The use and safety of non-allopathic Indian medicines

Ayurvedic Medicine: A Traditional Medical System and Its Heavy Metal Poisoning

Ayurveda is one of the oldest and most widely practiced traditional medical systems in the world. The ancient knowledge in this traditional medical system has yet to be fully explored. The interaction of rich knowledge from various traditional systems of medicine can open new pathways in the herbal drug discovery process. Apart from other hurdles in discovering plant-based medicines, the lack of knowledge of the differences and similarities between the theoretical doctrines of these systems is the greatest impediment to their convergence. Rasashastra is an Ayurvedic medicine section that deals with formulations that include minerals/metals, particularly Parad (mercury). According to the Ayurvedic Formulary of India, the most widely used heavy metals are mercury, arsenic, and lead. However, contemporary scientists are concerned about the use of heavy metals in Ayurvedic preparation. In this review article, we will discuss Ayurvedic medicine and the toxic effects of heavy metals.

Utilisation of public healthcare services by an indigenous group: a mixed-method study among Santals of West Bengal, India

A barrier to meeting the goal of universal health coverage in India is the inequality in utilisation of health services between indigenous and non-indigenous people. This study aimed to explore the determinants of utilisation, or non-utilisation, of public healthcare services among the Santals, an indigenous community living in West Bengal, India. The study holistically explored the utilisation of public healthcare facilities using a framework that conceptualised service coverage to be dependent on a set of determinants - viz. the nature and severity of the ailment, availability, accessibility (geographical and financial), and acceptability of the healthcare options and decision-making around these further depends on background characteristics of the individual or their family/household. This cross-sectional study adopts ethnographic approach for detailed insight into the issue and interviewed 422 adult members of Santals living in both rural (Bankura) and urban (Howrah) areas of West Bengal for demographic, socio-economic characteristics and healthcare utilisation behaviour using pre-tested data collection schedule. The findings revealed that utilisation of the public healthcare facilities was low, especially in urban areas. Residence in urban areas, being female, having higher education, engaging in salaried occupation and having availability of private allopathic and homoeopathic doctors in the locality had higher odds of not utilising public healthcare services. Issues like misbehaviour from the health personnel, unavailability of medicine, poor quality of care, and high patient load were reported as the major reasons for non-utilisation of public health services. The finding highlights the importance of improving the availability and quality of care of healthcare services for marginalised populations because these communities live in geographically isolated places and have low affordability of private healthcare. The health programme needs to address these issues to improve the utilisation and reduce the inequality in healthcare utilisation, which would be beneficial for all segments of Indian population.

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.

Pharmacovigilance of herbal medicines: Concerns and future prospects

ETHNOPHARMACOLOGICAL RELEVANCE

The use of herbal medicines for prophylaxis, prevention, and treatment of various ailments is rising throughout the world because they are thought to be safer than allopathic treatments, which they are. However, several investigations have documented the toxicity and adverse drug reactions (ADR) of certain formulations and botanicals if not consumed wisely.

AIM OF THE STUDY

The goal of the current study is to address herbal medication pharmacovigilance (PV) modeling and related considerations for improved patient safety. Also, focus is laid on the comprehensive and critical analysis of the current state of PV for herbal medications at the national and international levels.

MATERIALS AND METHODS

Targeted review also known as focused literature review methodology was utilized for exploring the data from various scientific platforms such as Science Direct, Wiley Online Library, Springer, PubMed, Google Scholar using "pharmacovigilance, herbal medicine, traditional medicine, ADR, under reporting, herb toxicity, herb interactions" as keywords along with standard literature pertaining to herbal medicines that is published by the WHO and other international and national organizations etc. The botanical names mentioned in the present article were authenticated using World Flora Online database.

RESULTS

The historical developments paving the way for PV in regulatory setup were also discussed, along with various criteria's for monitoring herbal medicine, ADR of herbs, phytoconstituents, and traditional medicines, herb-drug interactions, modes of reporting ADR, databases for reporting ADR's, provisions of PV in regulatory framework of different nations, challenges and way forward in PV are discussed in detail advocating a robust drug safety ecosystem for herbal medicines.

CONCLUSION

Despite recent efforts to encourage the reporting of suspected ADRs linked to herbal medicines, such as expanding the programme and adding community pharmacists and other healthcare professionals as recognized reporters, the number of herbal ADR reports received by the regulatory bodies remains comparatively low. Since users often do not seek professional advice or report if they have side effects, under-reporting, is anticipated to be significant for herbal medications. There are inadequate quality control methods, poor regulatory oversight considering herbs used in food and botanicals, and unregulated distribution channels. In addition, botanical identity, traceability of herbs, ecological concerns, over-the-counter (OTC) herbal medicines, patient-physicians barriers requires special focus by the regulatory bodies for improved global safety of herbal medicines.

Structural investigation of Ayurveda Lauha (Iron) Bhasma

In Ayurveda, 'Lauha' (Iron) Bhasma is primarily used to cure diseases related to iron deficiency in humans. It is produced from purified raw metallic iron using a combination of multi-step traditional preparation processes described in the Ayurveda literature. Here, we present the results of structural investigation performed on the medicinal grade 'Lauha' Bhasma using various X-ray based techniques. Our results indicate that after several rounds of heating and cooling in specific conditions following the Ayurvedic preparation procedure, metallic iron eventually converts to a natural iron-oxide mineral belonging to the magnetite group. Scanning electron microscopy (SEM) and X-ray standing wave assisted fluorescence measurements carried out on powdered Bhasma specimen reveal that the magnetite micro-particles in the Bhasma specimen are usually present in the form of agglomerates of nano-particles. We anticipate that the Ayurvedic Lauha Bhasma has great potential for noninvasive localized target killing of cancer cells, particularly in sensitive parts of the human body such as the brain, spinal cord, and lungs, via necrosis by application of an alternating external magnetic field or photo electron generation through X-rays.

Artocarpus hirsutus Lam Leaf Extract-Evaluation of Analgesic and Anti-Inflammatory Activity

The study involved extraction, identification, and evaluation of pharmacological activities of the phytochemicals present. Artocarpus hirsutus Lam, commonly known as Wild jack is a greatly valued medicinal plant, which belongs to the plant family Moraceae. Preliminary phytochemical screening studies indicated the presence of flavonoids, saponins, tannins, glycosides, and alkaloids. This study estimated the analgesic and anti-inflammatory prospective of ethanolic leaf extract of Artocarpus hirsutus Lam. The findings showed that at various doses of 100, 200, and 400 mg/kg body weight when administered orally to rats, analgesic effects were produced, also the anti-inflammatory effect studied by carrageenan-induced rat paw edema test showed major anti-inflammatory action. The result indicates that the leaf extract of Artocarpus hirsutus Lam possesses major analgesic and anti-inflammatory activity and therefore requires further investigations to better understand the mechanism of action.

Management of a patient with polymorphic ventricular tachycardia from aconitum poisoning

An 81-year-old man presented to the Emergency Department with shortness of breath, generalised weakness, numbness, giddiness, nausea and vomiting after consuming an inadequately prepared Traditional Chinese Medicine preparation that contained herbal aconitum (Chuanwu and Caowu). His electrocardiogram (ECG) and rhythm strips showed multiple runs of non-sustained ventricular tachycardia monomorphic ventricular tachycardia and slowed polymorphic ventricular tachycardia. He was treated with intravenous (IV) amiodarone, magnesium and lignocaine, and was started on IV noradrenaline after developing haemodynamic compromise. There was no digoxin detected in the blood and urine. At 12 h, aconitine was not detected in the blood (cut off at <1 ng/mL) but aconitine and hypaconitine was detected in the urine qualitatively. He underwent a coronary angiogram at 12 h post-admission which showed minor coronary artery disease. A formal echocardiogram showed left ventricular ejection fraction 50–55% with no regional wall motion abnormalities of the left ventricle. He made an uneventful recovery and reverted to normal sinus rhythm at 29 h of admission. He was discharged well on Day 4 of admission with a diagnosis of polymorphic ventricular tachycardia secondary to Aconitum poisoning.

Attenuation of Cigarette-Smoke-Induced Oxidative Stress, Senescence, and Inflammation by Berberine-Loaded Liquid Crystalline Nanoparticles: In Vitro Study in 16HBE and RAW264.7 Cells

Cigarette smoke is considered a primary risk factor for chronic obstructive pulmonary disease. Numerous toxicants present in cigarette smoke are known to induce oxidative stress and airway inflammation that further exacerbate disease progression. Generally, the broncho-epithelial cells and alveolar macrophages exposed to cigarette smoke release massive amounts of oxidative stress and inflammation mediators. Chronic exposure of cigarette smoke leads to premature senescence of airway epithelial cells. This impairs cellular function and ultimately leads to the progression of chronic lung diseases. Therefore, an ideal therapeutic candidate should prevent disease progression by controlling oxidative stress, inflammation, and senescence during the initial stage of damage. In our study, we explored if berberine (an alkaloid)-loaded liquid crystalline nanoparticles (berberine-LCNs)-based treatment to human broncho-epithelial cells and macrophage inhibits oxidative stress, inflammation, and senescence induced by cigarette-smoke extract. The developed berberine-LCNs were found to have favourable physiochemical parameters, such as high entrapment efficiency and sustained in vitro release. The cellular-assay observations revealed that berberine-LCNs showed potent antioxidant activity by suppressing the generation of reactive oxygen species in both broncho-epithelial cells (16HBE) and macrophages (RAW264.7), and modulating the genes involved in inflammation and oxidative stress. Similarly, in 16HBE cells, berberine-LCNs inhibited the cigarette smoke-induced senescence as revealed by X-gal staining, gene expression of CDKN1A (p21), and immunofluorescent staining of p21. Further in-depth mechanistic investigations into antioxidative, anti-inflammatory, and antisenescence research will diversify the current findings of berberine as a promising therapeutic approach for inflammatory lung diseases caused by cigarette smoking.

The Post-COVID 19 long term surveillance study sequel to an add-on Ayurveda Regimen

It has been 18 months now since the world-wide outbreak of COVID 19 (Corona Virus Disease 19) and still the ongoing research is being done for disease specific medicines. During June 2020 to August 2020, an attempt was made to explore if an add-on Ayurveda regimen comprising of Dasamoolkadutrayadi Kashayam and Guluchyadi Kwatham in tablet forms can be prescribed along with standard of care; which has established the clinical evidence that there is advantage of accelerated symptomatic recovery, early discharge from hospital, reducing the duration of hospital stay. After informed consent the patients were followed up over 9 months after discharged from hospital. The purpose of the present extended study was to find the impact of disease even though patients were discharged after appropriate treatment and if there were any late effects in the add-on Ayurveda treatment group after 9 months as it was one of the first few formal studies world-wide; since there was no long term follow up data available.

The study concluded that no additional late effects or symptoms or complications which were known in Post COVID phase; were observed in study group who received the add-on Ayurveda regimen as compared to the control group with conventional standard of care.

Future Directions for the Discovery of Natural Product-Derived Immunomodulating Drugs

Drug discovery from natural sources is going through a renaissance, having spent many decades in the shadow of synthetic molecule drug discovery, despite the fact that natural product-derived compounds occupy a much greater chemical space than those created through synthetic chemistry methods. With this new era comes new possibilities, not least the novel targets that have emerged in recent times and the development of state-of-the-art technologies that can be applied to drug discovery from natural sources. Although progress has been made with some immunomodulating drugs, there remains a pressing need for new agents that can be used to treat the wide variety of conditions that arise from disruption, or over-activation, of the immune system; natural products may therefore be key in filling this gap. Recognising that, at present, there is no authoritative article that details the current state-of-the-art of the immunomodulatory activity of natural products, this in-depth review has arisen from a joint effort between the International Union of Basic and Clinical Pharmacology (IUPHAR) Natural Products and Immunopharmacology, with contributions from a Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation number of world-leading researchers in the field of natural product drug discovery, to provide a "position statement" on what natural products has to offer in the search for new immunomodulatory argents. To this end, we provide a historical look at previous discoveries of naturally occurring immunomodulators, present a picture of the current status of the field and provide insight into the future opportunities and challenges for the discovery of new drugs to treat immune-related diseases.

The toxicology and detoxification of Aconitum: traditional and modern views

Aconitum carmichaeli Debx.-derived herbal medicine has been used for anti-inflammation and anti-arrhythmia purpose for more than two thousand years. It is processed into Chuanwu (Radix Aconiti praeparata) and Fuzi (Radix Aconiti lateralis praeparata) in Traditional Chinese Medicine, which are two useful drugs but with toxic properties. There have been patients poisoned by accidental ingestion of Aconitum plants or misuse of the herbal drug, and this is of great concern to study in-depth. In this review, we provided the traditional and contemporary practice of using Aconitum herbs as medicine, from functions, processing methods to toxicity in ethnomedicine aspects to discuss the underlying connections of traditional and modern understanding on the toxicity of Aconitum plants. We summarized the functions and toxicology of the herbal drugs are analyzed from chemical and clinical aspects, with the help of traditional and modern knowledge of medicine. The medicinal doses and lethal doses determined by researches are summarized, and the usage and processing methods are updated and reviewed in the modern view. In addition, clinical management of poisoned cases using western medicine is discussed. This review provides insights and awareness of safety when using Aconitum-derived herbal medicine, and the application of modern scientific knowledge to optimize the detoxification processes. We suggest the possibility to renew the current standard processing method from the official Pharmacopoeia all over the world.

Heavy Metals in Indian Traditional Systems of Medicine: A Systematic Scoping Review and Recommendations for Integrative Medicine Practice

Introduction: Ayurveda and Siddha are two important components of the traditional Indian medicine (TIM). The regulatory mechanisms have been insufficient, and heavy metal toxicity with TIM preparations continues to be a public health nuisance, putting integrated medicine practice in jeopardy. The current study was undertaken to review the potential health hazards of the heavy metal content in the TIM and formulate patient-safety recommendations for integrative medical practice. Materials and Methods: Systematic MEDLINE searches were performed using a combination of relevant MeSH terms and keywords, and case report/series of Ayurveda or Siddha-induced heavy metal toxicity, published in the previous two decades, were included. Risk of bias was assessed with the tool by Murad et al. Results: A total of 220 cases (51 case reports and 14 case series) were found (lead, n = 156; arsenic, n = 11; mercury, n = 47; thallium, n = 1; gold, n = 1; combination of heavy metals, n = 4) after screening for the inclusion and exclusion criteria. Among them, 169 (76.8%) had a low risk of bias, 113 (out of 135 [83.7%] analyzed) contained higher-than-permissible heavy metal content in the drug samples, and the majority showed elevated biological levels of the heavy metals in the body. Conclusion: The heavy metals in TIM are often the result of adulteration or improper manufacturing and prescribing practices, despite national and international guidelines recommending quality standards and protocols for preparing and dispensing TIM. We thus propose multipronged approaches and provide recommendations at various levels, including individual, institutional, national policy decisions essential to establish patient safety of TIM.

Bacterial and heavy metal contamination in selected commonly sold herbal medicine in Blantyre, Malawi

Background

There has been an increase in use of herbal medicine worldwide. It is either used as a stand-alone or complementary therapy to conventional medicine due to past good experience, poverty and family traditions. In Malawi, there are no regulations governing the supply, acquisition, marketing and quality enforcement of herbal medicine. This compromises its safety thereby exposing consumers to avoidable bacteria and heavy metals leading to various adverse health effects.

Methods

Cross-sectional laboratory experiments were conducted to determine bacterial and heavy metal contamination of herbal medicine commonly sold in Blantyre, Malawi. A total of 47 samples which were in three formulations namely liquid, powder and tablet were used in the experiments. 29 samples were used for bacterial limit tests and 18 samples were used for heavy metal analysis. Bacterial contamination was determined by streak plate method and biochemical tests while heavy metals were determined by atomic absorption spectroscopy. Descriptive statistics and t-tests were calculated using Microsoft excel and SPSS software programs.

Results

Twenty out of the 29 samples (68.9%) were contaminated with Bacillus, coagulase negative Staphylococcus, Klebsiella, Enterobacter, Citrobacter and other-Coliform bacterial species. Most isolated microorganism was Citrobacter spp. (30%), followed by Bacillus spp. (25%). Out of 20 contaminated samples, 75% were contaminated with coliforms. From these 75% which were contaminated with coliforms, 93.3% of them exceeded WHO regulatory limit (103 CFU/g for enterobacteria). Although liquid samples had the highest level of bacterial contaminants, the count was not statistically different from other formulations (P = 0.058). For heavy metals, lead and cadmium were detected and 67% of the samples had lead levels exceeding regulatory limits.

Conclusion

Levels of bacterial and lead contamination in herbal medicine from Blantyre markets are far above acceptable limits set by WHO and Canadian guidelines. The use of these herbal medicines is a major risk to the health of consumers.

Acute lead poisoning: a diagnostic challenge in the emergency department

Acute abdominal pain is a common presentation to the emergency department (ED). Ruling out life-threatening causes and giving pain relief are the most important tasks in ED. We describe a 32-year-old man who presented to ED with abdominal pain and vomiting which was unrelieved by usual doses of analgesic. Extensive investigations revealed no significant abnormalities. On further probing, he admitted taking traditional medications for infertility. The toxicological panel revealed a high blood lead level, leading to a diagnosis of acute lead toxicity. Chelation therapy with D-penicillamine was initiated and the patient's abdominal pain resolved within 4 days.

Subacute oral toxicity of ayurvedic anti-diabetic preparation Jambadyarista in Sprague-Dawley rats

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Jambadyarista, an Ayurvedic formulation used in the management of diabetes and its related complications.

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This study investigated the subacute oral toxicity of Jambadyarista in a rat model.

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Biochemical and hematological parameters were studied after 28-day of treatment.

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Evidence of mortality and change in observed parameters were not seen that proves the oral safety of Jambadyarista.

Background

Jambadyarista is an Ayurvedic polyherbal formulation widely prescribed by Ayurvedic practitioners for the management of diabetes and its associated complications. About 39 companies have marketed this formulation in Bangladesh with consent from the Directorate General of Drug Administration (DGDA).

Aim

This study investigated the sub-acute oral toxicity of Jambadyarista in the Sprague-Dawley rat model.

Methods

The sub-acute toxicity studies were executed in Sprague-Dawley rats. Jambadyarista formulation was given for 28-days through oral gavage at 10 mL/kg and 20 mL/kg dose to two different groups comprising 6 rats of both sex/groups. Across the experimental period mortality, adverse reactions were closely monitored. After 28-day feeding hematological, biochemical, and relative organ weights were quantified.

Results

No mortality and/or signs of morbidity were observed for 28-day of repeated-dose sub-acute toxicity. Any pernicious change in body weight, biochemical, and hematological parameters along with relative organ weight were not observed for Jambadyarista. Correlation study among parameters of the renal profile, liver profile, lipid profile also metabolic hormones (T₃ and TSH), and enzymes showed the non-toxic rather beneficial role (hypolipidemic) of Jambadyarista in Sprague-Dawley rats.

Conclusion

Jambadyarista preparation did not cause any potential toxic effect in repeated dose subacute toxicity study over Sprague-Dawley rats orally. Therefore, low dose administration of Jambadyarista could have a beneficial effect on diabetes and can be considered safe before the chronic study.

A study on the motivation of Indian patients to consult complementary and alternative medicine practitioners to treat coronary artery disease

BACKGROUND

In India, the use of traditional medicine for health problems is a part of the cultural discourse on treatment, but the introduction of Western medicines has adversely affected their popularity. However, with the rapid spread of chronic diseases like coronary artery disease (CAD), many Indians are reverting to complementary and alternative medicine (CAM) treatments. Although previous literature has identified several motivational factors underlying CAM usage, we know little from the perspective of its practitioners.

AIM

The aim of the present study was to investigate the motivations behind the use of CAM treatments among Indian patients with CAD.

METHOD

Using semi-structured interviews, we collected data from 15 CAM practitioners and 14 CAD patients utilising CAM treatments alongside conventional biomedical (BM) treatment. We used the Clarke and Braun (2006) method of thematic analysis.

RESULT AND CONCLUSION

Our findings suggest that the use of CAM treatments depends on various factors working at multiple levels viz., personal factors, disease' characteristics, perceived treatment characteristics (positive attributes of CAM and negative attributes of BM) and external facilitators. Furthermore, our analysis also identifies the role of two underlining forces-push and pull-in motivating CAD patients to choose CAM treatments. The push force comprises factors that participants found to have a repelling nature, whereas pull forces were regarded as advantageous for CAM usage. Although some reasons behind the usage of CAM treatments according to patients and practitioners were overlapping, both groups also provided many distinct insights into the studied health behaviour.

Fiction, Falsehoods, and Few Facts: Cross-Sectional Study on the Content-Related Quality of Atopic Eczema-Related Videos on YouTube

Background

In recent years, YouTube has become a recognized source of medical information for health care consumers. Although YouTube has advantages in this context, there are potential dangers as videos may contain nonscientific, misleading, or even harmful information.

Objective

As little is known about YouTube as a source of information on atopic dermatitis (AD), we investigated the content-related quality of AD videos and their perception among YouTube users.

Methods

The quality of the 100 most viewed AD videos was assessed by using the Global Quality Scale (GQS) and the DISCERN instrument. Videos were classified as “useful,” “misleading,” and “potentially harmful,” and the correlations of viewers’ ratings (likes) with the GQS and DISCERN scores were assessed.

Results

Among the 100 videos, 68.0% (68/100) and 62.0% (62/100) were of poor and very poor scientific quality, respectively. Additionally, 32.0% (32/100) of the videos were classified as useful, 48.0% (48/100) were classified as misleading, and 34.0% (34/100) were classified as potentially harmful. Viewers’ ratings did not correlate with the GQS and DISCERN scores. Overall, 50.0% (50/100) of the videos were posted by private individuals and promoters of complementary/alternative treatments, 42.0% (42/100) by therapeutical advertisers, and only 8.0% (8/100) by nonprofit organizations/universities.

Conclusions

Our study demonstrated that two-thirds of the videos analyzed were below acceptable medical quality standards and that many videos were disseminating misleading or even dangerous content. Subjective and anecdotal content was overrepresented, and viewers did not appear to be able to distinguish between high- and low-quality videos. Health promotion strategies by professional medical organizations are needed to improve their presence and visibility on YouTube.

Loading-induced antitumor capability of murine and human urine

While urine has been considered as a useful bio-fluid for health monitoring, its dynamic changes to physical activity are not well understood. We examined urine's possible antitumor capability in response to medium-level, loading-driven physical activity. Urine was collected from mice subjected to 5-minute skeletal loading and human individuals before and after 30-minute step aerobics. Six cancer cell lines (breast, prostate, and pancreas) and a mouse model of the mammary tumor were employed to evaluate the effect of urine. Compared to urine collected prior to loading, urine collected post-activity decreased the cellular viability, proliferation, migration, and invasion of tumor cells, as well as tumor weight in the mammary fat pad. Detection of urinary volatile organic compounds and ELISA assays showed that the loading-conditioned urine reduced cholesterol and elevated dopamine and melatonin. Immunohistochemical fluorescent images presented upregulation of the rate-limiting enzymes for the production of dopamine and melatonin in the brain. Molecular analysis revealed that the antitumor effect was linked to the reduction in molecular vinculin-linked molecular force as well as the downregulation of the Lrp5-CSF1-CD105 regulatory axis. Notably, the survival rate for the high expression levels of Lrp5, CSF1, and CD105 in tumor tissues was significantly lowered in the Cancer Genome Atlas database. Collectively, this study revealed that 5- or 10-minute loading-driven physical activity was sufficient to induce the striking antitumor effect by activating the neuronal signaling and repressing cholesterol synthesis. The result supported the dual role of loading-conditioned urine as a potential tumor suppressor and a source of diagnostic biomarkers.

New Approaches in Breast Cancer Therapy Through Green Nanotechnology and Nano-Ayurvedic Medicine - Pre-Clinical and Pilot Human Clinical Investigations

PURPOSE

The overarching objective of this investigation was to investigate the intervention of green nanotechnology to transform the ancient holistic Ayurvedic medicine scientifically credible through reproducible formulations and rigorous pre-clinical/clinical evaluations.

METHODS

We provide, herein, full details: (i) on the discovery and full characterization of gold nanoparticles-based Nano Swarna Bhasma (henceforth referred to as NSB drug); (ii) In vitro anti-tumor properties of NSB drug in breast tumor cells; (iii) pre-clinical therapeutic efficacy studies of NSB drug in breast tumor bearing SCID mice through oral delivery protocols and (iv) first results of clinical translation, from mice to human breast cancer patients, through pilot human clinical trials, conducted according to the Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (abbreviated as AYUSH) regulatory guidelines of the Government of India in metastatic breast cancer patients.

RESULTS

The preclinical in vitro and in vivo investigations, in breast tumor bearing mice, established unequivocally that the NSB Nano-Ayurvedic medicine-gold nanoparticles-based drug is highly effective in controlling the growth of breast tumors in a dose dependent fashion in vivo. These encouraging pre-clinical results prompted us to seek permission from the Indian Government's holistic medicine approval authority, AYUSH, for conducting clinical trials in human patients. Patients treated with the NSB drug capsules along with the "standard of care treatment" (Arm B) exhibited 100% clinical benefits when compared to patients in the treatment Arm A, thus indicating the tremendous clinical benefits of NSB drug in adjuvant therapy.

CONCLUSION

We have succeeded in clinically translating, from mice to humans, in using proprietary combinations of gold nanoparticles and phytochemicals to develop the Nano-Ayurvedic drug: Nano Swarna Bhasma (NSB), through innovative green nanotechnology, for treating human metastatic breast cancer patients.

Comparison of Toxic Metal Concentrations in Antidiabetic Herbal Preparations (ADHPs) Available in Bangladesh Using AAS and XRF Analytical Tools

Widespread escalation of type 2 diabetes is a concern throughout the world. Developing countries are leading with patients suffering from diabetes-related complications. Plant-based therapeutic, antidiabetic herbal preparations (ADHPs) are being sought for long and the consumption is increasing in in Bangladesh. Plant-based antidiabetic preparations do not go through the screening procedure in terms of safety. Toxic metals in ADHPs have been investigated by two different methods: atomic absorption spectroscopy (AAS) and X-ray fluorescence (XRF). Then, metal concentrations obtained by AAS and XRF were compared. A total of eleven ADHPs were subjected to nondestructive XRF analysis and destructive AAS analysis. Results from the two methods were analyzed statistically by Pearson correlation coefficient (PCC), r_xy. Pearson correlation coefficients were found to be −0.05, 0.94, and 1.00 for Mn, Cu, and Zn, respectively. Zn and Cu had significant strong positive correlation (r_xy = 1.00 and 0.94, respectively); however, very weak negative correlation was observed in Mn (r_xy = −0.05). The concentrations were regressed to observe the presence of linearity. Linear correlation was found for Zn and Cu which indicates a good agreement between AAS and XRF. However, very weak linear correlation in Mn indicates necessitating requirements for further investigation on getting scientific evidence of toxic metal assessment of the antidiabetic herbal preparations for searching and establishing instrumental agreement.

Blood Lead Levels of Children Using Traditional Indian Medicine and Cosmetics: A Feasibility Study

Background

Traditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 µg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied.

Methods

We assessed the feasibility of collecting BLLs in children attending Ayurvedic outpatient settings in India. Our pilot study took place over 3 days in the summer of 2010 at a large public Ayurveda hospital and a small pediatric clinic in southern India. Using a trained interpreter, we administered a standardized questionnaire in Malayalam, assessing sociodemographics, Ayurvedic medicine use, kohl use, and other potential risk factors for lead exposure, to parents of pediatric outpatients. We also analyzed BLLs using a portable lead analyzer.

Results

The study enrolled 29 children (mean age, 3.8 years). The mean BLL was 6.7 µg/dL (SD = 3.5; range, 3.5-20.2). Seventy-two percent of the children used Ayurvedic medicine in the past 2 years and 55% reported kohl use. Mean BLL of Ayurvedic users and nonusers was 6.2 µg/dL and 8.5 µg/dL, respectively (P = .08). Kohl users had a statistically significant higher BLL than nonusers (8.0 µg/dL vs 5.3 µg/dL, P = .03).

Conclusions

It is feasible to collect BLLs in pediatric Ayurvedic outpatient clinics in southern India. Collaborative relationships with community members and hospital staff were essential. Further research is needed to investigate Ayurveda and kohl use as risk factors for elevated lead burden among Indian children.

Metals and metalloids in traditional medicines (Ayurvedic medicines, nutraceuticals and traditional Chinese medicines)

Traditional medicine (TM) including Ayurvedic medicines, traditional Chinese medicines and nutraceuticals are popular across the globe as dietary supplements and traditional and alternative medicines. Health risks from these remedies continue to present serious concerns, with occurrences of poisoning by metals and metalloids present at concentrations above acceptable regulatory standards. This review overviews the prevalence of TM use, cases of metal and metalloid poisoning following TM consumption, and forms of TM contamination and adulteration. The review summarises regulations by the World Health Organization (WHO) and other relevant bodies. Finally, the review recommends how to protect consumers.

Sources of lead exposure in various countries

This review evaluates the sources of lead exposure worldwide. Studies from searches relating to sources of lead exposure in various countries within different regional zones were reviewed. Results indicated that in Nigeria, exposure sources include electronic waste, paint and batteries. In Mexico exposure sources include glazed ceramics, lead contaminated utensils and lead contaminated water, for India lead sources include cosmetics and traditional medicines. Sources of lead exposure in China include e-waste, traditional medicines and industrial emissions. In France, exposure sources included lead paint from older homes, imported ceramics and cosmetics and industrial emissions. Australia's exposure sources include paint, dust, imported toys and traditional medicines. Finally, in the United States exposure sources included paint, the industrial legacy of lead exposure and batteries. In high-income countries (HICs) the legacy of lead exposure keeps populations continuously exposed. In lower- and middle-income countries (LMICs), in addition to the legacy of lead exposure, lack of regulations or the inability to enforce regulations keeps populations exposed. In all, evidence suggests that lead exposure remains an issue of public health significance in both HIC and LMIC.

Chemoprotective effects of butanol fraction of Buchholzia coriacea (Capparidaceae) against type 2 diabetes and oxidative stress in male Wistar rats

Recent studies have shown that Type 2 diabetes (T2D) in rats can result through a synergy that links obesity to insulin resistance and β-cell dysfunction. The present study achieved T2D via high fructose (20%^w/v, p.o.), streptozotocin single dose (40 mg/kg, i.p.) (HFSTZ) in rats. Also, chemoprotective potential of butanol fraction of Buchholzia coriacea (BFBC) was demonstrated. Control normal and diabetic untreated (HFSTZ-induced T2D) rats received CM-cellulose (1 mg/kg, p.o.). Diabetic rats received intragastric BFBC (20, 200, 400 mg/kg), glibenclamide (0.07 mg/kg), and BFBC (200 mg/kg) plus glibenclamide treatments, respectively. 2,2-Diphenyl-1-picrylhydrazyl, nitric oxide radical, hydroxyl radical scavenging activities, and α-amylase inhibition were assessed. After 2 weeks of treatments, blood glucose levels, lipid profiles, renal and liver function, serum insulin as well as in vivo oxidative stress biomarkers were assessed. BFBC shows highest antioxidants and α-amylase inhibitory activities in vitro HFSTZ-induced T2D produced hyperglycemia (P<0.05-0.001; F = 5.26-26.47), serum hyperinsulinemia (six-folds) plus elevated lipid peroxidation levels. Similarly, there were altered lipid profiles, liver and renal biomarker enzymes plus weight loss. BFBC administration alone or in combination with glibenclamide reversed T2D symptomatologies in treated animals, and improved body weights against control diabetic rats. In vivo antioxidant activities also improved while histological sections in treated rats show reduced tissue damage in pancreas, kidneys, liver, and heart, respectively. Oleic, stearic, 2-methyl-pyrrolidine-2-carboxylic, and n-hexadecanoic acids were present in BFBC in large quantities given GC-MS analysis. Overall, data from the present study suggest chemoprotective potentials of BFBC against HFSTZ-induced T2D rats.

Integration of traditional herbal medicines among the indigenous communities in Thiruvarur District of Tamil Nadu, India

BACKGROUND

Ethnobotanical studies are recognized as effective methods of finding locally important plants for discovery of crude drugs. Siddha medicinal system is prevailed in south Indian states principally in Tamil Nadu and gaining recognition as alternative medicine among the indigenous communities for their primary healthcare needs.

OBJECTIVES

The study was aimed to explore and document folk medicinal plant knowledge among the local people in Puliyankudi village of Thiruvarur District, Tamil Nadu, India.

MATERIALS AND METHODS

An ethnobotanical study was carried out during February 2016 to January 2017 among the local people in study area. Traditional healers, traders, local vendors and local people who are practicing herbal medicines were approached for documentation of folk medicinal uses. Acquired results were further analyzed with descriptive statistical methods such as use value (UV) and informant consensus factor (ICF).

RESULTS

During the survey, a total 116 plant species from 49 families and 103 genera were recorded to treat 73 types of ailments. Among the plant parts used for preparation of medicine, leaves (73 reports) are often used and predominant method of preparation of medicine is paste (56 reports). Limonia acidissima was reported by all the interviewed informants with an UV of 0.98 and kidney problems have highest ICF value of 0.91.

CONCLUSION

Plants with highest use values in the study indicates possible occurrence of valuable metabolites and should be investigated for associated pharmacological activities which leads to development of potential new drugs to treat various ailments.

Psychodermatology: An Indian perspective

Psychodermatology, a relatively neglected branch of dermatology in India, refers to a holistic approach to skin diseases involving not only the mind and skin, but also the cutaneous effects of psychologic stress. Among many Indian people, culture, religion, the belief in karma, and the tendency to prefer indigenous medical systems can all have a major impact on lifestyle, as well as the approach to managing various diseases, including dermatologic conditions. The origin of psychodermatology in India can be traced to Buddha's period. Indigenous medical systems, such as Ayurveda, Yoga, and Unani, advocate control of skin disease through meditation, exercises, and related practices. Scientific practice of psychodermatology is still lacking in India, although there is an increasing understanding of the mind-skin connection among both health care providers and patients who have access to information over the Internet. The first dedicated psychodermatology liaison clinic was established in 2010 in Manipal, India. The common problems encountered have been anxiety, dysthymia, and depression, especially in patients with psoriasis, vitiligo, and urticaria.

Blood Lead Levels and Potential Risk Factors for Lead Exposures Among South Asians in New York City

New York City’s South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.

Traditional Medicines and Kidney Disease in Low- and Middle-Income Countries: Opportunities and Challenges

Traditional medicines are a principal form of health care for many populations, particularly in low- and middle-income countries, and they have gained attention as an important means of health care coverage globally. In the context of kidney diseases, the challenges and opportunities presented by traditional medicine practices are among the most important considerations for developing effective and sustainable public health strategies. However, little is known about the practices of traditional medicines in relation to kidney diseases, especially concerning benefits and harms. Kidney diseases may be caused, treated, prevented, improved, or worsened by traditional medicines depending on the setting, the person, and the types, modes, and frequencies of traditional medicine use. Given the profound knowledge gaps, nephrology practitioners and researchers may be uniquely positioned to facilitate more optimal public health strategies through recognition and careful investigation of traditional medicine practices. Effective implementation of such strategies also will require local partnerships, including engaging practitioners and users of traditional medicines. As such, practitioners and researchers investigating kidney diseases may be uniquely positioned to bridge the cultural, social, historical, and biologic differences between biomedicine and traditional medicine, and they have opportunities to lead efforts in developing public health strategies that are sensitive to these differences.

Complementary and Alternative Medicine: A Cross-Sectional Observational Study in Pediatric Inpatients

The aim was to study the prevalence of complementary and alternative medicine use in acutely sick hospitalized children and factors associated with it. This is a cross-sectional, hospital-based study in a tertiary care center of Delhi, India. Children admitted to a pediatric unit during the study period were assessed using a specially designed questionnaire. Out of the total 887 admitted children, 161 (18.1%) were using complementary and alternate medicine in one form or another. Of these, 113 (70.2%) were using complementary and alternate medicine for the current illness directly leading to admission and the remaining 48 (29.8%) had used complementary and alternate medicine in past. The common complementary and alternate medicine use observed in our study was combined ayurveda and spiritual approach (25.5%), ayurveda (24.8%), spiritual (21.7%), homeopathic (13%), and 47.2% of children were using spiritual approach in form of Jhada (tying piece of cloth on arm or leg or keeping a knife by the side of child). The significant factors associated with complementary and alternate medicine use were younger age, female gender, and father being employed. Complementary and alternate medicine is commonly used even in acutely sick children.

Toxic metals in ayurvedic preparations from a public health lead poisoning cluster investigation

Background Herbal formulations, traditional medicine, and complementary and alternative medicine are used by the majority of the world's population. Toxicity associated with use of Ayurvedic products due to metal content is an increasingly recognized potential public health problem. Objectives Report on toxic metals content of Ayurvedic products obtained during an investigation of lead poisoning among users of Ayurvedic medicine. Methods Samples of Ayurvedic formulations were analyzed for metals and metalloids following established US. Environmental Protection Agency methods. Results Lead was found in 65% of 252 Ayurvedic medicine samples with mercury and arsenic found in 38 and 32% of samples, respectively. Almost half of samples containing mercury, 36% of samples containing lead and 39% of samples containing arsenic had concentrations of those metals per pill that exceeded, up to several thousand times, the recommended daily intake values for pharmaceutical impurities. Conclusions Lack of regulations regarding manufacturing and content or purity of Ayurvedic and other herbal formulations poses a significant global public health problem.

The legislative and regulatory framework governing herbal medicine use and practice in Kenya: a review

Complementary and alternative medicine is an integral component of primary healthcare in Kenya. This is because the infrastructural health setup in the country is inadequate in catering for all the medical needs of the population. This particularly holds true in the rural areas where many rural folk rely on products of herbal origin to offset their healthcare needs. More often than not these products are an elaborate cacophony of several different substances of biological origin and thus need personnel adept in their preparation. Sadly, due to loopholes in legislation and regulation, quacks have a field day in the practice. Moreover, the process of planting, harvesting, preparation and storage of herbs and related products dictates that a significant number of people will ultimately be involved in the whole process. This is likely to set the stage for manipulation and compromise of the safety, quality and efficacy of these products. This state of affairs appears unabated especially in the context of the current legal and regulatory framework governing herbal medicine use and practice in Kenya. Not only are these laws inadequate, they are shrouded in ambiguity, open to interpretation and the authorities mandated to implement them often end up performing duplicate roles. The aim of this review is to critique the legal and regulatory provisions governing herbal medicine use and practice in Kenya. In conclusion, laws and regulations meant to control herbal medicine use and practice in Kenya are wanting. Clear and definitive legislation on herbal medicine use and practice coupled with effective implementation by mandated institutions will go a long way in inspiring confidence to all stakeholders of herbal medicine.

Heavy metals in contaminated environment: Destiny of secondary metabolite biosynthesis, oxidative status and phytoextraction in medicinal plants

Contamination of soils, water and air with toxic heavy metals by various human activities is a crucial environmental problem in both developing and developed countries. Heavy metals could be introduced into medicinal plant products through contaminated environment (soil, water and air resources) and/or poor production practices. Growing of medicinal plants in heavy metal polluted environments may eventually affect the biosynthesis of secondary metabolites, causing significant changes in the quantity and quality of these compounds. Certain medicinal and aromatic plants can absorb and accumulate metal contaminants in the harvestable foliage and, therefore, considered to be a feasible alternative for remediation of polluted sites without any contamination of essential oils. Plants use different strategies and complex arrays of enzymatic and non-enzymatic anti-oxidative defense systems to cope with overproduction of ROS causes from the heavy metals entered their cells through foliar and/or root systems. This review summarizes the reports of recent investigations involving heavy metal accumulation by medicinal plants and its effects on elicitation of secondary metabolites, toxicity and detoxification pathways, international standards regarding in plants and plant-based products, and human health risk assessment of heavy metals in soil-medicinal plants systems.

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.

Evaluation of Potentially Toxic Metal Contamination of Local Medicinal Plants and Extracts Sold in Ibadan, Nigeria

BACKGROUND

Extracts from medicinal plants have been widely used in the treatment of public health ailments, however, medicinal plants may be grown in polluted soil/water environments. Many of these plants are harvested and processed by local and illiterate natural healers and other vendors in an unhygienic manner. This results in the possibility of contamination with potentially toxic metals from the environment.

OBJECTIVES

This study evaluated the concentrations of lead (Pb), cadmium (Cd), chromium (Cr), nickel (Ni), copper (Cu) and zinc (Zn) in 25 samples of different medicinal plants procured from stores in open markets in Ibadan, Nigeria.

METHODS

After procurement, the samples were air dried, pulverized and dry ashed. All ashes were dissolved with dilute acid solutions, filtered and the filtrates were stored for metal analysis. Samples with elevated metal concentrations were extracted with water and alcohol solutions to mimic the medicinal extracts obtained from these plants. Metal concentrations were analysed in all extracts and filtrates using atomic absorption spectrophotometry.

RESULTS

Metal concentrations (mg/kg dry weight) in all samples ranged as follows: Cu, 0.04 - 9.44; Zn, 0.36 - 35.4 and Pb, below detection limits (BDL) - 6.15. The concentrations of Cd, Cr and Ni in all samples were BDL. The concentrations of all metals in the samples were within accepted limits set for medicinal plants according to international regulatory bodies. All ethanol extracts and 1 out of 4 water extracts contained Pb.

CONCLUSIONS

Medicinal plants could pose chronic metal toxicity effects from continual bioaccumulation along the food chain. Furthermore, extraction of active ingredients with water was deemed to be safer than the use of alcohol extracts. Continuous monitoring of these medicinal plant materials is needed.

Governing the mixed health workforce: learning from Asian experiences

Examination of the composition of the health workforce in many low and middle-income countries (LMICs) reveals deep-seated heterogeneity that manifests in multiple ways: varying levels of official legitimacy and informality of practice; wide gradation in type of employment and behaviour (public to private) and diverse, sometimes overlapping, systems of knowledge and variably specialised cadres of providers. Coordinating this mixed workforce necessitates an approach to governance that is responsive to the opportunities and challenges presented by this diversity. This article discusses some of these opportunities and challenges for LMICs in general, and illustrates them through three case studies from different Asian country settings.

Chemoprevention in African American Men With Prostate Cancer

BACKGROUND

Recommendations for cancer screening are uncertain for the early detection or prevention of prostate cancer in African American men. Thus, chemoprevention strategies are needed to specifically target African American men.

METHODS

The evidence was examined on the biological etiology of disparities in African Americans related to prostate cancer. Possible chemopreventive agents and biomarkers critical to prostate cancer in African American men were also studied.

RESULTS

High-grade prostatic intraepithelial neoplasia may be more prevalent in African American men, even after controlling for age, prostate-specific antigen (PSA) level, abnormal results on digital rectal examination, and prostate volume. Prostate cancer in African American men can lead to the overexpression of signaling receptors that may mediate increased proliferation, angiogenesis, and decreased apoptosis. Use of chemopreventive agents may be useful for select populations of men.

CONCLUSIONS

Green tea catechins are able to target multiple pathways to address the underlying biology of prostate carcinogenesis in African American men, so they may be ideal as a chemoprevention agent in these men diagnosed with high-grade prostatic intraepithelial neoplasia.

Monitoring heavy metals, residual agricultural chemicals and sulfites in traditional herbal decoctions

BACKGROUND

Asian traditional herbal preparations are frequently considered for the contamination with undeclared toxic or hazardous substances. The aim of this study was to determine the toxic heavy metals, pesticides and sulfur dioxide in decoctions that is a common form of final utilization in Korea.

METHODS

A total of 155 decoctions composed of multi-ingredient traditional herbs were randomly sampled from Seoul in Korea between 2013 and 2014. For each decoction, the concentrations of four heavy metals (arsenic, cadmium, lead and mercury), 33 pesticides and sulfur dioxide were analyzed using inductively coupled plasma mass spectrometry (ICP-MS), mercury analyzer, gas chromatography/nitrogen phosphorous detector (GC/NPD), gas chromatography/micro electron capture detector (GC/μECD), and Monier-Williams method respectively.

RESULTS

One hundred fifty-two of One hundred fifty-five decoctions (98.1%) contained one of three heavy metals (96.1% for As, 97.4% for Cd, and 90.3% for Pb, 0.0% for Hg). Their average concentrations (77.0 ± 79.7 ug/kg for As, 20.4 ± 23.7 ug/kg for Cd, and 68.8 ± 76.5 ug/kg for Pb) were approximately 20% of the maximum allowable limits of vegetable or ginseng beverage described in the Korean Food Standard Codex while their 95th percentile concentrations were below than the guideline for them. None of 33 pesticides was detected in 155 decoction samples, and only one sample showed over limit of detection for residual sulfites.

CONCLUSIONS

This study support that the contained status of toxic heavy metals, pesticides and sulfur dioxide in herbal decoctions are currently within safe level in Korea, and provide a reference data for the further studies focused on the safety herbal preparations.

Should all patients with unexplained anaemia be screened for chronic lead poisoning?

The global prevalence of lead poisoning is declining. However, the prevalence of lead poisoning in patients with either microcytic or normocytic anaemia is unknown. Blood samples from anaemic patients residing in south-east London without an obvious cause for anaemia had their blood lead concentration (BLC) analysed.A batch of 988 samples was analysed for BLC using atomic absorption spectroscopy. Median haemoglobin was 10.3 g/dL (range: 4.2–10.9) in females, 10.6 g/dL (range: 5.2–11.4) in males and 10.7 g/dL (range: 6.7–10.9) in children. Median BLC was 2.63 μg/dL (0.21–24.0 μg/dL; 95th centile 7.54 μg/dL). Fifteen samples (1.5%) had a BLC>10.0 μg/dL, five samples (1%)>15.0 μg/dL and one sample (0.1%)>20.0 μg/L. In the 106 children, median BLC was 2.34 μg/dL (0.5–14.5 μg/dL; 95th centile 6.12 μg/ dL). Only one child (14.5 μg/L) had a BLC>10.0 μg/dL. There was a poor correlation between haemoglobin and BLC (r2=0.08).Routine screening for lead poisoning cannot be justified in all patients with unexplained anaemia, unless there is a history or clinical features to suggest lead toxicity. Additionally, we have shown that in this former high-risk area for lead exposure, there is a low point prevalence of significant lead poisoning, even in an anaemic population.

Case of acute lead toxicity associated with Ayurvedic supplements

Use of traditional folkloric remedies not disclosed to the physician may be difficult to identify as a source of lead toxicity. This report illustrates the presentation of a 26-year-old man who, during his 1 month vacation in India, was treated for low back pain with Ayurvedic herbal medicine. On his return to the USA, he presented to the emergency department with epigastric pain, weight loss, dark stools, nausea and vomiting. He was admitted and noted to be anaemic with a blood lead level (BLL) of 94.8 µg/dL. Peripheral blood smear demonstrated basophilic stippling. Chelation therapy with succimer was initiated. The patient became asymptomatic within months. Three years later, he remained asymptomatic with BLL <20 µg/dL. Physicians should be cognisant of potential toxicity from these Ayurvedic medications and have a heightened level of suspicion for lead toxicity in the face of anaemia and abdominal pain without obvious cause.

Standard manufacturing procedure of Teekshna lauha bhasma

BACKGROUND

Lauha bhasma is one of the herbo-metallic preparations used in Ayurveda, a traditional Indian system of medicine for treating various ailments such as anemia, diarrhea, hyperlipidemia and diabetes.

OBJECTIVE

To establish standard manufacturing procedure of Teekshna lauha bhasma and analyze its physico-chemical properties.

MATERIALS AND METHODS

The preparation of T. lauha bhasma (calx of iron [Fe] turning) involves samanya shodhana, vishesha shodhana followed by bhanupaka, sthalipaka and putapaka with Triphala kwatha as a medium under temperature of 650 °C in electric muffle furnace (EMF) and maintained for 1 h. T. lauha bhasma were subjected to different physico-chemical characterization using X-ray fluorescence spectrophotometer and scanning electron microscopy.

RESULTS AND DISCUSSION

The results suggest that these steps are necessary to obtain a good quality of bhasma and also make it acceptable for trituration during Bhasmikarana process. It is found that T. lauha bhasma was prepared properly in 20 puta at a temperature of 650 °C. The particle size of 20 puta T. lauha bhasma is 100-500 nm in range.

CONCLUSION

Pharmaceutical procedures given in Ayurvedic texts are necessary to prepare pakwa jambu phala varna T. lauha bhasma that complies with all the classical bhasma pariksha and modern analytical parameters in 20 puta at a temperature of 650 °C maintained for 1 h in EMF.

Speciation and bioavailability of lead in complementary medicines

Complementary medicines have associated risks which include toxic heavy metal(loid) and pesticide contamination. The objective of this study was to examine the speciation and bioavailability of lead (Pb) in selected complementary medicines. Six herbal and six ayurvedic medicines were analysed for: (i) total heavy metal(loid) contents including arsenic (As), cadmium (Cd), Pb and mercury (Hg); (ii) speciation of Pb using sequential fractionation and extended x-ray absorption fine structure (EXAFS) techniques; and (iii) bioavailability of Pb using a physiologically-based in vitro extraction test (PBET). The daily intake of Pb through the uptake of these medicines was compared with the safety guidelines for Pb. The results indicated that generally ayurvedic medicines contained higher levels of heavy metal(loid)s than herbal medicines with the amount of Pb much higher than the other metal(loid)s. Sequential fractionation indicated that while organic-bound Pb species dominated the herbal medicines, inorganic-bound Pb species dominated the ayurvedic medicines. EXAFS data indicated the presence of various Pb species in ayurvedic medicines. This implies that Pb is derived from plant uptake and inorganic mineral input in herbal and ayurvedic medicines, respectively. Bioavailability of Pb was higher in ayurvedic than herbal medicines, indicating that Pb added as a mineral therapeutic input is more bioavailable than that derived from plant uptake. There was a positive relationship between soluble Pb fraction and bioavailability indicating that solubility is an important factor controlling bioavailability. The daily intake values for Pb as estimated by total and bioavailable metal(loid) contents are likely to exceed the safe threshold level in certain ayurvedic medicines. This research demonstrated that Pb toxicity is likely to result from the regular intake of these medicines which requires further investigation.