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

Acute urinary retention following frequent administration of Guggulu Tiktakam Kwatha and its management - a case report

A 72-year-old male patient, a diagnosed case of infective spondylodiscitis, was admitted in our hospital for severe pain in the right hip and lower back (in the lumbo-sacral region) in a non-ambulatory mode. Considering the criticality, we administered Kwatha in a Muhurmuhu (frequent administration) schedule. The initial medicines reduced pain, but not the elevated C-reactive protein (CRP). To reduce this elevated CRP, we administered Amruthotharam Kwatha and Guggulu Tiktakam Kwatha (GTK) in the dosage of 30 ml every 2 h for eight times. CRP started reducing, but we encountered an acute urinary retention as an adverse drug reaction. Naranjo Adverse Drug Reaction Probability Scale recording gave a score of eight, which shows that the AE could be probably due to administration of Guggulu Tiktakam Kwatha (GTK) in Muhurmuhu schedule. When the patient did not void urine for more than 6 hours, we did Marma therapy on left Mootthira Kala Marma. The patient voided urine within half an hour of Marma therapy. Clinically, after the medications, pain reduced considerably, CRP came to normal, and the patient came to an ambulatory mode. This case report shows that medicines like GTK should cautiously be administered, as it may complicate. This case report also focusses light on the fact that Marma therapy could be a possible mode of tackling acute conditions.

Estimation of selected elemental impurities by inductively coupled plasma-mass spectroscopy (ICP-MS) in commercial and fresh fruit juices

The main objective of the study is the estimation of elemental impurities in selected packaged commercial fruit juices and fresh fruit juices available in Ahmedabad, Gujarat. Estimation of seventeen samples (9 commercial fruit juices and 8 fresh fruit juices) was carried out for elemental impurities which include lead, cadmium, arsenic, mercury, methyl mercury, nickel, chromium, tin, copper, and zinc. Inductively coupled plasma-mass spectroscopy (ICP-MS) with microwave-assisted sample digestion was used to determine the element content of samples. The ICP-MS method was confirmed for accuracy by performing validation with validation parameters such as linearity, precision, and accuracy. The method's trueness was confirmed with single-element standards. The results were compared with Food Safety and Standards Authority of India (FSSAI) standards. Arsenic, mercury, methyl mercury, tin, and copper were within permissible limits in all samples of fruit juices. The concentration of lead was found to exceed limits in 5 samples of commercial fruit juices which were 0.07, 0.13, 0.18, 0.21, and 0.38 mg/kg, respectively. The concentration of nickel was found to be above permissible limits in 5 samples (1.26, 1.72, 1.95, 3.24, and 4.07 mg/kg) of commercial fruit juices and 6 samples of fresh fruit juices (0.19. 0.21, 0.21, 0.42, 0.66, and 2.42 mg/kg). The concentration of chromium was found to be above permissible limits in 5 samples (3.13, 3.51, 4.29, 5.91, and 6.02 mg/kg) of commercial fruit juices and 6 samples of fresh fruit juices (0.80. 0.88, 0.98, 0.99, 1.16, and 8.95 mg/kg). Health risk assessment was performed for elemental impurities. Target hazard quotient and health risk index for elemental impurities were found to be less than 1 which is considered safe for consumers. Hazard index for elemental impurities was found to be more than 1 in two samples which can cause serious non-carcinogenic risk to consumers. Target carcinogenic risk was found within acceptable levels for all elemental impurities in all samples of fruit juices. Essential elements like copper and zinc are required by the human body for various body functions but heavy metals like lead, arsenic, and cadmium are highly toxic to human beings due to their adverse effects and it needs to be controlled. Lead poses a significant health risk to human health. It is essential to further monitor the levels of elemental impurities on a regular basis in commercial and fresh fruit juices.

Health Remedies as a Source of Lead, Mercury, and Arsenic Exposure, New York City, 2010-2019

Objectives. To describe the types of health remedies collected during poisoning investigations in New York City over a 10-year period that were found to contain high levels of lead, mercury, or arsenic. Methods. Between 2010 and 2019, the New York City Department of Health and Mental Hygiene collected 584 samples of health remedies during poisoning investigations and store surveys for lead, mercury, or arsenic analysis. Results. There was a significant association between blood lead levels and estimated cumulative daily lead exposures among adult users of rasa shastra Ayurvedic medications. Also, average blood lead levels among adult rasa shastra users were significantly higher than levels among those using other types of non-Ayurvedic health remedies. Conclusions. Rasa shastra Ayurvedic medications can contain very high levels of lead, mercury, and arsenic. This underscores the importance of screening for lead, mercury, and arsenic exposures within at-risk populations. Public Health Implications. The general ease of accessibility to rasa shastra medications raises concerns. There is a need for systemic change that results in primary prevention, that is, removal of the source through policy development and regulatory enforcement in the country of origin. (Am J Public Health. 2022;112(S7):S730-S740. https://doi.org/10.2105/AJPH.2022.306906).