Nicotinic plant poisoning

A proposed screening strategy for evaluating the genotoxicity potential of botanicals and botanical extracts

Botanicals have long been used to promote health and treat diseases, but the safety of many currently marketed botanicals has not been adequately evaluated. Given the chemical complexity of botanicals, which often contain numerous unknown constituents, and their widespread use, comprehensive toxicity assessments are needed. The Botanical Safety Consortium was established to address this challenge. This international group of experts in toxicology, chemistry, bioinformatics, and pharmacognosy is developing a toolkit of assays to generate reliable toxicological profiles for botanicals. Genotoxicity assessment is especially critical, because, unlike other toxicities, genotoxicity is not adequately identified by adverse event and history-of-use reports, and genotoxicity is directly linked to health consequences such as cancer and birth defects. The Consortium's Genotoxicity Technical Working Group is exploring a genotoxicity testing strategy based on the use of in silico modeling and the bacterial reverse mutation and in vitro micronucleus assays and including several options for additional tests to further characterize genotoxicity and mode of action when indicated. The effectiveness of this testing strategy is being evaluated using 13 well-characterized botanicals with existing toxicological data as case studies. A brief overview of each of these 13 botanicals is provided. The final strategy for developing comprehensive genotoxicity profiles of botanicals will incorporate published genotoxicity data, chemical composition information, in silico and in vitro test data, and human exposure data, reducing the need for animal testing.

An overview of the poisonous plants of Lebanon and their effects

Poisonous plants are naturally found in the environment and are easily reachable especially by children. These plants pose significant risks ranging from mild or asymptomatic to severe and even life-threatening. Data on poisonous plants of Lebanon is scarce and scattered; therefore, there remains a significant gap in the literature concerning poisonous plants in Lebanon. This study relied on a thorough review of existing literature on poisonous plants of Lebanon and their effects. Based on our experience in the field and on leveraging available data from the literature, a list of important potentially toxic plants in Lebanon was compiled. Toxic plants in Lebanon were categorized based on their chemical properties into groups such as alkaloids; glycosides; proteins, peptides, and lectins; phenols and phenylpropanoids; terpenes and resins; carboxylic acids; and other (uncategorized). The clinical effects of these plants were discussed in detail to provide an overview of the toxicity that they can cause. This study is part of our ongoing work on poisonous plants of Lebanon. It aims to fill a gap pertaining to poisonous plant; it will benefit healthcare workers and the public at the same time. Prompt recognition of plant exposure and their manifestations will allow for better clinical management especially among emergency healthcare workers and professionals. In addition, this review will increase awareness of Lebanese public about the poisonous plants of Lebanon with the ultimate aim to prevent these toxic occurrences from the beginning.

Development of a simple and reproducible HPTLC method on protective effect induced by bark of Acacia nilotica on poisoning caused by use of nicotine containing tobacco products

Tobacco (Nicotiana tobacum) and tobacco products are the most critical public health challenges today across the globe. Nicotine is the main chemical composition of tobacco and is associated with withdrawal syndrome. A laboratory animal is commonly employed as a model to investigate nicotine toxicity, drug dependence, reinforcing effects, and the protective effects of samples against nicotine-induced toxicity. The first in-vitro model was developed to prove the protective effect of Babbul (Acacianilotica Linn.) against nicotine poisoning caused by consumption of tobacco products. The HPTLC method for estimating the protective effect against nicotine poisoning was performed by taking the solvent systems dichloromethane, methanol, and liquid ammonia (25 %)(9:1:0.04v/v/v). This in-vitro approach was done by treating the bark of the Acacia nilotica extract with a standard solution of nicotine, which reduced the concentration of nicotine by 39.12 %. The prescribed HPTLC method can be used successfully to assess Acacia nilotica's protective impact against nicotine toxicity caused by intake of nicotine containing tobacco products.

Antioxidant Activity and UHPLC-MS/MS Characterization of Polyphenol and Nicotine Content in Nicotiana Glauca Leaf Extracts: A Comparative Study of Conventional and Deep Eutectic Solvent Extraction Methods

The leaves of Nicotiana glauca (N. glauca; Solanaceae) plant are a known, major human health concern. This study investigated the antioxidant activity and polyphenols composition of aerial parts of N. glauca collected from its wild habitat in Jordan, using Methanol-Conventional (MC) and deep eutectic solvents (DES) extraction methods in addition to nicotine content determination using UHPLC. Our results showed that the MC extract contains fewer total phenols and flavonoid content than the 90% DES extract, (0.1194 ± 0.009 and 0.311 ± 0.020 mg/mL equivalent to gallic acid) and (0.01084 ± 0.005 and 0.928 ± 0.09 mg/mL equivalent to rutin), respectively. Moreover, this study showed that the prepared MC extract contain 635.07 ppm nicotine, while the 90% DES extract contain 1194.91 ppm nicotine. Extracts prepared using the MC and the DES methods exhibited weak antioxidant activities; the highest was a 33% inhibition rate (equivalent to ascorbic acid), obtained by the 90% DES extract,. The performed UHPLC-MS/MS analysis in this study also revealed the presence of variations in the detected compounds between the two extraction methods. Furthermore, this study found that environmentally friendly DES extraction of N. glauca produced higher phenol and flavonoid content than the MC method; this highlights the superior efficiency and environmental benefits of sustainable chemistry methods for extracting valuable phytoconstituents.

Urgent health concerns: Clinical issues associated with accidental ingestion of new metal-blade-containing sticks for heated tobacco products

INTRODUCTION

Recently, a concerning pattern has emerged in clinical settings, drawing attention to the potential health risks associated with the accidental ingestion, mostly by children, of a new Heated Tobacco Product (HTP) stick, which contains a sharp metal blade inside.

METHODS

Following a webinar of the Joint Action on Tobacco Control 2 project, where data on adverse health incidents related to novel tobacco and nicotine products from EU Member States were presented, the Milan Poison Control Center (PCC) conducted a case series study on the accidental ingestion of blade-containing HTP sticks in Italy, between July 2023 and February 2024. The data in the medical records were analyzed to identify the age distribution, clinical presentation symptoms, performed diagnostic procedures, and medical management.

RESULTS

Overall, 40 cases of accidental ingestion of HTP sticks were identified and are described. A total of 33 (82.5%) children (infants and toddlers, mean age 12.3 ± 3.3 months) were hospitalized. Of these, 29 underwent abdominal X-rays, two children underwent esophagogastroduodenoscopy, and one child suffered from cut injuries to the tonsillar pillar and genian mucosa, requiring anesthesia for fibroscopy. The observed clinical cases associated with new HTP sticks containing a metal blade occurred over just eight months. This issue required the immediate implementation of corrective measures to mitigate health risks. The Ministry of Health issued an alert regarding the dangers related to the accidental ingestion of the stick and imposed more visible warnings on the package.

CONCLUSIONS

It is of the utmost importance to raise awareness among both the general public and medical practitioners to prevent further cases of accidental ingestion of HTP sticks by infants and toddlers, and ensure a prompt and informed response in emergency situations.

Screening tools to evaluate the neurotoxic potential of botanicals: building a strategy to assess safety

AREAS COVERED

This paper outlines the selection of NAMs, including in vitro assays using primary rat cortical neurons, zebrafish embryos, and Caenorhabditis elegans. These assays aim to assess neurotoxic endpoints such as neuronal activity and behavioral responses. Microelectrode array recordings of rat cortical neurons provide insights into the impact of botanical extracts on neuronal function, while the zebrafish embryos and C. elegans assays evaluate neurobehavioral responses. The paper also provides an account of the selection of botanical case studies based on expert judgment and existing neuroactivity/toxicity information. The proposed battery of assays will be tested with these case studies to evaluate their utility for neurotoxicity screening.

EXPERT OPINION

The complexity of botanicals necessitates the use of multiple NAMs for effective neurotoxicity screening. This paper discusses the evaluation of methodologies to develop a robust framework for evaluating botanical safety, including complex neuronal models and key neurodevelopmental process assays. It aims to establish a comprehensive screening framework.

Death of Socrates: a likely case of poison hemlock (Conium maculatum) poisoning

INTRODUCTION

The death of Socrates in 399 BCE is described in Plato's dialogue, the Phaedo, written an unknown time afterwards from accounts by others.

THE EVIDENCE

Socrates' death has almost always been attributed to his drinking an extract of poison hemlock, Conium maculatum, despite apparent discrepancies between the clinical features described in classical translations of the Phaedo and general clinical experience of poisoning with the toxic alkaloids it contains.

EVALUATION

Recent acute philological analysis of the original Greek text has resolved many of the discrepancies by showing that the terms used in the classical translations were misinterpretations of the clinical signs described. It is also likely that the unpleasant clinical effects, such as vomiting, abdominal pain, diarrhoea and muscle fasciculation commonly described in modern reports of poison hemlock poisoning, were not mentioned to present the death of Socrates in a way consistent with his philosophical ideals and those of his pupil Plato.

CONCLUSIONS

Seen in this way, the death of Socrates can be accepted as a limited case report of Conium maculatum poisoning. Even after reaching that conclusion, intriguing scientific questions remain about the toxicity of the coniine alkaloids and the mechanisms of their effects.

Toxicities of herbal abortifacients

BACKGROUND

In the post-Roe era, barriers to facility-based abortions may lead to an increased incidence of self-managed abortions. While misoprostol-based medication abortions have significant literature supporting its safety profile, there is a knowledge deficit within the medical community regarding the toxicities of commonly used herbal abortifacients.

METHODS

This is a narrative review, based on a MEDLINE and HOLLIS database search, of self-managed abortion methods with herbal abortifacients and their associated toxicities.

RESULTS

Common herbal abortifacients with significant morbidity and mortality implications include pennyroyal, blue cohosh, rue, and quinine. Other commonly reported abortifacients considered to be less toxic also are discussed in brief. Special considerations for hepatic, cardiac, renal, and hematologic toxicities are important in patients with significant exposures to these herbal substances.

CONCLUSION

There is an anticipated increase in the utility of herbal xenobiotics for self-managed abortions with post-Roe restrictions to standard mifepristone-misoprostol protocols. Frontline providers should be aware of the associated toxicities and have special considerations when treating a poisoned patient in this population.

Vertigoheel promotes rodent cognitive performance in multiple memory tests

Introduction

Cognitive impairment associated with old age or various brain disorders may be very disabling for affected individuals, placing their carers and public health services under considerable stress. The standard-of-care drugs produce only transient improvement of cognitive impairment in older people, so the search for novel, safe and effective therapeutics that would help to reverse or delay cognitive impairment is warranted. Repurposing pharmacological therapies with well-established safety record for additional indications is a promising recent trend in drug development. Vertigoheel (VH-04), a multicomponent drug made of Ambra grisea, Anamirta cocculus L., Conium maculatum, and Petroleum rectificatum, has been successfully used for several decades in the treatment of vertigo. Here, we investigated effects of VH-04 on cognitive performance in standard behavioral tests assessing different types of memory and explored cellular and molecular underpinnings of VH-04's biological activity.

Methods

In the majority of behavioral experiments, namely in the spontaneous and rewarded alternation tests, passive avoidance test, contextual/cued fear conditioning, and social transmission of food preference, we examined the ability of single and repeated intraperitoneal administrations of VH-04 to improve cognitive parameters of mice and rats disrupted by the application of the muscarinic antagonist scopolamine. In addition, we also assessed how VH-04 affected novel object recognition and influenced performance of aged animals in Morris water maze. Furthermore, we also studied the effects of VH-04 on primary hippocampal neurons in vitro and mRNA expression of synaptophysin in the hippocampus.

Results

Administration of VH-04 positively influenced visual recognition memory in the novel object recognition test and alleviated the impairments in spatial working memory and olfactory memory caused by the muscarinic antagonist scopolamine in the spontaneous alternation and social transmission of food preference tests. In addition, VH-04 improved retention of the spatial orientation memory of old rats in the Morris water maze. In contrast, VH-04 did not have significant effects on scopolamine-induced impairments in tests of fear-aggravated memory or rewarded alternation. Experiments in vitro showed that VH-04 stimulated neurite growth and possibly reversed the age-dependent decrease in hippocampal synaptophysin mRNA expression, which implies that VH-04 may preserve synaptic integrity in the aging brain.

Discussion

Our findings allow a cautious conclusion that in addition to its ability to alleviate manifestations of vertigo, VH-04 may be also used as a cognitive enhancer.

Transdermal Nicotine Poisoning: A Rare Case Report of Occupational Exposure

We report a case of accidental nicotine intoxication following transdermal exposure in a 22-year-old man with no medical history, who worked in a company manufacturing e-liquids for electronic cigarettes. He accidentally spilled 300 mL of pure nicotine solution (>99%) on his right leg without wearing protective clothing or a mask. Less than a minute later, he experienced dizziness, nausea, and headaches, followed by painful burning sensations in the affected area. He immediately removed his pants and washed his leg thoroughly with water. He presented to the emergency department two hours later, where he exhibited a respiratory rate of 25 cpm, a heart rate of 70 bpm, headaches, abdominal pain, pallor, and vomiting. He recovered without specific treatment five hours post-intoxication. Plasma levels of nicotine, cotinine, and hydroxycotinine were measured five hours after exposure using liquid chromatography-mass spectrometry. The concentrations found were 447 ng/mL for nicotine, 1254 ng/mL for cotinine, and 197 ng/mL for hydroxycotinine. Nicotine is an alkaloid that can be highly toxic, with doses of 30-60 mg being potentially fatal. Transdermal intoxication is rare, with very few cases reported in the literature. This case highlights the risk of acute intoxication through cutaneous exposure to nicotine-containing liquid products and the need for protective clothing when handling such products in a professional context.

Poisonous Piperidine Plants and the Biodiversity of Norditerpenoid Alkaloids for Leads in Drug Discovery: Experimental Aspects

There are famous examples of simple (e.g., hemlock, Conium maculatum L.) and complex (e.g., opium poppy, Papaver somniferum L., Papaveraceae) piperidine-alkaloid-containing plants. Many of these are highly poisonous, whilst pepper is well-known gastronomically, and several substituted piperidine alkaloids are therapeutically beneficial as a function of dose and mode of action. This review covers the taxonomy of the genera Aconitum, Delphinium, and the controversial Consolida. As part of studying the biodiversity of norditerpenoid alkaloids (NDAS), the majority of which possess an N-ethyl group, we also quantified the fragment occurrence count in the SciFinder database for NDA skeletons. The wide range of NDA biodiversity is also captured in a review of over 100 recently reported isolated alkaloids. Ring A substitution at position 1 is important to determine the NDA skeleton conformation. In this overview of naturally occurring highly oxygenated NDAs from traditional Aconitum and Delphinium plants, consideration is given to functional effect and to real functional evidence. Their high potential biological activity makes them useful candidate molecules for further investigation as lead compounds in the development of selective drugs.

RETRACTED: Evaluation of therapeutic and toxic levels of Conium maculatum L. extract in gestation and foetal development of adult albino rats

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief and Author. The authors have plagiarized part of the Ph.d. thesis of Begum Salma B., Effect of Conium maculatum L. against physiologically induced and genetically inherited dopaminergic neuronal death caused by rotenone in albino rats, Kuppam: Dravidian university, 2015?. One of the conditions of submission of a paper for publication is that authors declare explicitly that their work is original and has not appeared in a publication elsewhere. Re-use of any data should be appropriately cited. As such this article represents a severe abuse of the scientific publishing system. The scientific community takes a very strong view on this matter and apologies are offered to readers of the journal that this was not detected during the submission process.

UPLC-HRESI-MS and GC-MS analysis of the leaves of Nicotiana glauca

The alkaloid-rich fraction obtained by fractionation of the crude methanolic extract of the leaves of wild tobacco tree Nicotiana glauca Graham (Solanaceae) was analyzed using UPLC-MS and GC-MS. Anabasine, a piperidine alkaloid, was identified as the major constituent with approximately 60 % (m/m) of the alkaloid-rich fraction. In addition to anabasine, six secondary metabolites were identified using high-resolution UPLC-MS. Anabasine was quantified in the leaves to be 1 mg g^-1 dry plant material. The GC-MS analysis revealed five compounds with anabasine as the major component, while nicotine was not detected. Moreover, GC-MS was used for the analysis of the volatile oil that was obtained by hydro-distillation from the leaves of N. glauca. The volatile plant oil was found to be rich in oxygenated sesquiterpenes (e.g., β-bisabolol) and carboxylic acids and esters (e.g., ethyl linoleate and hexadecanoic acid), whereas anabasine was not detected.

ZnO Tips Dotted with Au Nanoparticles-Advanced SERS Determination of Trace Nicotine

Long-term exposure to nicotine causes a variety of human diseases, such as lung damage/adenocarcinoma, nausea and vomiting, headache, incontinence and heart failure. In this work, as a surface-enhanced Raman scattering (SERS) substrate, zinc oxide (ZnO) tips decorated with gold nanoparticles (AuNPs) are fabricated and designated as ZnO/Au. Taking advantage of the synergistic effect of a ZnO semiconductor with morphology of tips and AuNPs, the ZnO/Au-based SERS assay for nicotine demonstrates high sensitivity and the limit of detection 8.9 × 10-12 mol/L is reached, as well as the corresponding linear dynamic detection range of 10-10-10-6 mol/L. Additionally, the signal reproducibility offered by the SERS substrate could realize the reliable determination of trace nicotine in saliva.

Classification of the mechanisms by which cardiotoxic plant poisons exert their effects

Episodes of poisoning due to plant-based toxins are an unusual presentation to the emergency department. Plant poisons may be ingested if the source plant is misidentified as benign (eg, Lily of the Valley being mistaken for wild garlic and water hemlock being mistaken for wild celery), or taken as part of a complementary medicine regime or otherwise for psychotropic effect. Numerous plant poisons demonstrate cardiotoxic effects resulting from action against cardiac myocyte ion channels, or other cardiac receptor targets. These mechanisms will produce stereotyped symptoms and including electrocardiogram (ECG) changes dependent on which ion channels or receptors are targeted. These mechanisms are stereotyped and may be grouped by toxidromic effect. This article proposes a novel classification of cardiotoxic plant poisons based on these actions. Given that these mechanisms mirror the Vaughan Williams classification used to categorise therapeutic antiarrhythmic agents, it is felt that this will serve as a mnemonic and diagnostic aid in clinical situations of cardiotoxic plant ingestion.

Mild-to-severe poisoning due to Conium maculatum as toxic herb: A case series

Conium maculatum toxicity may occur by mistakenly or intentionally eating this plant. Due to muscarinic or nicotinic symptoms associated with this plant toxicity, supportive care and treatment with atropine are urgently important.

Cytisine and cytisine derivatives. More than smoking cessation aids

Cytisine, a natural bioactive compound that is mainly isolated from plants of the Leguminosae family (especially the seeds of Laburnum anagyroides), has been marketed in central and eastern Europe as an aid in the clinical management of smoking cessation for more than 50 years. Its main targets are neuronal nicotinic acetylcholine receptors (nAChRs), and pre-clinical studies have shown that its interactions with various nAChR subtypes located in different areas of the central and peripheral nervous systems are neuroprotective, have a wide range of biological effects on nicotine and alcohol addiction, regulate mood, food intake and motor activity, and influence the autonomic and cardiovascular systems. Its relatively rigid conformation makes it an attractive template for research of new derivatives. Recent studies of structurally modified cytisine have led to the development of new compounds and for some of them the biological activities are mediated by still unidentified targets other than nAChRs, whose mechanisms of action are still being investigated. The aim of this review is to describe and discuss: 1) the most recent pre-clinical results obtained with cytisine in the fields of neurological and non-neurological diseases; 2) the effects and possible mechanisms of action of the most recent cytisine derivatives; and 3) the main areas warranting further research.

Chemical characterization of tobacco-free "modern" oral nicotine pouches and their position on the toxicant and risk continuums

As compared with cigarette smoking, use of Swedish snus is associated with significantly fewer health risks. Nicotine pouches (NPs), a new form of oral nicotine product, are smokeless and tobacco-free, comprising a nicotine-containing cellulose matrix inside a fiber pouch. NPs are similar in appearance/use to snus, but without tobacco, have the potential to further reduce tobacco-related harm. This study aimed to evaluate toxicant levels of NPs to estimate their position on the tobacco/nicotine product continuums of toxicant delivery and risk. NPs, snus and nicotine replacement therapy products (NRTs) were analyzed for 24-26 compounds applicable to oral tobacco, and their levels were compared. Twenty of these compounds were further used to compare the toxicant profile of NPs, as well as estimated daily toxicant exposure from NP use, with that of tobacco/nicotine products spanning the risk continuum. Of the compounds measured, 22 (NPs), 22 (lozenge NRT), 20 (gum NRT), and 11 (snus) were not quantifiable. Compared with snus, NPs had lower levels of 10 HPHCs and comparable/undetectable levels of a further 13. Across the product categories, NPs and NRTs had the lowest toxicant profiles and estimations of relative toxicant exposure. Based on the present chemical analysis and estimated exposure, use of NPs appears likely to expose users to lower levels of toxic compounds than Swedish snus, which is recognized to offer reduced levels of harm than associated with tobacco smoking. We conclude that NPs should be placed close to NRTs on the tobacco/nicotine product toxicant delivery continuum, although further studies will be needed to confirm this.

The Biodiversity of Edible Flowers: Discovering New Tastes and New Health Benefits

Floriculture and horticulture have always been two parallel and very distinct agronomic realities. Floriculture is concerned with meeting the ornamental needs of our urban ecosystems, while horticulture is based on meeting food requirements. These two activities have now converged toward a food chain where flowers are conceived of as a sort of "new vegetable" and one of the most promising novelties to satisfy the growing need for food innovation both in terms of an organoleptic and nutraceutical profile. This novelty has rapidly evolved, especially following the growing scientific evidence of the human health benefits of flowers used as food. The typically high pigment concentration of the corollas (especially flavonoids and carotenoids), which have evolved to chromatically attract pollinators, indicates a marked nutraceutical activity especially in terms of antioxidant power. In this review, we first attempted to explore which species are most promising and which should be avoided due to real or suspected toxicity problems. The nutraceutical virtues were therefore highlighted trying to focus attention on those "functional phytochemicals" capable of counteracting some specific human pathologies. Furthermore, the organoleptic profile of edible flowers was investigated since this is one of the least known aspects. The cropping systems suitable for their cultivation were therefore hypothesized and finally the criticalities of edible flowers were addressed in terms of shelf life and marketing opportunities.

Establishment of a High-Resolution Liquid Chromatography-Mass Spectrometry Spectral Library for Screening Toxic Natural Products

Many natural products have biological effects on humans and animals. Poisoning caused by natural products is common in clinical toxicology cases. Liquid chromatography-high-resolution-mass spectrometry (LC-HRMS) has recently emerged as a powerful analytical tool for large-scale target screening, and the application of LC-HRMS can be expanded to evaluate potential natural product poisoning in clinical cases. We report the construction of an LC-HRMS spectral library of 95 natural products commonly implicated in poisoning, and an LC-HRMS assay was validated for definitive detection of natural products in urine and serum samples. For each compound, the limit of detection (LOD) was determined in the analytical range of 1.0 - 1000 ng/mL for urine samples and 0.50 - 500 ng/mL for serum samples. The mean (SD) of matrix effects for urine samples and that for serum samples were both -21% (22%), and the mean (SD) of recovery for serum samples was 89% (26%). The LC-HRMS assay was successfully applied to identify natural products in clinical cases. The spectral library parameters of each compound are provided in the supplementary material to aid other laboratories in identification of unknown natural toxins and development of similar methods on different mass spectrometry platforms.

Cardiac arrest due to liquid nicotine intoxication: a case report

Background

With the introduction of electronic cigarettes, reports of nicotine intoxication due to ingestion of large amounts of liquid nicotine have increased. This report presents a rare case of cardiac arrest due to nicotine intoxication that was successfully treated with appropriate respiratory and circulatory support.

Case Presentation

A 55‐year‐old man ingested 600 mg of liquid nicotine and developed sinus bradycardia followed by asystole. Appropriate and prompt resuscitation led to the return of spontaneous circulation. He was admitted to the intensive care unit and discharged 24 days later without any medical sequelae of nicotine intoxication.

Conclusion

Ingestion of a large amount of liquid nicotine, as in this case, can result in lethal bradycardia followed by cardiac arrest. Prompt basic life support by paramedic produced good neurological outcomes. Emergency physicians should be aware of the symptoms and appropriate treatment of severe nicotine intoxication.

Traditional Herbal Medicine in Mesoamerica: Toward Its Evidence Base for Improving Universal Health Coverage

The quality of health care in Mesoamerica is influenced by its rich cultural diversity and characterized by social inequalities. Especially indigenous and rural communities confront diverse barriers to accessing formal health services, leading to often conflicting plurimedical systems. Fostering integrative medicine is a fundamental pillar for achieving universal health coverage (UHC) for marginalized populations. Recent developments toward health sovereignty in the region are concerned with assessing the role of traditional medicines, and particularly herbal medicines, to foster accessible and culturally pertinent healthcare provision models. In Mesoamerica, as in most regions of the world, a wealth of information on traditional and complementary medicine has been recorded. Yet these data are often scattered, making it difficult for policy makers to regulate and integrate traditionally used botanical products into primary health care. This critical review is based on a quantitative analysis of 28 survey papers focusing on the traditional use of botanical drugs in Mesoamerica used for the compilation of the "Mesoamerican Medicinal Plant Database" (MAMPDB), which includes a total of 12,537 use-records for 2188 plant taxa. Our approach presents a fundamental step toward UHC by presenting a pharmacological and toxicological review of the cross-culturally salient plant taxa and associated botanical drugs used in traditional medicine in Mesoamerica. Especially for native herbal drugs, data about safety and effectiveness are limited. Commonly used cross-culturally salient botanical drugs, which are considered safe but for which data on effectiveness is lacking constitute ideal candidates for treatment outcome studies.

Ingestion of A Common Plant's Leaves Leads to Acute Respiratory Arrest and Paralysis: A Case Report

Background

Nicotiana glauca is a plant known to cause acute toxicity upon ingestion or dermal exposure due to the nicotinic alkaloid, anabasine. Nicotinic alkaloids cause toxicity by acting as agonists on nicotinic-type acetylcholine receptors (nAChRs). Initial stimulation of these receptors leads to symptoms such as tachycardia, miosis, and tremors. The effects of high doses of nicotinic alkaloids are biphasic, and eventual persistent depolarization of nAChRs at the neuromuscular junction occurs. This causes apnea, paralysis, and cardiovascular collapse.

Case Report

In this report, we present a case of respiratory arrest due to nicotinic alkaloid poisoning from the ingestion of Nicotiana glauca. The diagnosis was suspected after the patient’s family gave a history of the patient ingesting a plant prior to arrival. They were able to also provide a physical sample of the plant.

Conclusion

The phone application, “Plant Snap”, determined the plant species and helped confirm the diagnosis. This case describes how modern technology and thorough history taking can combine to provide the best possible patient care.

Medicinal plants and their uses recorded in the Archives of Latvian Folklore from the 19th century

ETHNOPHARMACOLOGICAL RELEVANCE

The records of folk medicine present historical evidence of medicinal plant usage in the territory of Latvia and describe native and imported plants and plant products that were used as medicine.

AIM OF THE STUDY

To collect and analyse the ethnobotanical knowledge found in records of Latvian folk medicine available in the Archives of Latvian Folklore.

MATERIALS AND METHODS

Following the International Classification of Primary Care, plant uses were grouped into one of the 17 categories based on the body systems and psychological and social problems. Each plant was identified by its scientific name according to The Plant List website. Additionally, the plant parts used, dosage forms of herbal medicines and routes of administration were analysed.

RESULTS

In total, 211 genera belonging to 71 families were mentioned in the analysed materials. The most common health conditions were digestive system disorders, respiratory system disorders and skin disorders. The plant families with the largest number of taxa were Asteraceae, Rosaceae, Lamiaceae, and Apiaceae. The most frequently mentioned native plant taxa were Achillea millefolium L., Matricaria chamomilla L., Allium cepa L., Artemisia absinthium L., and Plantago sp. L. Leaves and flowers were the most commonly used parts, and herbal tea was the most common dosage form. Only 59 out of 211 taxa mentioned in this study are included in the official herbal monographs of the European Medicines Agency.

CONCLUSIONS

One hundred and fifty-two plant taxa mentioned in the records of Latvian folk medicine are not included in the European Union herbal monographs providing scientific information on the safety and efficacy and deserve further exploration as traditional herbal medicines.

The environmental externalities of tobacco manufacturing: A review of tobacco industry reporting

Growing research and public awareness of the environmental impacts of tobacco present an opportunity for environmental science and public health to work together. Various United Nations agencies share interests in mitigating the environmental costs of tobacco. Since 2000, transnational tobacco industry consolidation has accelerated, spotlighting the specific companies responsible for the environmental and human harms along the tobacco production chain. Simultaneously, corporate social responsibility norms have led the industry to disclose statistics on the environmental harms their business causes. Yet, independent and consistent reporting remain hurdles to accurately assessing tobacco's environmental impact. This article is the first to analyze publicly available industry data on tobacco manufacturing pollution. Tobacco's significant environmental impact suggests this industry should be included in environmental analyses as a driver of environmental degradation influencing climate change. Countries aiming to meet UN Sustainable Development Goals must act to reduce environmental harms caused by the tobacco industry.

Cytisine for nicotine addiction treatment: a review of pharmacology, therapeutics and an update of clinical trial evidence for smoking cessation

AIMS

To review cytisine's history of use, pre-clinical evidence, clinical pharmacokinetics, efficacy, adverse reactions (ARs) and safety for smoking cessation.

METHODS

A synoptic review of the use of cytisine as a smoking cessation medication, mechanism of action, pharmacokinetics and safety. Relevant literature on data included in these sections were identified through a search of 11 databases with additional literature obtained from reports and monographs. Three databases (PubMed, EMBASE and www.elibrary.ru) were systematically searched for studies published from 2012 to August 2018 in any language to provide an updated meta-analysis of cytisine's efficacy and ARs for smoking cessation compared with placebo. We pooled the relative risks (RR) of abstinence in the efficacy analysis and RR of ARs, either reported by the authors or calculated from the reports.

RESULTS

Cytisine has been in use since 1964 and is currently marketed in 18 countries. Systemic bioavailability from oral ingestion is high and clearance is primarily renal, with minimal or no metabolism. Brain uptake in animal models is moderate. The plasma half-life averages 4.8 hours. Eight studies were included for meta-analysis of efficacy. With heterogeneous results, the overall RR versus placebo of successful continuous abstinence at the longest follow-up was 1.74 [95% confidence interval (CI) = 1.38-2.19]. Nausea, vomiting, dyspepsia, upper abdominal pain and dry mouth that were mild or moderate were the most common ARs, with RR versus placebo 1.10 (95% CI = 0.95-1.28). The cost of cytisine in eastern and central Europe is several-fold less than that of other smoking cessation medications.

CONCLUSIONS

Cytisine is a low-cost medication found to increase the likelihood of smoking cessation. The most frequently reported ARs of cytisine involve gastrointestinal symptoms that are mostly reported as either mild or moderate in severity.

Rapid identification of Gloriosa superba and Colchicum autumnale by melting curve analysis: application to a suicide case involving massive ingestion of G. superba

The plant species Gloriosa superba and Colchicum autumnale produce extremely poisonous colchicine as a major toxic metabolite. Almost all previous studies on colchicine poisoning have focused on drug analysis and clinical and pathological aspects. In this study, we developed a rapid, highly sensitive method to identify G. superba and C. autumnale. This method, which can distinguish between G. superba and C. autumnale using even minute amounts of plant material, is based on duplex real-time PCR in combination with melting curve analysis. To discriminate between the two genera of colchicine-containing plants, we designed new primer pairs targeting the region of the ycf15 gene, which is present in C. autumnale but not G. superba. By producing PCR amplicons with easily distinguishable melting temperatures, we were able to rapidly and accurately distinguish G. superba from C. autumnale. The new primer pairs generated no PCR amplicons from commercially available human DNA or various plant DNAs except for G. superba and C. autumnale. Sensitivity testing indicated that this assay can accurately detect less than 0.031 ng of DNA. Using our method in conjunction with colchicine drug analysis, we successfully identified G. superba in the stomach contents of a suicide victim who ingested massive quantities of a colchicine-containing plant. According to these results, duplex real-time PCR analysis is very appropriate for testing forensic samples, such as stomach contents harboring a variety of vegetables, and enables discrimination between G. superba and C. autumnale in forensic and emergency medical fields.

Green tobacco sickness: mecamylamine, varenicline, and nicotine vaccine as clinical research tools and potential therapeutics

INTRODUCTION

Green tobacco sickness occurs from transdermal absorption of chemicals from freshly harvested, green tobacco leaves. Signs and symptoms include nausea, vomiting, headache, and abdominal cramps. Prevalence has shifted from the United States and Europe to China, India, and Brazil. Worldwide 8 million individuals are afflicted, including women and children. Areas covered: Mecamylamine (Inversine®, Vecamyl®), a nicotinic acetylcholine receptor (nAChR) antagonist, should be tested as a remedy for green tobacco sickness. Mecamylamine is approved as an oral tablet for the treatment of hypertension, is safe, and is off-patent. Mecamylamine attenuates many of the effects of nicotine and tobacco including seizures, thereby supporting its use as an effective pharmacotherapy for tobacco dependence. Varenicline (Chantix®) and cytisine (Tabex®) are low efficacy (i.e. intrinsic activity) nAChR agonists, are used as smoking cessation aids, and are viable options to test as remedies against green tobacco sickness. Nicotine immunization strategies may provide further options for future testing. Expert commentary: Efforts to demonstrate reversal and/or prevention of green tobacco sickness by mecamylamine will underscore the importance of nicotine in this illness and highlight a new medication for effective treatment of tobacco poisoning.

Symptomatic bradycardia due to nicotine intoxication

Nicotine is a dangerous substance extracted from tobacco leaves. When nicotine is absorbed in excessive amounts, it can lead to respiratory failure and cardiac arrest. The commercialization of electronic cigarettes (e-cigarettes) has allowed users to directly handle e-cigarette liquid. Consequently, the risk of liquid nicotine exposure has increased. We describe our experience of managing the case of a patient who orally ingested a high concentration of liquid nicotine from e-cigarette liquid. The patient presented with bradycardia and hypotension, which are symptoms of parasympathetic stimulation, together with impaired consciousness. He recovered following treatment with atropine and a vasopressor.

Respiratory Failure Due To Plant Poisoning: Nicotiana glauca Graham

BACKGROUND

Cases of human poisoning associated with Nicotiana glauca Graham are quite rare. Patients may consume the plant by mistaking it for spinach or use it as a folk remedy. The toxin stimulates the acetylcholine receptors in the central and autonomic nervous systems. A prompt and appropriate supportive treatment is crucial for survival.

CASE REPORT

A 72-year-old female with a known breast cancer was brought to our emergency department (ED) with complaints of nausea and vomiting. The patient stated that her complaints started 2 h after she had cooked and eaten a plant in the hopes that it would help cure her cancer. On the second hour after arrival, the patient became confused. It was observed that the chest wall movements had decreased and that the patient had difficulty breathing. Due to respiratory failure, orotracheal intubation was performed to secure the airway. A sample of the plant that was eaten was requested from the patient's relatives. According to an Internet search, the plant sample was identified as N. glauca Graham. The patient was diagnosed with N. glauca Graham poisoning. The patient was extubated after 30 h. On 3-month follow-up, the patient was neurologically intact and had no complaints related to poisoning. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with incurable diseases such as cancer tend to try folk remedies and can end up in ED. In patients who present with muscle paralysis and respiratory failure, emergency physicians should consider N. glauca Graham as a cause of plant poisoning.

Ethnopharmacology of Love

Background: Elixirs conferring eternal youth or inducing amatory and erotic attraction have been searched for without success. Lovesickness is a widespread affliction resulting from unrequited love and/or the impossibility for physical and emotional union. The symptoms are reflections of altered dopamine, serotonin, noradrenaline, testosterone and cortisol levels and range from frenzy and intrusive thinking to despair and depression, sharing traits with the neurochemistry of addiction and compulsive behavior disorder. Although it can seriously impact the quality of life, lovesickness is currently not considered in official disease classification systems. Consequently, no official therapeutic guidelines exist, leaving subjects to seek the cure on their own. Methods: We review literature of the past 2000 years dealing with the concept, diagnosis and the healing of lovesickness and contextualize it with neurochemical, ethnomedical, and ethnographic data. Since neurobiological and pharmacological connections between the love drive and the sex drive exist, we review also the literature about herbal an- and aphrodisiacs, focusing on their excitatory or calmative potential. Results: An overall consensus regarding socio-behavioral regimes exists for dealing with lovesickness from historical through contemporary literature. The herbal drugs used for treating lovesickness or inducing love passion do not possess the alleged properties. The pharmacological effects of aphrodisiacs are heterogeneous, including dopaminergic and adrenergic activities, but there is no evidence for any serotonergic effects. The libido-regulating properties of anaphrodisiacs seem to be associated with sedative and toxic effects or decreasing testosterone levels. CB2 receptors expressed on dopaminergic neurons of the ventral tegmental area, part of the brain's reward circuit, implicated with addiction, orgasm and strong emotions such as love, might constitute a new therapeutic target. Conclusion: The common food additive and CB2 agonist β-caryophyllene might have the potential to attenuate dopaminergic firing, quenching the reward and thus motivation associated with romantic love. From Greek mythology to modern history, cultural expressions and implications of love, sex and procreation is and was organized along hierarchical lines that put men on top. The neuronal predispositions and activities associated with falling in love will probably forever remain nature's and Eros' secret.

Poisoning after Ingestion of Spartium junceum Seeds: Dose-Dependent Effects in Three Boys

BACKGROUND

Spanish broom (Spartium junceum L.) is an ornamental, medicinal, and potentially poisonous plant.

CASE REPORT

Three children, aged 5-6 years, were accidentally poisoned from ingesting a variable number of seeds of Spanish broom. This plant contains several quinolizidine alkaloids as cytisine, which act as an agonist of nicotinic acetylcholine receptors. The potential danger varies, depending on the dose. After having ingested one to two seeds, one of the boys was asymptomatic. A second boy ingested four to five seeds and presented some digestive problems with favorable clinical evolution. A third boy ingested seven to eight seeds, and presented with digestive and neurologic symptoms, as well as minor metabolic acidosis. In this case there was vomiting with remains of the seeds. He responded well to a gastric lavage and activated charcoal. He was discharged 24 h post ingestion. The intake within one to eight seeds was accompanied by moderate symptoms, with good response to treatment. Children poisoned by plants with nicotine-like symptomatology usually fully recover, but some fatal cases have been reported. Prevention is always a key aspect to consider so as to reduce the risk of poisoning. There is a lack of legislative measures, based on lists provided by experts, to regulate real or potentially poisonous plants in children's areas. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case serves as an example of accidental plant poisoning. For emergency physicians, it is usually complicated to identify the specific plant involved, so initial treatment often starts with basic measures (airway, breathing, and circulation).

Poisoning by Herbs and Plants: Rapid Toxidromic Classification and Diagnosis

The American Association of Poison Control Centers has continued to report approximately 50,000 telephone calls or 8% of incoming calls annually related to plant exposures, mostly in children. Although the frequency of plant ingestions in children is related to the presence of popular species in households, adolescents may experiment with hallucinogenic plants; and trekkers and foragers may misidentify poisonous plants as edible. Since plant exposures have continued at a constant rate, the objectives of this review were (1) to review the epidemiology of plant poisonings; and (2) to propose a rapid toxidromic classification system for highly toxic plant ingestions for field use by first responders in comparison to current classification systems. Internet search engines were queried to identify and select peer-reviewed articles on plant poisonings using the key words in order to classify plant poisonings into four specific toxidromes: cardiotoxic, neurotoxic, cytotoxic, and gastrointestinal-hepatotoxic. A simple toxidromic classification system of plant poisonings may permit rapid diagnoses of highly toxic versus less toxic and nontoxic plant ingestions both in households and outdoors; direct earlier management of potentially serious poisonings; and reduce costly inpatient evaluations for inconsequential plant ingestions. The current textbook classification schemes for plant poisonings were complex in comparison to the rapid classification system; and were based on chemical nomenclatures and pharmacological effects, and not on clearly presenting toxidromes. Validation of the rapid toxidromic classification system as compared to existing chemical classification systems for plant poisonings will require future adoption and implementation of the toxidromic system by its intended users.

Poisonous or non-poisonous plants? DNA-based tools and applications for accurate identification

Plant exposures are among the most frequently reported cases to poison control centres worldwide. This is a growing condition due to recent societal trends oriented towards the consumption of wild plants as food, cosmetics, or medicine. At least three general causes of plant poisoning can be identified: plant misidentification, introduction of new plant-based supplements and medicines with no controls about their safety, and the lack of regulation for the trading of herbal and phytochemical products. Moreover, an efficient screening for the occurrence of plants poisonous to humans is also desirable at the different stages of the food supply chain: from the raw material to the final transformed product. A rapid diagnosis of intoxication cases is necessary in order to provide the most reliable treatment. However, a precise taxonomic characterization of the ingested species is often challenging. In this review, we provide an overview of the emerging DNA-based tools and technologies to address the issue of poisonous plant identification. Specifically, classic DNA barcoding and its applications using High Resolution Melting (Bar-HRM) ensure high universality and rapid response respectively, whereas High Throughput Sequencing techniques (HTS) provide a complete characterization of plant residues in complex matrices. The pros and cons of each approach have been evaluated with the final aim of proposing a general user's guide to molecular identification directed to different stakeholder categories interested in the diagnostics of poisonous plants.

Brain Anatomy in Latino Farmworkers Exposed to Pesticides and Nicotine

OBJECTIVE

Migrant tobacco farmworkers experience regular occupational exposure to pesticides and nicotine. The present study was designed to determine whether there are differences in brain anatomy between Latino farmworkers and non-farmworkers.

METHODS

Magnetic resonance brain images were compared between farmworkers and non-farmworkers. In addition, blood cholinesterase activity and urinary cotinine levels were also used to identify associations with pesticide and nicotine exposure.

RESULTS

Farmworkers had greater gray matter signal in putamen and cerebellum, and lower gray matter signal in frontal and temporal lobes. Urinary cotinine was associated with the observed differences in brain anatomy, but blood cholinesterase activity was not.

CONCLUSIONS

Nicotine exposure was associated with neuroanatomical differences between Latino farmworkers and non-farmworkers. Future studies are needed to differentiate iron deposition from brain atrophy and to further assess the potential role of nicotine and pesticide exposure.

A critical review of neonicotinoid insecticides for developmental neurotoxicity

A comprehensive review of published and previously unpublished studies was performed to evaluate the neonicotinoid insecticides for evidence of developmental neurotoxicity (DNT). These insecticides have favorable safety profiles, due to their preferential affinity for nicotinic receptor (nAChR) subtypes in insects, poor penetration of the mammalian blood-brain barrier, and low application rates. Nevertheless, examination of this issue is warranted, due to their insecticidal mode of action and potential exposure with agricultural and residential uses. This review identified in vitro, in vivo, and epidemiology studies in the literature and studies performed in rats in accordance with GLP standards and EPA guidelines with imidacloprid, acetamiprid, thiacloprid, clothianidin, thiamethoxam, and dinotefuran, which are all the neonicotinoids currently registered in major markets. For the guideline-based studies, treatment was administered via the diet or gavage to primiparous female rats at three dose levels, plus a vehicle control (≥20/dose level), from gestation day 0 or 6 to lactation day 21. F1 males and females were evaluated using measures of motor activity, acoustic startle response, cognition, brain morphometry, and neuropathology. The principal effects in F1 animals were associated with decreased body weight (delayed sexual maturation, decreased brain weight, and morphometric measurements) and acute toxicity (decreased activity during exposure) at high doses, without neuropathology or impaired cognition. No common effects were identified among the neonicotinoids that were consistent with DNT or the neurodevelopmental effects associated with nicotine. Findings at high doses were associated with evidence of systemic toxicity, which indicates that these insecticides do not selectively affect the developing nervous system.

Alkaloid variation in New Zealand kōwhai, Sophora species

Alkaloid contents of leaf and seed samples of eight species of Sophora native to New Zealand, plus Sophora cassioides from Chile are reported. Fifty-six leaf and forty-two seed samples were analysed for alkaloid content by proton nuclear magnetic resonance spectroscopy, which showed major alkaloids as cytisine, N-methyl cytisine and matrine. GC analyses quantified these and identified further alkaloid components. The alkaloids identified were cytisine, sparteine, and matrine-types common to Sophora from other regions of the world. Cytisine, N-methyl cytisine, and matrine were generally the most abundant alkaloids across all species with seeds containing the highest concentrations of alkaloids. However, there was no clear taxonomic grouping based on alkaloid composition. A quantitative analysis of various parts of two Sophora microphylla trees showed that the seeds were the richest source of alkaloids (total 0.4-0.5% DM), followed by leaf and twig (0.1-0.3%) and then bark (0.04-0.06%), with only low amounts (<0.02%) found in the roots. This study represents the most comprehensive phytochemical investigation of New Zealand Sophora species to date and presents data for three species of Sophora for which no prior chemistry has been reported.

The impact of Pseudomonas syringae type III effectors on transient protein expression in tobacco

The production of recombinant proteins in plants is often achieved by transient expression, e.g. following the injection or vacuum infiltration of Agrobacterium tumefaciens into tobacco leaves. We investigated the associated plant defence responses, revealing that callose deposition is triggered by T-DNA transfer and that subsets of secondary metabolites accumulate in response to mechanical wounding or the presence of bacteria. We also tested the ability of five co-expressed type III effector proteins from Pseudomonas syringae to modulate these defence responses and increase the yield of two model proteins, the fluorescent marker DsRed and monoclonal antibody 2G12. HopF2 and AvrRpt2 induced necrotic lesions 5 days post-injection (dpi) even at low doses (OD600 nm  = 0.0078), and increased the concentration of certain secondary metabolites. HopAO1 significantly reduced the number of callose deposits at 2 dpi compared to cells expressing DsRed and 2G12 alone, whereas HopI1 reduced the concentration of several secondary metabolites at 5 dpi compared to cells expressing DsRed and 2G12 alone. Co-expression with HopAO1, AvrPtoB or HopI1 increased the concentrations of DsRed and 2G12 increased by ~6% but this was not a significant change. In contrast, HopF2 and AvrRpt2 significantly reduced the concentrations of DsRed and 2G12 by 34% and 22%, respectively. Our results show that type III effector proteins can modulate plant defence responses and secondary metabolite profiles but that transient co-expression is not sufficient to increase the yields of target recombinant proteins in tobacco.