Serum Manganese Levels Research Articles

Insufficient Muscle Development Level Associated with Serum Zinc, Manganese and Cobalt Levels in Children Aged 6 to 9 Years in Shenzhen, China.

Some trace elements have been found to be associated with muscle mass and muscle function; however, evidence in children is limited, and it remains unclear which trace elements are more relevant. We aimed to explore the association of levels of individual and combined essential trace elements and muscle development level (MDL) in young children. Muscle mass was measured by body composition analysis, and trace elements were determined by using inductively coupled plasma mass spectrometry (ICP-MS). Logistic regression, restricted cubic spline (RCS) and weighted quantile sum regression (WQS) were used to assess the individual and joint associations between trace element levels and MDL. We enrolled 2851 children: 1595 boys (55.9%) and mean age 7.1years (range 6.8-7.3). The proportion of insufficient muscle mass in the whole body, limbs, upper and lower limbs was 1.9%, 6.5%, 44.9% and 4.6%, respectively. The odds of insufficient MDL decreased with the fourth versus first quartile of zinc (OR = 0.67, 95% CI: 0.51-0.89), manganese (OR = 0.80, 95% CI: 0.65-1.00), and cobalt (OR = 0.89, 95% CI: 0.81-0.99) and was increased with the fourth quartile of nickel (OR = 2.23, 95% CI: 1.72-2.89) and selenium (OR = 1.51, 95% CI: 1.14-1.98). The RCS yielded similar results, except for the discrepancy in high cobalt levels. The odds of insufficient MDL decreased with the combination of nine trace elements (OR = 0.84, 95% CI: 0.73-0.97), primarily zinc (weight = 0.297), manganese (weight = 0.198) and cobalt (weight = 0.173). Insufficient MDL in young children was mainly in upper limbs. Low levels of zinc, manganese, and cobalt, individually or combined, were significantly associated with risk of insufficient MDL. Further foods rich in zinc, manganese, and cobalt should be suggested to supplement in diet, and increase exercise of upper limbs to improve insufficient MDL in the young children should be needed.

Advanced chelate technology-based trace minerals reduce inflammation and oxidative stress in Eimeria-infected broilers by modulating NF-kB and Nrf2 pathways

This study investigated the effects of substituting inorganic trace minerals (ITM) with advanced chelate technology-based TM (ACTM) in broiler chicken feed on productive performance, metabolic profile, humoral immunity, antioxidant status, and modulation of NF-kB and Nrf2 signaling pathways in mixed Eimeria species exposure. The study involved 480 newly hatched male broiler chickens, which were divided into 5 treatment groups, each with 6 replicate cages and 16 chickens per replicate. The experimental treatments included an uninfected negative control group fed a basal diet with recommended inorganic TM levels (NC), an infected positive control group fed the same diet (PC), a PC group supplemented with salinomycin (SAL), and two PC groups in which the basal diet was replaced with 50% and 100% ACTM instead of inorganic TM (ACTM50 and ACTM100, respectively). All groups, except for the NC group, were orally challenged with mixed Eimeria species oocysts on day 14. According to the results, the PC group showed lower feed intake, breast yield, low-density lipoprotein-cholesterol concentration, lactobacillus spp. counts, and serum IgG levels, but higher jejunal TGF-β expression versus the NC group. The broilers in the NC, SAL, and ACTM100 groups showed higher body weight gain, carcass yield, and TGF-β expression, but lower serum alkaline phosphatase activity, ileal E. coli count, and jejunal expression levels of IL-1β, IL-6, IFN-γ, Nrf2, and SOD1 compared to the PC group, with the NC group having the highest body weight gain and lowest IL-1β and Nrf2 expression levels. Furthermore, the administration of ACTM100 treatment improved feed efficiency, increased serum iron, zinc, manganese, and copper levels, enhanced total antioxidant capacity and different antioxidant enzyme activities, and reduced malondialdehyde concentration. In conclusion, complete replacement of ITM with ACTM effectively protects broilers from Eimeria infection, with similar positive effects to SAL treatment in terms of productive performance and anti-inflammatory responses and better antioxidant responses and mineral availability.

Assessment of Serum Zn, Cu, Mn, and Fe Concentration in Women with Endometrial Cancer and Different Endometrial Pathologies.

There is conflicting evidence on the effect of specific micronutrient concentration and cancer risk. In this study, we investigated the differences in serum zinc, copper, iron, and manganese levels and different endometrial pathologies, including endometrial cancer. 110 patients with a confirmed diagnosis of endometrial cancer, benign uterine conditions (endometrial polyp, endometrial hyperplasia, uterine myoma), or normal endometrium were included in the study and assessed in terms of endometrial cancer risk factors. The measurements of serum micronutrients were conducted using inductively coupled plasma optical emission spectrometry. When assessing for differences between serum concentrations of trace metals, we found significant differences in the distribution of Mn (p < 0.001) and Fe (0.034). There was also a significant difference in Cu/Zn ratio between the analyzed groups (p = 0.002). Patients' BMI was found to influence Cu concentration, with obese patients having higher mean copper concentration (p = 0.006). Also, patients' menopausal status was shown to influence Cu concentration with postmenopausal patients having higher Cu levels (p = 0.001). The menopausal status was found to influence Cu/Zn ratio (p = 0.002). Univariable regression analysis did not confirm that any of the micronutrients significantly influence the risk of endometrial cancer. The concentration of specific trace metals varies between different histopathological diagnoses of endometrial pathologies. Menopausal status and patient BMI are endometrial cancer risk factors impacted by the concentrations of Cu and Zn and their ratio.

Manganese level and cognitive decline in older adults with the APOE e4 allele: a preliminary study

This study examined the relationship between serum manganese level and cognition, and the moderating effect of apolipoprotein E ε4 (APOE4) on this relationship. A total of 164 non-demented participants underwent clinical assessments including serum manganese level and cognition [episodic memory score (EMS), non-memory score (NMS) for executive function/attention/language/ visuospatial skill, and total score (TS)]. Serum manganese × APOE4 interaction had a significant effect on EMS and TS. Serum manganese level was inversely associated with EMS and TS in APOE4-positive but not APOE4-negative participants. APOE4 should be considered a key component in Alzheimer's disease studies that included manganese imbalance as a risk factor.

Association between serum manganese and serum klotho in a 40-80-year-old American population from NHANES 2011-2016.

Objectives: Manganese is one of the essential trace elements that are required by the human body. Klotho protein is a classic anti-aging marker. The association between the levels of serum manganese and serum klotho in individuals between the ages of 40-80 in the United States remains unclear. Methods: Data for this cross-sectional study was obtained from the National Health and Nutrition Examination Survey (NHANES 2011-2016) in the United States. We performed multiple linear regression analyses to investigate the association between the levels of serum manganese and serum klotho. Furthermore, we performed a fitted smoothing curve according to a restricted cubic spline (RCS). Stratification and subgroup analyses were performed for further verification of the results. Results: Weighted multivariate linear regression analysis showed that serum manganese levels were independently and positively associated with serum klotho levels (β = 6.30, 95% confidence interval: 3.30-9.40). Kruskal-Wallis test showed that participants with higher manganese quartiles had higher serum klotho levels (Q1: 808.54 ± 256.39pg/mL; Q2: 854.56 ± 266.13pg/mL; Q3: 865.13 ± 300.60pg/mL; and Q4: 871.72 ± 338.85pg/mL, p < 0.001). The RCS curve indicated that the association between the levels of serum manganese and serum klotho was non-linear. Furthermore, a significantly positive association was found between serum manganese and serum klotho levels in the majority of subgroups. Conclusion: A non-linear and positive association was found between the levels of serum manganese and serum klotho in individuals aged 40-80 in the United States according to the NHANES (2011-2016).

Hypermanganesemia with Dystonia Type 2: A Potentially Treatable Neurodegenerative Disorder: A Case Series in a Tertiary University Hospital.

Importance: Hypermanganesemia with dystonia type 2 is a rare autosomal recessive neurodegenerative disorder characterized by the loss of previously acquired milestones, dystonia, parkinsonian features, a high serum manganese level, and characteristic neuroimaging findings such as bilateral and symmetrically increased T1 and decreased T2/fluid-attenuated inversion recovery signal intensity in the basal ganglia. This condition is secondary to a mutation in the SLC39A14 gene. Objective: To present a series of three cases of hypermanganesemia with dystonia type 2, which was genetically confirmed secondary to a mutation in the SLC39A14 gene, and to describe the treatment and clinical course in these cases. Design: A retrospective case series. Setting: University, Tertiary hospital. Participants: Three unrelated pediatric patients with hypermanganesemia with dystonia type 2, genetically confirmed to be secondary to a mutation in the SLC39A14 gene. Exposures: Chelation therapy using calcium disodium edetate. Main outcome(s) and measure(s): The response to chelation therapy based on clinical improvements in motor and cognition developments. Results: All three patients were started on chelation therapy using calcium disodium edetate, and two of them showed an improvement in their clinical course. The chelation therapy could alter the course of the disease and prevent deterioration in the clinical setting. Conclusions and Relevance: Early diagnosis and intervention with chelating agents, such as calcium disodium edetate, will help change the outcome in patients with hypermanganesemia with dystonia type 2. This finding highlights the importance of early diagnosis and treatment in improving the outcomes of patients with treatable neurodegenerative disorders.

Clinical Profile and Treatment Outcomes of Hypermanganesemia with Dystonia 1 and 2 among 27 Indian Children.

Hypermanganesemia with dystonia 1 and 2 (HMNDYT1 and 2) are rare, inherited disorders of manganese transport. We aimed to describe clinical, laboratory features, and outcomes among children with HMNDYT. We conducted a retrospective multicenter study involving tertiary centers across India. We enrolled children between 1month to 18 years of age with genetically confirmed/clinically probable HMNDYT. Clinical, laboratory profile, genetic testing, treatment details, and outcomes scored by treating physicians on a Likert scale were recorded. We enrolled 27 children (19 girls). Fourteen harbored SLC30A10 mutations; nine had SLC39A14 mutations. The SLC39A14 cohort had lower median age at onset (1.3 [interquartile range (IQR), 0.7-5.5] years) versus SLC30A10 cohort (2.0 [IQR, 1.5-5.1] years). The most frequent neurological features were dystonia (100%; n=27), gait abnormality (77.7%; n=21), falls (66.7%; n=18), and parkinsonism (59.3%; n=16). Median serum manganese (Mn) levels among SLC39A14 (44.9 [IQR, 27.3-147.7] mcg/L) cohort were higher than SLC30A10 (29.4 [17.1-42.0] mcg/L); median hemoglobin was higher in SLC30A10 (16.3 [IQR, 15.2-17.5] g/dL) versus SLC39A14 cohort (12.5 [8.8-13.2] g/dL). Hepatic involvement and polycythaemia were observed exclusively in SLC30A10 variants. A total of 26/27 children underwent chelation with disodium calcium edetate. Nine demonstrated some improvement, three stabilized, two had marked improvement, and one had normalization. Children with SLC39A14 mutations had poorer response. Two children died and nine were lost to follow-up. We found female predominance. Children with SLC39A14 mutations presented at younger age and responded less favorably to chelation compared to SLC30A10 mutations. There is emerging need to better define management strategies, especially in low resource settings.

Association between serum manganese levels and diabetes in Chinese adults with hypertension.

Manganese (Mn) is an essential trace metal element that is associated with diabetes; however, the results of previous studies are inconsistent. Furthermore, few studies have been conducted in a hypertensive population. The purpose of this study is to explore the relationship between manganese and diabetes in a population with hypertension. A cross‐sectional study was conducted, including 2575 hypertensive individuals from 14 provinces in China. Serum manganese concentrations were measured by the inductively coupled plasma mass spectrometry (ICP‐MS) method. And logistic regression models were used to analyze the association between serum manganese and the risk of diabetes. The prevalence of diabetes was 27.0% in this hypertensive population. In logistic regression models, the odds ratios (95% confidence interval) for diabetes in tertile subgroups were 1.40 (1.12, 1.76) and 1.32 (1.05, 1.65) for tertiles 1 and tertiles 3, respectively, compared to tertile 2 (reference). Additionally, an interaction between sex and manganese was observed. The odds ratios (95% confidence interval) for diabetes were 1.29 (0.95, 1.75) and 0.96 (0.70, 1.31) for tertiles 1 and tertiles 3 among males, and 1.44 (1.01, 2.04) and 1.81 (1.29, 2.55) for tertiles 1 and tertiles 3 among females, respectively, compared to tertile 2. In conclusion, a U‐shaped association between serum manganese and diabetes was observed in a Chinese population with hypertension, and the association was modified by sex.

Assessment of serum level of selected essential trace elements in patients with renal disorders

Levels of some trace elements in the sera of patients (male and female) with kidney diseases were determined. The patients were twelve (12) in number, aged between 45-65 years and were having occupation traceable to heavy metal exposure. The trace elements determined were iron, manganese, copper and zinc. The investigation was conducted at the in-and-out patient unit of the University College Hospital, Ibadan, Oyo State, Nigeria and the results obtained were compared with the corresponding values obtained in control subjects. The results of this study revealed a significant (P&lt;0.05) increase in serum iron and manganese levels where mean serum iron levels of [(92.9±16.5), (45.0±150.9)] mg/100 ml were obtained in patients (both sexes) compared to [(82.5±5.14), (50.8±100.3)] mg/10 0 ml obtained in control subjects respectively. Mean serum manganese levels of [(2.39±1.30), (0.05±6.90)] mg/100 ml were also obtained in patients (both sexes) compared to [(1.20±0.22), (0.70±1.90)] mg/100 ml in control subjects respectively. However, there was significant (P&lt;0.05) decrease in serum copper and zinc levels in the patients compared to the control subjects. Mean serum copper levels of [(49.3±12.4), (20.5±92.2)] mg/100 ml were obtained from patients compared to [(82.5±47.3), (50.8±89.2)] mg/100 ml obtained in control subjects while mean serum zinc levels of [(54.3±15.9), (16.5±100.0)] mg/100 ml were obtained from patients compared to [(66.1±5.17), (40.8±84.0)] mg/10 0 ml in control subjects. The results suggest heavy metal interference with the essential trace elements in physiological system of the patients due to occupational exposure.

The association between manganese exposure with cardiovascular disease in older adults: NHANES 2011–2018

The aim of the current study was to explore possible connections between manganese exposure and the prevalence of cardiovascular disease (CVD) in older US adults. The relationship between serum manganese levels and CVD was explored in 2427 people aged 60 years and over using data from the National Health and Nutrition Examination Survey (NHANES) (2011–2018). Multivariate linear regression analysis was performed to investigate associations between CVD risk factors and serum manganese concentration. The relationship between manganese levels and the prevalence of CVD was probed using generalized linear models and restricted cubic spline curves. Stratified subgroup analysis was subsequently constructed to rule out spurious interactions between variables and manganese. Compared with the lowest quartile, the modified odds ratios (ORs) with 95% confidence intervals (CIs) for CVD prevalence across the manganese quartiles were 0.71 (OR: 0.51; CI: 1.00), 0.70 (0.50, 0.99), and 0.49 (0.34, 0.72). In the full adjusted model, a prominent negative relationship was observed between serum manganese concentration and CVD. A restricted cubic spline curve was used to show a nonlinear negative relationship between manganese concentration and CVD. In summary, manganese levels are negatively correlated with the risk of CVD in a nation-wide study of older US adults.

The association between PTX3 and serum manganese levels of welders in comparison with controls: An application of anti-inflammatory biomarker

Aim: The purpose of this study; it is to compare serum PTX3 levels of manganese-exposed welders with non-exposed people in order to evaluate the nature of manganese-induced inflammatory response.&#x0D; Material and Method: 51 of whom were exposed to manganese and 52 of whom were volunteers working in the same workplace, were evaluated in the study. PTX-3 levels were analyzed in the serum samples with ELISA. Mn levels were analyzed in whole blood samples in ICP-MS. &#x0D; Results: The mean values of manganese and Pentraxin-3 of the control group were found to be statistically significantly lower than those of the exposure group, respectively, for Mn levels: 5.04±2.32 µg/L and 11.54±3.09 µg/L; for PTX-3 36.96±24.20 ng/mL and 48.29±27.13 ng/mL; p

Alterations in manganese level in the biological samples of young obese Saudi women

ObjectivesThis study aims to evaluate the changes in serum manganese levels in the nails of women with obesity. MethodsA cross-sectional study was conducted between 2018 and 2019 at Imam Abdulrahman Bin Faisal University, KSA. It was conducted in a convenience sample of 30 women with obesity and 40 without obesity. We obtained biological samples of nails from the participants and analysed these samples using a plasma atomic emission spectrometer to estimate the levels of manganese. A standard questionnaire containing items related to demographic features, such as address, age, education, and marital status, was used. In addition, the data on the usual consumption of water, milk, and soft drinks during a day or week, eating habits, and other health information were included in the questionnaire. ResultsThe results of this study show that manganese levels are significantly lower (p < 0.001) in the group with obesity at 0.34 ± 0.06 mg/kg than in the group without obesity at 0.62 ± 0.02 mg/kg. Regular sports activity in a week and consumption of fruit, vegetables, fish, meat, and water are significant predictors of the levels of manganese in the body. ConclusionThe study demonstrates a significant difference in the levels of manganese in the nails of obese participants compared to non-obese participants. Further studies are needed to determine whether Saudi women are at risk for manganese deficiency.

Liver resection for a congenital intrahepatic portosystemic shunt in a child with hyperammonemia and hypermanganesemia: a case report

BackgroundCongenital portosystemic shunt (CPSS) is a rare malformation that leads to hyperammonemia, hypermanganesemia, and various symptoms. CPSSs are divided into intrahepatic and extrahepatic shunts. In patients with persistent CPSS including an intrahepatic portosystemic shunt (IPSS), early intervention to occlude the shunt reverses the associated complications.Case presentationThe patient was a 1-year-and-7-month-old girl. She presented with hypergalactosemia and elevation of blood ammonia level (75 μg/dL) and total bile acid levels (68.2 μmol/L) during the neonatal period. Two IPSSs were detected using ultrasound and enhanced computerized tomography. Magnetic resonance imaging (MRI) at 1 year and 3 months of age showed abnormally high signal intensity in the pallidum of her brain. Spontaneous closure was not observed. We performed a right hepatectomy at 1 year and 7 months of age. The portal vein pressure was 16 mmHg after temporary occlusion of the right portal vein. Blood ammonia and serum manganese levels decreased immediately after the operation. The abnormal signal on brain MRI disappeared. She had a favorable course with no sign of recurrence of IPSS 5 years postoperatively.ConclusionLiver resection for an IPSS to control the symptoms of a portosystemic shunt is reasonable in a child for whom interventional radiological treatment is not indicated.

Serum manganese level in children with iron deficiency

Serum manganese level in children with iron deficiency

Куріння, як фактор ризику виникнення полікістозу яєчників

ABSTRACT. Objective. To study the prevalence of smoking among women with polycystic ovary syndrome (PCOS), as well as to establish the relationship between intensity, duration of smoking and serum levels of manganese and nickel. Materials and methods. A questionnaire survey was performed in two groups of women: the control group (I) included 38 healthy women, and the second group included 52 women with PCOS. In both groups, serum levels of manganese and were determined using inductively coupled plasma mass spectrometry. Statistical processing of the results of the survey was conducted using Statistika 8 software program. The U-Mann-Whitney test was used to assess the statistical significance of the obtained results. Comparison of the prevalence of smoking in both groups was performed using the parameter of statistical significance of differences for two relative values. Spearman coefficient was used for correlation analysis. Results. In women with PCOS, significantly higher manganese (p = 0.0012) and nickel (p = 0.0000) serum levels were found. In group I, 3 women reported smoking, in group II — 13 women. Among women with PCOS, the prevalence of smoking was significantly higher (p = 0.0000). Both groups differ neither in duration (p = 0.9463) nor in intensity of smoking (p = 0.7366). Duration and intensity of smoking were not associated with serum manganese. The intensity of smoking also did not affect serum levels of nickel. A positive correlation was found between serum nickel and the duration of smoking. Authors believe that during smoking manganese directly penetrates cerebral structures via olfactory rout. Only its small portion penetrates the bloodstream. This explains the high toxicity of manganese. Conclusion. Among women with PCOS smoking is much more common, however, the intensity and duration of smoking do not differ from the control group. Serum manganese levels are associated neither with duration nor with the intensity of smoking. Serum nickel levels are affected by the duration of smoking, rather than by the intensity of smoking. Keywords: polycystic ovary syndrome, intensity of smoking, duration of smoking, manganese, nickel.

A case of dystonia with polycythemia and hypermanganesemia caused by SLC30A10 mutation: a treatable inborn error of manganese metabolism

BackgroundManganese is a critical trace element that not only has antioxidant properties, but also is essential for various metabolic pathways and neurotransmitters production. However, it can be toxic at high levels, particularly in the central nervous system. Manganese intoxication can be acquired, but an inherited form due to autosomal-recessive mutations in the SLC30A10 gene encoding a Mn transporter protein has also been reported recently. These mutations are associated with significant failure of manganese excretion and its storage in the liver, brain (especially basal ganglia), and other peripheral tissues, resulting in toxicity.Case presentationA 10-year-old boy from consanguineous parents presented with a history of progressive truncal instability, gait difficulty, and frequent falls for 2 months. He had dystonia, rigidity, ataxia, dysarthria, bradykinesia and a plethoric skin. Investigations showed polycythemia, low serum iron and ferritin levels, and increased total iron binding capacity. A brain MRI revealed symmetric hyperintensities in the basal ganglia and dentate nucleuses on TI images that were suggestive of brain metal deposition together with clinical manifestations. Serum calcium and copper levels were normal, while the manganese level was significantly higher than normal values. There was no history of environmental overexposure to manganese. Genetic testing showed a homozygous missense mutation in SLC30A10 (c.C1006T, p.His336Tyr) and Sanger sequencing confirmed a homozygous state in the proband and a heterozygous state in the parents. Regular treatment with monthly infusions of disodium calcium edetate and oral iron compounds resulted in decreased serum manganese and hemoglobin levels to normal values, significant resolution of MRI lesions, and partial improvement of neurological symptoms during 6 months of follow-up.ConclusionThe syndrome of hepatic cirrhosis, dystonia, polycythemia, and hypermanganesemia caused by SLC30A10 mutation is a treatable inherited metal deposition syndrome. The patient may only have pure neurological without hepatic manifestations. Although this is a rare and potentially fatal inborn error of metabolism, early diagnosis and continuous chelation therapy might improve the symptoms and prevent disease progression.

Change of the levels of trace elements and heavy metals in threatened abortion.

This study aimed to investigate the impact of changes in the serum levels of trace elements and heavy metals in threatened abortion, which is a common complication in early pregnancy. Earlier studies have shown that changes in the serum levels of some trace elements and increased serum concentrations of heavy metals are associated with spontaneous abortion; however, this relationship has not been fully clarified. The patient group consisted of 45 pregnant women diagnosed with threatened abortion. There were 40 healthy nonpregnant women in the control group. Blood samples were obtained from the patients and the healthy controls, and the concentrations of serum trace elements and heavy metals were measured using atomic absorption spectrophotometry. Statistically significant decreases were found in the serum zinc (Zn), iron (Fe), magnesium (Mg) and manganese (Mn) levels, and significant increases were found in the serum copper (Cu), cadmium (Cd) and lead (Pb) levels in cases of threatened abortion in comparison to the controls (p < 0.001). However, there was no difference between the groups in terms of the serum cobalt (Co) levels (p > 0.001). Changes in the balance of some essential trace elements (especially decreases in Fe and Zn) and elevated concentrations of some toxic heavy metals in the blood may be important diagnostic and prognostic parameters for threatened abortion.

Serum iron, Magnesium, Copper, and Manganese Levels in Alcoholism: A Systematic Review.

The aim of this paper was to review recent literature (from 2000 onwards) and summarize the newest findings on fluctuations in the concentration of some essential macro- and microelements in those patients with a history of chronic alcohol abuse. The focus was mainly on four elements which the authors found of particular interest: Iron, magnesium, copper, and manganese. After independently reviewing over 50 articles, the results were consistent with regard to iron and magnesium. On the other hand, data were limited, and in some cases contradictory, as far as copper and manganese were concerned. Iron overload and magnesium deficiency are two common results of an excessive and prolonged consumption of alcohol. An increase in the levels of iron can be seen both in the serum and within the cells, hepatocytes in particular. This is due to a number of factors: Increased ferritin levels, lower hepcidin levels, as well as some fluctuations in the concentration of the TfR receptor for transferrin, among others. Hypomagnesemia is universally observed among those suffering from alcoholism. Again, the causes for this are numerous and include malnutrition, drug abuse, respiratory alkalosis, and gastrointestinal problems, apart from the direct influence of excessive alcohol intake. Unfortunately, studies regarding the levels of both copper and manganese in the case of (alcoholic) liver disease are scarce and often contradictory. Still, the authors have attempted to summarize and give a thorough insight into the literature available, bearing in mind the difficulties involved in the studies. Frequent comorbidities and mutual relationships between the elements in question are just some of the complications in the study of this topic.

SERUM MANGANESE LEVELS IN CHILDREN WITH ATTENTION DEFICIT HYPERACTIVE DISORDER Hend Ahmed Onsi*,Gamal Samy* Aly, Manal Omar*, Michelle Sobhy**, Dina El-Alfy*. *Medical studies department for children, Faculty of Childhood Studies. **Psychological studies department for children, Faculty of Childhood Studies.

Abstract Background: ADHD is one of the most common neurodevelopmental and psychiatric disorders of childhood. Manganese is an essential micronutrient, however exposure to high doses of manganese either by ingestion or inhalation produces several adverse effects in humans. Objective: To assess whether serum manganese levels are high in children with ADHD. Methods: The present study is a case-control study that was conducted on forty patients and twenty controls from 1st September 2016 to end of December 2017. The ADHD patients were treatment-naive. Both case and control groups were assessed by history taking, Child Behavior Checklist, Attention Deficit Hyperactivity Disorder rating scale (SC4),Stanford Binet 5th edition and had their blood sample taken to measure serum Manganese levels using measured with Inductively Coupled Plasma- Mass Spectrometry. Results: Higher mean manganese level among ADHD cases (5.5±1) compared to controls (4.1± 0.6) respectively and the difference is highly significant statistically (P<0.001) Conclusion: We speculate that our observed relationship between ADHD diagnosis and higher Mn levels may be part of an ‘‘environmental etiology of dopamine deficits (ADHD)’’. Exposure to low/moderate but biologically relevant levels of Mn might interfere with optimal levels of dopamine in predisposed subjects leading to ADHD. Keywords: Attention Deficit Hyperactivity Disorder, Manganese, Dopamine, Dopamine Transporter, children. قياس المنغنيز في مصل الدم فى الأطفال الذين يعانون اضطراب نقص الانتباه و فرط النشاط المقدمة: اضطراب نقص الانتباه وفرط النشاط هو اضطراب النمو العصبي التي يحددها نمط مستمر من الغفلة و / أو فرط النشاط والاندفاع الذي يتداخل مع عمل أو التنمية، ظهرت عليه أعراض في مکانين أو أکثر (على سبيل المثال في المنزل أو المدرسة أو العمل؛ مع الأصدقاء أو أقارب، في أنشطة أخرى).ازداد اضطراب نقص الانتباه وفرط الحرکة في الانتشار خلال السنوات القليلة الماضية، مما أدى إلى زيادة الوعي وحث العديد من الباحثين للبحث عن العوامل البيئية ومراقبة دور المواد السامة المختلفة في الاضطرابات العصبية النمائية بما في ذلک نقص الانتباه وفرط الحرکة. على الرغم من المنجنيز هو معدن أساسي في الجرعات الملائمة، قد ارتبط التعرض المفرط والمزمن لجرعات عالية بالسمية العصبية، مؤدية إلى السلوکية العصبية التي تنطوي على الوظائف الحرکية والمعرفية فضلا عن المشاکل النفسية ويشمل التسمم نظام الدوبامين حيث أشارت دراسات حديثة أن المنغنيز يتراکم في الخلايا العصبية للدوبامين مما يؤدى لإنخفاض مستوياته فى المخ . وقد تم أيضا ربط اضطراب نقص الانتباه وفرط الحرکة إلى اختلال وظائف الدوبامين حيث أن نظام الدوبامين هو الموقع الرئيسي لعمل علاج اضطراب نقص الانتباه وفرط النشاط الدوائي. الهدف من الدراسة ١- تقييم مستويات المنغنيز في مصل الدم في الأطفال الذين يعانون من اضطراب نقص الانتباه فرط النشاط الحرکى ٢- المقارنة بين مستويات المصل المنغنيز وشدة الأعراض والتواکب المرضي في الأطفال الذين يعانون من اضطراب نقص الانتباه وفرط الحرکة منهجيةالدراسة : نوع الدراسة: دراسة حالات وشواهد المرضى: أجريت هذه الدراسة على اربعين طفلا من المصابين بفرط الحرکة وتشتت الانتباه وعشرين طفل طبيعي من الجنسين الذين يترددوا على عيادة الطب النفسي بمرکز ذوي الاحتياجات الخاصة، جامعة عين شمس. تم اخذ التاريخ الطبي الشامل ، فحص اکلينيکي شامل، وعمل القياسات النفسية ) مقياس مستوى الذکاء Stanford Binet 5th Edition ، مقياس فرط الحرکة وتشتت الانتباه ADHD rating scale- SC4، مقياس Child Behavior Checklist، وصاحب عينة دم لتحديد مستوى المنغنيز في مصل الدم النتائج: مستويات المنغنيز في مصل الدم أعلى في الاطفال المصابين بفرط حرکة وتشتت الانتباه عن أقرانهم الطبيعيين. الخلاصة: وجودعلاقة بين اضطراب فرط الحرکة وتشتت الانتباه ومستوى المنغنيزالعالي في مصل الدم يمکن ان يعتبر سبب بيئي يؤدي لاضطراب مستويات الدوبامين .

Zinc Deficiency in Autism: A Controlled Study

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by impaired socialisation and restricted and repetitive patterns of behaviour. Zinc deficiency has previously been reported in patients with ASD. A retrospective controlled trial of serum zinc levels in patients with ASD vs. non-ASD controls was undertaken to explore the potential presence of zinc deficiency in the ASD population. 72 patients with ASD were compared with 234 non-ASD controls. Serum zinc levels were compared between groups and correlations analysed for age, sex, supplement use and diet. Serum chromium and manganese levels were also compared between ASD and control groups to assess general micronutrient status. Further analysis was undertaken in the ASD group investigating potential correlations between serum zinc levels and immune function. 86% of patients with ASD were found to be zinc deficient versus 24% of the non-ASD control group. There was a mean difference of serum zinc levels between the ASD and non-ASD groups of 1·75 μmol/l (P<0·001, CI 1·2-2·1). There was no effect of age or sex on serum zinc levels in either the ASD or control groups. There was no significant difference in chromium or manganese levels between the ASD and control group. These results suggest zinc deficiency is likely to be common in ASD patients and is a potentially modifiable environmental factor associated with the condition. Zinc’s potential role in the aetio-pathogenesis and disease evolution is discussed, and the need to consider zinc status in patients with ASD is highlighted.