Analysis of some selected toxic metals in registered herbal products manufactured in Nigeria

The use of herbal medicine has been on the increase in many developing and industrialized countries and Nigerians in particular has been using herbal medicine for many centuries. The approval of these herbal remedies by regulatory bodies has further encouraged the use of herbal remedies. The safety of these herbal remedies is however poorly understood. This study investigated the concentration of arsenic, cadmium, lead and mercury in twenty registered ready to use herbal products. Twenty brands of herbal remedies were purchased randomly from the Pharmacy shops in Lagos, digested with aquaregia (3:1 HCl: HNO3) and were analysed using atomic absorption spectroscopy (Buck 205 Atomic Absorption Spectrophotometer). There was no detectable lead in any of the 20 herbal samples; however, all the samples contained a detectable amount of one or more of the other metals of interest. The Oral Component Limit (OCL) for arsenic, cadmium and mercury as stated by USP are 1.5, 0.5 and 1.5 μg/g, respectively. All the samples contained arsenic and mercury below the USP OCL, while sixtyfive percent contained cadmium out of which fifty-five percent were above USP OCL. The results obtained from this study suggest a significant risk to consumers’ health considering the toxicity of these heavy metals.Key words: Herbal remedies, toxic heavy metals, atomic absorption spectrophotometry

Phytochemical Screening and Antioxidant Activities of Some Selected Medicinal Plants Used for Malaria Therapy in Southwestern Nigeria

Purpose: Oxidative stress has been shown to play an important role in the development of anaemia in malaria. Indeed, increase in total antioxidant status has been shown to be important in recovery from malaria. The antioxidant activities of four medicinal plants traditionally used in the treatment of malaria in southwestern Nigeria were determined. Methods: The ethanolic extracts of the leaves of Carica papaya Linn. [Caricaceae] , stem bark of Magnifera indica Linn. [Anacardiaceae], leaves of Psidium guajava Linn. [Myrtaceae] and the leaves of Vernonia amygdalina Del. [Compositae], were used in the present study. The plant parts commonly used in the locality in malaria therapy were employed in this study. The plants were screened for the presence of phytochemicals and, their effect on 2,2-Diphenyl-1-picryl-hydrazyl radical (DPPH) was used to determine their free radical scavenging activity. Results: Phytochemical screening of the plants showed the presence of flavonoids, terpenoids, saponins, tannins and reducing sugars. M. indica did not contain cardiac glycosides and alkaloids while, P. guajava also showed the absence of alkaloids and anthraquinones. Anthraquinones was similarly absent from V. amygdalina. Concentrations of the plant extracts required for 50% inhibition of DPPH radical scavenging effect (IC50) were recorded as 0.04 mg/ml, 0.313 mg/ml, 0.58 mg/ml, 2.30 mg/ml and 0.054 mg/ml for P. guajava, M. Indica, C. papaya, V. amygdalina and Vitamin C, respectively. Conclusion: All the plants showed potent inhibition of DPPH radical scavenging activity, P. guajava being the most potent. The free radical scavenging (antioxidant) activities of these plants probably contribute to the effectiveness of the above plants in malaria therapy. Keywords: Carica papaya, Magnifera indica, Psidium guajava, Vernonia amygdalina, Antioxidants, Malaria, DPPH, Oxidative stress. Tropical Journal of Pharmaceutical Research Vol. 7 (3) 2008: pp. 1019-102

Evaluation of the chemical constituents and the antimicrobial activity of the volatile oil of Citrus reticulata fruit(Tangerine fruit peel) from South West Nigeria

The volatile oil of tangerine fruit (Citrus reticulata) was extracted by steam distillation and assessed for antibacterial and antioxidant activity. The volatile oil was tested against some Gram-negative organisms (Escherichia coli ATCC 35218, E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella paratyphi, Proteus mirabilis and Citrobacter spp); Gram-positive organisms such as Staphylococcus aureus ATCC 25923, S. aureus, Enterococcus faecalis and a fungus (Candida albicans). The minimum inhibitory concentration (MIC) was determined with concentrations of oil extract ranging from 0.87 to 445 mg/ml. Result of the study showed that the oil has a broad spectrum antibacterial activity. MIC recorded were S. aureus (0.74 mg/ml), S. aureus ATTC 25923 (2.46 mg/ml), E. faecalis (1.26 mg/ml), S. typhi (2.07 mg/ml), K. pneumoniae (0.56 mg/ml), E. coli ATTC 35218 (0.19 mg/ml), E. coli (1.95 mg/ml), P. aeruginosa (0.97 mg/ml), C. albicans (0.68 mg/ml). Antioxidant screening with 2,2-diphenyl-1-picrylhydrazyl (DPPH) was negative. Analysis of the chemical constituent by GC-MS showed the presence of D-limonene as the major constituent. Other constituents found were a-pinene and β-pinene

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings: In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. Interpretation: Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Funding: Bill & Melinda Gates Foundation

The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis

Background A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen–drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Findings In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000–1 316 000) associated with bacterial AMR and 250 000 deaths (192 000–325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000–151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000–82 000], or 22%), intra-abdominal infections (26 000 deaths [17 000–39 000], or 10%), and tuberculosis (18 000 deaths [3850–39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000–1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen–drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. Interpretation This study reveals a high level of AMR burden for several bacterial pathogens and pathogen–drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen–drug combinations. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)

Ocular Features of Hypocalcaemia in a 35-year Old Woman – A case report

The case of a 35-year-old teacher who developed persistent hypocalcaemia following subtotal thyroidectomy for simple multinodular goitre is presented. She developed carpopedal spasm with positive Trousseau's and Chvostek's signs 10 days after surgery and was found with a calcium level of 1.94mmol/l. Her serum calcium has been persistently below normal levels since then. She developed hypermetropia and early onset of presbyopia 6 weeks after surgery; by this time her lens was clear on examination. She had enjoyed good vision prior to the thyroidectomy surgery. A year later, she had developed a fully mature bilateral presenile cataract. The case illustrates an uncommon cause of rapidly progressive bilateral mature cataract in Nigeria and the difficulty encountered in managing a patient with persistent hypocalcaemia in our environment. Key Words: permanent hypocalcaemia, post thyroidectomy, refractive error, mature bilateral presenile cataract Nigerian Journal of Ophthalmology Vol.12 (1) 2004: 26-2

The physicochemical and antibacterial properties of Ciproflaxacin-Mg2* complex

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