levels. There was also a highly severe heterogeneity in the results, and no subgroup analysis revealed the cause of this heterogeneity. However, different continent subgroups, types of meat, and fat content of meat are universally defined as the primary sources of high toxic heavy metal (THM) concentrations. Also, the results of the subgroup analysis showed the Asia continent 1020.15 μg/kg (95 % CI = 605.13-1435.18), followed by Africa 965.73 μg/kg (95 % CI = 840.64-1094.42), have the highest level of Pb contamination. Similarly, Asia 232.12 μg/kg (95 % CI = 206.45-257.79) and Africa 84.68 μg/kg (95 % CI = 74.69-94.66) have reported high levels of Cd that exceeded the limit of the standards. The risk assessment results also revealed that red meat consumption carries health risks due to excessive heavy metals content particularily for heavy consumers. As a result, it is necessary to implement strict control measures to prevent heavy metal contamination in these critical food products for all consumers worldwide, particularly in Asia and Africa.
Topics: Humans; Cadmium; Lead; Metals, Heavy; Arsenic; Mercury; Red Meat; Risk Assessment; Environmental Monitoring; Soil Pollutants; China
PubMed: 37209751
DOI: 10.1016/j.scitotenv.2023.164100 -
PloS One 2022The presence of harmful environmental exposures, which disproportionately affects low-and-middle income countries (LMICs), contributes to >25% of deaths and diseases...
BACKGROUND
The presence of harmful environmental exposures, which disproportionately affects low-and-middle income countries (LMICs), contributes to >25% of deaths and diseases worldwide and detrimentally affects child neurodevelopment. Few resources succinctly summarize the existing literature on this topic. Our objective is to systematically review and characterize the evidence regarding the relationship between heavy metals and neurodevelopment of children in LMICs.
METHODS
We conducted a medical librarian-curated search on multiple online databases to identify articles that included individuals <18 years living in a LMIC, quantitatively measured exposure to a heavy metal (either prenatal or postnatal), and used a standardized measurement of neurodevelopment (i.e. cognitive, language, motor, and behavior). Reviews, editorials, or case studies were excluded. Results were analyzed qualitatively, and quality was assessed.
RESULTS
Of the 18,043 screened articles, 298 full-text articles were reviewed, and 100 articles met inclusion criteria. The included studies represented data from 19 LMICs, only one of which was classified as a low-income country. Ninety-four percent of postnatal lead and all postnatal manganese studies showed a negative association with metal exposure and neurodevelopment, which were the strongest relationships among the metals studied. Postnatal exposure of mercury was associated with poor neurodevelopment in only half of studies. Limited data on postnatal arsenic and cadmium suggests an association with worse neurodevelopment. Findings were mixed for prenatal arsenic and lead, although some evidence supports that the neurotoxicity of lead was amplified in the presence of manganese.
CONCLUSIONS AND POTENTIAL IMPACT
We found that lead and manganese appear to consistently have a detrimental effect on the neurodevelopment of children, and more evidence is needed for mercury, arsenic, and cadmium. Better characterization of these effects can motivate and inform prioritization of much needed international policies and programs to reduce heavy metal exposures for young children within LMICs.
Topics: Arsenic; Cadmium; Child; Child, Preschool; Developing Countries; Female; Humans; Manganese; Mercury; Metals, Heavy; Pregnancy; Vitamins
PubMed: 35358213
DOI: 10.1371/journal.pone.0265536 -
Experimental Dermatology Jul 2023Severe skin pain when exposed to long wave ultraviolet radiation or visible light is the main symptom of erythropoietic protoporphyria (EPP). Treatment options for EPP... (Review)
Review
Severe skin pain when exposed to long wave ultraviolet radiation or visible light is the main symptom of erythropoietic protoporphyria (EPP). Treatment options for EPP are inadequate and new treatments are needed but hampered by the lack of valid efficacy outcomes. Phototesting with well-defined illumination of the skin can be performed reliably. We aimed to provide an overview of phototest procedures used to evaluate EPP treatments. Systematic searches of Embase, MEDLINE and the Cochrane Library were performed. Searches identified 11 studies using photosensitivity as efficacy outcome. The studies used eight different phototest protocols. Illuminations were performed with a filtered high-pressure mercury arc, or a xenon arc lamp equipped with monochromator or filters. Some used broadband, others narrowband illumination. In all protocols phototests were performed on the hands or the back. Endpoints were minimal dose required to induce either first symptom of discomfort, erythema, urticaria or intolerable pain. Other endpoints were change in erythema intensity or diameter of any type of flare after exposure compared to before. In conclusion, protocols displayed extensive variability in illumination set-up and evaluation of phototest reactions. Implementation of a standardized phototest method will allow more consistent and reliable outcome evaluation in future therapeutic research of protoporphyric photosensitivity.
Topics: Humans; Protoporphyria, Erythropoietic; Ultraviolet Rays; Photosensitivity Disorders; Skin; Erythema
PubMed: 37052136
DOI: 10.1111/exd.14809 -
Journal of Environmental Sciences... Oct 2019Mercury is an important pollutant, released into aquatic ecosystems both naturally and by anthropogenic action. This element is transferred to aquatic organisms in...
Mercury is an important pollutant, released into aquatic ecosystems both naturally and by anthropogenic action. This element is transferred to aquatic organisms in different ways, causing potential health risks. In addition, mercury can be accumulated by humans, especially through the consumption of contaminated food. This systematic review aims to present mercury pathways, the major routes through which this element reaches the aquatic environment and its transformations until becoming available to living animals, leading to bioaccumulation and biomagnification phenomena. The key biotic and abiotic factors affecting such processes, the impact of mercury on animal and human health and the issue of seafood consumption as a source of chronic mercury contamination are also addressed. A total of 101 articles were retrieved from a standardized search on three databases (PubMed, Emabse, and Web of Science), in addition to 28 other studies not found on these databases but considered fundamental to this review (totaling 129 articles). Both biotic and abiotic factors display fundamental importance in mediating mercurial dynamics, i.e., muscle tropism, and salinity, respectively. Consequently, mercurial contamination in aquatic environments affects animal health, especially the risk of extinction species and also on human health, with methylmercury the main mercury species responsible for acute and chronic symptomatology.
Topics: Animals; Aquatic Organisms; Environmental Pollutants; Humans; Mercury; Methylmercury Compounds; Risk Assessment; Seafood
PubMed: 31284912
DOI: 10.1016/j.jes.2019.02.018