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Maharjan P, Ponganam MP, Lambert P, Vogel JP, McIntosh M, McDougall A. The quality of medicines for the prevention and management of hypertensive disorders of pregnancy: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002962. [PMID: 38412179 PMCID: PMC10898726 DOI: 10.1371/journal.pgph.0002962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
The quality of medicines for the prevention and management of hypertensive disorders of pregnancy globally is a critical challenge in the reduction of maternal mortality rate. We aimed to conduct a systematic review of available studies on the quality of the eight medicines recommended globally for the prevention and management of hypertensive disorders of pregnancy. We searched five electronic databases- Ovid MEDLINE, EMBASE, CINAHL, ProQuest and Cochrane Library, and also grey literature, without year or language limitations. Any study assessing the quality parameters (Active Pharmaceutical Ingredients, pH, sterility, solubility, impurities) of medicines by using any valid laboratory methods was eligible. Two reviewers independently screened the studies, extracted data and applied Medicine Quality Assessment Reporting Guidelines tool for quality assessment. Results were narratively reported and stratified by the drug types. Of 5669 citations screened, 33 studies from 27 countries were included. Five studies reported on the quality of magnesium sulphate-two (Nigeria and USA) found substandard medicine due to failing API specification and contaminants, respectively. Another study from Nigeria and a multi-country study (10 lower-middle- and low-income countries) found poor-quality due to failing the pH criteria. Seven of eight studies evaluating aspirin found quality issues, including degraded medicines in five studies (Brazil, USA, Yugoslavia and Pakistan). Five studies of calcium supplements found quality issues, particularly heavy metal contamination. Of 15 antihypertensives quality studies, 12 found substandard medicines and one study identified counterfeit medicines. This systematic review identified pervasive issues of poor-quality medicines across all recommended medicines used to prevent or treat hypertensive disorders of pregnancy, raising concerns regarding their safety and effectiveness.
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Affiliation(s)
- Pooja Maharjan
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | | | - Pete Lambert
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Joshua P Vogel
- Burnet Institute, Maternal, Child and Adolescent Health Program, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle McIntosh
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Annie McDougall
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- Burnet Institute, Maternal, Child and Adolescent Health Program, Melbourne, Australia
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Wawrzyniak N, Gramza-Michałowska A, Pruszyńska-Oszmałek E, Sassek M, Suliburska J. Effects of Calcium Lactate-Enriched Pumpkin on Calcium Status in Ovariectomized Rats. Foods 2022; 11:foods11142084. [PMID: 35885327 PMCID: PMC9325293 DOI: 10.3390/foods11142084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
This study aimed to evaluate the effects of enriched pumpkin on calcium status in ovariectomized rats. The study was conducted in sixty female Wistar rats, which were divided into six groups: a group fed a standard diet (C) and five ovariectomized groups fed a standard diet (OVX_C) or a diet with calcium lactate (CaL), with calcium lactate-enriched pumpkin (P_CaL), with calcium lactate and alendronate (CaL_B), or with calcium lactate-enriched pumpkin with alendronate (P_CaL_B). After 12 weeks of the intervention, the rats were sacrificed, and their blood and tissues were collected. The calcium concentrations in serum and in tissues were measured using flame atomic absorption spectrometry (AAS). Serum concentrations of procollagen type-1 amino-terminal propeptide (PINP), parathyroid hormone PTH, estrogen (ES), and osteocalcin (OC) were determined with enzyme-linked immunosorbent assay (ELISA). It was found that enriched pumpkin increased the calcium level in the kidneys (194.13 ± 41.01 mg) compared to the C (87.88 ± 12.42 mg) and OVX_C (79.29 ± 7.66 mg) groups. The addition of alendronate increased the calcium level in the femurs (267.63 ± 23.63 mg) and more than six times in the kidneys (541.33 ± 62.91 mg) compared to the OVX_C group (234.53 ± 21.67 mg and 87.88 ± 12.42 mg, respectively). We found that the CaL, P_CaL, and CaL_B groups had significantly lower PINP serum concentrations (4.45 ± 0.82 ng/mL, 4.14 ± 0.69 ng/mL, and 3.77 ± 0.33 ng/mL) and higher PTH serum levels (3.39 ± 0.54 ng/dL, 3.38 ± 0.57 ng/dL, and 3.47 ± 0.28 ng/dL) than the OVX_C group (4.69 ± 0.82 ng/mL and 2.59 ± 0.45 ng/dL, respectively). In conclusion, pumpkin enriched with calcium lactate affects calcium status and normalizes PINP and PTH serum levels in ovariectomized rats. Diet with enriched pumpkin and alendronate increase calcium concentration in the femur. Enriched pumpkin causes calcium to accumulate in the kidneys of ovariectomized rats; alendronate significantly exacerbates this effect.
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Affiliation(s)
- Natalia Wawrzyniak
- Department of Human Nutrition and Dietetics, Faculty of Food and Nutrition Science, University of Life Sciences, 60-624 Poznan, Poland;
| | - Anna Gramza-Michałowska
- Department of Gastronomy Sciences and Functional Foods, Faculty of Food and Nutrition Science, University of Life Sciences, 60-624 Poznan, Poland;
| | - Ewa Pruszyńska-Oszmałek
- Department of Animal Physiology and Biochemistry, Faculty of Veterinary Medicine and Animal Science, University of Life Sciences, 60-637 Poznan, Poland; (E.P.-O.); (M.S.)
| | - Maciej Sassek
- Department of Animal Physiology and Biochemistry, Faculty of Veterinary Medicine and Animal Science, University of Life Sciences, 60-637 Poznan, Poland; (E.P.-O.); (M.S.)
| | - Joanna Suliburska
- Department of Human Nutrition and Dietetics, Faculty of Food and Nutrition Science, University of Life Sciences, 60-624 Poznan, Poland;
- Correspondence:
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Santos WMD, de Souza ML, Nóbrega FP, de Sousa ALMD, De França EJ, Rolim LA, Rolim Neto PJ. A Review of Analytical Methods for Calcium Salts and Cholecalciferol in Dietary Supplements. Crit Rev Anal Chem 2020; 52:697-711. [PMID: 32985223 DOI: 10.1080/10408347.2020.1823810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dietary supplements composed by the combination of a calcium salt with cholecalciferol (vitamin D3) are widely used for improving bone health in conditions caused by the deficiency of these compounds in the body. Historically, these supplements have been linked to quality and safety issues. In the case of calcium salts, the presence of potentially toxic contaminants such as lead (Pb) has already been alerted by health authorities from different countries. Meanwhile, cholecalciferol is very unstable under inadequate manufacturing and storage conditions. The content of both compounds in commercial dietary supplements is often found to be in disagreement with the label claims, which can lead to a deficient or excessive nutrient intake by consumers. In this scenario, analyzing these compounds is still a difficult and time-consuming task, which usually requires specific pretreatment procedures and multiple analytical methods due to the inorganic nature of calcium and the organic nature of cholecalciferol. Therefore, this article reviews the analytical methods, described in official compendia and scientific literature, for the determination of calcium salts and cholecalciferol in dietary supplement formulations. We also approached the sample preparation procedures highly required due to the matrix complexity of these materials.
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Affiliation(s)
- Widson Michael Dos Santos
- Laboratório de Tecnologia dos Medicamentos (LTM), Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Myla Lôbo de Souza
- Laboratório de Tecnologia dos Medicamentos (LTM), Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Fernanda Pontes Nóbrega
- Laboratório de Tecnologia dos Medicamentos (LTM), Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | | | - Elvis Joacir De França
- Centro Regional de Ciências Nucleares do Nordeste (CRCN-NE), Comissão Nacional de Energia Nuclear (CNEN), Recife, Brazil
| | - Larissa Araújo Rolim
- Central de Análise de Fármacos, Medicamentos e Alimentos (CAFMA, Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, Brazil)
| | - Pedro José Rolim Neto
- Laboratório de Tecnologia dos Medicamentos (LTM), Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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Halder S, Kar R, Chakraborty S, Bhattacharya SK, Mediratta PK, Banerjee BD. Cadmium level in brain correlates with memory impairment in F1 and F2 generation mice: improvement with quercetin. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:9632-9639. [PMID: 30734250 DOI: 10.1007/s11356-019-04283-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
The increased exposure to cadmium (Cd) through environmental pollutants, food and cigarette smoke is a concern worldwide. The association of Cd with impaired learning disabilities led us to hypothesise that cadmium levels in brain tissue could be dose-dependently related to the extent of memory impairment and oxidative stress. In this study, we proposed to study whether cadmium exposure to dams could alter the brain Cd levels, memory parameters, antioxidant enzymes in brain and their gene expression in the F1-F2 generation mice and whether quercetin could modulate this effect. Animals were administered Cd alone and in combination with quercetin for 7 days during their gestation period. Their newborn pups (F1 and F2 mice) were reared until adulthood and were tested for memory using Morris water maze and step-down latency test. The brain tissue of F1 mice was collected. Cd levels were estimated using the atomic absorption spectrophotometer. G-S-transferase (GST) and catalase (CAT) activity were measured and fold increase in their respective gene expression was observed using the RT-PCR method. Cd levels were significantly increased in the brain tissue of animals exposed to Cd but cotreatment with quercetin showed decreased levels in both generations. Memory impairment was observed in animals of F1 generation exposed to Cd and cotreatment with quercetin (100 mg/kg) reversed this effect. Cd exposure significantly enhanced both activity and expression of GST and CAT in the brain tissue of F1 generation mice and quercetin attenuated this effect. In F2 generation, results were variable. GST activity and expression increased with Cd and decreased with quercetin cotreatment. However, CAT activity showed no significant change despite a decrease in gene expression. Quercetin cotreatment enhanced activity as well gene expression in F2 generation. Our study insinuates that Cd levels could act as a predictor of memory impairment and altered enzyme activity and gene expression in brain tissue. Quercetin helped to reduce Cd levels in brain tissue of F1 and F2 generation and modulated the antioxidant system of the cell by affecting expression of antioxidant enzymes at the transcription level.
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Affiliation(s)
- Sumita Halder
- Department of Pharmacology, University College of Medical Sciences and G. T. B. Hospital, New Delhi, 110095, India.
| | - Rajarshi Kar
- Department of Biochemistry, University College of Medical Sciences and G. T. B. Hospital, New Delhi, 110095, India
| | | | - Swapan K Bhattacharya
- Department of Pharmacology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, 110095, India
| | - Pramod K Mediratta
- Department of Pharmacology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, 201306, India
| | - Basu D Banerjee
- Department of Biochemistry, University College of Medical Sciences and G. T. B. Hospital, New Delhi, 110095, India
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Binns CW, Lee MK, Lee AH. Problems and Prospects: Public Health Regulation of Dietary Supplements. Annu Rev Public Health 2018; 39:403-420. [DOI: 10.1146/annurev-publhealth-040617-013638] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Colin W. Binns
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;,
| | - Mi Kyung Lee
- School of Health Professions, Murdoch University, Perth, Western Australia 6150, Australia
| | - Andy H. Lee
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia;,
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Taylor JM, Kieneker LM, de Borst MH, Visser ST, Kema IP, Bakker SJL, Gansevoort RT. Urinary Calcium Excretion and Risk of Chronic Kidney Disease in the General Population. Kidney Int Rep 2016; 2:366-379. [PMID: 29318214 PMCID: PMC5720525 DOI: 10.1016/j.ekir.2016.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction High urinary calcium excretion (UCaE) has been shown to lead to accelerated renal function decline in individuals with renal tubular diseases. It is not known whether this association also exists in the general population. Therefore, we investigated whether high UCaE is associated with risk of developing chronic kidney disease (CKD) in community-dwelling subjects. Methods Urine samples of 5491 subjects who were free of CKD at baseline and participated in the Prevention of Renal and Vascular End-Stage Disease study (a prospective, observational, general population-based cohort of Dutch men and women aged 28–75 years) were examined for UCaE. UCa concentration was measured in two 24-hour urine samples at baseline (1997–1998) by indirect potentiometry. UCaE was treated as a continuous variable and a categorical variable grouped according to sex-specific quintiles for UCaE. UCaE was compared with de novo development of estimated glomerular filtration rate <60 ml/min per 1.73 m2 and/or albuminuria >30 mg/24 h. Results Baseline median UCaE was 4.13 mmol/24 h for men and 3.52 mmol/24 h for women. During a median follow-up of 10.3 years, 899 subjects developed CKD. After multivariable adjustment, every 1 mmol/24 h higher baseline UCaE was associated with a 6% lower risk for incident CKD during follow-up (hazard ratio: 0.94 [0.88–0.99], P = 0.02). The association was shown to be significantly nonlinear, with highest risk of CKD in the lowest quintile for UCaE (hazard ratio: 1.28 [0.97–1.68], P = 0.09). There was no association between UCaE and mortality or cardiovascular health during follow-up, suggesting that this association was not a reflection of poor nutritional intake due to bad health. Discussion These findings indicate that high UCaE does not increase risk of CKD, but rather that low UCaE may be harmful.
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Affiliation(s)
- Jacob M Taylor
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lyanne M Kieneker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sipke T Visser
- Department of Pharmacoepidemiology and Pharmacoeconomics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Waheed S, Rahman S, Siddique N. Calcium supplements as source of trace elements: Adequacy and safety of supplements with vitamin C, vitamin D and phosphate formulations. Appl Radiat Isot 2014; 89:134-40. [DOI: 10.1016/j.apradiso.2014.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 01/16/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
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Rehman S, Husnain SM. A probable risk factor of female breast cancer: study on benign and malignant breast tissue samples. Biol Trace Elem Res 2014; 157:24-9. [PMID: 24254879 DOI: 10.1007/s12011-013-9865-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Abstract
The study reports enhanced Fe, Cu, and Zn contents in breast tissues, a probable risk factor of breast cancer in females. Forty-one formalin-fixed breast tissues were analyzed using atomic absorption spectrophotometry. Twenty malignant, six adjacent to malignant and 15 benign tissues samples were investigated. The malignant tissues samples were of grade 11 and type invasive ductal carcinoma. The quantitative comparison between the elemental levels measured in the two types of specimen (benign and malignant) tissues (removed after surgery) suggests significant elevation of these metals (Fe, Cu, and Zn) in the malignant tissue. The specimens were collected just after mastectomy of women aged 19 to 59 years from the hospitals of Islamabad and Rawalpindi, Pakistan. Most of the patients belong to urban areas of Pakistan. Findings of study depict that these elements have a promising role in the initiation and development of carcinoma as consistent pattern of elevation for Fe, Cu, and Zn was observed. The results showed the excessive accumulation of Fe (229 ± 121 mg/L) in malignant breast tissue samples of patients (p < 0.05) to that in benign tissues samples (49.1 ± 11.4 mg/L). Findings indicated that excess accumulation of iron in malignant tissues can be a risk factor of breast cancer. In order to validate our method of analysis, certified reference material muscle tissue lyophilized (IAEA) MA-M-2/TM was analyzed for metal studied. Determined concentrations were quite in good agreement with certified levels. Asymmetric concentration distribution for Fe, Cu, and Zn was observed in both malignant and benign tissue samples.
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Affiliation(s)
- Sohaila Rehman
- Chemistry Division, Pakistan Institute of Nuclear Science and Technology, P. O. Nilore, Islamabad, Pakistan,
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Calcium supplements as additional source of trace elements in health and disease Part 1: adequacy and safety of chelated calcium supplements. J Radioanal Nucl Chem 2013. [DOI: 10.1007/s10967-013-2550-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Filler G, Roach E, Yasin A, Sharma AP, Blake PG, Yang L. High prevalence of elevated lead levels in pediatric dialysis patients. Pediatr Nephrol 2012; 27:1551-6. [PMID: 22527529 DOI: 10.1007/s00467-012-2150-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/24/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND After parents raised concerns about potential lead (Pb) contamination of calcium carbonate for treatment of hyperphosphatemia in chronic kidney disease (CKD), we measured blood Pb using high-resolution sector field inductively coupled mass spectrometry in a quality-assurance investigation of ten pediatric dialysis patients (nine on hemodialysis) and six patients before dialysis. METHODS We assessed the kidney function as cystatin C estimated glomerular filtration rate (eGFR), blood Pb levels, calcium carbonate dose, and standard laboratory parameters, as well as Pb levels in the dialysis feed water. RESULTS Mean blood Pb concentration in the 16 pediatric CKD patients was 21.1 ± 15.8 µg/l with a maximum of 58 µg/l, which was significantly higher than that of 467 apparently healthy controls (median 6.35 µg/l, interquartile range 4.47, 8.71) and comparable to that of ten adult peritoneal dialysis (PD) patients. Lead levels correlated with red blood cell distribution width, eGFR, and calcium carbonate dose. Pb in dialysate feed water was always <0.00018 mg/l, which is below the accepted limit for water for dialysis of 0.005 mg/l. CONCLUSIONS We found a high prevalence of elevated Pb levels in pediatric CKD patients that correlated with the calcium carbonate dose and GFR. Lead levels should be monitored in these patients.
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Affiliation(s)
- Guido Filler
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada.
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