Thiol/disulfide homeostasis and ischemia-modified albumin as oxidative stress markers in patients with embedded fragments.

This article focuses on investigating oxidative stress markers and metal concentrations in patients with embedded fragments (PEF), such as shrapnel or bullet fragments retained in the body. The study found that PEF exhibited significantly higher blood and urine levels of multiple metals—including antimony, arsenic, copper, cadmium, lead, manganese, nickel, iron, cobalt, mercury, and selenium—compared to controls, with 64.86% of PEF showing elevated metal concentrations relative to reference values. Oxidative stress was evidenced by altered thiol-disulfide homeostasis (increased disulfide/native thiol ratios) and elevated ischemia-modified albumin (IMA) levels, indicating a shift toward oxidative conditions associated with metal burden. Longer retention time of fragments (≥20 years) was linked to a 2.7-fold increase in metal abnormalities. The findings suggest that embedded metal fragments may contribute to systemic oxidative stress and potential chronic metal toxicity, underscoring the importance of ongoing biomonitoring, imaging, and multidisciplinary management for affected individuals.