Purpose: As industries develop rapidly, the risk of heavy metals pollution and exposure in the environmentand food is increasing. Even the slightest amount of heavy metals can be harmful to the human body, especiallyin newborn babies. This study aimed to estimate the heavy metals content in breast milk and identifyrelated factors. Methods: Thirty-nine lactating mothers admitted to the postpartum care center in Changwon city betweenJuly 15 and September 20, 2019 were recruited. Barium, cadmium, cobalt, nickel, and lead concentrationsin breast milk were measured using an inductively coupled plasma-optical emission spectrometer. Collecteddata were analyzed using independent t-test, 1-way analysis of variance, Mann-Whitney U-test,Kruskal-Wallis test, and Pearson correlation coefficients. Results: The average concentration of heavy metals in breast milk (mg/kg) were as fellow: barium, 3.68±1.29; cadmium, 0.03±0.06; cobalt, 0.10±0.19; nickel, 0.22±0.27; and lead, 0.13±0.26. There was a significantdifference between lead concentration and monthly household income (t=2.46, p=0.019). Therewas a difference between a family history of diabetes and hypertension and barium concentration (t=1.97,p=0.056) and between smoking history and nickel concentration (t=-1.95, p=0.058), but they were notstatistically significant. A significantly positive correlation was observed between cobalt and cadmiumconcentrations (r=0.93, p<0.001), and a significant negative correlation was observed between nickel andcadmium concentrations (r=-0.40, p=0.010) and cobalt concentration (r=-0.46, p=0.003). In addition,lead concentration showed a significant negative correlation with age (r=-0.39, p=0.013). Conclusions Guidelines for safe levels of heavy metals concentrations in breast milk need to be establishedand lactating mothers should consider the risk factors related to heavy metals poisoning such as dietaryintake, smoking, and alcohol consumption.

BACKGROUND/AIMS: Recent studies have demonstrated that etomidate is a safe sedative drug with noninferior sedative effects. In our recent study, we revealed that etomidate/midazolam was more hemodynamically stable than propofol/midazolam in elderly patients undergoing colonoscopies. We aimed to investigate whether compared with propofol/midazolam, etomidate/midazolam causes fewer cardiopulmonary adverse events with noninferior efficacy for screening colonoscopies in patients of all ages. METHODS: In this single-center, randomized, double-blind study, we prospectively enrolled 200 patients. The patients were divided into etomidate and propofol groups. The primary outcome was the occurrence of cardiopulmonary adverse events. The secondary outcomes were the proportion of patients with fluctuations in vital signs (oxygen desaturation and transient hypotension), adverse events interrupting the procedure, and sedation-related outcomes. RESULTS: Adverse cardiopulmonary events were more common in the propofol group than the etomidate group (65.0% vs 51.0%, respectively; p=0.045). Forty-six patients (46.0%) in the propofol group and 29 (29.0%) in the etomidate group experienced fluctuations in their vital signs (p=0.013). The proportions of patients experiencing adverse events that interrupted the procedure, including myoclonus, were not significantly different between the two groups (etomidate: 20.0% vs propofol: 11.0%; p=0.079). Both groups had similar sedation-related outcomes. Multivariate analysis revealed that compared with the propofol groups, the etomidate group had a significantly lower risk of fluctuations in vital signs (odds ratio, 0.427; 95% confidence interval, 0.230 to 0.792; p=0.007). CONCLUSIONS: Compared with using propofol/midazolam, using etomidate/midazolam for screening colonoscopies results in more stable hemodynamic responses in patients of all ages; therefore, we recommend using etomidate/midazolam for colonoscopies in patients with cardiovascular risk factors.
Aged ; Colonoscopy ; Double-Blind Method ; Etomidate ; Hemodynamics ; Humans ; Hypnotics and Sedatives ; Mass Screening ; Midazolam ; Multivariate Analysis ; Myoclonus ; Propofol ; Prospective Studies ; Risk Factors ; Vital Signs