Mercury exposure and cutaneous disease

Efficacy and safety of purslane (Portulaca oleracea) for mild to moderate chronic hand eczema; A randomized, double-blind, placebo-controlled clinical trial

INTRODUCTION

Chronic hand eczema (CHE) is a common skin inflammation with a complex pathophysiology. Due to its anti-inflammatory properties, Portulaca oleracea L. (purslane) is traditionally used in Persian medicine for skin ailments. This study aimed to evaluate the safety and efficacy of a standardized purslane extract (based on traditional Persian medicine) for adults with mild or moderately severe CHE.

METHODS

A randomized, double-blind, placebo-controlled clinical trial was conducted at Razi Hospital in Iran from January to June 2022. Participants were randomly allocated to receive an oral purslane or placebo syrup plus topical Vaseline for four weeks. Seventy participants were randomly allocated into the intervention (n = 35) and placebo (n = 35) groups. The primary outcomes were the extent and severity of CHE symptoms over the four weeks after adjusting for age, gender and baseline score. Secondary outcomes were quality of life, symptom recurrence, treatment satisfaction, and adverse events.

RESULTS

After 4 weeks of treatment, compared to the placebo group (n = 31), the purslane group (n = 31) had significantly lower physician-reported fissure scores (adjusted mean difference (adjMD): -0.50, 95 %CI -3.93 to -0.34, p = 0.043), participant-reported itching (adjMD -0.51, 95 %CI -2.32 to -0.31, p = 0.041), dryness (adjMD -1.46, 95 %CI -2.89 to -0.03, p = 0.045), and total itching, dryness and thickness (adjMD -2.36, 95 %CI -6.23 to -1.51, p = 0.023) scores. Fourteen participants (purslane n = 10; placebo n = 4, p = 0.068) experienced adverse events of mild to moderate severity.

CONCLUSION

Purslane has some promising effects for reducing the extent and severity of CHE symptoms, and no direct comparisons have been made with commonly used treatments. Future multicenter trials and mechanistic studies are warranted to establish the safety and effectiveness of purslane as a potential therapeutic agent for CHE.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT20200707048040N1).

Part 2: The Pediatric Hazards of Art Materials

Children can encounter art materials that contain hazardous substances at school, in the home, and during outside activities. Hazardous substances can be found in both art materials that are made to be used by children and art materials used by adults. Some of these materials can be severe irritants, allergens, carcinogens, or other chronic disease hazards. Many of the most frequently used and potentially most hazardous materials are found in the categories of solvents, pigments, and adhesives. Selected members of these categories and where they may be found in common art materials are briefly discussed. Preventive techniques that specifically address the potential hazards of each category are included. [Pediatr Ann. 2023;52(6):e219-e230.].

Clinical and Forensic Signs Resulting from Exposure to Heavy Metals and Other Chemical Elements of the Periodic Table

Several heavy metals and other chemical elements are natural components of the Earth’s crust and their properties and toxicity have been recognized for thousands of years. Moreover, their use in industries presents a major source of environmental and occupational pollution. Therefore, this ubiquity in daily life may result in several potential exposures coming from natural sources (e.g., through food and water contamination), industrial processes, and commercial products, among others. The toxicity of most chemical elements of the periodic table accrues from their highly reactive nature, resulting in the formation of complexes with intracellular compounds that impair cellular pathways, leading to dysfunction, necrosis, and apoptosis. Nervous, gastrointestinal, hematopoietic, renal, and dermatological systems are the main targets. This manuscript aims to collect the clinical and forensic signs related to poisoning from heavy metals, such as thallium, lead, copper, mercury, iron, cadmium, and bismuth, as well as other chemical elements such as arsenic, selenium, and fluorine. Furthermore, their main sources of occupational and environmental exposure are highlighted in this review. The importance of rapid recognition is related to the fact that, through a high degree of suspicion, the clinician could rapidly initiate treatment even before the toxicological results are available, which can make a huge difference in these patients’ outcomes.

Mercury increases IL-1β and IL-18 secretion and intensifies coronary arteritis in an animal model of Kawasaki disease

Kawasaki disease (KD) is a multisystem vasculitis that predominantly targets the coronary arteries in young children. Epidemiological data suggest both environmental and genetic factors contribute to the susceptibility and severity of the disease. Mercury (Hg) is a known environmental pollutant and a Ca²⁺ signaling modulator. Ca²⁺ signaling regulates the activation of NLRP3 inflammasome. Using the Lactobacillus casei cell wall extract (LCWE) induced coronary arteritis mouse model of KD; we studied the effect of mercury on inflammasome activation and its impact on the immunopathogenesis of KD. Mercury enhances the expression of inflammasome activation resulting in caspase-1 mediated secretion of IL-1β and IL-18 cytokines. In vivo, the administration of mercury together with disease inducing LCWE exacerbates disease resulting in increased incidence and severity of coronary arteritis compared to LCWE alone. Mercury can act as a novel danger signal modulating Ca²⁺ signaling to increase IL-1β and IL-18 secretion and intensifies coronary arteritis in an animal model of KD.

Integrated review of the nexus between toxic elements in the environment and human health

Emerging pollutants in the environment due to economic development have become a global challenge for environmental and human health management. Potentially toxic elements (PTEs), a major group of pollutants, have been detected in soil, air, water and food crops. Humans are exposed to PTEs through soil ingestion, consumption of water, uptake of food crop products originating from polluted fields, breathing of dust and fumes, and direct contact of the skin with contaminated soil and water. The dose absorbed by humans, the exposure route and the duration (i.e., acute or chronic) determine the toxicity of PTEs. Poisoning by PTEs can lead to excessive damage to health as a consequence of oxidative stress produced by the formation of free radicals and, as a consequence, to various disorders. The toxicity of certain organs includes neurotoxicity, nephrotoxicity, hepatotoxicity, skin toxicity, and cardiovascular toxicity. In the treatment of PTE toxicity, synthetic chelating agents and symptomatic supportive procedures have been conventionally used. In addition, there are new insights concerning natural products which may be a powerful option to treat several adverse consequences. Health policy implications need to include monitoring air, water, soil, food products, and individuals at risk, as well as environmental manipulation of soil, water, and sewage. The overall goal of this review is to present an integrated view of human exposure, risk assessment, clinical effects, as well as therapy, including new treatment options, related to highly toxic PTEs.

Fish intake and risk of melanoma in the NIH-AARP diet and health study

PURPOSE

Prior epidemiological studies evaluating the association between fish intake and melanoma risk have been few and inconsistent. Few studies distinguished different types of fish intake with risk of melanoma.

METHODS

We examined the associations between intake of total fish and specific types of fish and risk of melanoma among 491,367 participants in the NIH-AARP Diet and Health Study. We used multivariable-adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

During 6,611,941 person-years of follow-up with a median of 15.5 years, 5,034 cases of malignant melanoma and 3,284 cases of melanoma in situ were identified. There was a positive association between higher total fish intake and risk of malignant melanoma (HR = 1.22, 95% CI = 1.11-1.34 for top vs. bottom quintiles, ptrend = 0.001) and melanoma in situ (HR = 1.28, CI = 1.13-1.44 for top vs. bottom quintiles, ptrend = 0.002). The positive associations were consistent across several demographic and lifestyle factors. There were also positive associations between tuna intake and non-fried fish intake, and risk of malignant melanoma and melanoma in situ. However, fried fish intake was inversely associated with risk of malignant melanoma, but not melanoma in situ.

CONCLUSIONS

We found that higher total fish intake, tuna intake, and non-fried fish intake were positively associated with risk of both malignant melanoma and melanoma in situ. Future studies are needed to investigate the potential biological mechanisms underlying these associations.

Case Report: Gold Miner’s Lung: A Case of Chronic Hypersensitivity Pneumonia in Amazonian Forest

The hostile conditions at informal and illegal mining sites in the Amazonian forest erode the miner’s health, exposing workers to a broad range of diseases because most of the gold is extracted using mercury (Hg). The Hg vapor used daily at gold panning sites presents an environmental threat to the ecosystems and human health. We report the case of a 58-year-old man who has worked in gold panning for over 30 years, presented with diffuse interstitial pneumonia characterized by bilateral images of ground glass and mosaic opacities on the chest CT scan. Based on the negative differential diagnosis (cardiovascular, infectious, autoimmune or cancer), the context of chronic exposure to Hg in a patient who has been working for decades on illegal gold panning sites, we concluded to a chronic form of heavy metal hypersensitivity pneumonia. This hypothesis was supported by high levels of mercury in blood and urine. Mercury hypersensitivity pneumonia might be more frequent than presently thought with thousands of workers chronically exposed to high mercury concentrations among others pollutants. Medical practitioners should systematically seek for chronic respiratory illnesses associated with pollutants exposure in these vulnerable workers with poor health.

Community-driven research in the canadian arctic: dietary exposure to methylmercury and gastric health outcomes

Indigenous Arctic Canadians have a higher prevalence of gastric neoplasms relative to North Americans of European ancestry. We investigated the hypothesis that low-dose methylmercury exposure from eating fish/whale increases the risk of gastric cancer in Arctic communities. We used intermediate endpoints from an established model of gastric carcinogenesis: intestinal metaplasia, atrophy, and severe chronic gastritis. During 2008-2012, we obtained gastric biopsies from participants of community-driven projects in 3 communities. In 2016, we collected hair samples to measure methylmercury levels and interviewed them about diet. In cross-sectional analysis, logistic regression estimated odds ratios for the estimated effect of hair-methylmercury concentration on the prevalence of each pathology outcome stratified by selenium intake. Among 80 participants, prevalence of intestinal metaplasia, atrophy and severe chronic gastritis was 17, 29 and 38%, respectively. Adjusted Odds of severe chronic gastritis and atrophy were highest at hair-methylmercury concentrations ≥1μg/g when estimated selenium intake was 0, and approached 0 for all methylmercury levels as estimated selenium intake increased. Gastric pathology increased with methylmercury exposure when selenium intake was low. Though limited by small numbers, these findings suggest selenium ingested by eating fish/whale may counter harmful effects of methylmercury exposure in Arctic populations.

Patterns of fish and whale consumption in relation to methylmercury in hair among residents of Western Canadian Arctic communities

BACKGROUND

Methylmercury contamination of the environment represents a substantial environmental health concern. Human exposure to methylmercury occurs primarily through consumption of fish and marine mammals. Heavily exposed subgroups include sport or subsistence fishers residing in Arctic communities. We aimed to estimate the association of fish/whale consumption patterns of Canadian Arctic subsistence fishers with the internal dose of methylmercury as measured in hair.

METHODS

This research was conducted within ongoing community projects led by the CANHelp Working Group in Aklavik and Fort McPherson, Northwest Territories and Old Crow, Yukon. We interviewed each participant using a fish-focused food-frequency questionnaire during September-November 2016 and collected hair samples concurrently. Methylmercury was measured in the full-length of each hair sample using gas chromatography inductively-coupled plasma-mass spectrometry. Multivariable linear regression estimated beta-coefficients and 95% confidence intervals (CIs) for the effect of fish/whale consumption on hair-methylmercury concentrations.

RESULTS

Among 101 participants who provided hair samples and diet data, the mean number of fish/whale species eaten was 3.5 (SD:1.9). The mean hair-methylmercury concentration was 0.60 μg/g (SD:0.47). Fish/whale consumption was positively associated with hair-methylmercury concentration, after adjusting for sex, hair length and use of permanent hair treatments. Hair-methylmercury concentrations among participants who consumed the most fish/whale in each season ranged from 0.30-0.50 μg/g higher than those who consumed < 1 meal/week.

CONCLUSIONS

In this population of Canadian Arctic subsistence fishers, hair-methylmercury concentration increased with fish/whale consumption, but the maximum concentrations were below Health Canada's 6.0 μg/g threshold for safe exposure.

Inhibition of Tyrosinase by Mercury Chloride: Spectroscopic and Docking Studies

Inorganic mercury compounds have been used in skin-lightening products since ancient times. Although a previous study demonstrated that mercury impeded the transfer of Cu²⁺ to the apotyrosinase, the effect of mercury on tyrosinase is still unclear. In the present study, the mechanism of mercury chloride (HgCl₂) induced inactivation of tyrosinase was investigated for the first time. The IC₅₀ values were 29.97 and 77.93 μmol/L for monophenolase and diphenolase, respectively. A kinetic analysis revealed that HgCl₂ inhibited tyrosinase activity in an irreversible non-competitive manner. The strong intrinsic fluorescence quenching suggested that the formation of the HgCl₂-tyrosinase complex induced conformational changes of the enzyme, and HgCl₂ had only one single binding site or a single class of binding site on tyrosinase. The molecular docking and further experiments demonstrated that HgCl₂ bound to the amino residuals (His) in the catalytic center of tyrosinase. To our knowledge, these findings presented in this paper were the first evidence of the direct interactions between HgCl₂ and tyrosinase, which provided a deep understanding of the inhibition mechanism of mercury on tyrosinase.

A Case of Accidental Mercury Intoxication

BACKGROUND

Mercury poisoning is an uncommon diagnosis in the United States, but it is a differential diagnosis that physicians should consider because it can lead to potentially fatal complications if untreated. Due to the nonspecific presentation of mercury poisoning, which includes symptoms such as fever, nausea, vomiting, and abdominal pain, misdiagnosis may occur unless a proper history is taken.

CASE REPORT

In the present case, a white female patient was misdiagnosed repeatedly with a viral illness and sent home from the local hospital. The patient presented with a diffuse full-body rash, fever, myalgias, headache, peripheral neuropathy, oral paresthesias, and tender cervical posterior lymphadenopathy. After obtaining a thorough history, it was discovered that the patient and her family were exposed to mercury through a spill of elemental mercury in their home. Blood mercury levels in the patient were 170 ng/mL. The patient was treated with a course of dimercaprol. Her symptoms improved and she was discharged on hospital day 5. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultimately, mercury poisoning is a treatable condition, but if exposure continues and the patient is not treated, it may lead to complications such as severe pneumonitis, renal tubular necrosis, and neurological dysfunction. In some instances, neurological symptoms may persist even if the source of exposure is removed. For these reasons, recognition and prompt treatment after a suspected exposure is important.

The life-threatening rash of poisoning

Dermatology is frequently viewed by physician and surgical colleagues as a specialty with few emergencies. Although the majority of dermatology practice is in the office setting, cutaneous emergencies do occur through referrals from primary care and as ward consults. Even though cutaneous signs of poisoning would be an uncommon emergency consultation, it is important for dermatologists to be aware of the clinical presentations so as to be able instigate appropriate time critical treatments.

Natural Phytotherapeutic Antioxidants in the Treatment of Mercury Intoxication-A Review

Heavy metals taken into the organism can make the toxic effects on the metabolism in various ways. For example, they may interact with proteins to alter and inhibit their enzymatic and structural functions. Mercury is one of the toxic elements that are widely distributed in nature. Mercury toxicity poses a serious threat to human health. It is an element that causes oxidative stress to increase in individuals, leading to tissue damage. Oxidative stress is the result of the imbalance between the production of oxidative species and cellular antioxidant defense. Phytotherapy continues to play an important role in health care. Natural phytotherapeutic antioxidants, exhibit a broad sequence of biological impacts, including anti-oxidative stress, anti-aging, anti-toxicicity and anticancer. Many studies have also shown that the phytotherapeutic agents play an important role in the removal of mercury from the tissue and in reducing oxidative stress. Our goal in this review was to investigate alternative ways of extracting the mercury in the tissue.

Misuse of Topical Corticosteroids for Cosmetic Purpose in Antananarivo, Madagascar

This cross-sectional study was conducted in Antananarivo, Madagascar, from June to September 2012. We aim to evaluate the misuse of TC on the face for cosmetic purpose and the adverse effects due to its application. A questionnaire-based analysis was done among females who use topical corticosteroids on the face for cosmetic purpose. Of the 770 women questioned, 384 (49,8%) used topical corticosteroids for cosmetic purpose whose mean age was 38 years (range 16-73 years). Two hundred and sixty-one females (68%) used TC combined with handcrafted cosmetics, and 123 (32%) used TC alone. "Pandalao," which contains salicylic acid, peppermint oil, lanolin, powder of Juanes de Vigo (mercury powder), and Vaseline, is the most handcrafted cosmetic combined with TC in our study (used by 29,4% respondents). Only one (0,26%) had obtained the TC by physician's prescription, 234 (61%) from cosmetic retailers, 92 (23%) directly from local pharmacies, 49 (12%) from beauticians, and 15 (4%) from unspecified sources. Lightening of skin color was the main reason for using TC in 44,8% of respondents in the absence of any primary dermatosis. Pigmentation disorders (63,2%) and cutaneous atrophy (52,1%) were the most adverse effects noted.

Cases of acute mercury poisoning by mercury vapor exposure during the demolition of a fluorescent lamp factory

Background

In 2015, workers dismantling a fluorescent lamp factory in Korea were affected by mercury poisoning from exposure to mercury vapor.

Case presentation

Eighteen out of the 21 workers who participated in the demolition project presented with symptoms of poisoning and, of these, 10 had persistent symptoms even at 18 months after the initial exposure to mercury vapor. Early symptoms of 18 workers included a general skin rash, pruritus, myalgia, sleep disturbance, and cough and sputum production. Following alleviation of these initial symptoms, late symptoms, such as easy fatigue, insomnia, bad dreams, and anxiety disorder, began to manifest in 10 out of 18 patients. Seven workers underwent psychiatric care owing to sleep disturbance, anxiety disorder, and depression, and three workers underwent dermatologic treatment for hyperpigmentation, erythematous skin eruption, and chloracne-like skin lesions. Furthermore, three workers developed a coarse jerky movement, two had swan neck deformity of the fingers, and two received care at an anesthesiology clinic for paresthesia, such as burning sensation, cold sensation, and pain. Two workers underwent urologic treatment for dysfunction of the urologic system and impotence. However, symptomatic treatment did not result in satisfactory relief of these symptoms.

Conclusion

Awareness of the perils of mercury and prevention of mercury exposure are critical for preventing health hazards caused by mercury vapor. Chelation therapy should be performed promptly following mercury poisoning to minimize damage.

Mercury contamination in facial skin lightening creams and its health risks to user

This study aims to determine concentrations of mercury in facial skin lightening cream according to different price categories (category I: <RM29.99, category II: RM30.00-RM59.99, category III: RM60.00-RM99.99 and category IV: ≥RM100.00) and their potential health risks to users. Prices of skin lightening creams were determined during a preliminary market survey. Thereafter, twenty samples were purchased from various locations such as cosmetic stalls, beauty shops, pharmacies and street vendors based on their stratified price categories. Samples were extracted using microwave digester and analyzed using cold vapor atomic absorption spectrometry (CV-AAS). Non-carcinogenic chronic health risks for application of facial skin lightening cream were calculated using Dermal Absorption Dose (DAD) and Hazard Quotient (HQ). Concentrations of mercury in samples were less than the United States Food and Drug Administration (USFDA) permitted trace levels (<1 ppm) except for one sample from category III which was manufactured in China. Concentrations of mercury in facial skin lightening creams ranged from not detected to 1.13 mg kg^-1. There was no significant association between concentrations of mercury with price categories (p = 0.12). There was no significant non-carcinogenic health risk due to daily application of the facial skin lightening creams based on assumption of 30 years exposure period (HQ < 1).

Chronic Mercury Intoxication Masquerading as Systemic Disease: A Case Report and Review of the Literature

Background

Mercury is a highly toxic environmental metal that exists in three different forms: elemental, inorganic and organic. Intoxication occurs in either occupational or non-occupational settings, mainly after the inhalation of vapour and fumes in work places, laboratories or homes. Chronic mercury toxicity ranges from mild and insignificant to severe and life-threatening. We describe the case of a young male patient who presented with multiple organ dysfunction after chronic mercury exposure.

Case presentation

We report the case of 28-year-old male artisanal gold miner who was admitted to hospital for severe neurological impairment associated with inflammatory bowel disease-like symptoms and a skin rash after mercury exposure. Symptomatic treatment and corticosteroid administration assured rapid clinical improvement. Chronic mercury poisoning can masquerade as an autoimmune or systemic inflammatory disease.

Conclusion

Physicians should be aware that low exposure to mercury, even from artisanal gold mining, may be harmful to health. Management can be simple without the need for aggressive or invasive therapeutic measures. Larger case series are required in order to establish a clear management plan.

LEARNING POINTS

Mercury intoxication has a wide the variety of clinical manifestations that may involve the neurological, gastrointestinal and dermatological systems.Therefore, it can mimic degenerative neurological conditions, autoimmune diseases, as well as metabolic and mitochondrial disorders.Once diagnosed, mercury intoxication is easily treated.

Immunotoxicity of mercury: Pathological and toxicological effects

Mercury (Hg) is toxic and hazardous metal that causes natural disasters in the earth's crust. Exposure to Hg occurs via various routes; like oral (fish), inhalation, dental amalgams, and skin from cosmetics. In this review, we have discussed the sources of Hg and its potential for causing toxicity in humans. In addition, we also review its bio-chemical cycling in the environment; its systemic, immunotoxic, genotoxic/carcinogenic, and teratogenic health effects; and the dietary influences; as well as the important considerations in risk assessment and management of Hg poisoning have been discussed in detail. Many harmful outcomes have been reported, which will provide more awareness.

A 3 Year-Old Male Child Ingested Approximately 750 Grams of Elemental Mercury

BACKGROUND

The oral ingestion of elemental mercury is unlikely to cause systemic toxicity, as it is poorly absorbed through the gastrointestinal system. However, abnormal gastrointestinal function or anatomy may allow elemental mercury into the bloodstream and the peritoneal space. Systemic effects of massive oral intake of mercury have rarely been reported.

CASE REPORT

In this paper, we are presenting the highest single oral intake of elemental mercury by a child aged 3 years. A Libyan boy aged 3 years ingested approximately 750 grams of elemental mercury and was still asymptomatic.

CONCLUSION

The patient had no existing disease or abnormal gastrointestinal function or anatomy. The physical examination was normal. His serum mercury level was 91 µg/L (normal: <5 µg/L), and he showed no clinical manifestations. Exposure to mercury in children through different circumstances remains a likely occurrence.

A rare case of self-injection of elemental mercury

Background

Self-injection of elemental mercury is a rare finding especially in healthy people who are mentally sound. Early detection and removal of mercury from the body by chelation and physical removal of a stored injected site is required to prevent long term toxicity.

Case presentation

A 15 year old previously healthy girl presented with an acute febrile illness with a generalized maculopapular skin rash for 3 days with a preceding history of self-injection of mercury to both her forearms. This was an imitating experimental act influenced by a movie and she was mentally sound. Very high whole blood mercury levels, x-rays of the forearms and histology confirmed mercury poisoning.

Conclusion

Self-injection of elemental mercury can also occur in mentally sound people and rapid diagnosis and decontamination is required. This also signifies the importance of imposing limitations for visual media which could misguide minors and lead those to imitate and cause serious self-harm.

Combinations of potent topical steroids, mercury and hydroquinone are common in internationally manufactured skin-lightening products: a spectroscopic study

BACKGROUND

The topical steroids betamethasone (BM) and clobetasol propionate (CP) are illegal in cosmetics. Hydroquinone (HQ) and mercury (Hg) are either illegal or allowed only in limited concentrations (2% and 1 ppm, respectively).

AIM

To investigate active ingredients and countries of origin of popular skin-lightening products available in Cape Town, South Africa.

METHODS

In total, 29 products were examined; of these, 22 products were purchased from informal vendors, and 2 products (out of a total of 29) were purchased over the counter. HQ, Hg(2+) and steroids were quantified by high-performance liquid chromatography-ultraviolet spectrophotometry, inductively coupled plasma-mass spectrometry and liquid chromatography-mass spectrometry, respectively.

RESULTS

Of the 29 products, 22 (75.9%), all imported and bought from informal vendors, contained illegal or banned ingredients: 13 (44.8%) contained steroids (9 CP, 4 BM), 12 (41.4%) contained Hg (30-2300 ppm), and 11 (37.9%) contained HQ. Sequentially, the products originated from Italy (27.3%, n = 6), India (22.7%, n = 5), the Democratic Republic of Congo (DRC) (22.7%, n = 5), Cote d'Ivoire (9.1%, n = 2), USA (9.1%, n = 2), UK (4.5%, n = 1) and France (4.5%, n = 1). Two products, one from India and one from the DRC, contained all four ingredients (HQ, Hg, BM, CP). Of the 12 products containing Hg, 10 also contained HQ and/or a steroid, yet none listed Hg as an ingredient. A significant proportion of the steroid-containing products (76.9%) also contained at least one other skin-lightening agent. Not all internationally available products were tested, which is a limitation of the study.

CONCLUSION

In spite of a European Union ban on skin lighteners, a third of the products tested were from Europe. Combinations of Hg and ultrapotent steroids were prominent. International law enforcement and random testing is needed to encourage industry compliance and help protect consumers.

Electroanalytical method for the determination of 5-fluorouracil using a reduced graphene oxide/chitosan modified sensor

A glassy carbon electrode (GCE) modified with a chemically reduced graphene oxide and chitosan (CRGO/CS) composite film was constructed and used to determine 5-fluorouracil using cyclic, staircase and square wave voltammetric techniques.

A sensitive assay of mercury using fluorescence correlation spectroscopy of gold nanoparticles

We described a new and sensitive method for the determination of mercury ions (Hg(2+) ) on the basis of fluorescence correlation spectroscopy (FCS) and recognition of oligonucleotides. In this assay, 30-nm gold nanoparticles (GNPs) were modified with oligonucleotides containing thymine bases (T) as fluorescent probes, and the principle of this assay was based on the specific binding of Hg(2+) by two DNA thymine bases. When two GNPs labelled with different oligonucleotides were mixed with a sample containing Hg(2+), the T-Hg(2+)-T binding reaction should cause GNPs to form dimers (or oligomers), which would lead to a significant increase in the characteristic diffusion time of GNPs in the detection volume. The FCS method is a single molecule detection method and can sensitively detect the change in the characteristic diffusion time of GNPs before and after binding reactions. The quantitative analysis was performed according to the relation between the change in the characteristic diffusion time of GNPs and the concentration of Hg(2+). Under optimal conditions, the linear range of this method was from 0.3 nM to 100 nM, and the detection limit was 0.14 nM for Hg(2+). This new method was successfully applied for direct determination of Hg(2+) levels in water and cosmetics samples.

Acute mercury poisoning presenting as fever of unknown origin in an adult woman: a case report

Introduction

Mercury intoxication may present in a wide range of clinical forms from a simple disease to fatal poisoning. This article presents a case of acute mercury poisoning, a rare condition that presents challenges for diagnosis with fever of unknown origin.

Case presentation

A 52-year-old Caucasian woman was admitted to the hospital with high fever, sore throat, a rash over her entire body, itching, nausea, and extensive muscle pain. She had cervical, bilateral axillary and mediastinal lymphadenopathies. We learned that her son and husband had similar symptoms. After excluding infectious pathologies, autoimmune diseases and malignancy were investigated. Multiple organs of our patient were involved and her fever persisted at the fourth week of admission. A repeat medical history elicited that her son had brought mercury home from school and put it on the hot stove, and the family had been exposed to the fumes for a long period of time. Our patient’s serum and urine mercury levels were high. She was diagnosed with mercury poisoning and treated accordingly.

Conclusions

Mercury vapor is a colourless and odorless substance. Therefore, patients with various unexplained symptoms and clinical conditions should be questioned about possible exposure to mercury.

Current approaches of the management of mercury poisoning: need of the hour

Mercury poisoning cases have been reported in many parts of the world, resulting in many deaths every year. Mercury compounds are classified in different chemical types such as elemental, inorganic and organic forms. Long term exposure to mercury compounds from different sources e.g. water, food, soil and air lead to toxic effects on cardiovascular, pulmonary, urinary, gastrointestinal, neurological systems and skin. Mercury level can be measured in plasma, urine, feces and hair samples. Urinary concentration is a good indicator of poisoning of elemental and inorganic mercury, but organic mercury (e.g. methyl mercury) can be detected easily in feces. Gold nanoparticles (AuNPs) are a rapid, cheap and sensitive method for detection of thymine bound mercuric ions. Silver nanoparticles are used as a sensitive detector of low concentration Hg²⁺ ions in homogeneous aqueous solutions. Besides supportive therapy, British anti lewisite, dimercaprol (BAL), 2,3-dimercaptosuccinic acid (DMSA. succimer) and dimercaptopropanesulfoxid acid (DMPS) are currently used as chelating agents in mercury poisoning. Natural biologic scavengers such as algae, azolla and other aquatic plants possess the ability to uptake mercury traces from the environment.

Subcutaneous mercury injection by a child: a histopathology case report

Intentional subcutaneous injection of mercury by mentally healthy children is rare. Usually, it is seen as a part of suicidal attempt in severely depressed patients or by athletes to enhance their performance. We report a case of a 15-year-old child, inspired by a movie, who deliberately self-injected mercury subcutaneously into his forearm that led to the formation of a non-healing ulcer. Histopathology of the biopsy confirmed the diagnosis. A surgical procedure was thereby performed to treat the ulcer and reduce the blood and urinary levels of mercury. However, the patient did not develop clinical signs of chronic poisoning, proving that subcutaneous mercury injection has a low risk of systemic toxicity, and that histopathology plays an important role in diagnosis.

Cutaneous mercury granuloma

Cutaneous mercury granuloma is rarely encountered. Clinically it may pose difficulty in diagnosis. Here, we report a 23-year-old male presented with erythematous, nodular lesions over the forearm and anterior aspect of chest wall. Metallic mercury in tissue sections appear as dark black, opaque, spherical globules of varying size and number. They are surrounded by granulomatous foreign-body reaction. It is composed of foreign body giant cells and mixed inflammatory infiltrate composed of histiocytes, lymphocytes, plasma cells, and few eosinophils.

Metallic mercury vapour poisoning revisited

Mercury poisoning was once common in the 19th century. With its declining use, now clinicians and the public in general are often unaware and unsuspecting of mercury toxicity. A 40-year-old woman and her two children were hospitalized with a 1-week history of a generalized lichenoid eruption. Clinical improvement occurred without a diagnosis; however, on returning home, features of acrodynia with digital gangrene developed in the woman, leading to suspicion of heavy metal poisoning. There was no recurrence after moving from their contaminated house.

Population-based inorganic mercury biomonitoring and the identification of skin care products as a source of exposure in New York City

BACKGROUND

Mercury is a toxic metal that has been used for centuries as a constituent of medicines and other items.

OBJECTIVE

We assessed exposure to inorganic mercury in the adult population of New York City (NYC).

METHODS

We measured mercury concentrations in spot urine specimens from a representative sample of 1,840 adult New Yorkers in the 2004 NYC Health and Nutrition Examination Survey. Cases with urine concentrations ≥ 20 µg/L were followed up with a telephone or in-person interview that asked about potential sources of exposure, including ritualistic/cultural practices, skin care products, mercury spills, herbal medicine products, and fish.

RESULTS

Geometric mean urine mercury concentration in NYC was higher for Caribbean-born blacks [1.39 µg/L; 95% confidence interval (CI), 1.14-1.70] and Dominicans (1.04 µg/L; 95% CI, 0.82-1.33) than for non-Hispanic whites (0.67 µg/L; 95% CI, 0.60-0.75) or other racial/ethnic groups. It was also higher among those who reported at least 20 fish meals in the past 30 days (1.02 µg/L; 95% CI, 0.83-1.25) than among those who reported no fish meals (0.50 µg/L; 95% CI, 0.41-0.61). We observed the highest 95th percentile of exposure (21.18 µg/L; 95% CI, 7.25-51.29) among Dominican women. Mercury-containing skin-lightening creams were a source of exposure among those most highly exposed, and we subsequently identified 12 imported products containing illegal levels of mercury in NYC stores.

CONCLUSION

Population-based biomonitoring identified a previously unrecognized source of exposure to inorganic mercury among NYC residents. In response, the NYC Health Department embargoed products and notified store owners and the public that skin-lightening creams and other skin care products that contain mercury are dangerous and illegal. Although exposure to inorganic mercury is not a widespread problem in NYC, users of these products may be at risk of health effects from exposure.

Recovery of silver residues from dental amalgam

Dental amalgam residues are probably the most important chemical residues generated from clinical dental practice because of the presence of heavy metals among its constituents, mainly mercury and silver.

OBJECTIVE

The purpose of this study was to develop an alternative method for the recovery of silver residues from dental amalgam.

MATERIAL AND METHODS

The residue generated after vacuum distillation of dental amalgam for the separation of mercury was initially diluted with 32.5% HNO3, followed by precipitation with 20% NaCl. Sequentially, under constant heating and agitation with NaOH and sucrose, the sample was reduced to metallic silver. However, the processing time was too long, which turned this procedure not viable. In another sequence of experiments, the dilution was accomplished with concentrated HNO3 at 90 degrees C, followed by precipitation with 20% NaCl. After washing, the pellet was diluted with concentrated NH4OH, water and more NaCl in order to facilitate the reaction with the reducer.

RESULTS

Ascorbic acid was efficiently used as reducer, allowing a fast reduction, thus making the procedure viable.

CONCLUSIONS

The proposed methodology is of easy application and does not require sophisticated equipment or expensive reagents.

Heavy metal poisoning: management of intoxication and antidotes

Of the known elements, nearly 80% are either metals or metalloids. The highly reactive nature of most metals result in their forming complexes with other compounds such oxygen, sulfide and chloride. Although this reactivity is the primary means by which they are toxic, many metals, in trace amounts, are vital to normal physiological processes; examples include iron in oxygen transport, manganese and selenium in antioxidant defense and zinc in metabolism. With these essential metals toxicity occurs when concentrations are either too low or too high. For some metals there are no physiological concentrations that are beneficial; as such these metals only have the potential to cause toxicity. This chapter focuses on four of these: arsenic, mercury, lead and thallium.

A case of argyria following colloidal silver ingestion

Argyria is a rare cutaneous discoloration caused by the intake of silver or various compounds containing silver. We report a case of argyria in a 73-year-old male following ingestion of colloidal silver as an alternative medicine over 5 years. He had a diffuse, slate gray discoloration of his face and hands. A biopsy specimen from the face revealed brown-black extracellular granules in the upper dermis and between collagen bundles. We also found silver particles in the mucous of the colon. The ingestion of colloidal silver appears to be increasing among patients using alternative health practices. We report this case to bring people's attention to the problems associated with the ingestion of colloidal silver.

[Contact dermatitis to elemental mercury with distant lesion]

A clinical case of contact dermatitis following direct skin contact with elemental mercury is presented. Patient had metal mercury in contact with extensive part of his leg and foot skin resulting in erythematous, edematous, and vesicular dermatitis. Lesions evolved to erythematous plaques with small scattered areas of necrosis and drying vesicle lesions. Distant lesions appeared in the right forearm, chest and abdomen. Urinary mercury 36h after contact was 5.9 microg/L, and one week later 19.6 microg/L, indicating dermal absorption. dermal absorption. Dermal effects due to elemental mercury must be expected after direct skin contact.