Environmental exposure to cadmium (Cd) or lead (Pb) is independently associated with increased risks of type 2 diabetes, and chronic kidney disease. The aim of this study was to examine the effects of concurrent exposure to these toxic metals on the risks of diabetes and kidney functional impairment. The Cd and Pb exposure levels among study subjects were low to moderate, evident from the means for blood concentrations of Cd and Pb ([Cd]_b and [Pb]_b) of 0.59 µg/L and 4.67 µg/dL, respectively. Of 176 study subjects (mean age 60), 71 (40.3%) had abnormally high fasting plasma glucose levels. Based on their [Cd]_b and [Pb]_b, 53, 71, and 52 subjects were assigned to Cd and Pb exposure profiles 1, 2, and 3, respectively. The diagnosis of diabetes was increased by 4.2-fold in those with an exposure profile 3 (p = 0.002), and by 2.9-fold in those with the estimated glomerular filtration (eGFR) ≤ 60 mL/min/1.73 m² (p = 0.029). The prevalence odds ratio (POR) for albuminuria was increased by 5-fold in those with plasma glucose levels above kidney threshold of 180 mg/dL (p = 0.014), and by 3.1-fold in those with low eGFR) (p = 0.050). Collectively, these findings suggest that the Cd and Pb exposure profiles equally impact kidney function and diabetes risk.

Background: The adult population in lead-related occupations or environmentally exposed to lead may be at risk for renal impairment and lead nephropathy. This meta-analysis aims to determine the impact of blood lead level (BLL) on renal function among middle-aged participants. Methods: Cross-sectional, longitudinal, or cohort studies that reported BLL and renal function tests among adult participants were retrieved from PubMed, Scopus, and ISI Web of Science. Relevant studies were included and assessed for quality using the Newcastle–Ottawa Scale (NOS). The pooled mean BLL of participants with a high BLL (≥30 µg/dL), moderate BLL (20–30 µg/dL), and low BLL (<20 µg/dL) was estimated using the random effects model. The pooled mean differences in BLL, blood urea nitrogen (BUN), creatinine, uric acid, and creatinine clearance between the exposed and non-exposed participants were estimated using the random effects model. Meta-regression was performed to demonstrate the association between the effect size (ES) of the pooled mean BLL and renal function. Heterogeneity among the included studies was assessed using the Cochrane Q and I² statistics. Cochrane Q with a p value less than 0.05 and I² more than 50% demonstrated substantial heterogeneity among the studies included. Publication bias was assessed using the funnel plot between the effect size and standard error of the effect size. Results: Out of 1657 articles, 43 were included in the meta-analysis. The meta-analysis demonstrated that the pooled mean BLL in the participants with a high BLL, moderate BLL, and low BLL was 42.41 µg/dL (95% confidence interval (CI): 42.14–42.67, I²: 99.1%), 22.18 µg/dL (95% CI: 21.68–22.68, I²: 60.4%), and 2.9 µg/dL (95% CI: 2.9–2.9, I²: 100%), respectively. The mean BLL of the exposed participants was higher than that of the non-exposed participants (weighted mean difference (WMD): 25.5, p < 0.0001, 95% CI: 18.59–32.45, I²: 99.8%, 17 studies). The mean BUN (WMD: 1.66, p < 0.0001, 95% CI: 0.76–2.55, I²: 76%, 10 studies) and mean creatinine (WMD: 0.05, p = 0.007, 95% CI: 0.01–0.08, I²: 76.8%, 15 studies) in the exposed participants were higher than those in the non-exposed participants. The mean creatinine clearance in the exposed participants was lower than that in the non-exposed participants (standard mean difference (SMD): −0.544, p = 0.03, 95% CI: −1.035–(−0.054), I²: 96.2%). The meta-regression demonstrated a significant positive effect of BLL on BUN (p = 0.022, coefficient: 0.75, constant: −3.7, 10 studies). Conclusions: BLL was observed to be associated with abnormal renal function test parameters, including high BUN, high creatinine, and low creatinine clearance. Moreover, BUN seemed to be the most valuable prognostic marker for lead-induced renal impairment. Therefore, regular checks for renal function among lead-exposed workers should be a priority and publicly promoted.

Background: Little information is available about malaria and scrub typhus co-infection. This study aimed to investigate the pooled prevalence of malaria and scrub typhus co-infection in febrile patients. Further, it aimed to estimate the prevalence of scrub typhus infection among patients with malaria and the odds of co-infection. This will aid the diagnosis and management of co-infected patients in endemic areas.Methods: We searched for relevant studies in three databases: PubMed, Scopus, and Web of Science. We assessed the quality of the included studies using the Joanna Briggs Institute checklist for analytical cross-sectional studies. We estimated (1) the pooled prevalence of malaria and scrub typhus co-infection, (2) the pooled prevalence of scrub typhus infection in malaria-positive patients, and (3) the pooled odds of co-infection using the DerSimonian–Laird method for random-effects models. The study results and summary estimates were visualized on a forest plot as point estimates (effect size, prevalence) and 95% confidence intervals (CI). We assessed the heterogeneity of the studies by Cochrane Q orI²statistics. We performed subgroup analyses of countries and scrub typhus diagnostic tests to explore the sources of heterogeneity of the included studies. We assessed publication bias if more than 10 studies were used to estimate the outcome. All data analyses were conducted using Stata version 14 (StataCorp, College Station, TX, USA).Results: Of the 542 studies retrieved from three databases, we included 14 meeting the inclusion criteria in the systematic review and meta-analysis. The pooled prevalence of malaria and scrub typhus co-infection (56 cases) among febrile patients (7920 cases) was 1% (95% CI: 0–1%,I²: 78.28%), while the pooled prevalence of scrub typhus infection (321 cases) in patients with malaria (1418 cases) was 21% (95% CI: 12–30%,I²: 98.15%). Subgroup analysis showed that the pooled prevalence of scrub typhus infection among patients with malaria in India was 8% (95% CI: 4–13%,I²: 85.87%, nine studies with 59/794 cases), while the pooled prevalence of scrub typhus infection among patients with malaria in Thailand was 35% (95% CI: 7–64%,I²: 98.9%, four studies with 262/624 cases). The co-infections did not occur by chance (P = 0.013, odds: 0.43, 95% CI: 0.22–0.84%,I²: 60.9%). In the sensitivity analysis, the pooled prevalence of malaria and scrub typhus co-infection among febrile patients was 0% (95% CI: 0–1%,I²: 59.91%).Conclusions: The present study showed the pooled prevalence and a significant association between malaria and scrub typhus. The results show the status of co-infection. Further research into co-infection in endemic areas is needed, in particular, to determine whether co-infection can accelerate disease progression or protect against severe disease.Graphical

Introduction/Objectives: Type 2 diabetes (T2D) continues to pose a substantial global public health challenge. Current evidence has linked an increase in the risk of T2D to chronic exposure to the heavy metals cadmium (Cd) and lead (Pb). The present study aimed to examine whether the reported links existed in an area of southern Thailand with known Pb contamination. Materials and Methods: A case–control study design was used to recruit 88 diagnosed T2D cases and 90 age-, gender- and locality-matched non-diabetic controls. Blood levels of Cd and Pb were used as exposure indicators. Exposure-related risk factors and socio-demographic data were collected through questionnaires. Results: A significant association was found between blood Pb and T2D diagnosis, but the association between blood Cd and T2D was not statistically significant. Factors related to high Pb exposure were education, occupation, income, smoking habits, alcohol consumption, and dietary patterns, particularly the consumption of sweet and fatty foods. Participants with higher blood Pb levels had poorer glycemic control, thereby suggesting potential interference of Pb with oral hypoglycemic agents. Conclusions: This study confirms the connection between Pb exposure and increased risk of having T2D. Additionally, it identified socio-demographic factors, and consumption habits that contributed to such an enhanced T2D risk. The role of Cd exposure requires further studies, using urinary Cd excretion, which reflects long-term exposure conditions. These findings suggest the need to incorporate environmental and occupational exposure in diabetes care strategies. From the clinical and public health perspectives, targeted interventions should focus on reducing heavy metal exposure, improving risk awareness, and strengthening occupational safety measures to prevent disease progression.

The present study explored environmental and behavioral factors associated with elevated blood lead (Pb) levels in 311 children (151 girls and 160 boys), aged 3–7 years, who lived in a coastal fishing community of the Pakpoon Municipality, Nakhon Si Thammarat, Thailand. The geometric mean for blood Pb was 2.81 µg/dL, ranging between 0.03 and 26.40 µg/dL. The percentage of high blood Pb levels, defined as blood Pb ≥ 5 µg/dL, was 10.0% in boys and 13.9% in girls. Parental occupation in producing fishing nets with lead weights was associated with a marked increase in the prevalence odds ratio (POR) for high blood Pb (POR 17.54, 95%; CI: 7.093, 43.390; p < 0.001), while milk consumption was associated with 61% reduction in the POR for high blood Pb (POR 0.393, 95%; CI: 0.166, 0.931; p = 0.034). High blood Pb was associated with an increased risk for abnormal growth (POR 2.042, 95%; CI: 0.999, 4.174; p = 0.050). In contrast, milk consumption was associated with a 43% reduction in POR for abnormal growth (POR 0.573, 95%; CI: 0.337, 0.976; p = 0.040). After adjustment for age, the mean (standard error of mean, SE) values for blood Pb were 6.22 (0.50) μg/dL in boys and 6.72 (0.49) μg/dL in girls of parents with an occupation in making fishing nets with lead weights. These mean blood Pb values were respectively 2.3 and 2.5 times higher than similarly aged boys and girls of parents with other occupations. These data are essential for setting surveillance and programmes to prevent toxic Pb exposure, especially in children of coastal fishing communities in southern Thailand.

Background and Aim: Alzheimer’s disease (AD) poses a significant health-care challenge, often linked to cognitive decline caused by oxidative stress. This study investigated the potential neuroprotective effects of the Paederia foetida leaf extract (PFE) in rats that exhibited scopolamine-induced dementia mimicking AD. Materials and Methods: Forty-two male rats were treated with either donepezil (0.5 mg/kg) or PFE at doses of 250, 500, and 1000 mg/kg for 14 days before and 14 days after the beginning of Alzheimer’s-like symptoms after 14 consecutive days of scopolamine administration. Behavioral tests, including the open-field test for locomotor activity and the Morris water maze task for learning and memory assessment, were conducted. Neuronal cell counts and biochemical assays were performed to further analyze outcomes. Results: All groups exhibited normal locomotor activity. The scopolamine group displayed longer escape latency times, reduced time in the target quadrant, decreased number of surviving neurons, and increased malondialdehyde and decreased glutathione levels compared with the control group. However, pre-treatment with 1000 mg/kg PFE notably mitigated the neurotoxic effects of scopolamine. Conclusion: The neuroprotective properties of PFE are highlighted, suggesting its potential as a promising treatment strategy for AD. Keywords: Alzheimer’s disease, neuroprotection, oxidative stress, Paederia foetida, scopolamine.