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Biswas P, Anand U, Saha SC, Kant N, Mishra T, Masih H, Bar A, Pandey DK, Jha N, Majumder M, Das N, Gadekar V, Shekhawat MS, Kumar M, Radha, Proćków J, de la Lastra JMP, Dey A. Betelvine (Piper betle L.): A comprehensive insight into its ethnopharmacology, phytochemistry, and pharmacological, biomedical and therapeutic attributes. J Cell Mol Med 2022; 26:3083-3119. [PMID: 35502487 PMCID: PMC9170825 DOI: 10.1111/jcmm.17323] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 12/11/2022] Open
Abstract
Piper betle L. (synonym: Piper betel Blanco), or betel vine, an economically and medicinally important cash crop, belongs to the family Piperaceae, often known as the green gold. The plant can be found all over the world and is cultivatedprimarily in South East Asian countries for its beautiful glossy heart-shaped leaves, which are chewed or consumed as betelquidand widely used in Chinese and Indian folk medicine, as carminative, stimulant,astringent, against parasitic worms, conjunctivitis, rheumatism, wound, etc., andis also used for religious purposes. Hydroxychavicol is the most important bioactive compound among the wide range of phytoconstituents found in essential oil and extracts. The pharmacological attributes of P. betle are antiproliferation, anticancer, neuropharmacological, analgesic, antioxidant, antiulcerogenic, hepatoprotective, antifertility, antibacterial, antifungal and many more. Immense attention has been paid to nanoformulations and their applications. The application of P. betle did not show cytotoxicity in preclinical experiments, suggesting that it could serve as a promising therapeutic candidate for different diseases. The present review comprehensively summarizes the botanical description, geographical distribution, economic value and cultivation, ethnobotanical uses, preclinical pharmacological properties with insights of toxicological, clinical efficacy, and safety of P. betle. The findings suggest that P. betle represents an orally active and safe natural agent that exhibits great therapeutic potential for managing various human medical conditions. However, further research is needed to elucidate its underlying molecular mechanisms of action, clinical aspects, structure-activity relationships, bioavailability and synergistic interactions with other drugs.
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Affiliation(s)
- Protha Biswas
- Department of Life SciencesPresidency UniversityKolkataWest BengalIndia
| | - Uttpal Anand
- Department of Life SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Suchismita Chatterjee Saha
- Department of ZoologyNabadwip Vidyasagar College (Affiliated to the University of Kalyani)NabadwipWest BengalIndia
| | - Nishi Kant
- Department of BiotechnologySchool of Health and Allied ScienceARKA Jain UniversityJamshedpurJharkhandIndia
| | - Tulika Mishra
- Department of BotanyDeen Dayal Upadhyay Gorakhpur UniversityGorakhpurUttar PradeshIndia
| | - Harison Masih
- Department of Industrial MicrobiologyJacob Institute of Biotechnology and BioengineeringSam Higginbottom University of Agriculture, Technology and SciencesPrayagrajUttar PradeshIndia
| | - Ananya Bar
- Department of ZoologyWilson College (Affiliated to University of Mumbai)MumbaiMaharashtraIndia
| | | | - Niraj Kumar Jha
- Department of BiotechnologySchool of Engineering & TechnologySharda UniversityGreater NoidaUttar PradeshIndia
| | - Madhumita Majumder
- Department of BotanyRaidighi College (Affiliated to University of Calcutta)RaidighiWest BengalIndia
| | - Neela Das
- Department of BotanyRishi Bankim Chandra College (Affiliated to the West Bengal State University)NaihatiWest BengalIndia
| | - Vijaykumar Shivaji Gadekar
- Zoology DepartmentSangola College (Affiliated to Punyashlok Ahilyadevi Holkar Solapur University)SolapurMaharashtraIndia
| | - Mahipal S. Shekhawat
- Plant Biotechnology UnitKanchi Mamunivar Government Institute for Postgraduate Studies and ResearchPuducherryIndia
| | - Manoj Kumar
- Chemical and Biochemical Processing DivisionICAR ‐ Central Institute for Research on Cotton TechnologyMumbaiMaharashtraIndia
| | - Radha
- School of Biological and Environmental SciencesShoolini University of Biotechnology and Management SciencesSolanHimachal PradeshIndia
| | - Jarosław Proćków
- Department of Plant BiologyInstitute of Environmental BiologyWrocław University of Environmental and Life SciencesWrocławPoland
| | - José M. Pérez de la Lastra
- Instituto de Productos Naturales y Agrobiología (IPNA)Consejo Superior de Investigaciones científicas (CSIS)Santa Cruz de TenerifeSpain
| | - Abhijit Dey
- Department of Life SciencesPresidency UniversityKolkataWest BengalIndia
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Manvar T, Mangukia N, Patel S, Rawal R. Understanding the Molecular Mechanisms of Betel miRNAs on Human Health. Microrna 2022; 11:45-56. [PMID: 35307000 DOI: 10.2174/2211536611666220318142031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Since ancient times, "betel leaf" (Piper betle) has been revered for its religious, cultural, and medicinal properties. Phytochemicals from the Piper betle are effective in a variety of conditions, including cancer. To date, however, no genomic study or evidence has been found to elucidate the regulatory mechanism that underpins its therapeutic properties. This is the first study of its kind to predict Piper betle miRNAs and also the first genomics source representation of Piper betle. According to previous research, miRNAs from the plants we eat can regulate gene expression. In line with this, our in-silico study revealed that Piper betle and human cross-kingdom control occurs. METHOD This study demonstrates the prediction and in-silico validation of Piper betle miRNAs from NGS-derived transcript sequences. The cross-kingdom regulation which can also be understood as inter-species RNA regulation was studied to identify human mRNA targets being controlled by Piper betle miRNAs. Functional annotation and gene-disease association of human targets were performed to understand the role of Piper betle miRNAs in human health and disease. The protein-protein interaction and expression study of targets was further carried out to decipher their role in cancer development. RESULTS Identified six Piper betle miRNAs belonging to miR156, miR164, miR172, and miR535 families were discovered to target 198 human mRNAs involved in various metabolic and disease processes. Angiogenesis and the cell surface signaling pathway were the most enriched gene ontology correlated with targets, both of which play a critical role in disease mechanisms, especially in the case of carcinoma. In an analysis of gene-disease interactions, 40 genes were found to be related to cancer. According to a protein-protein interaction, the CDK6 gene, which is thought to be a central regulator of cell cycle progression, was found as a hub protein, affecting the roles of CBFB, SAMD9, MDM4, AXIN2, and NOTCH2 onco genes. Further investigation revealed that pbe-miRNA164a can be used as a regulator to minimise disease severity in Acute Myeloid Leukemia, where CDK6 expression is highest compared to normal cells. CONCLUSION The predicted pbe-miRNA164a in this study can be a promising suppressor of CDK6 gene involved in tumour angiogenesis. In vivo validation of the pbe-miRNA164a mimic could pave the way for new opportunities to fight cancer and leverage the potential of Piper betle in the healthcare sector.
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Affiliation(s)
- Toral Manvar
- Department of Botany, Bioinformatics and Climate change impacts management, School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
- Xcelris Labs Ltd, Ahmedabad, Gujarat, India
| | - Naman Mangukia
- Department of Botany, Bioinformatics and Climate change impacts management, School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
- BioInnovations, Mumbai, India
| | - Saumya Patel
- Department of Botany, Bioinformatics and Climate change impacts management, School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
| | - Rakesh Rawal
- Department of Life Sciences, Food Science and Nutrition, School of Sciences, Gujarat University, Ahmedabad, Gujarat, India
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Naik P, Valli K. Comparative study of effects of home bleach and laser bleach using digital spectrophotometer: An in vitro study. J Conserv Dent 2022; 25:161-165. [PMID: 35720824 PMCID: PMC9205359 DOI: 10.4103/jcd.jcd_568_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
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Havale R, Rao DG, S P S, M Tuppadmath K, Tharay N, Mathew I, Taj KE. Comparative evaluation of pain perception following topical application of clove oil, betel leaf extract, lignocaine gel, and ice prior to intraoral injection in children aged 6-10 years: a randomized control study. J Dent Anesth Pain Med 2021; 21:329-336. [PMID: 34395900 PMCID: PMC8349677 DOI: 10.17245/jdapm.2021.21.4.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/15/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background In the field of dentistry, topical anesthetics play an important role in reducing pain during needle pricks. The anesthetic property of betel leaves remain unexplored, even though they have been widely used for the treatment of various ailments. The purpose of this study was to compare and evaluate pain perception following topical application of lignocaine gel, clove gel, ice, and newly developed betel leaf extract gel during intraoral injection in children. Methods Sixty children aged 6–10 years who met the inclusion criteria were divided into four groups. Topical anesthetic agents, 2% lignocaine (Lox-2% Jelly, Neon, Mumbai, India), 4.7% clove gel (Pain Out Dental Gel, Colgate Palmolive India Ltd, Solan, India), 10% betel leaf extract gel, and ice were applied to each group for one min, followed by administration of infiltration anesthesia. Pain perception was analyzed during needle insertion. The Wong Bakers FACES pain rating scale (WBFPRS) was used for subjective assessment and the Sound, Eye, Motor (SEM) scale for objective assessment. Recorded values were tabulated and subjected to appropriate statistical analysis using SPSS software with a P value set at 0.05. Results The clove oil and betel leaf groups demonstrated the highest WBFPRS scores, followed by the ice and lignocaine groups. The clove, betel leaf extract, and ice groups showed equal and highest SEM scores, followed by the lignocaine group. The mean WBFPRS and mean SEM scores were statistically significant. Conclusion Betel leaf extract gel is effective in reducing pain and can act as an alternative topical anesthetic agent.
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Affiliation(s)
- Raghavendra Havale
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
| | - Dhanu G Rao
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
| | - Shrutha S P
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
| | - Kanchan M Tuppadmath
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
| | - Namratha Tharay
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
| | - Irin Mathew
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
| | - Kausar E Taj
- Department of Pediatric and Preventive Dentistry, Academy of Medical Education Dental College and Hospital, Raichur, India
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Raimondeau P, Manzi S, Brucato N, Kinipi C, Leavesley M, Ricaut FX, Besnard G. Genome skims analysis of betel palms (Areca spp., Arecaceae) and development of a profiling method to assess their plastome diversity. Gene 2021; 800:145845. [PMID: 34274465 DOI: 10.1016/j.gene.2021.145845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
The betel nut (Areca catechu L., Arecaceae) is a monoecious cultivated palm tree that is widespread in tropical regions. It is mainly cultivated for producing areca nuts, from which seeds are extracted and chewed by local populations principally in the Indo-Pacific region. Seeds contain alkaloids which are central nervous system stimulants and are highly addictive. Wild relatives of the betel nut are distributed in South Asia and Australasia, with ca. 40-50 Areca species currently recognized. The geographic origin(s) of the betel nut and its subsequent diffusion and diversification remains poorly documented. Here, a genome skimming approach was applied to screen nucleotidic variation in the most abundant genomic regions. Low coverage sequencing data allowed us to assemble full plastomes, mitochondrial regions (either full mitogenomes or the full set of mitochondrial genes) and the nuclear ribosomal DNA cluster for nine representatives of the Areca genus collected in the field and herbarium collections (including a 182-years old specimen collected during the Dumont d'Urville's expedition). These three genomic compartments provided similar phylogenetic signals, and revealed very low genomic diversity in our sample of cultivated betel nut. We finally developed a genotyping method targeting 34 plastid DNA microsatellites. This plastome profiling approach is useful for tracing the spread of matrilineages, and in combination with nuclear genomic data, can resolve the history of the betel nut. Our method also proves to be efficient for analyzing herbarium specimens, even those collected >100 years ago.
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Affiliation(s)
- Pauline Raimondeau
- Laboratoire Évolution & Diversité Biologique (EDB, UMR 5174), Université de Toulouse, CNRS-IRD-UPS, 118 route de Narbonne, Bât. 4R1, 31062 Toulouse, France
| | - Sophie Manzi
- Laboratoire Évolution & Diversité Biologique (EDB, UMR 5174), Université de Toulouse, CNRS-IRD-UPS, 118 route de Narbonne, Bât. 4R1, 31062 Toulouse, France
| | - Nicolas Brucato
- Laboratoire Évolution & Diversité Biologique (EDB, UMR 5174), Université de Toulouse, CNRS-IRD-UPS, 118 route de Narbonne, Bât. 4R1, 31062 Toulouse, France
| | - Christopher Kinipi
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, PO Box 320, University 134, National Capital District, Papua New Guinea
| | - Matthew Leavesley
- Strand of Anthropology, Sociology and Archaeology, School of Humanities and Social Sciences, University of Papua New Guinea, PO Box 320, University 134, National Capital District, Papua New Guinea; CABAH & College of Arts, Society and Education, James Cook University, PO Box 6811, Cairns, QLD 4870, Australia
| | - François-Xavier Ricaut
- Laboratoire Évolution & Diversité Biologique (EDB, UMR 5174), Université de Toulouse, CNRS-IRD-UPS, 118 route de Narbonne, Bât. 4R1, 31062 Toulouse, France
| | - Guillaume Besnard
- Laboratoire Évolution & Diversité Biologique (EDB, UMR 5174), Université de Toulouse, CNRS-IRD-UPS, 118 route de Narbonne, Bât. 4R1, 31062 Toulouse, France.
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Oral potentially malignant disorders: clinical diagnosis and current screening aids: a narrative review. Eur J Cancer Prev 2021; 29:65-72. [PMID: 30921006 DOI: 10.1097/cej.0000000000000510] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Around 300 000 patients are estimated to have oral cancer worldwide annually, and the incidence is higher in South Asian countries. In 2005, at the Congress of WHO, the term potentially malignant disorder (PMD)/lesion was suggested as a replacement for premalignant oral lesions and conditions. PMDs are those lesions of the oral mucosa that are at an increased risk of malignant transformation compared with the healthy mucosa. PMDs consist of leukoplakia, erythroplakia, oral lichen planus, oral submucous fibrosis, and other miscellaneous lesions. A literature search was performed using PubMed, Scopus, and Web of Science without any language restrictions. There is no standardized method for identifying a site for biopsy and various methods such as toluidine blue stain, methylene blue, Lugol's iodine, and chemiluminescence have been proposed in the literature. Despite easy access to the oral cavity, there has been significant mortality associated with oral cancer as they are often diagnosed late because of the inability of healthcare professionals to identify them at early premalignant states. This article aims to provide healthcare professionals with the knowledge to identify potentially malignant disorders and to aid them in biopsy site identification.
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Kuhar N, Nazeer SS, Kumar RV, Mukherjee G, Umapathy S. Infrared Microspectroscopy With Multivariate Analysis to Differentiate Oral Hyperplasia From Squamous Cell Carcinoma: A Proof of Concept for Early Diagnosis. Lasers Surg Med 2021; 53:1435-1445. [PMID: 34058028 DOI: 10.1002/lsm.23427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite having numerous advances in therapeutics, mortality and morbidity due to oral cancer incidence are still very high. Early detection can improve the chances of survival in most patients. However, diagnosis at early stages can be challenging as premalignant conditions are usually asymptomatic. Currently, histological assessment remains the gold standard for diagnosis. Early diagnosis poses challenges to pathologists due to less severe morphological changes associated with early stages. Therefore, a fast and robust method of detection based on molecular changes is needed for early diagnosis. © 2021 Wiley Periodicals LLC. STUDY DESIGN/MATERIAL AND METHODS In the present study, Fourier transform infrared (FTIR) spectroscopic imaging has been used to differentiate early-stage oral hyperplasia from adjacent normal (AN) and oral squamous cell carcinoma (OSCC). Hyperplasia is often considered as an initial event in the pathogenesis of oral cancer and OSCC is the most common advanced stage of malignancy. Differentiating normal versus hyperplasia and hyperplasia versus OSCC can remain quite challenging on occasion using conventional staining as the histological assessment is based on morphological changes. RESULTS Unsupervised hierarchical cluster analysis (UHCA) has been performed on FTIR images of multiple tissues together that provided some degree of classification among tissue groups. The AN epithelium clustered distinctively using UHCA from both hyperplasia and grades 1 and 2 of OSCC. An increase in the content of DNA, denaturation of protein, and altered lipid structures were more clearly elucidated with spectral analysis. CONCLUSION This study demonstrates a simple strategy to differentiate early-stage oral hyperplasia from AN and OSCC using UHCA. This study also proposes a future alternative method where FTIR imaging can be used as a diagnostic tool for cancer at early stages.
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Affiliation(s)
- Nikki Kuhar
- Department of Inorganic and Physical Chemistry, Indian Institute of Science, Bengaluru, Karnataka, 560 012, India
| | - Shaiju S Nazeer
- Department of Inorganic and Physical Chemistry, Indian Institute of Science, Bengaluru, Karnataka, 560 012, India.,Department of Chemistry, Indian Institute of Space Sciences and Technology, Thiruvananthapuram, Kerala, 695 547, India
| | - Rekha V Kumar
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, 560 029, India
| | - Geetashree Mukherjee
- Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, 560 029, India
| | - Siva Umapathy
- Department of Inorganic and Physical Chemistry, Indian Institute of Science, Bengaluru, Karnataka, 560 012, India.,Department of Instrumentation & Applied Physics, Indian Institute of Science, Bangalore, Karnataka, 560012, India
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Pharmacology of Herbal Sexual Enhancers: A Review of Psychiatric and Neurological Adverse Effects. Pharmaceuticals (Basel) 2020; 13:ph13100309. [PMID: 33066617 PMCID: PMC7602496 DOI: 10.3390/ph13100309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
Sexual enhancers increase sexual potency, sexual pleasure, or libido. Substances increasing libido alter the concentrations of specific neurotransmitters or sex hormones in the central nervous system. Interestingly, the same pathways are involved in the mechanisms underlying many psychiatric and neurological disorders, and adverse reactions associated with the use of aphrodisiacs are strongly expected. However, sexual enhancers of plant origin have gained popularity over recent years, as natural substances are often regarded as a safer alternative to modern medications and are easily acquired without prescription. We reviewed the psychiatric and neurological adverse effects associated with the consumption of herbal aphrodisiacs Areca catechu L., Argemone Mexicana L., Citrus aurantium L., Eurycoma longifolia Jack., Lepidium meyenii Walp., Mitragyna speciosa Korth., Panax ginseng C. A. Mey, Panax quinquefolius L., Pausinystalia johimbe (K. Schum.) Pierre ex Beille, Piper methysticum G. Forst., Ptychopetalum olacoides Benth., Sceletium tortuosum (L.) N. E. Brown, Turnera diffusa Willd. ex. Schult., Voacanga africana Stapf ex Scott-Elliot, and Withania somnifera (L.) Dunal. A literature search was conducted on the PubMed, Scopus, and Web of Science databases with the aim of identifying all the relevant articles published on the issue up to June 2020. Most of the selected sexual enhancers appeared to be safe at therapeutic doses, although mild to severe adverse effects may occur in cases of overdosing or self-medication with unstandardized products. Drug interactions are more concerning, considering that herbal aphrodisiacs are likely used together with other plant extracts and/or pharmaceuticals. However, few data are available on the side effects of several plants included in this review, and more clinical studies with controlled administrations should be conducted to address this issue.
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de la Monte SM, Moriel N, Lin A, Abdullah Tanoukhy N, Homans C, Gallucci G, Tong M, Saito A. Betel Quid Health Risks of Insulin Resistance Diseases in Poor Young South Asian Native and Immigrant Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186690. [PMID: 32937888 PMCID: PMC7558723 DOI: 10.3390/ijerph17186690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/30/2023]
Abstract
Betel quid, traditionally prepared with areca nut, betel leaf, and slaked lime, has been consumed for thousands of years, mainly in the form of chewing. Originally used for cultural, medicinal, and ceremonial purposes mainly in South Asian countries, its use has recently spread across the globe due to its psychoactive, euphoric, and aphrodisiac properties. Now it is widely used as a social lubricant and source of financial profit. Unfortunately, the profit motive has led to high rates of habitual consumption with eventual conversion to addiction among young girls and boys. Moreover, the worrisome practice of including tobacco in quid preparations has grown, particularly among pregnant women. Major health concerns include increased rates of malignancy, oral pathology, and cardiovascular, hepatic, fertility, metabolic, and neuropsychiatric disorders. Metabolic disorders and insulin resistance disease states such as type 2 diabetes, obesity, and metabolic syndrome contribute to cognitive decline and neurodegeneration. Mechanistically, the constituents of areca nut/betel quid are metabolized to N-nitroso compounds, i.e., nitrosamines, which are carcinogenic at high doses and cause insulin resistance following chronic low-level exposures. From an epidemiological perspective, the rising tide of insulin resistance diseases including obesity, diabetes, and dementias that now disproportionately burden poor countries has been propagated by rapid commercialization and enhanced access to betel quid. Public health measures are needed to impose socially and ethically responsible barriers to yet another cause of global health disparity.
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Affiliation(s)
- Suzanne M. de la Monte
- Department of Pathology and Laboratory Medicine, Providence VA Medical Center, Providence, RI 02808, USA
- Women & Infants Hospital of Rhode Island, Providence, RI 02808, USA
- Alpert Medical School, Brown University, Providence, RI 02808, USA
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
- Neurology, Neurosurgery and Neuropathology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA
- Correspondence:
| | - Natalia Moriel
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Amy Lin
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Nada Abdullah Tanoukhy
- Department of Molecular Pharmacology and Physiology at Brown University, Providence, RI 02912, USA; (N.M.); (A.L.); (N.A.T.)
| | - Camille Homans
- Department of Neuroscience, Brown University, Providence, RI 02912, USA;
| | - Gina Gallucci
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
| | - Ming Tong
- Departments of Medicine, Rhode Island Hospital, Providence, RI 02808, USA; (G.G.); (M.T.)
| | - Ayumi Saito
- Department of Epidemiology in the School of Public Health, Brown University, Providence, RI 02912, USA;
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Gheddar L, Ricaut FX, Ameline A, Brucato N, Tsang R, Leavesley M, Raul JS, Kintz P. Testing for Betel Nut Alkaloids in Hair of Papuans Abusers using UPLC-MS/MS and UPLC-Q-Tof-MS. J Anal Toxicol 2020; 44:41-48. [PMID: 31263904 DOI: 10.1093/jat/bkz045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/08/2019] [Accepted: 04/28/2019] [Indexed: 01/28/2023] Open
Abstract
Betel nut is the fruit of Areca palm, growing in Papua New Guinea. Mixed with limestone and stick mustard, arecoline and guvacoline, which are present in betel nut, are hydrolyzed into arecaidine and guvacine, respectively. As part of the study on dietary habits of Papuans residents, our laboratory was asked to analyze the four alkaloids in hair to document long-term exposure. Hair samples were collected from 19 adult subjects (males = 11; females = 8), by some of the authors, and were sent to the laboratory for analysis. The four alkaloids have very similar chemical structures. In order to accurately identify the drugs, two methods were developed. First, the compounds were identified using an ultra-high-performance liquid chromatography system coupled to time-of-flight mass spectrometry. Then, they were quantified by an ultra-high-performance liquid chromatography system coupled to tandem mass spectrometry. After decontamination with dichloromethane, hair samples were cut into very small segments and 20 mg were incubated in methanol for 2 h 30 min in an ultrasound bath. After cooling, the methanol was evaporated to dryness in presence of 20-μL octanol to prevent volatilization. Nicotine-d4 was used as an internal standard. Linearity was observed for concentrations ranging from the limit of quantification to 20 ng/mg for arecoline, arecaidine, guvacine and guvacoline. Measured concentrations were in the range 60 pg/mg to 18 ng/mg for arecoline (n = 19), 14 pg/mg to 2.5 ng/mg for guvacoline (n = 11), 63 pg/mg to 3.8 ng/mg for arecaidine (n = 11) and 100 pg/mg to 3.2 ng/mg for guvacine (n = 6). There was no correlation between concentrations of arecoline and arecaidine (ratio from 0.01 to 0.18) and guvacoline and guvacine (ratio from 0.06 to 3.50). However, the identification of these substances in hair is a good marker of consumption of betel nut and allows us to document a local practice that remains difficult to evaluate just by questioning.
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Affiliation(s)
- Laurie Gheddar
- Institut de Médecine Légale, 11 rue Humann, F-67000 Strasbourg, France
| | - François-Xavier Ricaut
- Laboratoire Évolution & Diversité Biologique (EDB UMR 5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, 118 route de Narbonne, F-31077 Toulouse, France
| | - Alice Ameline
- Institut de Médecine Légale, 11 rue Humann, F-67000 Strasbourg, France
| | - Nicolas Brucato
- Laboratoire Évolution & Diversité Biologique (EDB UMR 5174), Université de Toulouse Midi-Pyrénées, CNRS, IRD, UPS, 118 route de Narbonne, F-31077 Toulouse, France
| | - Roxanne Tsang
- Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, College of Arts, Society & Education, James Cook University, PO Box 6811 Cairns, Qld 4870, Queensland, Australia
| | - Matthew Leavesley
- Archaeology, School of Humanities & Social Sciences, University of Papua New Guinea, College of Arts, Society & Education, James Cook University, PO Box 6811 Cairns, Qld 4870, Queensland, Australia
| | | | - Pascal Kintz
- Institut de Médecine Légale, 11 rue Humann, F-67000 Strasbourg, France.,X-Pertise Consulting, 42 rue principale, F-67206 Mittelhausbergen, France
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Liu FL, Chen CL, Lai CC, Lee CC, Chang DM. Arecoline suppresses RANKL-induced osteoclast differentiation in vitro and attenuates LPS-induced bone loss in vivo. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2020; 69:153195. [PMID: 32200293 DOI: 10.1016/j.phymed.2020.153195] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/13/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Areca nut has anti-inflammatory, antiparasitic, antihypertensive, and antidepressant properties. The pathological hallmarks of inflammatory joint diseases are an increased number of osteoclasts and impaired differentiation of osteoblasts, which may disrupt the bone remodeling balance and eventually lead to bone loss. PURPOSE The present study assessed the effects of arecoline, the main alkaloid found in areca nut, on osteoclast and osteoblast differentiation and function. METHOD M-CSF/RANKL-stimulated murine bone marrow-derived macrophages (BMMs) were incubated with several concentrations of arecoline, and TRAP staining and pit formation were assessed to monitor osteoclast formation. Quantitative real-time RT-PCR and western blot analyses were used to analyze the expression of osteoclast-associated genes and signaling pathways. The effects of arecoline on bone were investigated in an in vivo mouse model of lipopolysaccharide (LPS)-induced trabecular bone loss after oral administration of arecoline. Alizarin red S staining and assays to measure ALP activity and the transcription level of osteoblast-related genes were used to evaluate the effects of arecoline on osteoblast differentiation and bone mineralization. RESULTS In a dose-dependent manner, arecoline at concentrations of 50-100 μM reduced both the development of TRAP-positive multinucleated osteoclasts and the formation of resorption pits in M-CSF/RANKL-stimulated BMMs. In M-CSF/RANKL-stimulated BMMs, arecoline also suppressed the expression and translocation of c-Fos and NFATcl, and osteoclast differentiated-related genes via interference with the AKT, MAPK, and NF-kB activation pathways. Femur bone loss and microcomputed tomography parameters were recovered by oral administration of arecoline in the mouse LPS-induced bone loss model. Lastly, arecoline increased ALP activity, bone mineralization, and the expression of osteoblast differentiation-related genes, such as ALP and Runx2, in MC3T3-E1 cells. CONCLUSION Our data suggest that arecoline may attenuate or prevent bone loss by suppressing osteoclastogenesis and promoting osteoblastogenesis. These findings provide evidence supporting arecoline's use as a potential therapeutic agent in bone-loss disorders and diseases.
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Affiliation(s)
- Fei-Lan Liu
- Division of Allergy-Immunology-Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Liang Chen
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy-Immunology-Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chung Lee
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Deh-Ming Chang
- Division of Allergy-Immunology-Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
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Stone JH, Nelson GC, Fitzpatrick SM. Temporomandibular joint osteoarthritis at Chelechol ra Orrak, Palau. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 28:20-31. [PMID: 31902741 DOI: 10.1016/j.ijpp.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore the frequency and severity of temporomandibular joint osteoarthritis (TMJ-OA) and its causative factors in a skeletal assemblage from the prehistoric site of Chelechol ra Orrak, Palau, western Micronesia. MATERIALS 50 temporomandibular joint surfaces (mandibular condyles and articular eminences), representing a minimum of 22 adult individuals, 17 of which retain teeth. METHODS Joint surfaces were macroscopically evaluated for characteristics associated with TMJ-OA and joint morphology. Dental remains were scored for tooth wear and staining. RESULTS Nine individuals (40.1 %) displayed lesions typical of TMJ-OA. The strongest associations were between tooth wear and TMJ-OA. CONCLUSIONS Indirect effects of parafunctional dental activity appear to be a factor in TMJ-OA frequency at Chelechol ra Orrak. While betel nut chewing may be one of those activities, it does not appear to be solely driving the presence of TMJ-OA. SIGNIFICANCE This study highlights the association between a specific parafunctional use of the temporomandibular joint and the potential pathological consequences. It also reinforces the need to carefully evaluate the archaeological context of skeletal remains in order to evaluate specific etiological factors in the presence of TMJ-OA in present and past populations. LIMITATIONS Sample sizes are limited in this study. This will increase as excavations continue. SUGGESTIONS FOR FURTHER RESEARCH Because dental occlusion appears to be associated with TMJ-OA, focus on dental conditions affecting occlusal patterns, such as third molar agenesis, antemortem tooth loss, and malocclusion, and their relationship to TMJ-OA frequency, are recommended.
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Affiliation(s)
- Jessica H Stone
- Department of Anthropology, University of Oregon, Eugene, OR, United States.
| | - Greg C Nelson
- Department of Anthropology, University of Oregon, Eugene, OR, United States; Museum of Natural and Cultural History, University of Oregon, Eugene, OR, United States
| | - Scott M Fitzpatrick
- Department of Anthropology, University of Oregon, Eugene, OR, United States; Museum of Natural and Cultural History, University of Oregon, Eugene, OR, United States
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Volgin AD, Bashirzade A, Amstislavskaya TG, Yakovlev OA, Demin KA, Ho YJ, Wang D, Shevyrin VA, Yan D, Tang Z, Wang J, Wang M, Alpyshov ET, Serikuly N, Wappler-Guzzetta EA, Lakstygal AM, Kalueff AV. DARK Classics in Chemical Neuroscience: Arecoline. ACS Chem Neurosci 2019; 10:2176-2185. [PMID: 30664352 DOI: 10.1021/acschemneuro.8b00711] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Arecoline is a naturally occurring psychoactive alkaloid from areca (betel) nuts of the areca palm ( Areca catechu) endemic to South and Southeast Asia. A partial agonist of nicotinic and muscarinic acetylcholine receptors, arecoline evokes multiple effects on the central nervous system (CNS), including stimulation, alertness, elation, and anxiolysis. Like nicotine, arecoline also evokes addiction and withdrawal symptoms (upon discontinuation). The abuse of areca nuts is widespread, with over 600 million users globally. The importance of arecoline is further supported by its being the world's fourth most commonly used human psychoactive substance (after alcohol, nicotine, and caffeine). Here, we discuss neuropharmacology, pharmacokinetics, and metabolism of arecoline, as well as social and historical aspects of its use and abuse. Paralleling clinical findings, we also evaluate its effects in animal models and outline future clinical and preclinical CNS research in this field.
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Affiliation(s)
- Andrey D. Volgin
- Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk 630117, Russia
| | - Alim Bashirzade
- Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk 630117, Russia
| | | | - Oleg A. Yakovlev
- Institute of Experimental Medicine, Almazov National Medical Research Centre, St. Petersburg 194156, Russia
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
| | - Konstantin A. Demin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, St. Petersburg 194156, Russia
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
| | - Ying-Jui Ho
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
| | - Dongmei Wang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | | | - Dongni Yan
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Zhichong Tang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Jingtao Wang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Mengyao Wang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Erik T. Alpyshov
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Nazar Serikuly
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | | | - Anton M. Lakstygal
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
- Russian Scientific Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, St. Petersburg 197758, Russia
| | - Allan V. Kalueff
- School of Pharmacy, Southwest University, Chongqing 400700, China
- Ural Federal University, Ekaterinburg 620002, Russia
- The International Zebrafish Neuroscience Research Consortium (ZNRC), Slidell, Louisiana 70458, United States
- Anatomy and Physiology Laboratory, Ural Federal University, Ekaterinburg 620002, Russia
- ZENEREI Research Center, Slidell, Louisiana 70458, United States
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Dalisay F, Buente W, Benitez C, Herzog TA, Pokhrel P. Adolescent betel nut use in Guam: beliefs, attitudes and social norms. ADDICTION RESEARCH & THEORY 2019; 27:394-404. [PMID: 31231175 PMCID: PMC6588185 DOI: 10.1080/16066359.2018.1538410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 05/27/2023]
Abstract
Betel (areca) nut is an addictive substance chewed with or without tobacco widely in Asia and the Pacific, including the U.S.-affiliated Pacific Islands (USPI). Betel nut use has been found to cause oral cancer. Research suggests that most betel nut use initiation occurs in adolescence. However, very little is currently known about the etiology of adolescent betel nut use. The present study reports findings of a formative, qualitative research conducted to understand the attitudinal and social factors associated with adolescent betel nut use in USAPI. The objective was to develop a theoretical framework of adolescent betel nut etiology that would guide the development of a prevention program. Semi-structured interviews were conducted with 20 adolescent betel nut users (M age = 14.5; SD = 2.2) from Guam. Findings suggested a framework of adolescent betel nut etiology in which intrapersonal, social, and environmental factors influence betel nut use behavior. The framework is consistent with ecological frameworks of adolescent substance use in which proximal personal and social influences on adolescent substance use occur within the context of a wider socio-cultural context conducive to adolescent substance use. Specifically, we found that beliefs such as betel nut tastes good and induces relaxation represent some of the betel nut use motives; parental permissiveness and peer and sibling use encourage betel nut use; and cultural acceptance and easy accessibility to betel nuts provide an environmental context conducive to betel nut use. Findings are discussed in the context of developing an adolescent betel nut use prevention program.
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Affiliation(s)
- Francis Dalisay
- College of Liberal Arts & Social Sciences, University of Guam
| | - Wayne Buente
- School of Communications, University of Hawaii at Manoa
| | - Chantay Benitez
- College of Liberal Arts & Social Sciences, University of Guam
| | | | - Pallav Pokhrel
- University of Hawaii Cancer Center, University of Hawaii at Manoa, 701 Ilalo St., Honolulu, HI 96813;
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Hemamalini V, Velayutham DPM, Lakshmanan L, Muthusamy K, Sivaramakrishnan S, Premkumar K. Inhibitory potential of Hydroxychavicol on Ehrlich ascites carcinoma model and in silico interaction on cancer targets. Nat Prod Res 2018; 34:1591-1596. [PMID: 30470141 DOI: 10.1080/14786419.2018.1519819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hydroxychavicol (HC), a major phenolic derivative isolated from the leaves of Piper betle L. is well known for its antibacterial, antifungal and antimutagenic properties. The present study evaluated the in vivo antitumor activity of HC against Ehrlich Ascites Carcinoma (EAC) cells in Swiss albino mice and in silico interaction of HC with the receptors involved in the cancer. Hydroxychavicol (200 and 400 mg/kg bw) was orally administered for 21 consecutive days and was effective in inhibiting the tumor growth in ascitic mouse model. HC consistently reduced the tumor volume, viable cell count, lipid peroxidation and elevated the life span of HC treated mice. Besides the hematological profiles, SGOT and SGPT levels reverted back to normal and oxidative stress markers GSH, SOD and CAT also increased in HC treated groups. In silico docking analysis revealed that HC possessed potent antagonist activity against all the cancer targets demonstrating its inhibitory activity.
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Affiliation(s)
- Vedagiri Hemamalini
- Department of Bioinformatics, Bharathiar University, Coimbatore, Tamil Nadu, India
| | | | | | | | | | - Kumpati Premkumar
- Department of Biomedical Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India
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Chu YH, Wang L, Ko PC, Lan SJ, Liaw YP. The risk of cirrhosis in non-alcohol drinkers is greater in female than male betel nut chewers. Oncotarget 2018; 9:8731-8737. [PMID: 29492232 PMCID: PMC5823571 DOI: 10.18632/oncotarget.23885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022] Open
Abstract
Background and Aim The association of betel nut with liver cirrhosis among alcohol drinkers has been clearly shown. However, very few studies have shown such an association among non-alcohol drinkers. The aim of this study was to assess the relationship between betel nut chewing and cirrhosis among non-alcohol drinkers. Materials and Methods This study retrospectively analyzed data retrieved from the 2012 Adult Preventive Medical Services and the National Health Insurance Research Datasets in Taiwan. Participants’ information included physical examination and lifestyle, alongside laboratory tests. Betel nut chewers were grouped into three categories: never, occasional and frequent. Diseases were diagnosed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Initially, 1573024 adults aged 40 years and above who engaged in the free adult preventive medical services in 2012 were recruited. However, only 1065246 of them were included in the analysis. Chi-square test and logistic regression were used for the analyses. Results After multivariable adjustments, there were significant relationships between cirrhosis and betel nut chewing in both sexes (P-trend < 0.0001). The risk of cirrhosis was greater in females than males. The odds ratios of cirrhosis in occasional and frequent female chewers were respectively 2.91; 95% C.I: 1.75–4.83 and 3.06; 95% C.I: 1.69–5. However, they were respectively 1.76; 95% C.I: 1.47–2.10 and 2.32; 95% C.I: 1.90–2.85 in occasional and frequent male chewers. Conclusions This study demonstrated significant relationships between betel nut chewing and cirrhosis in both male and female non-alcohol drinkers. The risk of cirrhosis was greater in female than male chewers.
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Affiliation(s)
- Yu-Hua Chu
- Department of Healthcare Administration, Asia University, Wufeng District, Taichung City, Taiwan
| | - Lee Wang
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Pei-Chieh Ko
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Wufeng District, Taichung City, Taiwan.,Department of Medical Research, China Medical Hospital, China Medical University, Taichung, Taiwan
| | - Yung-Po Liaw
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan.,Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Venkatesh D, Puranik RS, Vanaki SS, Puranik SR. Study of salivary arecoline in areca nut chewers. J Oral Maxillofac Pathol 2018; 22:446. [PMID: 30651702 PMCID: PMC6306580 DOI: 10.4103/jomfp.jomfp_143_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aims: Arecoline, a predominant alkaloid present in arecanut, has been implicated in the pathogenesis of several oral diseases because of its mutagenic and carcinogenic potential. The response of cultured cells to arecoline is highly dependent on its concentration; arecoline stimulates cultured cells above 0.1 μg/ml and is cytotoxic above 10 μg/ ml. Although this alkaloid seems important for areca nut induced oral diseases and carcinogenesis, little is known of the levels achieved before, during and after chewing. Also, it is prudent to understand its effects in arecanut chewers for a comprehensive understanding of its pathogenesis. Accordingly, the present study quantified the salivary arecoline levels in arecanut chewers. Materials and Methods: The study participants were divided into Study Group A & B and Control Group C; unstimulated whole saliva was collected by spitting method for a period of 5 min. Then, participants in Group A and C chewed 0.5 g of areca nut without any other additives while in Group B were asked to chew 0.5 g of inert rubber base impression material. Stimulated whole saliva from all three groups was collected into graduated tubes during chewing at time intervals of 1, 3, 5, 10, 15, 20 and 25 min. Then, all participants were asked to remove nut particles or inert rubber base material from the mouth, and saliva samples were collected further up to 20 min, changing tubes at 5 min interval. Salivary arecoline was quantitated by HPLC-MS. The tabulation and descriptive statistics of the study were carried out. Results: In the present study, baseline levels of arecoline were zero in all three groups, whereas mean salivary arecoline levels during chewing were 76.93 ng/ml, 129.83 ng/ml and 64.83 ng/ml and after chewing were 196.17 ng/ml, 321.12 ng/ml and 43.75 ng/ml in Groups A, B and Control respectively, which were significantly higher than reported threshold levels. Conclusions: The data from this study reveals that a significant amount of arecoline would be trapped in oral cavity, or being re-circulated between blood and saliva might have resulted in surprisingly high levels of arecoline even 10 mins after chewing in both groups after which the levels started declining. The higher levels of salivary arecoline achieved during and after chewing are enough to cause cytotoxic and genotoxic effects on oral tissues over a period of time in chronic chewers. The great differences in salivary arecoline levels achieved during chewing, may contribute to the variable response to areca nut seen in communities where this habit is widespread. Areca nut users have persistent background salivary arecoline levels long after chewing, whereas concentrations achieved are highly variable and consistent with a role in oral pre-malignancy and malignancy..
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Affiliation(s)
- Deepak Venkatesh
- Department of Dentistry, ESIC Medical College and Hospital, Bengaluru, Karnataka, India
| | - R S Puranik
- Department of Oral and Maxillofacial Pathology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - S S Vanaki
- Department of Oral and Maxillofacial Pathology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Surekha R Puranik
- Department of Oral Medicine and Radiology, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
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Karthik R, Mohan N. Prevalence of Oral Mucosal Lesions among Dental Patients with Mixed Habits in Salem District - A Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2017; 9:S55-S67. [PMID: 29284937 PMCID: PMC5731045 DOI: 10.4103/jpbs.jpbs_86_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The practice of betel nut chewing with or without tobacco is still practiced in south india, salem inspite of its harmful effects. METHODOLOGY 200 Patients visiting the outpatient department, Oral medicine and radiology from Aug 2015 to Aug 2016. RESULT AND CONCLUSION In our study, 3 women were exclusively churut smokers. Thirty-eight percent of the dental patients were beedi smoker, 32% were tobacco chewers, 12% were both betel nut and tobacco chewers, 8% were exclusively betel nut chewers, 1% of the dental population were exclusively churut smokers. Mean age group of the study population is 50.2 (14.4). There are 28 females and 172 males in the study group. Chi-square test revealed a statistically significant difference (P = 0.001) between males and females based on soft-tissue findings and no statistically significant difference (P = 0.572) between males and females based on distribution of hard-tissue findings.
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Affiliation(s)
- R. Karthik
- Department of Oral Medicine, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
| | - N. Mohan
- Department of Oral Medicine, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
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Paediatric oral submucous fibrosis - The neglected pre-malignancy of childhood. Int J Pediatr Otorhinolaryngol 2017; 97:55-60. [PMID: 28483252 DOI: 10.1016/j.ijporl.2017.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 11/27/2022]
Abstract
Oral submucous fibrosis in children is one of the devastating consequences of arecanut addiction in children. Arecanut is the fourth commonest psychoactive agents used worldwide. However, regrettably, unlike other addictions like tobacco and alcohol, its use in children has become socially acceptable atleast in a few countries. Consequently, children as young as two years have been noticed to be addicted to arecanuts. It has been a menace in most Asian countries and with increasing population migration, this has picked up even in the west. In order to understand the social factors leading to arecanut addiction in children and prognostic outcomes of paediatric oral submucous fibrosis, this review has been undertaken.
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20
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How psychoactive drugs shape human culture: A multi-disciplinary perspective. Brain Res Bull 2016; 126:138-151. [DOI: 10.1016/j.brainresbull.2016.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 12/23/2022]
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Bhandare AM, Vyawahare NS, Kshirsagar AD. Anti-migraine effect of Areca Catechu L. nut extract in bradykinin-induced plasma protein extravasation and vocalization in rats. JOURNAL OF ETHNOPHARMACOLOGY 2015; 171:121-124. [PMID: 26068422 DOI: 10.1016/j.jep.2015.05.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 05/03/2015] [Accepted: 05/29/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Areca catechu Linn. (Arecaceae) nut is a popular folk remedy for the treatment of migraine in Kerala and Tamil Nadu states of India. AIM OF THE STUDY This study was designed to investigate the effect of hydroalcoholic extract of A. catechu L. nut (ANE) treatment on migraine pain in rat models to strengthen its use as an anti-migraine therapy. MATERIALS AND METHODS Bradykinin (0.1 μmol/kg) injection in to left femoral vein of rat produced PPE which was measured with luminescence spectrometer. Vocalizations were produced in rats with 10 μg of bradykinin infusion into common carotid artery. Phonogram was recorded before, during and for 5min after bradykinin injection and sumatriptan was used as a standard anti-migraine drug. In both models, the ANE was orally administered at doses of 250 and 500 mg/kg, 60 min before bradykinin infusion. RESULTS The PPE was reduced in both ANE treated groups of rats. The percent fluorescein was significantly increased in positive control group (97.00±1.7%; p<0.0001) compared to negative control (63.87±1.2%). With ANE treatments (250 and 500 mg/kg) PPE was significantly decreased to 88.88±1.4% (p<0.01) and 83.55±0.1% (p<0.0001) compared to positive control group, respectively. On the other hand in the model of vocalization, with 250 and 500 mg/kg ANE treatment, vocalization was significantly reduced to 33.33% and 16.66%, respectively, compared to saline treated rats. The reduction in vocalization is comparable to the reference drug sumatriptan. CONCLUSION The findings provide the strong evidence for anti-migraine potential of ANE in rat models of migraine. In summary, therapeutic intervention with ANE treatment could be a promising strategy for prevention of migraine.
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Affiliation(s)
- Amol M Bhandare
- All India Shri Shivaji Memorial Society׳s College of Pharmacy, Kennedy Road, Near RTO, Pune, 411001 Maharashtra, India; Australian School of Advanced Medicine, Macquarie University, Sydney, 2109 New South Wales, Australia.
| | - Neeraj S Vyawahare
- All India Shri Shivaji Memorial Society׳s College of Pharmacy, Kennedy Road, Near RTO, Pune, 411001 Maharashtra, India; Department of Pharmacology, Padmashree Dr. D Y Patil College of Pharmacy, Akurdi, Pune, 411044 Maharashtra, India.
| | - Ajay D Kshirsagar
- All India Shri Shivaji Memorial Society׳s College of Pharmacy, Kennedy Road, Near RTO, Pune, 411001 Maharashtra, India; School of Pharmacy, Swami Ramanand Teerth Marathwada University, Nanded, 431606 Maharashtra, India.
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Abstract
Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | | | - Fareedi Mukram Ali
- Departments of Oral and Maxillofacial Surgery, SMBT Dental College, Sangamner, Maharashtra, India
| | - Kishor Patil
- Departments of Oral Pathology and Microbiology, SMBT Dental College, Sangamner, Maharashtra, India
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The impact of GSTM1/GSTT1 polymorphism for the risk of oral cancer. Clin Oral Investig 2015; 19:1791-7. [PMID: 25595865 DOI: 10.1007/s00784-015-1400-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Since development of oral squamous cell cancer (OSCC) is triggered by various noxa, different variants of the antioxidant glutathione S-transferases (GSTs) can counteract toxic compounds (e.g., tobacco smoke). Because different polymorphisms of GST are known to have an increased sensitivity to carcinogenic agents, the aim of this study was to analyze whether GSTM1 or GSTT1 polymorphisms increase the risk for the development of OSCC. MATERIALS AND METHODS GSTM1 and GSTT1 polymorphism was examined in healthy volunteers (n = 93) and in patients with OSCC (n = 100) by PCR after brush biopsy of oral mucosa. Odds ratio (OR) was calculated to evaluate the risk of oral cancer development. RESULTS GSTM1 and GSTT1 deletion was found in 57% (53/93) and 18% (17/93), respectively, in healthy patients, while the OSCC group showed 57% (57/100) for GSTM1 deletion and 22% (22/100) with a deletion of GSTT1. Odds ratio for GSTM1 polymorphism was 1.00 and for GSTT1 1.26. Comparing smokers and nonsmokers with GSTM1 deletion polymorphism, OR was 4.35, while smokers without GSTM1 deletion showed an OR of 1.45. Adapting these data to the smoking habits of the general population in Germany, the OR was 9.25 for smokers with a GSTM1 deletion and OR 6.68 for smokers without a GSTM1 deletion. In smokers with GSTT1 deletion polymorphism, OR was 1.6 (adapted to the smoking habits of the general population: OR 6.16) and 3.16 (OR 8.56) in smokers without deletion in GSTT1 gene. CONCLUSIONS Analysis of GST-M1 polymorphism in smokers could help to identify patients with a higher risk for the development of oral cancer. CLINICAL RELEVANCE Early detection of OSCC due to a close meshed monitoring program for patients with GST-M1 polymorphism could help to improve the patient outcome. For polymorphism investigations, the oral brush biopsy is a sufficient method to gain DNA material.
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Lee CH, Chiang SL, Ko AMS, Hua CH, Tsai MH, Warnakulasuriya S, Ibrahim SO, Sunarjo, Zain RB, Ling TY, Huang CL, Lane HY, Lin CC, Ko YC. Betel-quid dependence domains and syndrome associated with betel-quid ingredients among chewers: an Asian multi-country evidence. Addiction 2014; 109:1194-204. [PMID: 24650227 DOI: 10.1111/add.12530] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/08/2013] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
Abstract
AIMS Betel-quid (BQ) contains biologically psychoactive ingredients; however, data are limited concerning the symptoms and syndrome of BQ dependence among chewers. The aims of this study were to evaluate the ingredients-associated BQ dependence syndrome and country-specific chewing features and behaviour for BQ dependence among chewers from six Asian communities. DESIGN An intercountry Asian Betel-quid Consortium study. SETTING Six Asian general communities in Taiwan, Mainland China, Indonesia, Malaysia, Sri Lanka and Nepal. PARTICIPANTS Six multi-stage random samples of BQ chewers in the Asian Betel-quid Consortium study (n = 2078). MEASUREMENTS All chewers were evaluated for BQ dependence using the DSM-IV and ICD-10 criteria. FINDINGS The 12-month BQ dependence rate was 12.5-92.6% and 47.9-99.3% (P = 0.023) among tobacco-free and tobacco-added BQ chewers across the six Asian communities, with a higher dependence rate in chewers who used tobacco-free BQ with lime added than without (23.3-95.6% versus 4.0%, P ≤ 0.001). Taiwanese and Hunanese BQ chewers both notably endorsed the dependency domain of 'time spent chewing'. 'Tolerance' and 'withdrawal' were the major dependence domains associated with the Nepalese and Indonesian chewers, with high BQ dependence rates. Malaysian and Sri Lankan chewers formed a BQ dependence cluster linked closely to 'craving'. In Sri Lanka, the quantity consumed explained 90.5% (P < 0.001) of the excess dependence risk for tobacco-added use, and could be a mediator between tobacco-derived psychoactive effect and BQ dependence development. CONCLUSIONS DSM-IV criteria for dependence apply to a significant proportion of betel quid users in Asian communities, more so if they use it with tobacco or lime.
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Affiliation(s)
- Chien-Hung Lee
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan; Centre of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Synthesis and evaluation of antiproliferative activity of a novel series of hydroxychavicol analogs. Eur J Med Chem 2014; 75:1-10. [DOI: 10.1016/j.ejmech.2014.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 01/02/2023]
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Dalai MK, Bhadra S, Bandyopadhyay A, Mukherjee PK. Evaluation of anti-cholinesterase activity of the standardized extract of Piper betel L. leaf. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13596-013-0141-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kailasa SK, Wu HF. Recent Advances in Mass Spectrometry for the Identification of Neuro-chemicals and their Metabolites in Biofluids. Curr Neuropharmacol 2013; 11:436-64. [PMID: 24381533 PMCID: PMC3744906 DOI: 10.2174/1570159x11311040007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 11/22/2022] Open
Abstract
Recently, mass spectrometric related techniques have been widely applied for the identification and quantification of neurochemicals and their metabolites in biofluids. This article presents an overview of mass spectrometric techniques applied in the detection of neurological substances and their metabolites from biological samples. In addition, the advances of chromatographic methods (LC, GC and CE) coupled with mass spectrometric techniques for analysis of neurochemicals in pharmaceutical and biological samples are also discussed.
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Affiliation(s)
- Suresh Kumar Kailasa
- Department of Applied Chemistry, S. V. National Institute of Technology, Surat – 395007, India
| | - Hui-Fen Wu
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, 80424, Taiwan
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, 800, Kaohsiung, Taiwan
- Center for Nanoscience and Nanotechnology, National Sun Yat-Sen University, Kaohsiung, 80424, Taiwan
- Doctoral Degree Program in Marine Biotechnology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
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Sharan RN, Mehrotra R, Choudhury Y, Asotra K. Association of betel nut with carcinogenesis: revisit with a clinical perspective. PLoS One 2012; 7:e42759. [PMID: 22912735 PMCID: PMC3418282 DOI: 10.1371/journal.pone.0042759] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/11/2012] [Indexed: 01/04/2023] Open
Abstract
Betel nut (BN), betel quid (BQ) and products derived from them are widely used as a socially endorsed masticatory product. The addictive nature of BN/BQ has resulted in its widespread usage making it the fourth most abused substance by humans. Progressively, several additives, including chewing tobacco, got added to simple BN preparations. This addictive practice has been shown to have strong etiological correlation with human susceptibility to cancer, particularly oral and oropharyngeal cancers. The PUBMED database was searched to retrieve all relevant published studies in English on BN and BQ, and its association with oral and oropharyngeal cancers. Only complete studies directly dealing with BN/BQ induced carcinogenesis using statistically valid and acceptable sample size were analyzed. Additional relevant information available from other sources was also considered. This systematic review attempts to put in perspective the consequences of this widespread habit of BN/BQ mastication, practiced by approximately 10% of the world population, on oral cancer with a clinical perspective. BN/BQ mastication seems to be significantly associated with susceptibility to oral and oropharyngeal cancers. Addition of tobacco to BN has been found to only marginally increase the cancer risk. Despite the widespread usage of BN/BQ and its strong association with human susceptibility to cancer, no serious strategy seems to exist to control this habit. The review, therefore, also looks at various preventive efforts being made by governments and highlights the multifaceted intervention strategies required to mitigate and/or control the habit of BN/BQ mastication.
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Affiliation(s)
- Rajeshwar N Sharan
- Radiation and Molecular Biology Unit, Department of Biochemistry, North-Eastern Hill University, Shillong, Meghalaya, India.
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Coppola M, Mondola R. Potential action of betel alkaloids on positive and negative symptoms of schizophrenia: a review. Nord J Psychiatry 2012; 66:73-8. [PMID: 21859398 DOI: 10.3109/08039488.2011.605172] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Areca catechu Linn. is the fourth most used drug in the world after nicotine, ethanol and caffeine. This plant contains nine alkaloids with muscarinic and nicotinic action, which could have an antipsychotic effect. AIM The aim of this work is reviewing literature data about the potential action of betel alkaloids on positive, negative and cognitive symptoms of schizophrenia. METHOD We reviewed the clinical literature data since 1980 via a PubMed search for the terms: arecoline, arecaidine, guvacine, guvacoline, betel, Areca catechu, positive and negative symptoms, cognitive symptoms, psychosis and schizophrenia in combination. CONCLUSION Male high consumption of betel had significantly lower positive symptoms than low consumers or non-betel users.
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Shah G, Chaturvedi P, Vaishampayan S. Arecanut as an emerging etiology of oral cancers in India. Indian J Med Paediatr Oncol 2012; 33:71-9. [PMID: 22988348 PMCID: PMC3439794 DOI: 10.4103/0971-5851.99726] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Arecanut (AN) usage is widespread in Asian countries, especially India and Taiwan. The incidence of oral cancer is increasing day by day, but there is no exponential increase with tobacco usage. Especially in the country like Taiwan where betel quid mostly do not contain tobacco, AN can be correlated with the increased incidence of cancer. There are different studies in the literature about AN and oral cancer but none of them have concluded with the definite pathway for carcinogenesis. The present paper includes reviews of the literature for AN and oral cancer and summarizes the possible mechanisms associated with AN-induced carcinogenesis; and we have also tried to propose pathway of carcinogenesis.
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Affiliation(s)
- Gunjan Shah
- Consultant Maxillofacial Surgeon, Shalby Hospitals, Ahmedabad, India
| | - Pankaj Chaturvedi
- Department of Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sagar Vaishampayan
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Yusriah L, Sapuan S, Zainudin E, Mariatti M. Exploring the Potential of Betel Nut Husk Fiber as Reinforcement in Polymer Composites: Effect of Fiber Maturity. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.proche.2012.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rotolo MC, Pellegrini M, Bose D, Marchei E, Durgbanshi A, Pichini S. Systematic toxicological analysis of Indian herbal ready-to-chew pouches by gas chromatography mass spectrometry. ACTA ACUST UNITED AC 2011. [DOI: 10.1051/ata/2011127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Al-Rmalli SW, Jenkins RO, Haris PI. Betel quid chewing elevates human exposure to arsenic, cadmium and lead. JOURNAL OF HAZARDOUS MATERIALS 2011; 190:69-74. [PMID: 21440366 DOI: 10.1016/j.jhazmat.2011.02.068] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/17/2011] [Accepted: 02/21/2011] [Indexed: 05/09/2023]
Abstract
Several studies have reported increased skin lesions in betel quid (a mixture of Piper betel leaves, areca nut, tobacco/flavoured tobacco, lime) chewers compared to non-chewers, exposed to arsenic (As) contaminated drinking water in Bangladesh and India. The current study has determined As, cadmium (Cd) and lead (Pb) levels of betel quids and its components using inductively coupled plasma mass spectrometry (ICP-MS). The highest concentrations of As were found in slaked lime (4.56 mg kg(-1)) followed by Piper betel leaves (0.406 mg kg(-1)) and flavoured tobacco (zarda) (0.285 mg kg(-1)), with a mean concentrations of As in betel quids of 0.035 mg kg(-1) (SD 0.02 mg kg(-1)). Mean concentrations of Cd and Pb in ordinary quids were 0.028 (SD 0.07 mg kg(-1)) and 0.423 (SD 1.4 mg kg(-1)), respectively. We estimated that a daily intake of 6 betel quids could contribute 1.2, 1.9 and 8.5% of the provisional maximum tolerable daily intake (PMDTI) for As, Cd and Pb, respectively. Since betel quid chewing is most prevalent among women, our finding raises concern that women chewers - especially pregnant chewers - may be harming their health and that of their unborn babies through increased exposure to a mixture of toxic elements (As, Cd and Pb).
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Affiliation(s)
- Shaban W Al-Rmalli
- Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester LE1 9BH, UK
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Bhandare AM, Kshirsagar AD, Vyawahare NS, Hadambar AA, Thorve VS. Potential analgesic, anti-inflammatory and antioxidant activities of hydroalcoholic extract of Areca catechu L. nut. Food Chem Toxicol 2010; 48:3412-7. [PMID: 20849907 DOI: 10.1016/j.fct.2010.09.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/16/2010] [Accepted: 09/09/2010] [Indexed: 10/19/2022]
Abstract
The hydroalcoholic extract of Areca catechu L. (ANE) nut was screened for its analgesic, anti-inflammatory and in vitro antioxidant potential. Three doses of ANE (250, 500 and 1000 mg/kg orally) were tested for analgesic and anti-inflammatory activities. Evaluation of analgesic activity of ANE was performed using hot plate and formalin test in mice. ANE showed maximum increase in hot plate reaction time (56.27%, p<0.01), while reduced the duration of licking/biting behaviors in first (39.45%, p<0.05) and second (92.71%, p<0.01) phases of the formalin test indicating significant analgesic activity. ANE reduced the paw edema considerably (86.79% inhibition after 24h, p<0.01) in dose-dependent manner compared to carrageenan-induced rat. In addition, in vitro antioxidant activity of ANE was investigated by total phenolic content (TPC) and hydrogen peroxide assay. The IC(50) observed in hydrogen peroxide assay was 83.14 μg/ml and TPC 120.56±21.09 mg QE/g. Altogether, these results suggest that the hydroalcoholic extract of Areca catechu could be considered as a potential analgesic, anti-inflammatory and antioxidant agent.
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Affiliation(s)
- Amol M Bhandare
- All India Shri Shivaji Memorial Society's College of Pharmacy, Department of Pharmacology, Pune, Maharashtra, India.
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Leask A. When there's smoke there's.....CCN2. J Cell Commun Signal 2010; 4:157-8. [PMID: 21063506 DOI: 10.1007/s12079-010-0096-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 08/05/2010] [Indexed: 11/28/2022] Open
Abstract
Smoking causes oral fibrosis. In a recent report, Takeuchi and colleagues (J Dent Res 89:34-9, 2010) evaluate whether nicotine can directly elevate collagen production in gingival fibroblasts. They show that CCN2 (connective tissue growth factor, CTGF) is elevated in response to nicotine and that a neutralizing CCN2 antibody reduces the ability of nicotine to promote collagen production. These data suggest that nicotine from smoking may promote periodontal fibrosis via CCN2. This commentary summarizes these findings.
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Affiliation(s)
- Andrew Leask
- Department of Dentistry, University of Western Ontario, London, ON Canada NGA 5C1
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He X, Li Y, Zhang C, Hu X. Arborinol methyl ether from Areca catechu L. Acta Crystallogr Sect E Struct Rep Online 2010; 66:o2273-4. [PMID: 21588629 PMCID: PMC3007998 DOI: 10.1107/s1600536810030758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 08/02/2010] [Indexed: 11/23/2022]
Abstract
The title compound isolated from Areca catechu L. (common name: arborinol methyl ether; a member of the arborane family) was established as 3α-methoxyarbor-9(11)-ene, C31H52O. Rings A/B/C/D assume a chair conformation, while ring E has an envelope conformation. The absolute configuration was determined to be (3R,5R,8S,10S,13R,14S,17S,18S, 21S) by analysis of Bijvoet pairs based on resonant scattering of light atoms, yielding a Hooft parameter y of −0.03 (3).
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Ali I, Khan FG, Suri KA, Gupta BD, Satti NK, Dutt P, Afrin F, Qazi GN, Khan IA. In vitro antifungal activity of hydroxychavicol isolated from Piper betle L. Ann Clin Microbiol Antimicrob 2010; 9:7. [PMID: 20128889 PMCID: PMC2841090 DOI: 10.1186/1476-0711-9-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 02/03/2010] [Indexed: 11/30/2022] Open
Abstract
Background Hydroxychavicol, isolated from the chloroform extraction of the aqueous leaf extract of Piper betle L., (Piperaceae) was investigated for its antifungal activity against 124 strains of selected fungi. The leaves of this plant have been long in use tropical countries for the preparation of traditional herbal remedies. Methods The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of hydroxychavicol were determined by using broth microdilution method following CLSI guidelines. Time kill curve studies, post-antifungal effects and mutation prevention concentrations were determined against Candida species and Aspergillus species "respectively". Hydroxychavicol was also tested for its potential to inhibit and reduce the formation of Candida albicans biofilms. The membrane permeability was measured by the uptake of propidium iodide. Results Hydroxychavicol exhibited inhibitory effect on fungal species of clinical significance, with the MICs ranging from 15.62 to 500 μg/ml for yeasts, 125 to 500 μg/ml for Aspergillus species, and 7.81 to 62.5 μg/ml for dermatophytes where as the MFCs were found to be similar or two fold greater than the MICs. There was concentration-dependent killing of Candida albicans and Candida glabrata up to 8 × MIC. Hydroxychavicol also exhibited an extended post antifungal effect of 6.25 to 8.70 h at 4 × MIC for Candida species and suppressed the emergence of mutants of the fungal species tested at 2 × to 8 × MIC concentration. Furthermore, it also inhibited the growth of biofilm generated by C. albicans and reduced the preformed biofilms. There was increased uptake of propidium iodide by C. albicans cells when exposed to hydroxychavicol thus indicating that the membrane disruption could be the probable mode of action of hydroxychavicol. Conclusions The antifungal activity exhibited by this compound warrants its use as an antifungal agent particularly for treating topical infections, as well as gargle mouthwash against oral Candida infections.
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Affiliation(s)
- Intzar Ali
- Clinical Microbiology Division Indian Institute of Integrative Medicine, Canal Road, Jammu-180 001, India
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Sun YP, Liu Q, Luo J, Guo P, Chen F, Lawrence AJ, Liang JH. Systemic administration of arecoline reduces ethanol-induced sleeping through activation of central muscarinic receptor in mice. Alcohol Clin Exp Res 2009; 34:150-7. [PMID: 19860797 DOI: 10.1111/j.1530-0277.2009.01076.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiological evidence of co-use of alcohol and areca nuts suggests a potential central interaction between arecoline, a major alkaloid of areca and a muscarinic receptor agonist, and ethanol. Moreover, the central cholinergic system plays an important role in the depressant action of ethanol and barbiturates. The purpose of this study was to investigate the effects of arecoline on pentobarbital- and ethanol-induced hypnosis in mice. METHODS Male ICR mice were tested for locomotor activity following acute systemic administration of ethanol alone, arecoline alone, or ethanol plus arecoline. For the loss of the righting reflex (LORR) induced by pentobarbital and ethanol, sleep latency and sleeping duration were evaluated in mice treated with arecoline alone or the combination of arecoline and scopolamine or methscopolamine. RESULTS Ethanol (1.0 to 3.0 g/kg, i.p.) reduced locomotor activity significantly and a declining trend was observed after treatment with arecoline (0.25 to 1.0 mg/kg, i.p.), but there were no synergistic effects of ethanol and arecoline on locomotor activity. The experiments on LORR demonstrated that arecoline (0.125 to 1.0 mg/kg, s.c.) shortened the duration of sleeping induced by ethanol (4.0 g/kg, i.p.), but not pentobarbital (45 mg/kg, i.p.). In addition, alterations of sleep latency were not obvious in both pentobarbital- and ethanol-induced LORR. Statistical analyses revealed that scopolamine (centrally acting), but not methscopolamine (peripherally acting), could antagonize the effect of arecoline on the duration of ethanol-induced LORR in mice. CONCLUSIONS These results suggest that central muscarinic receptor is a pharmacological target for the action of arecoline to modulate ethanol-induced hypnosis.
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Affiliation(s)
- Yan-Ping Sun
- National Institute on Drug Dependence, Peking University, Beijing, China
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Abstract
The "style of life is the unique way in which individuals try to realize their fictional final goal and meet or avoid the three main tasks of life: work, community, love" (Alfred Adler, founder of the Individual Psychology). Lifestyle refers to the way individuals live their lives and how they handle problems and interpersonal relations. The lifestyle behaviours associated to oral cancer with convincing evidence are tobacco use, betel quid chewing, alcohol drinking, low fruit and vegetable consumption (the detrimental lifestyle is high fat and/or sugar intake, resulting in low fruit and/or vegetable intake). Worldwide, 25% of oral cancers are attributable to tobacco usage (smoking and/or chewing), 7-19% to alcohol drinking, 10-15% to micronutrient deficiency, more than 50% to betel quid chewing in areas of high chewing prevalence. Carcinogenicity is dose-dependent and magnified by multiple exposures. Conversely, low and single exposures do not significantly increase oral cancer risk. These behaviours have common characteristics: (i) they are widespread: one billion men, 250 million women smoke cigarettes, 600-1200 million people chew betel quid, two billion consume alcohol, unbalanced diet is common amongst developed and developing countries; (ii) they were already used by animals and human forerunners millions of years ago because they were essential to overcome conditions such as cold, hunger, famine; their use was seasonal and limited by low availability, in contrast with the pattern of consumption of the modern era, characterized by routine, heavy usage, for recreational activities and with multiple exposures; (iii) their consumption in small doses is not recognized as detrimental by the human body and activates the dopaminergic reward system of the brain, thus giving instant pleasure, "liking" (overconsumption) and "wanting" (craving). For these reasons, effective Public Health measures aimed at preventing oral cancer and other lifestyle-related conditions fail to realize their final goal to eradicate these lifestyles. Following Adler's theory and the principles of the "Ottawa Charter for Health Promotion", conditions such as education, sustainable resources, social justice, and equity must be satisfied before the implementation of physical health promotion campaigns.
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Affiliation(s)
- Stefano Petti
- Department of Public Health Sciences G. Sanarelli, Sapienza University, P.le Aldo Moro 5, 00185 Rome, Italy.
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Singh M, Shakya S, Soni VK, Dangi A, Kumar N, Bhattacharya SM. The n-hexane and chloroform fractions of Piper betle L. trigger different arms of immune responses in BALB/c mice and exhibit antifilarial activity against human lymphatic filarid Brugia malayi. Int Immunopharmacol 2009; 9:716-28. [PMID: 19281872 DOI: 10.1016/j.intimp.2009.02.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 02/01/2009] [Accepted: 02/18/2009] [Indexed: 10/21/2022]
Abstract
Modulation of immune functions by using herbal plants and their products has become fundamental regime of therapeutic approach. Piper betle Linn. (Piperaceae) is a widely distributed plant in the tropical and subtropical regions of the world and has been attributed as traditional herbal remedy for many diseases. We have recently reported the antifilarial and antileishmanial efficacy in the leaf extract of Bangla Mahoba landrace of P. betle which is a female plant. The present report describes the in vivo immunomodulatory efficacy of the crude methanolic extract and its n-hexane, chloroform, n-butanol fractions of the female plant at various dose levels ranging between 0.3 and 500 mg/kg in BALB/c. Attempts were also made to observe antifilarial activity of the active extracts and correlate it with the antigen specific immune responses in another rodent Mastomys coucha infected with human lymphatic filarial parasite Brugia malayi. The crude methanol extract and n-hexane fraction were found to potentiate significant (p<0.001) enhancement of both humoral (plaque forming cells, hemagglutination titre) as well as cell-mediated (lymphoproliferation, macrophage activation, delayed type hypersensitivity) immune responses in mice. The flow cytometric analysis of splenocytes of treated mice indicated enhanced population of T-cells (CD4(+), CD8(+)) and B-cells (CD19(+)). The n-hexane fraction (3 mg/kg) was found to induce biased type 2 cytokine response as revealed by increased IL-4(+) and decreased IFN-gamma(+) T-cell population while the chloroform fraction (10 mg/kg) produced a predominant type 1 cytokines. Crude methanolic extract (100 mg/kg) demonstrated a mixed type 1 and type 2 cytokine responses thus suggesting a remarkable immunomodulatory property in this plant. The induction of differential T-helper cell immune response appears ideal to overcome immunosuppression as observed in case of lymphatic, filarial Brugia malayi infection which may also be extended to other infections as well.
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Affiliation(s)
- Meghna Singh
- Division of Parasitology, Central Drug Research Institute, P. Box 173, Lucknow-226001, India
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Abstract
Milk-alkali syndrome (MAS) consists of hypercalcemia, various degrees of renal failure, and metabolic alkalosis due to ingestion of large amounts of calcium and absorbable alkali. This syndrome was first identified after medical treatment of peptic ulcer disease with milk and alkali was widely adopted at the beginning of the 20th century. With the introduction of histamine2 blockers and proton pump inhibitors, the occurrence of MAS became rare; however, a resurgence of MAS has been witnessed because of the wide availability and increasing use of calcium carbonate, mostly for osteoporosis prevention. The aim of this review was to determine the incidence, pathogenesis, histologic findings, diagnosis, and clinical course of MAS. A MEDLINE search was performed with the keyword milk-alkali syndrome using the PubMed search engine. All relevant English language articles were reviewed. The exact pathomechanism of MAS remains uncertain, but a unique interplay between hypercalcemia and alkalosis in the kidneys seems to lead to a self-reinforcing cycle, resulting in the clinical picture of MAS. Treatment is supportive and involves hydration and withdrawal of the offending agents. Physicians and the public need to be aware of the potential adverse effects of ingesting excessive amounts of calcium carbonate.
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Affiliation(s)
- Boris I Medarov
- Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, 1200 N State St, GNH-11900, Los Angeles, CA 90033, USA.
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Abstract
Milk-alkali syndrome (MAS) consists of hypercalcemia, various degrees of renal failure, and metabolic alkalosis due to ingestion of large amounts of calcium and absorbable alkali. This syndrome was first identified after medical treatment of peptic ulcer disease with milk and alkali was widely adopted at the beginning of the 20th century. With the introduction of histamine2 blockers and proton pump inhibitors, the occurrence of MAS became rare; however, a resurgence of MAS has been witnessed because of the wide availability and increasing use of calcium carbonate, mostly for osteoporosis prevention. The aim of this review was to determine the incidence, pathogenesis, histologic findings, diagnosis, and clinical course of MAS. A MEDLINE search was performed with the keyword milk-alkali syndrome using the PubMed search engine. All relevant English language articles were reviewed. The exact pathomechanism of MAS remains uncertain, but a unique interplay between hypercalcemia and alkalosis in the kidneys seems to lead to a self-reinforcing cycle, resulting in the clinical picture of MAS. Treatment is supportive and involves hydration and withdrawal of the offending agents. Physicians and the public need to be aware of the potential adverse effects of ingesting excessive amounts of calcium carbonate.
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Affiliation(s)
- Boris I Medarov
- Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, 1200 N State St, GNH-11900, Los Angeles, CA 90033, USA.
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Stadler ME, Patel MR, Couch ME, Hayes DN. Molecular biology of head and neck cancer: risks and pathways. Hematol Oncol Clin North Am 2009; 22:1099-124, vii. [PMID: 19010262 DOI: 10.1016/j.hoc.2008.08.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patients present with a differential baseline risk of cancer based on normal and expected variations in genes associated with cancer. The baseline risk of developing cancer is acted on throughout life as the genome of different cells interacts with the environment in the form of exposures (eg, toxins, infections). As genetic damage is incurred throughout a lifetime (directly to DNA sequences or to the epigenome), events are set in motion to progressively disrupt normal cellular pathways toward tumorigenesis. This article attempts to characterize broad categories of genetic aberrations and pathways in a manner that might be useful for the clinician to understand the risk of developing cancer, the pathways that are disrupted, and the potential for molecular-based diagnostics.
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Affiliation(s)
- Michael E Stadler
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina at Chapel Hill, CB #7070, Chapel Hill, NC 27599, USA
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Effect ofPiper betleon Hepatotoxicity and Antioxidant Defense in Ethanol-Treated Rats. ACTA ACUST UNITED AC 2008. [DOI: 10.1300/j044v12n01_06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wang BJ, Guo YL, Guo HR, Chang HY. Piper betle L. inflorescence causes allergic contact dermatitis of the hands during betel quid assembly. Contact Dermatitis 2008; 58:368-70. [PMID: 18503689 DOI: 10.1111/j.1600-0536.2007.01295.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bour-Jr Wang
- Department of Environmental and Occupational Health, National Cheng Kung University Medical College, Tainan, Taiwan
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Lin CF, Shiau TJ, Ko YC, Chen PH, Wang JD. Prevalence and determinants of biochemical dysfunction of the liver in Atayal Aboriginal community of Taiwan: is betel nut chewing a risk factor? BMC Gastroenterol 2008; 8:13. [PMID: 18439308 PMCID: PMC2443869 DOI: 10.1186/1471-230x-8-13] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 04/27/2008] [Indexed: 11/24/2022] Open
Abstract
Background We address the independent and interactive roles of habitual betel quid chewing and other known risk factors for biochemical dysfunction and cirrhosis of the liver. Methods To determine the prevalence rates and risk factors associated with biochemical dysfunction of the liver, a total of 3,010 adult residents in an Atayal Aboriginal community were invited to participate in the study. Abdominal ultrasonography was used to diagnose liver cirrhosis. Results There were 2,063 Atayal Aboriginal and 947 non-Aboriginal in this study. The result showed overall prevalence rates for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) were 21.2 % and 2.9 %, respectively. There were 16.5 %, 15.1 % and 22.4 % subjects with abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transpeptidase (GGT), accordingly. Multiple logistic regression analysis showed that combined infections with HBV and HCV presented with the highest risks with OR (odds ratio) and 95% CI (confidence interval) of 4.2 (1.2–17.4) and 3.8 (1.0–14.1), respectively for elevation of ALT and AST; followed by alcohol (1.7 and 3.1), male gender (1.7 and 1.6), betel quid (1.5 and 1.3), smoking (1.4 and 1.8), and aboriginal (1.4 and 1.3). There is effect-measure modification between viral infection and betel quid chewing for increased severity of abnormal ALT elevation. Among 1,382 subjects consenting to abdominal ultrasonography, 41(3.0%) were found to have liver cirrhosis with the same factors associated with higher risks. Conclusion In addition to infections with viral hepatitis B and/or C, we found Atayal Aboriginal, males, current smokers, drinkers and betel quid chewers were independently associated with biochemical dysfunction and probably cirrhosis of the liver. Further study is needed to corroborate the above hypothesis.
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Affiliation(s)
- Ching-Feng Lin
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health and Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Richardson WH, Slone CM, Michels JE. Herbal drugs of abuse: an emerging problem. Emerg Med Clin North Am 2007; 25:435-57; abstract ix. [PMID: 17482027 DOI: 10.1016/j.emc.2007.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Some herbal products are emerging as popular drugs for recreational abuse. Plant and herbal supplements used recreationally can have a wide spectrum of clinical effects ranging from euphoric and stimulant effects to hallucinogenic experiences. Despite the potential for abuse, addiction, and serious adverse effects, there may be a false perception that these products are all safe, legal, and organic. These perceptions and the ease of accessibility to herbal products could result in greater potential for recreational abuse and subsequent complications presenting to emergency departments. Health care professionals must be cognizant of this emerging problem as increased media coverage and marketing have made these products accessible and recognizable to many young adults and teenagers.
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Affiliation(s)
- William H Richardson
- Department of Emergency Medicine, Palmetto Health Richland, 3 Medical Park, Columbia, SC 29203, USA.
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Caruso JB, Patel RM, Julka K, Parish DC. Health-behavior induced disease: return of the milk-alkali syndrome. J Gen Intern Med 2007; 22:1053-5. [PMID: 17483976 PMCID: PMC2219730 DOI: 10.1007/s11606-007-0226-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 04/11/2007] [Accepted: 04/16/2007] [Indexed: 11/24/2022]
Abstract
The milk-alkali syndrome is a well-documented consequence of excessive calcium and alkali intake first recognized in association with early 20th century antacid regimens. The syndrome became rare after widespread implementation of modern peptic ulcer disease therapies. With recent trends in osteoporosis therapy coupled with widely available calcium-containing supplements, the milk-alkali syndrome has reemerged as an important clinical entity. Our case illustrates a patient who self-medicated his peptic ulcer disease with a regimen resembling a common early 20th century dyspepsia regimen. When superimposed upon chronic high calcium supplementation, the patient became acutely ill from the milk-alkali syndrome. When taken to excess, or used inappropriately, medications and supplements ordinarily considered beneficial, can have harmful effects. Our case underscores the importance of obtaining a thorough medication history including use of over-the-counter supplementation.
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Affiliation(s)
- Joseph B. Caruso
- Department of Internal Medicine, Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201 USA
| | - Rajendrakumar M. Patel
- Department of Internal Medicine, Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201 USA
| | - Karan Julka
- Department of Internal Medicine, Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201 USA
| | - David C. Parish
- Department of Internal Medicine, Mercer University School of Medicine, 707 Pine Street, Macon, GA 31201 USA
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