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Background: Lead (Pb), cadmium (Cd) and mercury (Hg) are toxic trace elements that represent a public health problem as risk factors for cardiovascular disease and hypertension (HT) and could also contribute to the development of resistant hypertension (rHT) AIMS: To compare the blood concentrations of Pb, Cd and Hg in subjects with resistant and non-resistant HT and to define whether there is a relationship between its levels and rHT., Methods: Cross-sectional study. Subjects aged ≥ 21 to ≤ 80 years with a body mass index < 40 kg/m2 were recruited on a discretionary basis from October 2001 to October 2004 in a hypertension unit of a tertiary hospital amongst those sent to the hypertension unit by their family physician. Resistant hypertension was defined according to the American Heart Association (AHA) criteria. Whole blood concentrations of Cd, Pb and Hg were measured by electrothermal atomic absorption spectrometry., Results: 46 out of 73 included subjects (63%) suffered from rHT. Blood Pb median: HT 3.9 (IQR 2.7-5.2) vs. rHT 3.6 (IQR 2.8-6.0) µg/dL (p=0.941). Blood Cd median: HT 0.07 (IQR 0.07-0.80) vs. rHT 0.30 (IQR 0.07-0.65) µg/L (p=0.681). Blood Hg median: HT 7.9 (IQR 5.8-12.9) vs. rHT 7.3 (IQR 4.6-13.3) µg/L (p=0.611). Considering the 75th percentile of each element (Pb: 5.55 µg/dL, Cd: 0.75 µg/L, Hg: 13.15 µg/L), a multiple logistic regression analysis (adjusted for age, BMI, diabetes mellitus, clearance of creatinine and only for Cd the smoking habit) showed an OR = 3.44 (0.84-14.10, p=0.086) for Pb, OR = 1.80 (0.39-8.24, p=0.451), for Cd and OR = 2.31 (0.59-9.14, p=0.232) for Hg. Moreover, the stratified analyses showed that men with Pb ≥5.55 µg/dL have a 14 times higher risk of suffering from rHT (p=0.026). Interestingly, a 9-fold increased risk was found for non-obese subjects with elevated Pb levels, above 5.55 µg/dL (p=0.029). Also in men, the probability of suffering from rHT was more than 7 times higher if Cd levels were ≥ 0.75 µg/L (p=0.076). Most smokers had higher Cd levels, with a high risk of suffering from rHT (ORa 12.6 (0.8-200.2), p=0.072)., Conclusion: A higher blood Pb levels, defined by the 75th percentile (Pb ≥ 5.55 µg/dL), is associated with a greater risk of suffering from rHT and to a lesser extent in the case of Cd and Hg., Competing Interests: Declaration of Competing Interest No conflicts of interest related to this work are declared., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Aim: Pathologies associated with gluten intake are increasingly prevalent. Diagnosis of celiac disease (CD) or non-celiac gluten sensitivity (NCGS) is based on compatible clinical alterations and in case of CD on compatible serology or intestinal biopsy. The aim was to determine the values of iron, vitamins and minerals prior to diagnosis and to verify whether a gluten-free diet treatment can cause the normalization of these parameters both in patients diagnosed with celiac disease and gluten sensitivity. METHODS: Retrospective observational study from November 2016 to November 2021. 101 celiac patients and 26 with NCGS were included, all under 18 years of age. Levels of Fe, Na+ , K+ , Cl-, Ferritin, Ca2 + , P, Vitamin B12, Vitamin D and Transferrin were determined, following the quality standards of the Hospital Clínico San Carlos laboratory. Statistical software IBM SPSS Statistics v.26 was used., Results: Calcium levels in celiac patients follow a positive trend after 3 months of gluten-free diet. Ferritin levels in patients with NCGS increased in a statistically significant way (p < 0.017)., Conclusion: Calcium in the CD group increases its values after the establishment of a gluten-free diet as treatment, as well as ferritin in patients with NCGS. No significant changes were found in the rest of the analyzed parameters. This could be due to the precocity of the diagnosis thanks to a rapid clinical suspicion that determines few analytical alterations., Competing Interests: Declaration of Competing Interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Measurements of inorganic elements in clinical laboratories produce results used for the diagnosis, the treatment and the monitoring of deficiencies or overloads. The main objective of External Quality Assessment Schemes is to verify, on a regular frequency, that clinical laboratory results correspond to the quality requirement for patient care. Therefore, External Quality Assessment Schemes represent an essential component of a laboratory's quality management system. However, External Quality Assessment Schemes within the same analytical field remain heterogeneous for different reasons such as samples, determination of assigned value, acceptable limits, content of the reports. The aim of this review was to describe and illustrate some major critical aspects of External Quality Assessment Schemes based on Occupational and Environmental Laboratory Medicine external quality assessment scheme experience., Competing Interests: Declaration of Competing Interest The authors are either employees from public institutions (J Arnaud, I De Graaf, MB Fofou-Caillierez, M González-Estecha, M Patriarca, V Patriarca, M Ropert-Bouchet, L Schröer-Janssen, C Siebelder, M Te Winkel, C Weykamp) or from non-governmental non-profit associations (MC González Gómez, M Ventura Alemany). They do not receive any financial support linked to the OELM scheme. The participating laboratory annual fees are managed by a public institution in Italy: Istituto Superiore di Sanita (ISS) or non-governmental non-profit associations in the other countries: Societé Francaise de Toxicologie Analytique (SFTA) for France, Stichting Kwaliteits Bewaking Medische Laboratoria (SKML) for the Netherlands and Sociedad Española de Medicina de Laboratorio (SEQC(ML)) for Spain. The examples that illustrate this review are based on objective analyses of OELM data or on past published research reports., (Copyright © 2019. Published by Elsevier GmbH.)

Background: No safe blood lead concentration in children has been identified. Lead can affect nearly every system in the body and is especially harmful to the developing central nervous system of children. The aim of this study is to analyze blood lead in a population of children and its association with sociodemographic variables, biochemical parameters, copper, iron, selenium and zinc., Methods: We recruited 155 children (86 boys and 69 girls) with a mean age of 7.3 (SD:4.1). Blood lead and serum selenium concentrations were measured by electrothermal atomic absorption spectrometry. Serum copper and zinc concentrations were measured by flame atomic absorption spectrometry. Serum iron levels were determined by colorimetric assay. A risk exposure questionnaire for lead was administered to the participants., Results: The median blood lead level was 1.1 (IQR 0.7-1.6) μg/dL. Regarding risk exposure factors, the youngest children (<2 years) who played outdoors presented a median blood lead concentration of 1.1 μg/dL IQR: 0.48-1.48, compared to the median of 0.3 μg/dL IQR:0.2-0.48 in the children who stated they played at home (p = 0.024). Significant differences were also found when taking into account those parents who smoked (median 1.3 IQR 0.8-1.9 μg/dL vs 0.9 IQR 0.5-1.4 μg/dL of non-smokers, p = 0.002). Children who drank tap water had higher blood lead levels (median 1.2 IQR 0.7-1.6 μg/dL) than those who drank bottled water (median 0.7 IQR 0.2-1.3 μg/dL p = 0.014). In addition, children whose mothers had not finished school had higher blood lead levels (median 1.7 IQR 1.2-2.3 μg/dL) than those whose mothers had finished school (median 1.2 IQR 0.7-1.7 μg/dL) and those whose mothers had gone to university (median 0.9 IQR 0.5-1.4 μg/dL) p = 0.034. In the multivariate lineal regression analysis we continue to observe the association between mother's higher level of education and lower blood levels (p = 0.04) and the interaction between age and outdoor play (p = 0.0145)., Conclusions: In spite of the decline in blood lead concentrations, associated risk factors continue to exist in vulnerable populations such as children., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Introduction: Several studies have shown an inverse relationship between selenium status and cardiovascular health, although epidemiologic evidence yielded by the randomized trials did not find a beneficial effect of selenium administration. The aim of this study was to analyze the association between serum selenium levels and lipid profile adjusted by age, sex and other associated factors among a general adult population in Spain., Materials and Methods: We recruited 372 hospital employee volunteers (60 men and 312 women) with a mean age of 47 (SD: 10.9), whom were given a standardized questionnaire. Serum selenium concentration was measured by electrothermal atomization atomic absorption spectrometry. Serum copper and zinc concentrations were measured using flame atomic absorption spectrometry., Results: The mean of serum selenium was 79.5μg/L (SD: 11.7) with no sex-dependent differences. In the multivariate linear regression analysis, the associated factors with the mean levels of selenium were: age (β=0.223; CI 95%: 0.101-0.345), p<0.001; widowhood (β=-9.668; CI 95%: -17.234 to -2.102), p=0.012; calcium supplements (β=3.949; CI 95%: 0.059-7.838), p=0.047; zinc (β=0.126; CI 95%: 0.013-0.238), p=0.028 and glucose (β=0.172; CI 95%: 0.062- 0.281), p=0.002; Participants with serum selenium≥79.5μg/L were 1.98 (OR=1.98; CI 95% 1.17-3.35; p=0.011) and 2.04 times (OR=2.04; CI 95% 1.06-3.97; p=0.034) more likely to have cholesterol ≥200mg/dL and LDL-c ≥100mg/dL respectively than those with serum selenium <79.5μg/L., Conclusions: Higher selenium was positively associated with increased total and LDL cholesterol but not with HDL-c and triglycerides. More studies are needed in order to confirm the lower serum selenium findings in widows., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

In Spain, recently, the public institutions have given information to the population in relation to fish consumption and the risk that it poses to health from the ingestion of mercury supposedly contained in the fish. At the same time, several scientific societies have published various works in this direction. All this without there being, up to now, any study on the evaluation of a probabilistic risk from mercury due to fish and seafood intake in Spain, which is the objective of this present work. For that purpose, we took individual data from a survey of the total diet of 3000 people, whose consumption of the principal fish and seafood species (49) was estimated. We compiled individualized data (2000) on the total mercury content of those species, which were completed and validated with bibliographic statistical data. After estimating the distributions of each fish and seafood species, both of their consumption and their mercury content, a simulation was made of the distribution of mercury ingestion from fish and seafood offered by 2.6% of the Spanish population at risk of exceeding total mercury recommendations, and between 12.2% and 21.2% of those exceeding methylmercury ones. The main species responsible were tuna fish, swordfish and hake, and significant differences were identified in fish consumption between sexes and ages, although, in the risk percentage, what stands out is an increase in the latter with an increase in age., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

The beneficial effects of fish consumption in both children and adults are well known. However, the intake of methylmercury, mainly from contaminated fish and shellfish, can have adverse health effects. The study group on the prevention of exposure to methylmercury (GEPREM-Hg), made up of representatives from different Spanish scientific societies, has prepared a consensus document in a question and answer format, containing the group's main conclusions, recommendations and proposals. The objective of the document is to provide broader knowledge of factors associated with methylmercury exposure, its possible effects on health amongst the Spanish population, methods of analysis, interpretation of the results and economic costs, and to then set recommendations for fish and shellfish consumption. The group sees the merit of all initiatives aimed at reducing or prohibiting the use of mercury as well as the need to be aware of the results of contaminant analyses performed on fish and shellfish marketed in Spain. In addition, the group believes that biomonitoring systems should be set up in order to follow the evolution of methylmercury exposure in children and adults and perform studies designed to learn more about the possible health effects of concentrations found in the Spanish population, taking into account the lifestyle, eating patterns and the Mediterranean diet., (Copyright © 2015 Elsevier GmbH. All rights reserved.)

Introduction: Trace elements may play an important role in bipolar disorders. The objective of this study is to determine serum copper and zinc, blood lead and cadmium and urine lead, cadmium and thallium concentrations in patients diagnosed with bipolar disorders and to compare these levels with those of a healthy control group., Materials and Methods: A total of 25 patients diagnosed with bipolar disorder and 29 healthy subjects participated in this study. Serum copper and zinc concentrations were measured using flame atomic absorption spectrometry; the blood lead and cadmium concentrations were measured by electrothermal atomization atomic absorption spectrometry with Zeeman background correction; urine lead, cadmium and thallium concentrations were measured by inductively coupled plasma mass spectrometry., Results: Median blood and urine lead and cadmium levels were significantly higher among the bipolar patients than among the control group: Blood lead (μg/dL): patient median: 3.00 (IQR: 1.40-4.20); control median (μg/dL): 2.20 (IQR: 0.90-3.00) p=0.040. Blood cadmium (μg/L): patient median: 0.39 (IQR: 0.10-1.15); control median: 0.10 (IQR: 0.10-0.17) p<0.001. The median of cadmium (μg/L) in patients who smoked (1.20 IQR: 0.44-2.30) was higher than that in non-smokers (0.12 IQR: 0.10-0.34) p<0.001. There was a statistically significant increase (p=0.001) in zinc levels among patients in the manic phase (mean 111.28, SD: 33.36 μg/dL) with respect to the control group (mean 86.07, SD: 12.39 μg/dL)., Conclusions: The results suggest that there could be higher levels of some toxic trace elements in the group of patients with bipolar disorder than in the healthy control group., (Copyright © 2010 Elsevier GmbH. All rights reserved.)

Introduction: Exposure to lead and cadmium is a public health problem due to the broad exposure to these toxic substances among the general population. The objective of this study is to determine blood lead and cadmium concentrations in a working population drawn from six university hospitals in Madrid, Getafe, Cartagena, Santiago de Compostela, Santander and Palma de Mallorca (Spain) and to identify associated factors., Materials and Methods: 951 individuals participated in the study and were administered the standardized PESA® questionnaire regarding exposure to lead and cadmium. The blood lead and cadmium concentrations were measured by electrothermal atomization atomic absorption spectrometry with Zeeman background correction in Perkin-Elmer spectrometers, guaranteeing the transferability of the results., Results: The median overall blood lead concentration was: 1.6 μg/dL (IQR: 0.9-2.7) and that of cadmium was: 0.21 μg/L (IQR: 0.10-0.50). There were significant differences in lead levels between men (2 μg/dL) and women (1.5 μg/dL), postmenopausal (2.6 μg/dL) and premenopausal women (1.1 μg/dL), and between participants who cooked in earthenware (2.1 μg/dL) and those who did not (1.5 μg/dL). The median of cadmium in women (0.24 μg/L) was higher than in men (0.11 μg/L) and was also higher in subjects who smoked (0.70 μg/L) than in non-smokers (0.13 μg/L)., Conclusions: A reduction in blood lead and cadmium levels was observed with respect to previous studies carried out in Spain. Nevertheless, the results suggest there are certain factors which increase risk such as age, gender, menopause, age of housing, cooking in lead-glazed earthenware and exposure to cigarette smoke., (Copyright © 2010 Elsevier GmbH. All rights reserved.)

The aim of this study was to evaluate the relationship between cerium content in human breast milk and blood plasma or serum. Blood samples and breast milk at various stages of lactation, from 5 days to 51 weeks post partum, were donated by 42 healthy breast-feeding mothers from Munich, Germany and by 26 lactating Spanish mothers from Madrid at 4 weeks post partum. Inductively coupled plasma mass spectrometry was applied for the determination of cerium in the biological samples. Cerium concentration in the digested milk samples from Munich showed low values and the arithmetic mean values ranged between the quantification limit of 5 ng/L up to 65 ng/L. The median value amounted to 13 ng/L. The cerium concentrations in the Spanish breast milk samples amounted to similar low values. The data were about a factor of eight lower than values found in a former study of samples from an eastern German province. All cerium concentrations in the German plasma samples, except for two, were at the quantification limit of 10 ng/L. Interestingly, the serum samples of the Spanish mothers showed cerium values ranging between 21.6 and 70.3 ng/L; these higher data could be explained by an enhanced intake of cerium by humans in Madrid. This could be caused by increased cerium concentrations in particulate matter due to a higher traffic volume in Madrid compared to Munich. The results obtained in this study contribute to setting reference baseline values of cerium in human breast milk and blood plasma/serum and indicate a varying cerium amount depending on the cerium environmental pollution. Possibly, the cerium content in plasma/serum could be an indicator for environmental cerium, which is not valid for breast milk., (Copyright 2010 Elsevier GmbH. All rights reserved.)

The aim of this study is to investigate the effects of angiotensin-converting enzyme (ACE) inhibitors and furosemide on zinc metabolism by assessing serum zinc and urine levels in hospitalized subjects. We recruited 11 patients with heart failure from the Internal Medicine Department; these patients had been hospitalized less than 72 h before. Heart failure was defined using clinical and radiological signs. Serum zinc concentrations were measured using an air/acetylene flame atomic absorption spectrophotometer. Urine zinc levels were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Data were obtained from the 11 patients and 24 healthy controls matched for age and sex. Results indicate higher urine zinc levels and lower concentrations of zinc in serum in heart failure patients vs matched controls (p<0.05). This study suggests that treating heart failure patients with ACE inhibitors may result in zinc deficiency.