[Lead poisoning from traditional Indian medicines]

Lead and arsenic intoxications by traditional and alternative medicine: men are more sensitive than women

Traditional and alternative medicines are widely used around the world and include for example herbal medicine, Ayurveda, traditional Chinese medicine, and indigenous therapies. Due to the long history and the mostly natural origin of traditional remedies, it is often assumed that they are harmless, but in recent decades more and more case reports have been published in which traditional medicine has caused metal poisoning. This paper provides an analysis of published cases in which patients have suffered metal poisoning due to traditional or alternative medicines. A systematic literature search was performed on PubMed, whereby 210 patient cases from a total of 102 case reports and 30 case series were identified and then analyzed about various aspects. Most of the traditional medicines involved come from Asia and are mainly contaminated with lead and arsenic. The analyzed patient cases show a high degree of heterogeneity with regard to age, sex, intake reason, symptoms, and severity of intoxication. The metal intoxication itself and the cause of the poisoning often remained unrecognized for a long time, which resulted in many patients undergoing unnecessary diagnostic methods and ineffective therapeutic approaches before the correct diagnosis was made. The evaluation of the available patient cases revealed a higher sensitivity to metal poisoning in children compared to adults and a higher sensitivity in men compared to women. Anemia and basophilic stippling were frequently observed and became more common as the metal content in the blood increased. Hopefully, this paper raises awareness of the potential dangers of traditional and alternative medicines, both from the patient's and the doctor's perspective, so that in case of intoxication, treatment can be initiated quickly using the correct diagnostic methods. As ingested metals do not only circulate in the blood but also accumulate in soft tissues and bones, long-term monitoring is necessary to ensure that patients make a full recovery. Doctors should be aware that, in contrast to common belief, men are more sensitive to this type of intoxication than women, necessitating particular attention for diagnosis and treatment.

Assessment of sub-chronic oral toxicity of Nityanand Rasa: An ayurvedic herbo-metallic formulation

ETHNOPHARMACOLOGICAL RELEVANCE

Nityananda Rasa (NR) is an ayurvedic herbo-metallic formulation used to treat gout, obesity, hypothyroidism, elephantiasis, and other diseases. However, its safety is a concern owing to the use of heavy metals like mercury and arsenic.

AIM OF THE STUDY

To study the sub-chronic oral toxicity of NR on albino wistar rats for safety evaluation.

MATERIALS AND METHODS

The male and female albino wistar rats were administered a daily dose of 30 (low), 300 (medium) and 600 (high) mg/kg BW/day of NR for 90-day period. The body weight and feed consumption were monitored once a week. After 90 days, blood and vital organs were harvested for genotoxicity, hematology, biochemistry, histopathology, gene expression and the biodistribution analysis.

RESULTS

There was no mortality or severe behavioural changes observed in rats. Significant changes in biochemical enzyme levels were seen at medium and high doses of NR i. e. 300 and 600 mg/kg BW/day respectively. No hematological changes were observed. Mild histopathological changes seen at high dose of NR which were found in concurrence with the biochemical alterations in liver and brain. There was mild genotoxicity and no detectable level of mercury but significant arsenic level in blood at high dose. Gene expression was mildly affected.

CONCLUSIONS

NR induced moderate toxic effects at high dose but can be considered safe at therapeutic doses.

Ninety days repeated dose oral toxicity study of Makaradhwaja in Wistar rats

Context:

Makaradhwaja is a KupipakwaRasayana. Since it contains two heavy metals, namely mercury and gold, it is essential to evaluate its safety. Hence, the present study was undertaken with an objective to evaluate toxicity and target organ of toxicity of Makaradhwaja if so.

Aims:

The objective was to evaluate toxicological profile, the target organ of toxicity and to find no observed effect level (NOEL) or no observed adverse effect level (NOAEL) in rats after oral administration for ninety consecutive days.

Materials and Methods:

Makaradhawaja preparation was administered to male and female Wistar rats for ninety consecutive days at 2.7, 13.5, and 27 mg/kg body weight. All relevant biochemical and hematological changes were observed. At termination, all the rats were sacrificed and necropsy was performed. Histopathological evaluation was also performed.

Statistical Analysis Used:

Dunnett's test followed by analysis of variance.

Results:

There was a significant increase in high-dose group kidney weight of both sexes which could not be correlated with histopathology findings and serum biochemistry. Therefore, the change was not considered as an adverse effect.

Conclusions:

The dose level 27 mg/kg of Makaradhwaja was found as NOAEL and dose level 13.5 mg/kg of Makaradhwaja was found as NOEL.

Evidence for safety of Ayurvedic herbal, herbo-metallic and Bhasma preparations on neurobehavioral activity and oxidative stress in rats

Heavy metals in Ayurvedic formulations have been used for centuries with claimed efficacy and safety. However, concerns are often raised about the toxicity due to heavy metals used in Ayurvedic formulations. The aim of present study is to explore the effect of Calcury tablet, Energic-31 capsule and Basanta Kusumakara Rasa (BKR) on neurobehavioral activity and oxidative stress in rats. Male wistar rats weighing 200-250 g were used and divided into normal control, positive control (mercury chloride, lead acetate, cadmium chloride, sodium arsenite, each 10 mg/kg, p.o for 28 days) and treated group (Calcury tablets at doses of 130, 650, 1300 mg/kg, Energic-31 capsule at doses of 150, 750, 1500 mg/kg and BKR at doses of 26, 130, 260 mg/kg, p.o. for 28 days). After performing the behavioural parameters on the 29^th day, homogenate of rat's brain was used to determine malondialdehyde (MDA) and glutathione (GSH) levels and heavy metal level in brain. Results showed that there were no significant change in cognitive function, motor coordination, MDA and GSH levels as compared to normal control group at all doses of Calcury tablet, Energic-31 capsule and Basant Kusumkar Rasa. However, heavy metals level in rat's brain was higher as compared to normal control group at all doses of Calcury tablet, Energic-31 capsule and BKR. In conclusion, Calcury tablet, Energic-31 capsule and BKR in doses equivalent to the human dose does not have appreciable adverse effects on brain which demonstrates the non-toxic nature of metal based Ayurvedic formulations.

Role of traditional antimalarial plants in the battle against the global malaria burden

Malaria continues to be a major global public health problem with 3.3 billion people at risk in 106 endemic countries. Globally, over 1000 plants have been used as potential antimalarials in resource-poor settings due to fragile health-care systems and lack of accessibility and affordability of artemisinin-based combination therapies (ACTs). Although many believe that the use of medicinal plants that have folklore reputations for antimalarial properties is relatively safe, many herbs may be potentially toxic due to their intrinsic adverse side effects. Therefore, herbal-derived remedies require powerful and deep assessment of their pharmacological qualities to establish their mode of action, safety, quality, and efficacy. In addition, the evolution of drug resistance also demands new antimalarial agents. This can be achieved by forming a vibrant antimalarial discovery pipeline among all stakeholders, including traditional healers, ethnobotanists, scientists, entomologists, pharmacists, and research institutions, for the isolation and characterization of the bioactive compounds with the ultimate objective of finding novel modes of action antimalarial compounds that can be used to fight against drug-resistant malarial parasites.

Traditional Medicinal Plants

Despite recent scientific advancement and globalization, the system of traditional medicine and complementary/alternative medicine is considered as a primary health care modality in the resource-constrained health care settings. Herbal medicinal system has been postulated and established through empirical observation and trial and error experiments since time immemorial to maintain good health and alleviate ailments and diseases. Earlier, the importance of traditional medicinal plants and phytotherapy have often been disregarded and undervalued. Presently revitalization and renewed interest on traditional medicinal plants has been observed among the public and scientific community. However, several daunting challenges need to be flagged effectively and immediately for the promotion of traditional medicinal plants. The collaborative efforts of ethnobotanists, anthropologists, pharmacists, and physicians could be a workable strategy to evaluate and validate the usage of traditional medicinal plants with the modern scientific methods and innovative techniques. Furthermore, conducting clinical trials to assess their efficacy and human safety is imperative and inevitable.

Safety evaluation of an Ayurvedic medicine, Arogyavardhini vati on brain, liver and kidney in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Arogyavardhini vati, an Ayurvedic polyherbal formulation has been used for liver and skin disorders in the Ayurvedic system of medicine. However, toxicity due to the presence of heavy metals in this traditional medicine is a matter of concern.

AIM OF THE STUDY

To evaluate the safety of Arogyavardhini vati on brain, liver and kidney in rats.

MATERIALS AND METHODS

Arogyavardhini vati at doses of 50, 250 and 500mg/kg (1, 5 and 10 times of human equivalent dose respectively), mercury chloride (1mg/kg) and normal saline were administered orally to male Wistar rats for 28 days. Behavioral parameters were assessed on day 1, 7th, 14th and 28th using Morris water maze, passive avoidance, elevated plus maze and rota rod. Biochemical parameters (acetyl-cholinesterase activity, malondialdehyde, reduced glutathione), histopathology and mercury level in brain, liver, kidney were assessed at the end of the experiment.

RESULTS

There was no significant change in behavioral parameters, acetyl-cholinesterase activity, liver function (ALT, AST, ALP and bilirubin) and kidney (serum urea and creatinine) function tests at all doses of Arogyavardhini vati (50, 250 and 500mg/kg) as compared to normal control. However, significant change was observed in mercury chloride treated group. Mercury chloride treated group as well as Arogyavardhini vati treated groups (50, 250 and 500mg/kg) showed increased levels of mercury in brain, liver and kidney as compared to normal control. Histopathological results showed significant cytoarchitectural changes in brain, liver and kidney architecture in mercury chloride treated group. Whereas, normal cytoarchitecture was observed at all doses of Arogyavardhini vati.

CONCLUSION

The finding of the present study suggests that Arogyavardhini vati in the doses equivalent up to 10 times of the human dose administered to rats for 28 days does not have appreciable toxicological effects on brain, liver and kidney.

Cross-sectional audit of blood lead levels in regular outpatient haemodialysis patients dialysing in north London

AIM

Blood lead was measured and found to be high in one haemodialysis patient with atypical abdominal pain and peripheral neuropathy. This prompted an audit of blood lead concentrations in prevalent haemodialysis patients under the care of a University Teaching hospital.

METHODS

Blood lead was determined in 271 prevalent adult haemodialysis patients regularly dialysing three times a week, in five dialysis centres and/or on the home dialysis programme. All samples were carefully collected into lead-free plastic containers, and measured by graphite furnace atomic absorption spectrometry.

RESULTS

25.5% of haemodialysis patients had abnormal blood lead concentrations (>200 microg/L), compared with 59% with high-normal values of 100-200 microg/L, and only 15.5% with normal values (<100 microg/L). Blood lead increased with haemodialysis vintage (r = 0.38, P < 0.001), the use of a single carbon filter and reverse osmosis water purification device unit (r = 0.29, P < 0.001), but reduced by urine output (r = -0.44, P < 0.001).

CONCLUSION

Despite UK government legislation to reduce permissible lead contamination of drinking water, blood lead was increased in 84.5% of prevalent haemodialysis patients. Single reverse osmosis machines and carbon filters may not be as effective at filtering out possible lead contamination compared with large industrial reverse osmosis devices and carbon filters, and thus blood lead testing should be considered for home haemodialysis patients, particularly in those areas where monochloramines are used to sterilize domestic water supplies.

From traditional medicine to witchcraft: why medical treatments are not always efficacious

Complementary medicines, traditional remedies and home cures for medical ailments are used extensively world-wide, representing more than US$60 billion sales in the global market. With serious doubts about the efficacy and safety of many treatments, the industry remains steeped in controversy. Little is known about factors affecting the prevalence of efficacious and non-efficacious self-medicative treatments. Here we develop mathematical models which reveal that the most efficacious treatments are not necessarily those most likely to spread. Indeed, purely superstitious remedies, or even maladaptive practices, spread more readily than efficacious treatments under specified circumstances. Low-efficacy practices sometimes spread because their very ineffectiveness results in longer, more salient demonstration and a larger number of converts, which more than compensates for greater rates of abandonment. These models also illuminate a broader range of phenomena, including the spread of innovations, medical treatment of animals, foraging behaviour, and self-medication in non-human primates.

Safety of alternative medicines reconsidered: lead-induced anaemia caused by an indian ayurvedic formulation

We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with abdominal pain and a normochromic normocytic anaemia. The diagnosis was based on the clinical symptoms, the anaemia, the basophilic stippling of erythrocytes and the elevated blood lead level Upon further questioning, both patients reported the use of Ayurvedic medications. Toxicological analysis of the different pills revealed that, in both, the same orange-red pills contained a remarkably high amount of lead. Cases of lead poisoning associated with the use ofAyurvedic formulations are emerging around the world. However, to our knowledge, these are the first reported cases in Belgium.