Iman Al-Saleh

King Faisal Specialist Hospital and Research Centre, Ar Riyāḑ, Ar Riyāḑ, Saudi Arabia

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Publications (69)142.94 Total impact

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    ABSTRACT: This cross-sectional study analyzed mercury (Hg) levels in healthy Saudi mothers and their infants (age 3-12 months) and examined the influence of Hg on the infants' neurodevelopment using screening tools, such as the Denver Developmental Screening Test II (DDST-II) and Parents' Evaluation of Developmental Status (PEDS). A total of 944 mothers and their 944 infants were recruited from 57 Primary Health Care Centers (PHCCs) in Riyadh. The total Hg (THg) levels were measured in the mothers' and infants' urine (UTHg-M and UTHg-I) and hair (HTHg-M and HTHg-I) samples and in the breast milk and mothers' blood. Methylmercury (MeHg) levels were determined in hair samples from the mothers (MeHg-M) and infants (MeHg-I). Only 40.1% of the infants were breast-fed when enrolled, and 59.9% had stopped breastfeeding. Only 1.8% of the mothers and 0.3% of the infants had MeHg levels above the Environmental Proection Agency (EPA) reference dose (1μg/g), with low medians of 0.132 and 0.091μg/g dw, respectively, but the MeHg levels were significantly associated with infant DDST-II performance. The levels of corrected UTHg-M for creatinine (Cr), HTHg-M, HTHg-I, and HMeHg-M, however, displayed an association with infant PEDS performance. The medians and percentage of the tested population that exceeded the recommended limits for Hg in urine and hair set by the World Health Organization (5μg/g Cr) and EPA (1μg/g) were 0.695μg/g Cr and 3% UTHg, 0.118μg/g dw and 4.1% HTHg-M, 0.101μg/g dw and 2.8% HTHg-I, and 0.132μg/g dw and 1.8% HMeHg-M. Our study provides evidence of an association between some Hg measures and delays in infant neurodevelopment, despite their low levels and regardless of the infant's breastfeeding status. The results are of potential concern, because delayed psychomotor or mental performance in infants could be an indicator of later neurocognitive development in children, which may persist into adulthood, as shown in other studies. The absence of local standardization of the DDST-II and PEDS screening tools might raise some questions, although the DDST-II has been used in local institutions for a number of years. The development of effective standardized developmental screening tools is necessary to ensure that all children at risk of neurodevelopmental problems early in life are identified so that they can receive appropriate and timely intervention.
    International journal of hygiene and environmental health 11/2015; 219(1). DOI:10.1016/j.ijheh.2015.10.002 · 3.83 Impact Factor
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    ABSTRACT: A total of 1016 healthy Saudi mothers and their respective infants (aged 3–12 months) were recruited from 57 Primary Health Care Centers (PHCCs) in Riyadh, Saudi Arabia, to evaluate the extent of mercury (Hg) exposure and predict its sources in the healthy Saudi population. Total Hg levels were measured in maternal urine, breast milk, blood, and hair and in the infants’ urine and hair. Only 1.9 % of the mothers had urinary Hg (UHg) >10 μg/l, the limit for asymptomatic adults recommended by the World Health Organization, but the median (0.99 μg/l) was higher than in other countries. Also, 49.3 % of the mothers had UHg >1 μg/l, the German reference value for adults. Median infant UHg was 0.729 μg/l, and 77 and 93 % of the infants had levels higher than 0.4 and 0.1 μg/l, the reference values of the Centers for Disease Control and Prevention and for Germany, respectively. The median Hg level in breast milk was 0.884 μg/l. Even though 43.2 % of the milk samples were above the background level for Hg in human milk (1 μg/l), our results were lower than those reported from other countries. Median maternal total Hg in blood was 0.637 μg/l, and only 0.4 and 6.9 % of samples were higher than the Hg reference levels of 5.8 μg/l of the Environmental Protection Agency (EPA) and of 2 μg/l for Germany, respectively. Total Hg levels in hair (HHg) varied widely among mothers and infants, but only 3.9 % of the mothers and 2.8 % of the infants had HHg >1 μg/g (the EPA reference level). Median HHg values were 0.117 μg/g dry weight in mothers and 0.1 μg/g dry weight in infants; both were lower than in other countries. The Hg levels in mothers and their respective infants were relatively low, but our results were consistent with other studies indicating that dental amalgam fillings and fish consumption were the main predictors of maternal Hg exposure. Among the several biomarkers of Hg exposure, Hg levels in maternal hair and urine were the strongest predictors of infant exposure. The lack of an association between Hg in breast milk and Hg in infant urine and hair suggested that the infants were exposed to Hg predominately during pregnancy rather than during breastfeeding. We expect that our data can serve as a baseline for further biomonitoring and follow-up studies, particularly of the long-term impact of Hg on childhood neurodevelopment.
    Environmental Monitoring and Assessment 11/2015; 187(11). DOI:10.1007/s10661-015-4858-y · 1.68 Impact Factor
  • Iman Al-Saleh · Rola Elkhatib ·
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    ABSTRACT: In the last few years, the use of phthalates in perfumes has gained attention because these chemicals are sometimes added intentionally as a solvent and a fixative. Five phthalate esters, dimethyl phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), benzyl butyl phthalate (BBP), and diethyl hexyl phthalate (DEHP), were measured in 47 branded perfumes using headspace solid phase microextraction (SPME) followed by gas chromatography-mass spectrometry (GC-MS). The results revealed considerable amounts of phthalate in all 47 brands with detection frequencies > limit of quantitation in the following order: DEP (47/47) > DMP (47/47) > BBP (47/47) > DEHP (46/47) > DBP (23/45). Of the 47 brands, 68.1, 72.3, 85.1, 36.2, and 6.7 % had DEP, DMP, BBP, DEHP, and DBP levels, respectively, above their reported threshold limits. Of these phthalates, DEP was found to have the highest mean value (1621.625 ppm) and a maximum of 23,649.247 ppm. The use of DEP in the perfume industry is not restricted because it does not pose any known health risks for humans. DMP had the second highest level detected in the perfumes, with a mean value of 30.202 ppm and a maximum of 405.235 ppm. Although DMP may have some uses in cosmetics, it is not as commonly used as DEP, and again, there are no restrictions on its use. The levels of BBP were also high, with a mean value of 8.446 ppm and a maximum of 186.770 ppm. Although the EU banned the use of BBP in cosmetics, 27 of the tested perfumes had BBP levels above the threshold limit of 0.1 ppm. The mean value of DEHP found in this study was 5.962 ppm, and a maximum was 147.536 ppm. In spite of its prohibition by the EU, 7/28 perfumes manufactured in European countries had DEHP levels above the threshold limit of 1 ppm. The DBP levels were generally low, with a mean value of 0.0305 ppm and a maximum value of 0.594 ppm. The EU banned the use of DBP in cosmetics; however, we found three brands that were above the threshold limit of 0.1 ppm, and all were manufactured in European countries. The results of this study are alarming and definitely need to be brought to the attention of the public and health regulators. Although some phthalate compounds are still used in cosmetics, many scientists and environmental activists have argued that phthalates are endocrine-disrupting chemicals that have not been yet proven to be safe for any use, including cosmetics. Phthalates may also have different degrees of estrogenic modes of action. Furthermore, we should not dismiss the widespread use of phthalates in everyday products and exposure to these chemicals from sources such as food, medications, and other personal care products.
    Environmental Science and Pollution Research 08/2015; DOI:10.1007/s11356-015-5267-z · 2.83 Impact Factor
  • Iman Al-Saleh · Rola Elkhatib ·
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    ABSTRACT: Fruit juices are popular beverages regularly consumed by both adults and children. Various brands of different fruit juices in Saudi markets are packaged in disposable plastic bottles made of polyethylene terephthalate (PET). Some evidence suggests that phthalates may leach from PET bottles. Few studies have analyzed the presence or assessed the risk of phthalates in fruit juice. The concentrations of dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DBP), benzyl butyl phthalate (BBP), diethyl hexyl phthalate (DEHP), and di-n-octylphthalate (DOP) were measured in seven brands of commercially manufactured apple juice available in the Saudi market using solid-phase microextraction connected to gas chromatography-mass spectrometry. Nearly all targeted compounds were found in the brands of juice, with DOP being detected in all samples. Of 70 samples of apple juice, 11, 39, 2, 11 and 11 had levels of DEP, DBP, BBP, DEHP, and DOP, respectively, above their limit of quantification (LOQ). These phthalates may have either leached into the juice from the PET bottles or were contaminants during manufacturing. Benzyl benzoate (BB) was used as an internal standard, and was unexpectedly found in two brands of apple juice, which forced us to use external calibration method for quantifying the phthalates and to measure BB concentrations in these two brands. All samples were above the LOQ of 0.628 µg/L. BB exposure via the consumption of apple juice may represent a negligible risk, but the use of BB in cosmetics, personal-care products, and as a preservative in food demands studies to assess its potential impact on health. With the absence of regulations governing the safety of contaminants in these products, the presence of phthalates in apple juice or other dietary sources could pose a health risk to consumers.
    Journal of Food Measurement and Characterization 12/2014; 8(4):373-380. DOI:10.1007/s11694-014-9202-7
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    ABSTRACT: To our knowledge, this study may be the first to examine the antagonistic role of selenium (Se) on oxidative stress induced by cadmium (Cd) and its impact on birth measures. Cd and Se levels were measured in umbilical-cord blood and the placentas of a subsample of 250 healthy mothers who participated between 2005 and 2006 in the project “Prenatal Exposure to Pollutants”. The median Cd levels in cord and maternal blood and placental tissue were 0.78 μg/l, 0.976 μg/l and 0.037 μg/g dry wt., respectively. The median levels of Se in cord serum and placental tissue were 65.68 μg/l and 1.052 μg/g dry wt., respectively. Se was more than 100-fold in molar excess over Cd in both cord serum and placental tissue. The median molar Cd/Se ratios in cord serum and placental tissue were 0.008 and 0.024, respectively, which were much lower than unity. This study suggests that both Cd and Se play a role in the mechanism of oxidative stress, but, the process underlying this mechanism remains unclear. Nevertheless, three biomarkers of oxidative stress had inconsistent relationships with Cd and/or Se in various matrices, perhaps due to potential untested confounders. Our results generally support an association between low in utero exposure to Cd and the anthropometric development of the fetus. Adjusted regression models indicated a negative association of cord blood Cd levels ≥0.78 μg/l with Apgar 5-min scores and birth height. Maternal Cd levels ≥0.976 μg/l were associated with a 5.94-fold increased risk of small-for-gestational-age births, which increased to 7.48-fold after excluding preterm births. Placenta weight decreased with increasing placental Cd levels ≥0.037 μg/g dry wt. (p = 0.045), an association that became stronger after excluding preterm births or adjusting for birth weight. Cord Se levels ≥65.68 μg/l were positively associated with placenta weight (p = 0.041) and thickness (p = 0.031), an association that remained unchanged after excluding preterm births. Cord Se levels, however, were negatively associated with cephalization index, but only after excluding preterm births (p = 0.017). Each birth measure was again modeled as a function of the Cd/Se ratios in cord blood and placenta tissue. Interestingly cord ratios ≥0.008 were negatively associated with Apgar-5 min score (p = 0.047), birth weight (p = 0.034) and placenta thickness (p = 0.022). After excluding preterm births, only the association with placenta thickness remained significant (p = 0.021), while birth weight (p = 0.053) was marginally significant. In contrast, cephalization index increased with Cd/Se ratios ≥0.008 (p = 0.033), an association that became marginally significant after excluding preterm births (p = 0.058). For placental Cd/Se ratios ≥0.024, only placenta weight was reduced with (p = 0.037) and without (p = 0.009) the inclusion of preterm births. These findings do not support an antagonistic mechanism between Cd and Se. The role of oxidative mechanisms either induced by Cd exposure or alleviated by Se on these birth anthropometric measures was examined by principal component analysis. Se did not have a clear protective role against Cd-induced adverse effects despite its substantial excess over Cd, and its role in alleviating oxidative stress by reducing malondialdehyde levels. The results may suggest that the extent of the Se beneficial effects is not governed only by its concentration but also by the chemical forms of Se that interact with various proteins. Consequently, the speciation of Se in such studies is essential for understanding and predicting Se availability for absorption.
    International Journal of Hygiene and Environmental Health 09/2014; 218(1). DOI:10.1016/j.ijheh.2014.08.001 · 3.83 Impact Factor
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    ABSTRACT: The objective of this work was to assess exposure to mercury (Hg) and its induction of oxidative stress in 155 healthy lactating Saudi mothers and their infants. Samples of breast milk and blood were collected from the mothers, while urine was taken from both infants and mothers. Both urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) were measured in mothers and infants as biomarkers of oxidative stress. The mean concentration of Hg in breast milk was 1.19 μg/L (range 0.012-6.44 μg/L) with only one mother having Hg >4 μg/L, the upper limit established by the US Agency for Toxic Substance and Disease Registry. However, 57.4 % had Hg ≥1 μg/L, the background level for Hg in human milk. The mean urinary Hg corrected for creatinine (Hg-C) in mothers and infants was 1.47 and 7.90 μg/g creatinine, respectively, with a significant correlation between the two (p < 0.001). Urinary Hg levels over 5 μg/g creatinine (the background level in an unexposed population) were found in 3.3 % of mothers and 50.1 % of infants. None of the mothers had total blood Hg above the US Environmental Protection Agency's maximum reference dose of 5.8 μg/L. No correlation was noted between urinary Hg in infants and Hg in breast milk (p > 0.05). Hg in breast milk, though, was associated with Hg in blood (p < 0.001), suggesting the efficient transfer of Hg from blood to milk. Hg in the breast milk of mothers and in the urine of infants affected the excretion of urinary MDA and 8-OHdG, respectively, in a dose-related manner. These findings reveal for the first time lactational exposure to Hg-induced oxidative stress in breast-fed infants, which may play a role in pathogenesis, particularly during neurodevelopment. This will also contribute to the debate over the benefits of breast milk versus the adverse effects of exposure to pollutants. Nevertheless, breastfeeding should not be discouraged, but efforts should be made to identify and eliminate the source of Hg exposure in the population.
    Biological trace element research 05/2013; 153(1-3). DOI:10.1007/s12011-013-9687-7 · 1.75 Impact Factor
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    ABSTRACT: This cross-sectional study was conducted to assess the association between exposure to heavy metals (lead, cadmium and mercury) during pregnancy and birth outcomes in 1578 women aged 16-50 years who delivered in Al-Kharj hospital, Saudi Arabia, in 2005 and 2006. The levels of lead, cadmium and mercury were measured in umbilical cord blood, maternal blood and the placenta. Outcome variables were anthropometric measures taken at birth, along with the risk of being small-for-gestational age (SGA). We selected the 10th percentile as the cutoff for dichotomizing measures of birth outcome. Cadmium, despite its partial passage through the placenta had the most prominent effect on several measures of birth outcome. After adjustment for potential confounders, logistic regression models revealed that crown-heel length (p=0.034), the Apgar 5-minute score (p=0.004), birth weight (p=0.015) and SGA (p=0.049) were influenced by cadmium in the umbilical cord blood. Significant decreases in crown-heel length (p=0.007) and placental thickness (p=0.022) were seen with higher levels of cadmium in maternal blood. As placental cadmium increased, cord length increased (p=0.012) and placental thickness decreased (p=0.032). Only lead levels in maternal blood influenced placental thickness (p=0.011). Mercury in both umbilical cord and maternal blood was marginally associated with placental thickness and placental weight, respectively. Conversely, placental mercury levels significantly influenced head circumference (p=0.017), the Apgar 5-minute score (p=0.01) and cord length (p=0.026). The predictions of these models were further assessed with the area under the curve (AUC) of the receiver operating curves (ROCs), which were modest (larger than 0.5 and smaller than 0.7). The independence of gestational age or preterm births on the observed effect of metals on some measures of birth outcome, suggested detrimental effects of exposure on fetal development. The magnitude of the estimated effects might not necessarily be of clinical significance for infants but may have a considerable public-health relevance given the high prevalence of exposure to heavy metals. Further research should be conducted to confirm these findings and to evaluate their long-term risks, if any.
    International journal of hygiene and environmental health 05/2013; 217(2-3). DOI:10.1016/j.ijheh.2013.04.009 · 3.83 Impact Factor
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    ABSTRACT: Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental contaminants that are known to induce oxidative stress. There have been several reports about the link between PAH exposure and complications in pregnancy. This cross-sectional study was conducted to: (1) measure the levels of benzo(a)anthracene (BaA), chrysene (Ch), benzo(b)fluoranthene (BbF), benzo(a)pyrene (BaP), and dibenzo(a,h)anthracene (DBahA) in placentas and maternal and -umbilical cord blood obtained at delivery from 1578 women between June 2005 and 2006 in the area of Al-Kharj, Saudi Arabia; (2) assess their influence on various anthropometric measures of birth outcome taking into consideration the carcinogenic properties of these PAHs; and (3) determine the degree of PAH-related oxidative DNA damage and birth outcome. Among the five tested PAHs, only BaP was carcinogenic; therefore, the levels of the other four probable or possible carcinogenic PAHs (BaA, Ch, BaF, and DBahA) were summed as ∑4-PAHs. Levels of 1-hydroxypyrene (1-HP) were determined in maternal urine samples as a biomarker of PAH internal dose. Urinary cotinine (COT) was measured as an index of smoking. The following markers of oxidative stress were selected: malondialdehyde (MDA) in cord (C-MDA) and maternal (M-MDA) serum and 8-hydroxy-2-deoxyguanosine (8-OHdG) in maternal urine. None of the tested PAHs was found in maternal or cord blood. However, all five PAH compounds were detected in placentas; Ch was the highest (6.582μg/kg dry wt.), and BaA was the lowest (0.236μg/kg dry wt.). The mean concentration of urinary 1-HP found in this study was 0.216±0.856μg/g Cr. After adjusting for gestational age and other confounding variables, regression models revealed an inverse relationship between placental weight, cord length and placental BaP. A similar trend was observed between cord length and ∑4-PAHs in placental tissues. Urinary 1-HP, though, cannot be used as an unequivocal biomarker of PAH exposure, but it can be an appropriate indicator of exposure to environmental tobacco smoke (ETS). The data demonstrate that ETS exposure (as measured by urinary COT) may adversely affect birth outcome as shown by reduced head circumference, birth weight, and birth length, as well as increased cephalization index. The positive relationship between 8-OHdG levels and 1-HP in urine provides evidence of an oxidative stress mechanism. Although this study provides no direct evidence of an association between PAH exposure and DNA damage, increased oxidative stress in the form of lipid peroxidation significantly affected various birth measures. Therefore, there is a need for studies regarding PAH exposure and its associated biological effects to determine the extent of potential fetal damage as well as possible long-term effects, such as cancer.
    Science of The Total Environment 01/2013; 444C:565-578. DOI:10.1016/j.scitotenv.2012.12.021 · 4.10 Impact Factor
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    ABSTRACT: This study was conducted to: (a) investigate the antagonistic interaction between selenium (Se) and mercury (Hg) in mothers and their newborns, (b) delineate the role of oxidative mechanisms induced by Hg exposure and (c) examine the protective effect of Se on Hg-induced oxidative stress and birth outcomes. Levels of Hg and Se were measured in umbilical cord blood and the placentas of 250 healthy mothers who participated in a study between 2006 and 2006 assessing prenatal exposure various pollutants. Levels of malondialdehyde (MDA) in cord and maternal blood and of 8-hydroxy-2-deoxyguanosine in urine were measured for assessing oxidative stress. Tail moment (TM) in the comet assay, as a biomarker of DNA damage was measured in samples of cord and maternal blood. The mean Se levels in umbilical cord blood (67.618 ± 12.897 μg/l) were lower than those reported in many countries, but none of the newborns had Se levels <20 μg/l (the threshold limit of Keshan disease). More than 80% of the newborns, though, had Se levels below the 80 μg/l needed for maximum glutathione peroxidase activity. Even though 18.6% of the newborns had levels of Hg ≥5.8 μg/l (the reference dose of the Environmental Protection Agency), no relationship was observed with the biomarkers of oxidative stress. The mean placental Hg levels (0.056 ± 0.075 μg/g dry wt.) were higher than those reported for newborns with abnormal fetal development. Our study also documented significant placental transfer of Hg and Se to the fetus. The Hg/Se molar ratio in both cord blood and placental tissue was well below 1. The average amount of Se in both matrices was approximately 50-fold in molar excess over Hg. The molar excess of Se in the umbilical cord (0.843 μmol/l), however, was lower than in placental tissues (13.098 μmol/kg dry wt.). In further support of the relationships of Hg and Se on oxidative stress, we observed significantly lower levels of maternal MDA associated with Se levels in both cord blood and placental tissues and significantly higher TM levels associated with placental Hg in both newborns and their mothers. In contrast, Se/Hg molar ratios in placental tissues were positively associated with MDA and negatively with TM. The disproportion between Hg and Se might be influenced by the length of Hg exposure that in turn might affect Se bioavailability. Each birth anthropometric outcome was modeled as a function of Hg, Se and their interactions. After an adjustment for confounding variables, Hg in cord blood had a significantly positive rather than the expected negative association with crown-heel length. Placental Hg was associated with reduced birth height. Both associations were independent of prematurity. The status of Se in newborns was positively associated with crown-heel length and placental weight, with and without preterm births, and with birth weight, but only without preterm births. In contrast, a lower cephalization index was correlated with Se levels in cord blood, which may be an indicator of a detrimental effect on health. Our study, however, revealed associations between significantly lower levels of placental Se and several birth anthropometric measures (head circumference, birth weight and birth height) but the significance disappeared after excluding preterm births. Regression analyses generally indicated either significant or marginally significant Hg–Se antagonistic interactions that may have moderated the toxic effect of Hg on head circumference and birth weight. This finding may be due to chance or residual confounding and so may not be clinically relevant, but it may also suggest that Hg, Se and Hg–Se interactions are important factors for understanding Hg-induced adverse birth outcomes. Additional research will be necessary to evaluate the biological impact of combined metals in the assessment of fetal growth and development.
    International journal of hygiene and environmental health 01/2013; 217(4). DOI:10.1016/j.ijheh.2013.11.001 · 3.83 Impact Factor
  • Iman Al-Saleh · Al anoud Al-Sedairi · Rola Elkhatib ·
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    ABSTRACT: We examined the effect of mercury (Hg) associated with dental amalgam fillings on biomarkers of renal and oxidative stress in children between the ages of 5-15.5 years. Urine samples were analyzed for N-acetyl-β-D-glucosaminidase (NAG), α(1)-microglobulin (α(1)-MG), β(2)-microglobulin (β(2)-MG), retinol binding protein (RBP), albumin (ALB), 8-hydroxy-2-deoxyguanosine (8-OHdG) and malondialdehyde (MDA). The level of urinary Hg (UHg-C) was calculated as μg/g creatinine. Multiple regression analyses revealed that the excretion of urinary NAG was significantly associated with the presence of dental amalgam fillings (β=0.149, P=0.03) and the levels of UHg-C (β=0.531, P=0), with an interaction between the two (P=0). The increase in urinary NAG in relation to UHg-C levels had a dose-effect pattern. The lowest observed effect was seen at UHg-C levels above 1.452 μg/g creatinine, which is lower than previously reported. In contrast, α(1)-MG was negatively associated with the presence of dental amalgam fillings (β=-0.270, P=0), but positively with UHg-C levels (β=0.393, P=0). There were 7 children without, and one child with, dental amalgam fillings with urinary α(1)-MG levels above the reference limit of >7 mg/g creatinine. Even though α(1)-MG seems to be a reliable biomarker for early changes in renal functions, it might exert its effect only at a higher level of exposure. An inverse relationship was also observed between urinary 8-OHdG levels and the presence of dental amalgam fillings. This might suggest that the dental amalgam does not increase DNA damage but reduces the capacity to repair DNA, leading to lower urinary excretion of 8-OHdG. On the other hand, we found that Hg affected the excretion of urinary 8-OHdG in a dose-related pattern that was mostly associated with long-term exposure to low Hg levels. Urinary NAG levels were positively associated with urinary MDA levels (β=0.516, P=0) but not with 8-OHdG (β=0.134, P=0.078) after adjustment for potential confounders. Both UHg-C and the presence of dental amalgam fillings remained predictors of the NAG model. Our data provide evidence that low exposure to Hg from dental amalgam fillings exerts an effect on kidney tubular functions in children. Oxidative stress may have played a role in this mechanism. The results of this study would also suggest that urinary NAG is the most sensitive of all the investigated renal biomarkers. These results should be confirmed with further investigation.
    Science of The Total Environment 06/2012; 431:188-96. DOI:10.1016/j.scitotenv.2012.05.036 · 4.10 Impact Factor
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    ABSTRACT: Previous studies of in utero exposure to dichlorodiphenyltrichloroethane (DDT) have shown mixed results for the harmful effects on fetal growth and development. This cross-sectional study was designed to: (1) examine the extent of DDT exposure in 1578 women, aged 28.5±6.0 who delivered between June 2005 and 2006 in the area of Al-Kharj, Saudi Arabia; and (2) assess its influence on neonatal anthropometric measurement of newly born babies. DDT and its metabolites, namely 1,1-dichloro-2,2-bis (p-chlorophenyl) ethylene (p,p'-DDE), 1,1-dichloro-2,2-bis (p-chlorophenyl) ethane (p,p'-DDD) and 1,1,1-trichloro-2,2' bis (p-chlorophenyl) ethane (p,p'-DDT) were measured in cord and maternal serum as well as placenta by Gas Chromatography coupled with an Electron Capture Detector (GC/ECD). p,p'-DDE was detected in 28.3% of cord and 54.4% of maternal serum, reflecting past exposure, whereas the p,p'-DDT was only found in 0.46% cord and 1.2% maternal samples. As expected the p,p'-DDE cord levels (0.197±0.961μg/L) were 2.8 times lower than the maternal levels (0.551±1.778μg/L), and both were significantly correlated (r=0.517) suggesting its transplacental transfer. The picture was different in placental tissues. p,p'-DDE and p,p'-DDT were detected in 84% and 99% of placental tissues, with the highest p,p'-DDT in placental tissues (29.62±158.282µg/kg dry wt.) compare to p,p'-DDE (10.167±18.851μg/kg dry wt.). In general, the presence of DDT metabolites in our participants indicates that these chemicals are still relevant despite the fact that they have been banned or restricted in the study area for many years. Our results support the view for an association between low in utero exposure to DDT and the anthropometric development of the fetus leading to a reduction in its head circumference, crown-heel length, birth weight and birth height. Since the reduction in these measures was independent of gestational age and/or preterm births, our findings suggest a detrimental effect of the DDT exposure on fetal growth. Neonatal anthropometric measures are considered as an important tool to detect newborns at higher risk of morbidity and impairment of growth. Efforts should be made to decrease exposure of women of reproductive age and to examine maternal DDT exposure in relation to long-term impact on health.
    Science of The Total Environment 12/2011; 416:62-74. DOI:10.1016/j.scitotenv.2011.11.020 · 4.10 Impact Factor
  • Iman Al-Saleh · Neptune Shinwari · Ammar Alsabbaheen ·
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    ABSTRACT: This study was conducted to determine the presence of phthalates in 10 different brands of bottled water available in Saudi markets and stored under different conditions. Dimethyl phthalate (DMP), diethylphthalate (DEP), di-n-butyl phthalate (DBP), benzyl butyl phthalate (BBP) and diethyl hexyl phthalate (DEHP) were measured by headspace solid-phase microextraction followed by gas chromatography- mass spectrometer detector. Most of these phthalates were detected in the selected bottled water sample that might be either leached from the plastic packaging materials or contamination during bottling processes. Bottled waters stored at 4°C contained higher levels of DMP, DEP, BBP and DEHP than those stored at room temperature and outdoors. On the other hand, the levels of DMP, DEP and BBP were significantly lower in bottled waters stored at room temperature than those outdoor. It seems that temperature and sunlight play a role in the degradation of phthalates within time. The levels of BBP were the highest at 4°C storage (4.592 ± 3.081 µg/l; range: 1.194-21.128 µg/l) and approximately 76% of the bottled waters had BBP above the limit of quantification (LOQ) of 0.994 µg/l. Apart from DEHP (< 6 µg/l), there are not current legislations for other phthalates. Regardless of storage conditions, all our samples did not exceed the maximum established limit of DEHP. Although, the levels of phthalates in tested bottled waters were low, one should not dismiss that these chemicals may cause endocrine disruption through several mechanisms, especially to potentially vulnerable populations such as infants and pregnant women. Saudi Arabia ranks 12 in bottled water consumption (88 L per capita in 2004) among the 71 reported countries. With this high consumption, a quality assurance scheme for residue monitoring in water is quite important. Although, one cannot avoid phthalates contamination in bottled waters due to manufacturing process but at least special care should be taken regarding their storage conditions.
    The Journal of Toxicological Sciences 08/2011; 36(4):469-78. DOI:10.2131/jts.36.469 · 1.29 Impact Factor
  • Iman Al-Saleh · Al Anoud Al-Sedairi ·
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    ABSTRACT: The risks and benefits of using mercury (Hg) in dental amalgam have long been debated. This study was designed to estimate Hg body burden and its association with dental amalgam fillings in 182 children (ages: 5-15 years) living in Taif City. Hg was measured in urine (UHg), hair (HHg) and toenails (NHg) by the Atomic Absorption Spectrophotometer with Vapor Generator Accessory system. Urinary Hg levels were calculated as both micrograms per gram creatinine (μg/g creatinine) and micrograms per liter (μg/L). We found that children with amalgam fillings (N=106) had significantly higher UHg-C levels than children without (N=76), with means of 3.763 μg/g creatinine versus 3.457 μg/g creatinine, respectively (P=0.019). The results were similar for UHg (P=0.01). A similar pattern was also seen for HHg, with means of 0.614 μg/g (N=97) for children with amalgam versus 0.242 μg/g (N=74) for those without amalgam fillings (P=0). Although the mean NHg was higher in children without amalgam (0.222 μg/g, N=61) versus those with (0.163 μg/g, N=101), the relationship was not significant (P=0.069). After adjusting for many confounders, the multiple logistic regression model revealed that the levels of UHg-C and HHg were 2.047 and 5.396 times higher, respectively, in children with dental amalgam compared to those without (P<0.01). In contrast, a significant inverse relationship was seen between NHg levels and dental amalgam fillings (P=0.003). Despite the controversy surrounding the health impact of dental amalgam, this study showed some evidence that amalgam-associated Hg exposure might be related with symptoms of oral health, such as aphthous ulcer, white patches, and a burning-mouth sensation. Further studies are needed to reproduce these findings. The present study showed that significant numbers of children with or without amalgam had Hg levels exceeding the acceptable reference limits. The detrimental neurobehavioral and/or nephrotoxic effects of such an increased Hg on children should be a cause of concern, and further investigation is warranted. Our results are alarming and indicate an urgent need for biomonitoring and assessment of exposure. Changes in dental practices involving amalgam, especially for children, are highly recommended in order to avoid unnecessary exposure to Hg.
    Science of The Total Environment 07/2011; 409(16):3003-15. DOI:10.1016/j.scitotenv.2011.04.047 · 4.10 Impact Factor
  • Iman Al-Saleh · Sami Al-Enazi ·
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    ABSTRACT: Cosmetics still retain their glittering appeal, but public concern about their toxicity has become a hot issue. Trace amounts of toxic metals can be either intentionally added to cosmetics or present as impurities in the raw materials. We therefore assessed the levels of lead, cadmium, nickel, chromium, mercury, antimony, and arsenic in 14 brands of lipstick (28 samples) that are widely available in local Saudi markets. This study found that the levels of all metals were generally lower than the specifications of the US Food and Drug Administration for metallic impurities in color additives used in cosmetics. Only one brand of lipstick exceeded the specifications, containing levels of arsenic higher than 3 ppm. Also, the levels of nickel and chromium contents in 10 and 4 of the 28 lipsticks, respectively, were above 1 ppm, the trigger limit of allergic contact dermatitis (ACD). Despite the metallic contents in lipsticks being below the acceptable limits for impurities in color additives used in the cosmetic industry, safer limits should be seriously considered, especially for those causing ACD.
    Toxicological and Environmental Chemistry 07/2011; 93(6-6):1149-1165. DOI:10.1080/02772248.2011.582040 · 0.83 Impact Factor
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    ABSTRACT: Skin-lightening creams are extensively promoted online and in the media. They may contain a wide variety of active ingredients such as mercury, hydroquinone, and steroids that are highly toxic, especially after prolonged application. For more than a decade, we found high mercury content in many products sold on Saudi markets. Some of these products were later banned by the government. However, the presence of other ingredients has not been documented. We undertake this study on some of the most popular skin-lightening creams on the market to test for toxic ingredients such as mercury, titanium dioxide, hydroquinone, and corticosteroids. A total of 33 different brands were selected for the analysis of titanium (50 samples), hydroquinone (55 samples), and corticosteroids (56 samples) with the exception of mercury in which only 23 brands (34 samples) were tested. This study showed that 2 of 34 skin-lightening creams had mercury above the US FDA limit of 1 µg g. All products had titanium dioxide at less than 25% (w/w) of the EU and US FDA safety limits for personal products but 8 products from 7 different brands contained titanium dioxide above 1%, the permissible limit in cosmetics as color additives. In this study, we found 8 creams from 7 different brands had hydroquinone above 1.5% (w/w), the newly proposed FDA limit of hydroquinone in OTC skin-lightening drug products. Among the four tested corticosteroid compounds, the most frequently detected was cortisone and 18 products from 13 different brands were above 6 µg g (MDL) with a maximum of up to 0.32% (w/w). Dexamethasone was found in 7 creams from 5 different brands with only 3 above the MDL of 9 µg g. Although one might argue that these corticosteroids are of mild or low potency, and they may be unlikely to have any adverse effects, these products are marketed as personal-care products on the assumption that they are safe and free of steroids. The overall results indicate that many of the skin-lightening creams sold in the Saudi market contained one or more toxic ingredients that in most cases were not listed on the packaging. Many of these ingredients are harmful and pose health risks if we take into account the frequency of application, the duration of practice, and area of the body applied, and their use during pregnancy and/or periods of lactation.
    Toxicological and Environmental Chemistry 01/2011; 94(1):1-25. DOI:10.1080/02772248.2011.631925 · 0.83 Impact Factor
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    ABSTRACT: Lead, cadmium and mercury were measured in placental tissue, umbilical cord and maternal blood samples of 1578 women who delivered at the Al-Kharj King Khalid Hospital between 2005 and 2006. The aim of this study was to evaluate the status of heavy metal exposure in mothers and their newborns and to identify predictors of maternal exposure. Lead was detected in all cord and maternal blood and in 96% of placental tissues. Only in 0.89% and 0.83% of cord and maternal blood samples were the levels of lead above the CDC threshold limit of 10 μg/dl. Maternal blood lead was also higher (2.3%) than the German Reference value in women of 7 μg/dl. Approximately 9.3% of women had a placental lead above the 95th percentile in the range of 0.83-78 μg/g dry wt., a level of possible developmental toxicity. Cadmium was detected in 94.8% and 97.9% of cord and maternal blood samples respectively, though only five newborns had a cadmium level above the OSHA threshold limit of 5 μg/l. Comparing our results to the newly revised German Reference value for nonsmokers, 48.6% of mothers had blood cadmium levels >1.0 μg/l. We found as well that 25% of women had placental cadmium in the >75th percentile, in the range of 0.048-4.36 μg/g dry wt., which is likely to affect fetal growth and development. Of the maternal and cord blood samples, 11.2% and 13%, respectively, had mercury levels >5.8 μg/l, which is the EPA reference dose. Nearly 49% of women had mercury levels >2.0 μg/l, the German Reference value for those who consume fish ≤3 times a month. Around 50% of the mothers had placental mercury in the range of 0.031-13.0 μg/g dry wt. Regression analyses indicated that the levels of metals in the blood and placenta were influenced by several factors. This study provides informative baseline biomonitoring data and reveals a substantial exposure to heavy metals in non-occupationally exposed Saudi mothers and their newborns that might jeopardize the health of both. Additional research is also urgently needed to explore factors such as environment, diet, lifestyle and/or cultural habits contributing to maternal and fetal exposures. Preventive measures to eliminate or minimize the unnecessary risk of fetus exposure to heavy metals or other pollutants during pregnancy should be initiated once these factors are identified.
    International journal of hygiene and environmental health 11/2010; 214(2):79-101. DOI:10.1016/j.ijheh.2010.10.001 · 3.83 Impact Factor
  • Iman Al-Saleh · Inaam El-Doush · Bellido Grisellhi · Serdar Coskun ·
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    ABSTRACT: This study evaluated the effect of caffeine consumption on the success rate of pregnancy and various in vitro fertilization (IVF) performance parameters. Serum and follicular fluid samples were collected from 619 women undergoing IVF treatment (2002-2003). Caffeine assessment was based on measuring the levels of caffeine in serum and follicular fluid and on the number of coffee or tea or caffeinated drinks consumed per day. A total of 97.3% of participants reported the consumption of caffeinated drinks such as coffee, tea and soft drinks. Their average caffeine consumption was 455.82 mg/day (range: 3.71-3561 mg/day). Coffee was the primary source of caffeine intake. The average caffeine levels in serum (0.913 µg/ml) were significantly higher than in follicular fluid (0.701 µg/ml). After controlling for various potential confounding variables, no association was found between coffee or tea consumption and the success rate of pregnancy. Looking at the effect of caffeine consumption on the IVF performance parameters, we found that the number of eggs decreased as the caffeine serum levels increased (P=0.011). An increase in coffee consumption was positively associated with the number of aborted pregnancy (P=0.007), while the number of good embryo decreased with high tea consumption (P=0.015). Though no association was seen between coffee or tea consumption and pregnancy rate, this study is the first to report that caffeine can reach the follicular fluid and there is a suggestive evidence of its possible harmful role on the consequences of reproductive process. This clearly warrants further investigation.
    Medical science monitor: international medical journal of experimental and clinical research 11/2010; 16(12):CR598-605. · 1.43 Impact Factor
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    ABSTRACT: Although p,p'-dichlorodiphenyltrichloroethane (DDT) is banned for agricultural purpose in Saudi Arabia, it is occasionally used to control vector-borne diseases in certain regions of the country. A case-control study was designed to investigate the possible effects of DDT and its metabolites on pregnancy and fertilization rate outcome. The study population was composed of 619 Saudi women (age 19-50 years) who sought in-vitro fertilization (IVF) treatment between 2002 and 2003. p,p'-DDE, the main metabolite of DDT, was the most frequently detected residue in serum or follicular fluid, with mean values of 1.646 microg/L and 0.407 microg/L, respectively. After controlling for many potential confounding variables, multiple logistic regression analysis revealed no association between pregnancy outcome or fertilization rate and p,p'-DDE levels in serum or follicular fluid. The inability to identify an effect may be related to the comparatively low concentrations of DDE in our population. But because p,p'-DDE was detected in the serum of 77.7% our participants, it should be considered as a matter of public heath concern. Currently there is no active source of DDT in our region; therefore, further studies are needed to identify sources in order to develop preventive measures because we can not exclude its potential reproductive toxicity.
    Medical science monitor: international medical journal of experimental and clinical research 11/2009; 15(11):BR320-33. · 1.43 Impact Factor
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    ABSTRACT: This study is designed to investigate the impact of DNA damage on pregnancy and fertilization rate outcome in a sub-sample of women undergoing IVF treatment. Blood and follicular fluid samples (n = 60) were analyzed for DNA adducts. While no BPDE-DNA adducts were detected, other unknown lipophilic adducts were seen in blood and follicular fluid. Women who failed to achieve pregnancy had higher DNA adducts in follicular fluid than those who succeeded (p < 0.05). Follicular fluid cotinine levels were associated with DNA adduct levels in blood and follicular fluid (p < 0.05). Evaluation of DNA damage resulting from oxidative stress could have a role in predicting IVF success rate.
    Bulletin of Environmental Contamination and Toxicology 10/2009; 84(1):23-8. DOI:10.1007/s00128-009-9889-z · 1.26 Impact Factor
  • Source
    Iman Al-Saleh · Sami Al-Enazi · Neptune Shinwari ·
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    ABSTRACT: There have been a number of recent reports in the media and on the internet about the presence of lead in brand-names lipsticks. This has drawn our attention to assess the safety of various cheap brands of cosmetics sold at 2-riyals stores in Saudi market that are imported from countries where safety regulations are poorly enforced as well as they lack perfect conditions for manufacturing. Lead contents were determined in 26 and eight different brands of lipsticks and eye shadows using the Zeeman atomic absorption spectrophotometer coupled to graphite tube atomizer after an acid digestion procedure. Lead was detected in all the studied samples. The median (25th-75th percentile) lead content in 72 lipsticks samples was 0.73 (0.49-1.793) PPM wet wt. in the range of 0.27-3760 PPM wet wt. There were four brands of lipsticks with lead content above the FDA lead limit as impurities in color additives (20 PPM). The FDA does not set a limit for lead in lipstick. Three of them were extremely high points and considered outliers. The median (25th-75th percentile) lead contents in pressed powder eye shadow was 1.38 (0.944-1.854) PPM wet wt. (n=22) in the range of 0.42-58.7 PPM wet wt. One brand was above 20 PPM the US FDA's lead limit as impurities. The overall results indicate that lead in lipsticks and eye shadows are below the FDA lead limit as impurities and, thus, probably have no significant toxicological effects. Nevertheless, few brands had lead content above 20 PPM that might put consumers at the risk of lead poisoning. Lead is a cumulative, and applying lead-containing cosmetics several times a day or every day, can potentially add up to significant exposure levels. Pregnant and nursing mothers are vulnerable population because lead passes through placenta and human milk and affect fetus or infant's developments. Our findings call for an immediate mandatory regular testing program to check lead and other toxic metals in lipsticks and other cosmetic products imported to Saudi Arabia in order to curtail their excess and safeguard consumer health.
    Regulatory Toxicology and Pharmacology 03/2009; 54(2):105-13. DOI:10.1016/j.yrtph.2009.02.005 · 2.03 Impact Factor

Publication Stats

969 Citations
142.94 Total Impact Points


  • 1994-2015
    • King Faisal Specialist Hospital and Research Centre
      • Department of Biological and Medical Research
      Ar Riyāḑ, Ar Riyāḑ, Saudi Arabia
  • 1997-2009
    • King Faisal Specialist Hospital Jeddah
      Djidda, Makkah, Saudi Arabia