Chromium In Patients Research Articles

Elevated cobalt levels in metal-on-polyethylene knee megaprostheses: a prospective 1-year cohort study of 56 patients with hip and knee megaprostheses.

Concerns have emerged regarding elevated levels of cobalt and chromium in patients with metal-on-metal megaprostheses. This prospective study aims to identify systemic cobalt and chromium levels in metal-on-polyethylene knee and hip megaprostheses and their associations with other factors. 56 patients underwent knee or hip megaprosthesis surgery at 2 sarcoma centers. Serum cobalt and chromium levels were measured preoperatively and thrice within the first year using inductively coupled plasma mass spectrometry. A statistically significant difference in serum cobalt levels (1.4 ppb; 95% confidence interval [CI] 0.0-3.3) was observed 1 year after knee megaprosthesis surgery compared with preoperative levels. In contrast no difference in chromium levels was observed after 1 year compared with preoperative levels (0.05 ppb; CI 0.0-0.8). An association between younger age, higher eGFR, and increased cobalt levels was observed. No significant correlations were found between ion levels and resection length or the number of modular connections. We found elevated serum ion levels in metal-on-polyethylene knee megaprostheses in contrast to metal-on-polyethylene hip megaprostheses. Furthermore, a positive correlation between cobalt and chromium levels, and between cobalt and eGFR was identified, along with a negative correlation between cobalt and age. This study highlights the importance of monitoring systemic cobalt and chromium levels in patients with megaprostheses.

Patch Testing With Nickel, Cobalt, and Chromium in Patients With Suspected Allergic Contact Dermatitis.

Background: Allergic contact dermatitis is frequently caused by metals, including multiple metals simultaneously. Objectives: To assess characteristics and associations of positive and clinically relevant patch test (PT) reactions with solitary and concurrent metal sensitization. Methods: A retrospective analysis of PT results for nickel, cobalt, and/or chromium from the North American Contact Dermatitis Group between 2001 and 2018 (n = 43,522). Results: 18.0% had a positive/allergic reaction to nickel sulfate hexahydrate, 7.3% to cobalt chloride hexahydrate, and 3.0% to potassium dichromate. 87.9% patients had a currently relevant reaction to 0, 9.4% to 1, and 2.7% to multiple metals tested. Patients with 1 versus no currently relevant reactions to metal were more likely to have a primary dermatitis site of trunk, feet, and ears; patients with currently relevant reactions to multiple metals had more dermatitis affecting the trunk and ears. Metal sources varied by co-reacting metal, especially for patients with cobalt and chromium allergy. Jewelry was the most commonly identified source of nickel and cobalt for both solitary and concurrent metal allergy. Conclusions: Sensitization to multiple metals occurred in 6% of patients. Allergen sources varied between patients with sensitivity to 1 metal versus those who had concurrent sensitivity to cobalt and/or chromium.

Assessment Of Some Amino Acids, Metal And Biomarkers In Diabetic Patients With Type2 DM In Thi-Qar Governorate, South Of Iraq

The study was designed to investigate the levels of l-arginine, l-carnitine, zinc, magnesium and chromium in patients with type2 diabetes. 100 samples of peoples with type 2 diabetes aged )17-65( years were used, divided into (50 males and 50 females), and the data was compared with 100 healthy subjects (50 males and 50 females) as a control group. Also, biochemical parameters of fasting blood glucose, serum insulin, serum c-peptide and cumulative hemoglobin HbA1c% were measured for both patients and control groups. The results indicate that diabetic patients have lowered levels of l-arginine and l-carnitine (88.03± 4.45b, 38.79± 4.18b) sequentially, and zinc, magnesium and chromium (0.54± 0.08b, 1.58± 0.10b, 0.12± 0.02b) sequentially in blood compared with the healthy subjects of control group where the levels of l-arginine, l-carnitine, zinc, magnesium and chromium (107.59± 9.75a, 56.48± 4.08a, 0.90± 0.12a, 1.99± 0.20a, 0.22 ± 0.04a) sequentially, Also there was elevated of levels of fasting blood glucose, serum insulin, serum c-peptide and HbA1c% in diabetic patients (206.85± 33.34a, 27.48± 5.78a, 4.45± 0.81a, 9.09± 1.52a) sequentially compared with the control groups (87.04 ± 9.37b, 16.48 ± 3.64b, 2.66 ± 0.73b, 3.83 ± 0.96b) sequentially.

Blood and plasma titanium levels associated with well-functioning hip implants

BackgroundHip implants are usually manufactured from cobalt-chromium and titanium alloys. As the implants wear and corrode, metal debris is released into the surrounding tissue and blood, providing a potential biomarker for their function. Whilst there are laboratory reference levels for blood cobalt and chromium in patients with well and poorly functioning hip implants, there are no such guidelines for titanium. This is despite the increasing use of titanium implants worldwide. Patients and methodsWe recruited a consecutive series of 95 patients (mean age 71 years, mean time after surgery 8.5 years) with one hip implant type, inserted by the same surgeon. We assessed clinical and radiological outcome, and measured blood and plasma titanium using high resolution inductively-coupled plasma mass spectrometry. ResultsThe upper normal reference limit for blood and plasma titanium was 2.20 and 2.56 μg L−1, respectively, and did not differ significantly between males and females. ConclusionWe are the first to propose a laboratory reference level for blood and plasma titanium in patients with well-functioning titanium hip implants. This is an essential starting point for further studies to explore the clinical usefulness of blood titanium as a biomarker of orthopaedic implant performance, and comes at a time of considerable controversy regarding the use of certain titanium alloys in hip arthroplasty.

Use of Metformin versus Chromium Picolinate in the Management of Polycystic Ovarian Syndrome: A Randomized Controlled Clinical Trial

Objective: To compare the effects of metformin and chromium pico- linate on females with polycystic ovarian syndrome. Background: Polycystic ovarian syndrome is the most common en- docrinopathy of reproductive-aged women. It presented with exces- sive hair growth(hyperandrogenism), menstrual irregularities (an- ovulation), and polycystic ovaries.They are commonly accompanied by obesity, insulin resistance, and infertility. Methods: Sixty female patients with polycystic ovarian syndrome were enrolled for our study at Suez Canal University Hospitals, from January 2016 to December 2016. They were randomly assigned into 2 groups. FSH, LH, testosterone, TSH, prolactin, fasting blood sug- ar, fasting insulin, QUICKI, HOMA-IR were measured for all pa- tients. The first group received metformin 500 mg twice daily while the other group received chromium picolinate 200 μg once daily for 3 months. Results: Fifty-four patients completed the study, we compared the effect of metformin and chromium in patients with PCOs, it showed significant difference regarding free testosterone, serum prolactin (p=0.01), FSH level, FBS, Fasting insulin and QUIKI between the two groups (p=0.001). In Group I, there was significant difference regarding the values of BMI, free testosterone, TSH, fasting blood sugar, fasting insulin, HOMA-IR, QUICKI, ovarian volume(p <0.001)prolactin (p=0.01), and hirsutism score (0.02) before and after treatment with metformin. In Group II, there were significant differences regarding the values of testosterone (p=0.01), BMI LH, FSH, TSH, fasting blood sugar, fasting insulin, HOMA-IR, QUICKI, ovarian volume and hirsutism score before and after treatment with chromium picolinate(p =0.001). After treatment, twenty-two (81.48%) patients had normal men- struation in Group I compared to 24 (88.89%) patients in Group II (p=0.35) meanwhile, 11(40.7%) patients had normal ovulation in Group I compared to 12 (44.4%) patients in Group II (p=0.78). Pregnancy occurred in 6 (22.2%) patients in group I and 5 (18.5%) patients in Group II with no significant difference (p=0.73). After 3 months of treatment, there were no significant differences between the groups regarding the side effects except abdominal discomfort which was more significant with metformin (p= 0.018). Conclusion: Chromium picolinate was better tol- erated than metformin due to lower side effects; nevertheless, no significant differences were ob- served between the two groups regarding ovula- tion and pregnancy rates. Therefore, metformin could be replaced by chromium in some PCOS patients.

Effect of Fixed Orthodontic Treatment on Salivary Nickel and Chromium Levels: A Systematic Review and Meta-Analysis of Observational Studies.

Nickel and chromium ions released from fixed orthodontic appliances may act as allergens. This study aimed to systematically review the effect of fixed orthodontic treatment on salivary levels of these ions by doing a meta-analysis on cross-sectional and cohort studies. The Web of Science, Scopus, Cochrane Library, and PubMed databases were searched for articles on salivary profile of nickel or chromium in patients under fixed orthodontic treatment published from January 1983 to October 2017. A random-effect meta-analysis was done using Review Manager 5.3 to calculate mean difference (MD) and 95% confidence interval (CI), and the quality of questionnaire was evaluated by the Newcastle–Ottawa scale. Fourteen studies were included and analyzed in this meta-analysis. Salivary nickel level was higher in periods of 10 min or less (MD = −11.5 µg/L, 95% CI = −16.92 to −6.07; P < 0.0001) and one day (MD = −1.38 µg/L, 95% CI = −1.97 to −0.80; P < 0.00001) after initiation of treatment compared to baseline (before the insertion of appliance). Salivary chromium level was higher in periods of one day (MD = −6.25 µg/L, 95% CI = −12.00 to −0.49; P = 0.03) and one week (MD = −2.07 µg/L, 95% CI = −3.88 to −0.26; P = 0.03) after the initiation of treatment compared to baseline. Corrosion of fixed orthodontic appliances leads to elevated salivary nickel and chromium concentrations early after initiation of orthodontic treatment. Randomized clinical trials controlling for factors affecting the saliva composition are recommended on a higher number of patients and among different ethnicities.

Assessment of hair nickel and chromium levels in patients with a fixed orthodontic appliance: a systematic review and meta-analysis of case-control studies.

IntroductionThe metals nickel (Ni) and chromium (Cr) can cause immunological sensitivity and adverse biological and cytotoxic effects.AimTo evaluate hair levels of these metals in patients undergoing fixed orthodontic treatment compared with controls.Material and methodsFive databases – PubMed, Web of Science, Scopus, Cochrane Library, and ScienceDirect – were searched up to January 2018 for evaluation of the hair levels of nickel and/or chromium in patients undergoing fixed orthodontic treatment. To assess the study quality, the Newcastle-Ottawa Scale was used (NOS), and to compare hair Ni and Cr levels in the cases compared with the controls, a random-effects meta-analysis was performed by Review Manager 5.3 using standard mean differences (SMDs) and 95% confidence intervals (CIs).ResultsOut of 38 studies in the databases searched, 6 studies were included in the meta-analysis. The pooled SMD of hair Ni levels between the cases and controls was 0.95 μg/g (95% CI: –0.09, 1.99; p = 0.07), which showed that the Ni level was similar in the cases compared with the controls, and that for hair Cr levels was 0.88 μg/g (95% CI: –0.45, 2.21; p = 0.20), so the Cr level was similar in the cases compared with the controls.ConclusionsThe slightly elevated hair levels of Ni and Cr in patients undergoing fixed orthodontic treatment suggest that changing the components of fixed orthodontic appliances can be considered as an acceptable solution in the future.

Mild or moderate renal insufficiency does not increase circulating levels of cobalt and chromium in patients with metal-on-metal hip arthroplasty.

To determine whether there is any association between glomerular filtration rate (GFR) and blood cobalt (Co) and chromium (Cr) levels in patients with metal-on-metal (MoM) hip arthroplasty. We identified 179 patients with a unilateral 36 mm diameter head as part of a stemmed Summit-Pinnacle MoM hip arthroplasty. GFR was calculated using the Modification of Diet in Renal Disease formula. Normal renal function (GFR ≥ 90 ml/min/1.73 m2) was seen in 74 patients. Mild renal insufficiency (GFR 60 to 89 ml/min/1.73 m2) was seen in 90 patients and moderate renal insufficiency (GFR 30 to 59 ml/min/1.73 m2) in 15. There was no statistical difference in Co and Cr levels between patients with normal renal function and those with mild or moderate renal insufficiency. No correlation was seen between creatinine and blood metal ion levels or between GFR and blood metal ion levels. Linear regression analysis did not show any association between Co and Cr levels and GFR. We did not find any association between GFR and blood metal ion levels. Consequently, the accumulation of Co and Cr in blood due to renal insufficiency does not seem to be a major risk in patients with mild or moderate renal insufficiency. Cite this article Bone Joint J 2017;99-B:1147-52.

Metal release from hip prostheses: biological monitoring of cobalt and chromium in patients with metal-on-metal hip arthroplasty

Metal release from hip prostheses: biological monitoring of cobalt and chromium in patients with metal-on-metal hip arthroplasty

Serum status of selenium and chromium in patients with cardiovascular diseases and controls in Iraq.

Serum status of selenium and chromium in patients with cardiovascular diseases and controls in Iraq.

Metal Ion Levels in Patients With Stainless Steel Spinal Instrumentation

Case-control study. To determine whether metal ion concentrations are elevated in patients with spinal instrumentation. Studies have shown that serum and urinary levels of component metal ions are abnormally elevated in patients with total joint arthroplasties. Little is known of metal ion release and concentrations in patients with spinal instrumentation. The study group consisted of patients who had undergone spinal instrumentation for various spinal disorders with a variety of stainless steel implants, 5 to 25 years previously. A group of volunteers without metal implants were controls. All subjects were tested for serum nickel, blood chromium, and random urine chromium/creatinine ratio estimation. The study group consisted of 32 patients with retained implants and 12 patients whose implants had been removed. There were 26 unmatched controls. There was no difference in serum nickel and blood chromium levels between all 3 groups. The mean urinary chromium/creatinine ratio for patients with implants and those with implants removed was significantly greater than controls (P < 0.001). The difference between study subgroups was not significant (P = 0.16). Of several patient and instrumentation variables, only the number of couplings approached significance for correlation with the urine chromium excretion (P = 0.07). Spinal implants do not raise the levels of serum nickel and blood chromium. There is evidence that metal ions are released from spinal implants and excreted in urine. The excretion of chromium in patients with spinal implants was significantly greater than normal controls although lower where the implants have been removed. The findings are consistent with low-grade release of ions from implants with rapid clearance, thus maintaining normal serum levels. Levels of metal ions in the body fluids probably do not reach a level that causes late side-effect; hence, routine removal of the implants cannot be recommended.

RELATIONSHIP BETWEEN LATE PREGNANCY AND SERUM CHROMIUM CONCENTRATION IN PATIENTS WITH DIABETES MELLITUS

Chromium is essential element in human nutrition. Serum concentration of chromium are not well characterized during pregnancy or in gestational diabetes mellitus. Fifty females were involved in this study, all of them were in the third trimester, twenty without diabetes mellitus and thirty with diabetes mellitus. The aims of our study were to detect the alteration in the serum chromium levels in late pregnancy in women suffering from diabetes mellitus type 1 and those with gestational diabetes mellitus, and the association of altered serum chromium concentration with lipid concentration. The results of this study show that low serum concentrations of chromium are associated with hyperglycemia and hypetriglycerdemia. There were no significant differences in serum chromium in patients with type 1 D.M. and those with gestational D.M.

Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty

Metal-on-metal bearings are being increasingly used in young patients. The potential adverse effects of systemic metal ion elevation are the subject of ongoing investigation. The purpose of this study was to investigate whether cobalt and chromium ions cross the placenta of pregnant women with a metal-on-metal hip resurfacing and reach the developing fetus. Whole blood levels were estimated using high-resolution inductively-coupled plasma mass spectrometry. Our findings showed that cobalt and chromium are able to cross the placenta in the study patients with metal-on-metal hip resurfacings and in control subjects without any metal implants. In the study group the mean concentrations of cobalt and chromium in the maternal blood were 1.39 microg/l (0.55 to 2.55) and 1.28 microg/l (0.52 to 2.39), respectively. The mean umbilical cord blood concentrations of cobalt and chromium were comparatively lower, at 0.839 microg/l (0.42 to 1.75) and 0.378 microg/l (0.14 to 1.03), respectively, and this difference was significant with respect to chromium (p < 0.05). In the control group, the mean concentrations of cobalt and chromium in the maternal blood were 0.341 microg/l (0.18 to 0.54) and 0.199 microg/l (0.12 to 0.33), and in the umbilical cord blood they were 0.336 microg/l (0.17 to 0.5) and 0.194 microg/l (0.11 to 0.56), respectively. The differences between the maternal and umbilical cord blood levels in the controls were marginal, and not statistically significant (p > 0.05). The mean cord blood level of cobalt in the study patients was significantly greater than that in the control group (p < 0.01). Although the mean umbilical cord blood chromium level was nearly twice as high in the study patients (0.378 microg/l) as in the controls (0.1934 microg/l), this difference was not statistically significant. (p > 0.05) The transplacental transfer rate was in excess of 95% in the controls for both metals, but only 29% for chromium and 60% for cobalt in study patients, suggesting that the placenta exerts a modulatory effect on the rate of metal ion transfer.

Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty

This is a longitudinal study of the daily urinary output and the concentrations in whole blood of cobalt and chromium in patients with metal-on-metal resurfacings over a period of four years. Twelve-hour urine collections and whole blood specimens were collected before and periodically after a Birmingham hip resurfacing in 26 patients. All ion analyses were carried out using a high-resolution inductively-coupled plasma mass spectrometer. Clinical and radiological assessment, hip function scoring and activity level assessment revealed excellent hip function. There was a significant early increase in urinary metal output, reaching a peak at six months for cobalt and one year for chromium post-operatively. There was thereafter a steady decrease in the median urinary output of cobalt over the following three years, although the differences are not statistically significant. The mean whole blood levels of cobalt and chromium also showed a significant increase between the pre-operative and one-year post-operative periods. The blood levels then decreased to a lower level at four years, compared with the one-year levels. This late reduction was statistically significant for chromium but not for cobalt. The effects of systemic metal ion exposure in patients with metal-on-metal resurfacing arthroplasties continue to be a matter of concern. The levels in this study provide a baseline against which the in vivo wear performance of newer bearings can be compared.

Serum levels of cobalt and chromium in patients with Sikomet metal–metal total hip replacements

Metal/metal total hip replacements (M/M THRs) made of CoCr-based alloys were reintroduced in hip arthroplasty in order to avoid the problem of polyethylene wear and consequently to diminish the wear debris-related osteolysis. Emerging concerns accompanying the reintroduction of M/M THRs are related to the possibility increase of Co and Cr serum levels and, therefore, a careful surveillance of M/M patients is recommended. In the present work three groups of patients with Sikomet SM21 low-carbon alloy were investigated: retrospective group, prospective group and revision group. The investigation of these different groups of patients provided data concerning the metal concentration as a function of time in situ, as well as time ex situ, i.e., following the removal of M/M bearing. A retrospective group of 25 patients sampled at average 60 ± 20 months postoperatively showed a 3-fold increase in cobalt and a 4.4-fold increase in chromium compared with the control group. In the prospective group of seven patients both cobalt and chromium increase with time and at average 140 ± 80 days achieved a significant increase compared with preoperative values. An important contribution of this study to the current knowledge on M/M bearings is achieved by the measurements in the revision group of 10 patients, where we observed a decline of serum Co and Cr levels following the removal of M/M articulation. While the link between the increase in metal serum levels and the presence of M/M THR is proved, the biological impact of these results remains to be elucidated.

Salivary nickel and chromium in patients with fixed orthodontic appliances.

The purpose of this study was to determine the alterations in the chromium and nickel concentrations in the saliva of orthodontic patients treated with fixed orthodontic appliances. Forty-five orthodontic patients were included in this study. The first group consisted of 15 patients (7 female, 8 male) with fixed appliances placed in their upper and lower arches. The second group consisted of 15 patients (8 female, 7 male) with a fixed appliance placed only in the upper arch. The control group consisted of 15 patients (7 female, 8 male) who were not undergoing orthodontic treatment. Four samples of stimulated saliva were collected from each patient before insertion of the fixed appliance, 1 week after insertion of the appliance, 1 month after insertion of the appliance, and 2 months after insertion of the appliance. The same 4 samples of saliva were collected from each control patient at the same time intervals as for the fixed-appliance groups. The chemical analyses were done with an electrothermal atomic absorption spectrophotometer (Perkin Elmer 2380, Perkin Elmer Corp, Baden Seewerk, Germany). The Wilcoxon matched-pairs signed ranks test was used to test differences between samples before and after insertion of orthodontic appliances. A Kruskal Wallis 1-way analysis of variance was used to test differences in nickel and chromium concentration among the 3 test groups. It was observed that there was a large variation in the concentrations of both nickel and chromium in saliva. No significant differences were found between the no-appliance group and the samples obtained after insertion of the appliances. The results of the study suggest that fixed orthodontic appliances do not significantly affect nickel and chromium concentrations of saliva during the first 2 months of treatment.

Concentrations of chromium, cesium, and tin in cerebrospinal fluid of patients with brain neoplasms, leukemia or other noncerebral malignancies, and neurological diseases.

We measured the concentrations of chromium, cesium, and tin in the cerebrospinal fluid (CSF) of 29 patients with brain tumors [21 benign (BBT) and eight malignant (MBT)], 28 leukemic patients, 14 patients with lymphoma or noncerebral solid tumors (NLCT), and 32 control patients (15 with neurological disorders and 17 with noneurological conditions) by use of flameless atomic absorption spectrophotometry. We detected chromium in 94% of the patients, tin in 79%, and cesium in 50%. The mean (and SEM) concentrations (micrograms/L) of these metals in the control group were 4.7 (1.1) for chromium, 3.8 (1.6) for cesium, and 6.4 (1) for tin. We observed significant differences (P less than 0.05) in the concentration of chromium in CSF between the MBT group and all other tumor groups; the ratios for the mean CSF concentration of chromium in patients with BBT, leukemia, or NLCT to that in patients with MBT were 2.6, 2.1, or 4.4, respectively. We saw no significant differences in the concentrations of cesium or tin among the various groups investigated.

Chromium deficiency after long-term total parenteral nutrition

A 63-year-old female developed unexplained hyperglycemia and glycosuria during administration of a total parenteral nutrition regimen on which she had been stable for several months. Because the patient had no history of diabetes or evidence of an infection, chromium deficiency was considered. Plasma chromium level was 0.1 microgram/dl (laboratory reference interval: 1.8-3.8 micrograms/dl). Fourteen days of supplemental intravenous chromium chloride (200 micrograms/day) allowed complete withdrawal of exogenous insulin with no further hyperglycemia or glycosuria. Correction of unexplained glucose intolerance following vigorous chromium supplementation indicates that the patient had chromium deficiency. Subsequent plasma chromium levels remained unchanged, possibly reflecting the sensitivity limits of the assay that was used, the uncertainty that exists regarding appropriate reference intervals for this element, and the fact that plasma levels do not always correlate with total body stores. The patient did not manifest peripheral neuropathy, which was present in one of the two previously reported cases, nor encephalopathy, which was reported in the other. We conclude that this patient developed chromium deficiency as a result of inadequate administration of chromium in the parenteral formula (6 micrograms/day) plus excessive enteric losses, and she presented with glucose intolerance as the only clinical manifestation of the deficiency. Caution should be exercised when interpreting plasma chromium in patients with suspected deficiency.

Low plasma Chromium in patients with coronary artery and heart diseases

Plasma chromium concentrations have been determined for 150 patients. These were subjected to coronary artery cineangiography and thereby divided into three groups: group CAD (those with coronary artery disease), group HD (those with heart disease, but no CAD) and group N (those with no CAD and no HD). Weighted, average chromium levels for these groups were 1.05, 1.72, and 8.51 ng/mL, respectively. The distributions of plasma chromium levels for the three groups suggest that an upper limit for plasma chromium may be established (6 ng/mL in this work) beyond which CAD may be considered to be extremely unlikely, thus eliminating the need for a certain number of cineangiographic examinations.

Serum chromium in patients with recent and old myocardial infarction

The serum chromium in 45 subjects with no clinical evidence of ischemic heart disease was found to be 1.71 parts per billion (ppb) (S.E. ± 0.14). In 34 patients with a previously documented myocardial infarction, it was 1.84 ppb (S.E. ± 0.18). The difference was not significant nor was there any difference with age or sex. In 37 patients with acute myocardial infarction the serum chromium level rose to a mean of 6.36 ppb (S.E. ± 0.51; p < 0.001) during the first five days following the infarct, returning to normal over the next five days. There was no correlation between the serum chromium and blood glucose levels in these patients or in a further 14 patients who were receiving glucose infusions (chest pain without electrocardiographic or enzyme changes) or who were diabetics.