Zinc Protoporphyrin Concentrations Research Articles

Prevalence and predictors of anemia among six-week-old infants in Kwale County, Kenya: A cross-sectional study.

Anemia is a significant public health problem among children worldwide. The etiology of anemia is multifactorial but iron deficiency (ID) is the most common cause of anemia in low- and middle-income countries. ID and anemia in infancy can impair growth and cognitive development. The aim of this study was to determine the prevalence and predictors of anemia among six-week-old infants in Kwale County, Kenya. This cross-sectional study included 424 mother-infant pairs. Structured questionnaires were administered to the mothers to obtain information on socio-demographic variables, maternal characteristics and birth information. Anthropometric data was collected for each child. A heel prick was done to measure hemoglobin and zinc protoporphyrin concentration levels. Chi-square test, bivariate and multivariate regression analyses were done to determine factors associated with anemia. The prevalence of ID, anemia and IDA was 60.4% (95%CI: 55.9-65.2), 21.0% (95%CI: 17.5-25.2) and 15.8% (95%CI: 12.7-19.7) respectively. Bivariate analysis showed that the risk of anemia was significantly higher among male infants (odds ratio (OR) = 2.20 (95%CI: 1.33-3.63), p = 0.002), iron deficient infants (OR = 2.35 (95%CI: 1.39-3.99), p = 0.001) and infants from Msambweni Sub-County (OR = 2.80 (95%CI: 1.40-4.62), p<0.001). Multivariate analysis revealed that odds of anemia were significantly higher in infants born to mothers who did not use iron supplements during pregnancy (adjusted odds ratio (aOR) = 74.01 (95%CI: 2.45-2238.21), p = 0.013 and significantly lower in infants born to mothers with parity ≥ 4 (aOR = 0.05 ((95%CI: 0.00-0.77), p = 0.024). In six-week-old infants in rural Kenya, anemia prevalence was 21.0% with ID accounting for 75.3% of anemia cases. Given the physical and cognitive impairments associated with ID and anemia in early infancy, it may be prudent to re-evaluate the current Kenyan pediatric protocols to include anemia screening and potential treatment of infants less than 6-months of age.

Trends in Blood Lead Levels Quantified by ICP-MS: A Reference Laboratory Retrospective Study.

Exposure to lead may cause severe adverse effects such as anemia, neurologic damage, developmental disorders, and reproductive disorders. Consequently, in 2021, the Centers for Disease Control and Prevention (CDC) reduced its blood lead reference value from 5 µg/dL to 3.5 µg/dL in pediatric patients, 1 to 5 years old. The objective of this study was to perform a retrospective analysis of patient blood lead concentrations reported by ARUP Laboratories to evaluate the frequency of blood lead concentrations greater than 3.5 µg/dL. The analysis of blood lead concentration was performed in venous whole blood specimens using inductively coupled plasma mass spectrometry (ICP-MS). In addition, retrospective data analysis was performed to evaluate zinc protoporphyrin (ZPP) concentrations in adult patients with corresponding lead results, using the lead industrial exposure panel. The analysis for ZPP was performed using quantitative hematofluorometry. Retrospective data analysis identified a decline in blood lead concentrations from 2012 to 2021 for pediatric and adult patients. The calculated nonparametric 95% range for ZPP blood was 15 to 43 μg/dL and the ZPP heme ratio 26 to 74 μmol ZPP/mol heme. Lowering the blood lead reference value (BLRV) to 3.5 μg/dL presents an opportunity for healthcare providers and public health agencies to extend medical or environmental interventions for lead exposure in pediatric patients.

Fortification of salt with iron and iodine versus fortification of salt with iodine alone for improving iron and iodine status.

Fortification of salt with iron and iodine versus fortification of salt with iodine alone for improving iron and iodine status.

The Relationship between Occupationally Exposed Arsenic, Cadmium and Lead and Brain Bioelectrical Activity-A Visual and Brainstem Auditory Evoked Potentials Study.

The aim of this study was to evaluate the parameters of visual and brainstem auditory evoked potentials in patients occupationally exposed to arsenic, cadmium and lead. The study group comprised 41 copper smelter and refinery workers (average age: 51.27) with occupational exposure to arsenic, cadmium and lead. The control group consisted of 36 healthy volunteers (35 men and 1 woman, aged 27–66, average age: 51.08). Neurological examination, brain imaging, and visual and brainstem auditory evoked potentials were performed, and the relationship between blood Cd, Pb concentration (Cd-B, Pb-B), blood zinc protoporphyrin (ZnPP), and urine As concentration (As-U) were assessed. In the workers, exceedances of allowable biological concentrations were observed, with the urinary concentration of arsenic being 5.2%, the cadmium and lead in blood being 1.3%, while the case of ZnPP was 2.6%. The mean P100, relative P100, and N145 visual evoked potential (VEP) latencies were significantly longer in exposed workers than in the controls. The mean wave III and V brainstem auditory evoked potential (BAEP) latency and the mean wave III–V and I–V interpeak latencies were longer, and the I and V amplitude was lower in the workers than the controls. In summary, occupational exposure to As, Cd, and Pb is associated with prolonged latency and reduced evoked potential amplitude, but As-U, Pb-B, Cd-B, and ZnPP concentrations are not linearly related to potential components. The analysis of evoked potentials may be a useful method of assessment of the central nervous system in patients with occupational exposure to heavy metals.

Delayed iron does not alter cognition or behavior among children with severe malaria and iron deficiency.

BackgroundMalaria and iron deficiency (ID) in childhood are both associated with cognitive and behavioral dysfunction. The current standard of care for children with malaria and ID is concurrent antimalarial and iron therapy. Delaying iron therapy until inflammation subsides could increase iron absorption but also impair cognition.MethodsIn this study, Ugandan children 18 months to 5 years old with cerebral malaria (CM, n=79), severe malarial anemia (SMA, n=77) or community children (CC, n=83) were enrolled and tested for ID. Children with ID were randomized to immediate vs. 28-day delayed iron therapy. Cognitive and neurobehavioral outcomes were assessed at baseline and 6 and 12 months (primary endpoint) after enrollment.ResultsAll children with CM or SMA and 35 CC had ID (zinc protoporphyrin concentration ≥80 μmol/mol heme). No significant differences were seen at 12-month follow-up in overall cognitive ability, attention, associative memory, or behavioral outcomes between immediate and delayed iron treatment (mean difference (standard error of mean) ranged from −0.2 (0.39) to 0.98 (0.5), all P≥0.06).ConclusionChildren with CM or SMA and ID who received immediate vs. delayed iron therapy had similar cognitive and neurobehavioral outcomes at 12-month follow-up.

Delayed iron improves iron status without altering malaria risk in severe malarial anemia

WHO guidelines recommend concurrent iron and antimalarial treatment in children with malaria and iron deficiency, but iron may not be well absorbed or utilized during a malaria episode. We aimed to determine whether starting iron 28 d after antimalarial treatment in children with severe malaria and iron deficiency would improve iron status and lower malaria risk. We conducted a randomized clinical trial on the effect of immediate compared with delayed iron treatment in Ugandan children 18 mo-5 y of age with 2 forms of severe malaria: cerebral malaria (CM; n=79) or severe malarial anemia (SMA; n=77). Asymptomatic community children (CC; n=83) were enrolled as a comparison group. Children with iron deficiency, defined as zinc protoporphyrin (ZPP) ≥ 80 µmol/mol heme, were randomly assigned to receive a 3-mo course of daily oral ferrous sulfate (2 mg · kg-1 · d-1) either concurrently with antimalarial treatment (immediate arm) or 28 d after receiving antimalarial treatment (delayed arm). Children were followed for 12 mo. All children with CM or SMA, and 35 (42.2%) CC, were iron-deficient and were randomly assigned to immediate or delayed iron treatment. Immediate compared with delayed iron had no effect in any of the 3 study groups on the primary study outcomes (hemoglobin concentration and prevalence of ZPP≥80 µmol/mol heme at 6 mo, malaria incidence over 12 mo). However, after 12 mo, children with SMA in the delayed compared with the immediate arm had a lower prevalence of iron deficiency defined by ZPP (29.4% compared with 65.6%, P=0.006), a lower mean concentration of soluble transferrin receptor (6.1 compared with 7.8 mg/L, P=0.03), and showed a trend toward fewer episodes of severe malaria (incidence rate ratio: 0.39; 95% CI: 0.14, 1.12). In children with SMA, delayed iron treatment did not increase hemoglobin concentration, but did improve long-term iron status over 12 mo without affecting malaria incidence.This trial was registered at clinicaltrials.gov as NCT01093989.

Concentration of Thyrotropic Hormone in Persons Occupationally Exposed to Lead, Cadmium and Arsenic

Thyroid hormones are essential for body homeostasis. The scientific literature contains restricted proofs for effects of environmental chemical factors on thyroid function. The present study aimed at evaluating the relationship between toxicological parameters and concentration of thyrotropic hormone in persons occupationally exposed to lead, cadmium and arsenic. The studies were conducted on 102 consecutive workers occupationally exposed to lead, cadmium and arsenic (mean age 45.08 ± 9.87 years). The estimated parameters characterizing occupational exposure to metals included blood cadmium concentration (Cd-B), blood lead concentration (Pb-B), blood zinc protoporphyrin concentration (ZnPP) and urine arsenic concentration (As-U). Thyroid function was evaluated using the parameter employed in screening studies, the blood thyrotropic hormone concentration (TSH). No differences were disclosed in mean values of toxicological parameters between the subgroup of persons occupationally exposed to lead, cadmium and arsenic with TSH in and out of the accepted normal values. Logistic regression demonstrated that higher blood total bilirubin concentrations (ORu = 4.101; p = 0.025) and higher Cd-B (ORu = 1.532; p = 0.027) represented independent risk factors of abnormal values of TSH in this group. In conclusion, in the group of workers exposed to lead, cadmium and arsenic, higher blood cadmium concentration seems to augment the risk of abnormal hormonal thyroid function.

Delaying Iron Therapy by 28 Days Is Associated with Improved Long‐Term Iron Status and Equivalent Hemoglobin in Children with Severe Malaria and Iron Deficiency

BackgroundIron therapy started concurrently with antimalarial treatment in children with severe malaria and iron deficiency may not be well absorbed due to inflammation‐induced impairment of iron absorption and trapping of iron in reticuloendothelial stores under the influence of the hepatic protein hepcidin. Malaria‐induced increases in hepcidin concentration normalize after approximately 4 weeks.ObjectiveWe aimed: 1) To determine if iron therapy started concurrently with vs. 28 days after antimalarial treatment is associated with improvements in long‐term hemoglobin and iron status in children with severe malaria and iron deficiency; and 2) To establish how delayed iron affects long‐term iron and inflammatory markers in children with severe malarial anemia (SMA) vs. cerebral malaria (CM).MethodsWe enrolled Ugandan children with severe malaria (CM, n=77; SMA, n=79) and healthy community children (CC, n=83) aged 6–18 mos into a 12‐mo iron therapy study in Kampala, Uganda. Children with zinc protoporphyrin (ZPP) ≥ 80 μmol/mol heme were randomized to start a 3‐month‐course of oral iron therapy (2 mg/kg/day as ferrous sulfate) concurrently with antimalarial treatment on Day 0 (immediate group, I) or 28 days after antimalarial treatment (delayed group, D). We compared markers of iron status [hemoglobin (Hb), ferritin, soluble transferrin receptor (sTfR), hepcidin] and inflammation [C‐reactive protein (CRP)] at 6 and 12 mos follow up between the treatment groups and also among the study groups using ANOVA.ResultsAll children with severe malaria and 35/83 CC had elevated ZPP. There was no interaction between study group and treatment group for any biomarker at 6 or 12 months. At both time points, children in the I and D groups had equivalent hemoglobin, but children in the D group had significantly lower adjusted geometric mean ZPP (95% CI) concentrations [I vs. D: 6 mos: 86.7 (79.1, 95.1) vs. 75.8 (68.8, 83.4) μmol/mol heme, p=0.02; 12 mos: 84.3 (78.0, 91.0) vs. 72.7 (67.3, 78.6), p&lt;0.01]. Children in the D group also had lower mean sTFR (95% CI) concentrations at 6 months [I vs. D: 6.0 (5.4, 6.7) vs. 5.1 (4.6, 5.7) mg/L, p=0.01) and higher mean hepcidin (95% CI) concentrations at 12 months [I vs. D 10.1 (8.3, 12.2) vs. 14.5 (11.8, 17.8) ng/mL, p&lt;0.01]. At 6 and 12 months, children with SMA had significantly lower hemoglobin concentrations than children in the CM or CC group (pooled group effect 6 mos p=0.03; 12 mos p=0.02), higher ferritin (pooled group effect 6 &amp; 12 mos p&lt;0.001), and marginally higher CRP concentrations (pooled group effect 6 mos p=0.07; 12 mos p=0.08).ConclusionsDelaying iron by 28 days in children with severe malaria may improve long‐term iron status, while causing no change in hemoglobin concentrations as compared to immediate iron. The aberrations to iron metabolism in children with SMA appear to be persistent and associated with chronic inflammation, while those in children with CM are acute and rapidly reversible.Support or Funding InformationFunded by 1U01HD064698 from NIH/NICHD

Genetic variability in the system of natriuretic B peptide and principal toxicological parameters in workers exposed to lead.

The study was aimed at evaluating the influence of selected polymorphisms of natriuretic peptide B precursor (NPPB) and natriuretic peptide receptor C (NPR3) genes on blood lead concentration (Pb-B) and blood zinc protoporphyrin concentration (ZnPP) in persons occupationally exposed to lead. Investigations were conducted on 360 persons (mean age: 44.49±9.62years), workers exposed to lead compounds. The analysis examined four polymorphisms of BNP gene, i.e.,: rs198388, rs198389, rs632793, and rs6676300; as well as one polymorphism of receptor C for natriuretic peptides, i.e., rs1421811. Heterozygosity in locus rs632793 of NPPB gene may result in higher concentrations of Pb-B, while allele A in locus rs632793 of NPPB gene seems to determine higher concentrations of ZnPP in persons occupationally exposed to lead. Workers exposed to lead and carrying allele C in locus rs198388 of NPPB gene, particularly in the heterozygotic setup, seem to be predisposed to present higher concentrations of ZnPP. Carriership of A allele in locus rs198389 of NPPB gene probably determines higher concentrations of ZnPP in study group. In summary, among persons occupationally exposed to lead, certain relationships were demonstrated between rs632793, rs198388 and rs198389 polymorphisms of NPPB gene and principal toxicological parameters characterizing exposure to lead.

Delaying Iron Therapy until 28 Days after Antimalarial Treatment Is Associated with Greater Iron Incorporation and Equivalent Hematologic Recovery after 56 Days in Children: A Randomized Controlled Trial

Background: Iron therapy begun concurrently with antimalarial treatment may not be well absorbed because of malaria-induced inflammation. Delaying the start of iron therapy may permit better iron absorption and distribution.Objective: We compared erythrocyte iron incorporation in children who started iron supplementation concurrently with antimalarial treatment or 28 d later. We hypothesized that delayed iron supplementation would be associated with greater incorporation and better hematologic recovery.Methods: We enrolled 100 children aged 6–59 mo with malaria and hemoglobin concentrations of 50.0–99.9 g/L who presented to Mulago Hospital, Kampala, into a randomized trial of iron therapy. All children were administered antimalarial treatment. Children with zinc protoporphyrin (ZPP) ≥80 μmol/mol heme were randomly assigned to start iron supplementation concurrently with the antimalarial treatment [immediate iron (I) group] or 28 d later [delayed iron (D) group]. All children were administered iron-stable isotope 57Fe on day 0 and 58Fe on day 28. We compared the percentage of iron incorporation at the start of supplementation (I group at day 0 compared with D group at day 28, aim 1) and hematologic recovery at day 56 (aim 2).Results: The percentage of iron incorporation (mean ± SE) was greater at day 28 in the D group (16.5% ± 1.7%) than at day 0 in the I group (7.9% ± 0.5%; P < 0.001). On day 56, concentrations of hemoglobin and ZPP and plasma ferritin, soluble transferrin receptor (sTfR), hepcidin, and C-reactive protein did not differ between the groups. On day 28, the hemoglobin (mean ± SD) and plasma iron markers (geometric mean; 95% CI) reflected poorer iron status in the D group than in the I group at this intervening time as follows: hemoglobin (105 ± 15.9 compared with 112 ± 12.4 g/L; P = 0.04), ferritin (39.3 μg/L; 23.5, 65.7 μg/L compared with 79.9 μg/L; 58.3, 110 μg/L; P = 0.02), sTfR (8.9 mg/L; 7.4, 10.7 mg/L compared with 6.7 mg/L; 6.1, 7.5 mg/L; P = 0.01), and hepcidin (13.3 ng/mL; 8.3, 21.2 ng/mL compared with 38.8 ng/mL; 28.3, 53.3 ng/mL; P < 0.001).Conclusions: Delaying the start of iron improves incorporation but leads to equivalent hematologic recovery at day 56 in Ugandan children with malaria and anemia. These results do not demonstrate a clear, short-term benefit of delaying iron. This trial was registered at clinicaltrials.gov as NCT01754701.

Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria

AbstractBackground: The provision of iron with antimalarial treatment is the standard of care for concurrent iron deficiency and malaria. However, iron that is given during a malaria episode may not be well absorbed or used, particularly in children with severe malaria and profound inflammation.Objectives: We aimed to 1) determine baseline values of iron and inflammatory markers in children with severe malarial anemia (SMA), children with cerebral malaria (CM), and community children (CC) and 2) compare markers in iron-deficient children in each group who received 28 d of iron supplementation during antimalarial treatment with those in children who did not receive iron during treatment..Design: Seventy-nine children with CM, 77 children with SMA, and 83 CC who presented to Mulago Hospital, Kampala, Uganda, were enrolled in a 28-d iron-therapy study. Children with malaria received antimalarial treatment. All children with CM or SMA, as well as 35 CC, had zinc protoporphyrin (ZPP) concentrations ≥80 μmol/mol heme and were randomly assigned to receive a 28-d course of iron or no iron. We compared iron markers at day 0 among study groups (CM, SMA, and CC groups) and at day 28 between children in each group who were randomly assigned to receive iron or to not receive iron.Results: At day 0, children with CM and SMA had greater values of C-reactive protein, ferritin, and hepcidin than those of CC. At day 28, interactions between study and treatment group were NS. Children in the no-iron compared with iron groups had similar mean values for hemoglobin (115 compared with 113 g/L, respectively; P = 0.73) and ZPP (124 compared with 124 μmol/mol heme, respectively; P = 0.96) but had lower median ferritin [101.0 μg/L (95% CI: 84.2, 121.0 μg/L) compared with 152.9 μg/L (128.8, 181.6 μg/L), respectively; P ≤ 0.001] and hepcidin [45.8 ng/mL (36.8, 56.9 ng/mL) compared with 83.1 ng/mL (67.6, 102.2 ng/mL), respectively; P < 0.011].Conclusions: Severe inflammation is a characterization of children with CM and SMA. The withholding of iron from children with severe malaria is associated with lower ferritin and hepcidin at day 28 but not a lower hemoglobin concentration. This trial was registered at clinicaltrials.gov as NCT01093989.

Function of respiratory system evaluated using selected spirometry parameters in persons occupationally exposed to lead without evident health problems

This study aimed at evaluation of selected spirometric parameters in persons occupationally exposed to lead without evident health problems. The studies were conducted on 69 men occupationally exposed to lead. Occupational exposure to lead was characterized by estimation of blood lead concentration (Pb-B) and blood zinc protoporphyrin concentration (ZnPP). Function of respiratory system was examined using spirometric analysis with evaluation of its basic parameters: forced vital capacity (FVC), forced expiratory volume (in 1s) (FEV1), Tiffeneau index (FEV1%VC) and peak expiratory flow (PEF). In the study group negative linear correlations were documented between Pb-B and FVC, FEV 1 and FEV1%VC. A more pronounced age, higher values of BMI and higher blood lead concentration constituted independent risk factors for reduced FEV1%VC. ConclusionPersons occupationally exposed to lead with elevated blood lead concentration and blood zinc protoporphyrin concentration manifested the impaired function of respiratory system, evaluated using parameters of spirometry.

A 60-Year-Old Male With Synchronous Acute Myeloid Leukemia and Metastatic Adenocarcinoma of the Pancreas

This study aimed at evaluation of selected spirometric parameters in persons occupationally exposed to lead without evident health problems. The studies were conducted on 69 men occupationally exposed to lead. Occupational exposure to lead was characterized by estimation of blood lead concentration (Pb-B) and blood zinc protoporphyrin concentration (ZnPP). Function of respiratory system was examined using spirometric analysis with evaluation of its basic parameters: forced vital capacity (FVC), forced expiratory volume (in 1 s) (FEV1), Tiffeneau index (FEV1%VC) and peak expiratory flow (PEF). In the study group negative linear correlations were documented between Pb-B and FVC, FEV 1 and FEV1%VC. A more pronounced age, higher values of BMI and higher blood lead concentration constituted independent risk factors for reduced FEV1%VC.Persons occupationally exposed to lead with elevated blood lead concentration and blood zinc protoporphyrin concentration manifested the impaired function of respiratory system, evaluated using parameters of spirometry.

A multicenter, randomized clinical trial of IV iron supplementation for anemia of traumatic critical illness*.

To evaluate the efficacy of IV iron supplementation of anemic, critically ill trauma patients. Multicenter, randomized, single-blind, placebo-controlled trial. Four trauma ICUs. Anemic (hemoglobin < 12 g/dL) trauma patients enrolled within 72 hours of ICU admission and with an expected ICU length of stay of more than or equal to 5 days. Randomization to iron sucrose 100 mg IV or placebo thrice weekly for up to 2 weeks. A total of 150 patients were enrolled. Baseline iron markers were consistent with functional iron deficiency: 134 patients (89.3%) were hypoferremic, 51 (34.0%) were hyperferritinemic, and 64 (42.7%) demonstrated iron-deficient erythropoiesis as evidenced by an elevated erythrocyte zinc protoporphyrin concentration. The median baseline transferrin saturation was 8% (range, 2-58%). In the subgroup of patients who received all six doses of study drug (n = 57), the serum ferritin concentration increased significantly for the iron as compared with placebo group on both day 7 (808.0 ng/mL vs 457.0 ng/mL, respectively, p < 0.01) and day 14 (1,046.0 ng/mL vs 551.5 ng/mL, respectively, p < 0.01). There was no significant difference between groups in transferrin saturation, erythrocyte zinc protoporphyrin concentration, hemoglobin concentration, or packed RBC transfusion requirement. There was no significant difference between groups in the risk of infection, length of stay, or mortality. Iron supplementation increased the serum ferritin concentration significantly, but it had no discernible effect on transferrin saturation, iron-deficient erythropoiesis, hemoglobin concentration, or packed RBC transfusion requirement. Based on these data, routine IV iron supplementation of anemic, critically ill trauma patients cannot be recommended (NCT 01180894).

Tracking Blood Lead and Zinc Protoporphyrin Levels in Andean Adults Working in a Lead Contaminated Environment

The purpose of this study was to investigate current blood lead (PbB) and zinc protoporphyrin (ZPP) levels in adults presently living in environmentally Pb-contaminated Andean communities, and to compare the findings with the PbB and ZPP levels of Pb-exposed adult cohorts from the same study area tested between 1996 and 2007. Blood samples from 39 adults were measured for PbB and ZPP concentrations. The current mean PbB level (22.7 μg/dl) was significantly lower than the mean (37.9 μg/dl) of the initial 1996 cohort. PbB levels for the 1997, 1998, 2003, and 2006 cohorts were also significantly lower than the levels for the 1996 group. Elevated ZPP/heme ratios of 103.3, 128.4, and 134.2 μmol/mol were not significantly different for the 2006, 2007, and 2012 groups, indicating chronic Pb exposure. While ZPP levels of Andean Ecuadorian Pb-glazing workers have remained elevated, PbB levels declined. Lead exposure of the workers needs to be continually monitored.

Reference intervals for red cell variables and platelet counts in infants at 2, 5 and 13 months of age: a cohort study

AimsTo derive reference values for red cell variables and platelet counts from a cohort of infants sampled at precise ages during the first 13 months of life.MethodsBlood counts, reticulocyte counts...

Echocardiographic assessment of myocardial function in workers occupationally exposed to lead without clinically evident heart disease

PurposeThe aim of the study was to evaluate echocardiographic changes in workers occupationally exposed to low doses of lead. MethodsWe enrolled 63 men occupationally exposed to lead into the study (group I). Unexposed group consisted of 49 healthy men (group II). Blood lead concentration (Pb-B) and blood zinc protoporphyrin concentration (ZnPP) were determined. Transthoracic echocardiographic examination was performed. ResultsIn the studied groups, selected on the criterion of occupational exposure to lead, comparative analysis of echocardiographic parameters indicated statistically significant differences. A negative linear correlations between ZnPP and E′ was observed in group I. It was proved that a higher concentration of ZnPP is independent risk factor of lowering the E′ mean value in group I. ConclusionsOccupational exposure to low doses of lead is associated with the occurrence of discreet morphological and functional heart changes that in the future may predispose to disclosed pathology of heart.

The effect of occupational lead exposure on lipid peroxidation, protein carbonylation, and plasma viscosity

The aim of the study was to investigate the influence of occupational lead (Pb) exposure on lipid peroxidation, protein carbonylation, and plasma viscosity in workers. The examined group included 283 healthy male employees of manufacturing facilities using zinc and Pb. The mean blood concentrations of Pb and zinc protoporphyrin as well as the mean urine δ-aminolevulinic acid levels were used as markers of exposure for the examined group. Taking into account the obtained mean values of blood lead level, the examined group was divided into three subgroups. When comparing the control group with the subgroups, Pb exposure markers were significantly elevated in all the three subgroups. Concentrations of conjugated dienes (CD), lipid hydroperoxides, malondialdehyde (MDA), and protein carbonyl groups were also significantly increased. Conversely, the levels of total protein and protein sulfhydryls were significantly decreased in the subgroups compared with the controls. The plasma viscosity was significantly elevated in the subgroups. A dose-response between Pb levels and plasma viscosity was not observed. Pb supposedly elevates MDA and CD in a dose-dependent manner. In conclusion, occupational Pb exposure induces oxidative stress that results in lipid and protein damage. Moreover, Pb-induced oxidative stress is likely the primary factor that elevates plasma viscosity, despite decreased protein levels.

Comparison of zinc protoporphyrin concentration in capillary whole blood and venous washed red blood cells among young Burkinabe children

BackgroundZinc protoporphyrin (ZPP) is a useful indicator of iron (Fe) status. Washing red blood cells (RBC) prior to ZPP analysis has been advised to avoid false positives in individuals with malaria, but this procedure adds complexity to sample processing.ObjectiveTo compare ZPP in capillary whole blood samples (ZPPcap) and washed RBCs from venous blood (ZPPven) among young Burkinabe children in a malaria endemic region.MethodsCapillary and venous lithium‐heparinized blood samples were collected within 0–4 d in children aged 9 mo (n=592). The RBCs of venous samples were washed twice using saline solution. ZPPcap and ZPPven concentrations were assessed by hematofluorometer (AVIV). Malaria was identified using HRP‐II rapid diagnostic test, and presence of inflammation was based on C‐reactive protein (CRP ≥5 mg/L) and/or α‐1‐acid glycoprotein (AGP ≥1 g/L).ResultsThe median (range) of ZPPcap and ZPPven were 212.3 (20.3–1526.7) and 136.5 (11.5–1455.5) μmol/mol heme, respectively. The mean ZPPcap is higher than the mean ZPPven (p&lt;0.0001), but the log transformed ZPPcap and ZPPven concentrations are highly correlated even in the presence of malaria and inflammation (r=0.88–0.92; p&lt;0.0001).ConclusionUnwashed whole blood can be used to determine Fe deficiency by ZPP, even in the presence of malaria or inflammation.Funded by the Bill &amp; Melinda Gates Foundation.

Comparison of indicators of iron deficiency in Kenyan children

In the absence of a feasible, noninvasive gold standard, iron deficiency (ID) is best measured by the use of multiple indicators. However, the choice of an appropriate single iron biomarker to replace the multiple-criteria model for screening for ID at the population level continues to be debated. We compared ID defined as ≥ 2 of 3 abnormal ferritin (< 12 μg/L), soluble transferrin receptor (TfR; > 8.3 mg/L), or zinc protoporphyrin (ZP; > 80 μmol/mol) concentrations (ie, multiple-criteria model) with ID defined by abnormal concentrations of any of the independent candidate iron biomarkers (ferritin alone, TfR alone, or ZP alone) and TfR/ferritin index (ID, > 500). Values either were adjusted for inflammation [as measured by C-reactive protein (> 5 mg/L) and α(1)-acid glycoprotein (> 1 g/L) before applying cutoffs for ID] or were unadjusted. In this community-based cluster survey, capillary blood was obtained from 680 children (aged 6-35 mo) for measurement of iron status by using ferritin, TfR, and ZP. On the basis of the multiple-criteria model, the mean (±SE) prevalence of ID was 61.9 ± 2.2%, whereas the prevalences based on abnormal ferritin, TfR, or ZP concentrations or an abnormal TfR/ferritin index were 26.9 ± 1.7%, 60.9 ± 2.2%, 82.8 ± 1.6%, and 43.1 ± 2.3%, respectively, for unadjusted values. The prevalences of ID were higher for adjusted values only for low ferritin and an elevated TfR/ferritin index compared with the unadjusted values. The κ statistics for agreement between the multiple-criteria model and the other iron indicators ranged from 0.35 to 0.88; TfR had the best agreement (κ = 0.88) with the multiple-criteria model. Positive predictive values of ID based on the other iron indicators in predicting ID based on the multiple-criteria model were highest for ferritin and TfR. Receiver operating characteristic curve analysis indicated that TfR (AUC = 0.94) was superior to the other indicators in diagnosing ID based on the multiple-criteria model (P < 0.001). The inflammation effect did not appear to alter these observations appreciably. TfR better estimates the prevalence of ID in preschoolers than do ferritin, ZP, and the TfR/ferritin index on the basis of multiple indexes in a high inflammation, resource-poor setting. This trial was registered at clinicaltrials.gov as NCT101088958.