Epidemic dropsy in India

Clinical Profile and Outcomes of Epidemic Dropsy Patients Attending a Tertiary Care Centre in Assam, India

Background The clinical condition of epidemic dropsy is caused by the consumption of edible oils contaminated with Argemone mexicana oil. Two of the most toxic alkaloids found in argemone oil are sanguinarine and dehydrosanguinarine, which cause capillary dilation, proliferation, and increased permeability. Extreme cardiac decompensation leading to congestive heart failure and glaucoma resulting in blindness are the most serious consequences of epidemic dropsy.  Materials and methods All patients attending the medicine department of Tezpur Medical College and Hospital with clinical features of epidemic dropsy were included in the study after obtaining informed consent. All patients, after a complete history, underwent a thorough clinical examination, and findings were recorded using a pre-formed proforma. Along with routine blood examination, patients were also evaluated with echocardiography, ECG, and chest X-ray. Cooking oil samples obtained from patients were investigated for the presence of sanguinarine in a standardized laboratory with the help of the district authority. The statistical analysis was done using MS Excel 2017. Results Out of 38 patients, 36 were male (94.7%), and only two were female (5.2%). Male to female ratio was 18:1. This difference in sex ratio may be due to the fact that only severely ill patients attended our tertiary care hospital. In contrast, moderate and mildly ill patients were treated in local hospitals. The mean age of patients was 28.1 years, and the mean length of hospital stay was eight days. Bilateral pitting type of ankle edema was the most common clinical manifestation, and all 38 patients (100%) exhibited edema. A total of 76% of patients had dermatological manifestations. Sixty-two percent of patients had gastrointestinal manifestations. In cardiovascular manifestation, persistent tachycardia was seen in 52% of patients, pansystolic murmur was best heard in the apical area in 42% of patients, and 21 percent had evidence of a raised jugular venous pressure (JVP). Five percent of patients had pleural effusion. Sixteen percent of patients had ophthalmological manifestations. Eight patients (21%) required ICU care. The in-hospital fatality rate was 10.53% (n=4). Of the expired patients, 100% were male. The most common cause of death was cardiogenic shock (75%), followed by septic shock (25%). Conclusion From our study, it was found that most of the patients were male, with an age group of 25-45 years. The most common clinical manifestation was dependent edema, along with signs of heart failure. Other common manifestations were dermatological and gastrointestinal. The severity and outcome were directly related to the delay in seeking medical consultation and diagnosis.

Dietary and Environmental Risk Factors in Parkinson's and Alzheimer's Disease: A Semi-Quantitative Pilot Study

Objective

Environmental influence and dietary variations are well-known risk factors for various diseases including neurodegenerative disorders. Preliminary evidence suggests that diet in early-life and living environment might influence the incidence of Parkinson's disease (PD) in later phase of life. There have been limited epidemiologic studies on this aspect especially in India. In this hospital-based case-control study, we intended to identify dietary and environmental risk factors of PD.

Methods

Patients with PD (n = 105), Alzheimer's disease (AD) (n = 53) and healthy individuals (n = 81) were recruited. Dietary intake and environmental exposures were assessed using a validated Food-Frequency and Environmental Hazard Questionnaire. Their demographic details and living environment were also recorded using the same questionnaire.

Results

Pre-morbid consumption of carbohydrate and fat was significantly higher whereas dietary fiber and fruit content was significantly lesser in PD as compared to AD and healthy age-matched controls. Meat and milk intake was the highest among all the food groups in PD patients. Rural living and their habitation near water bodies were significantly more frequent in PD patients.

Conclusion

We found that past intake of carbohydrate, fat, milk, and meat are associated with increased risk of PD. On the other hand, rural living and habitat near water bodies might be associated with incidence and severity of PD. Hence, preventive strategies related to dietary and environmental modulators in PD might be clinically useful in the future.

Association between mustard oil consumption and BMI in India

OBJECTIVE

This study examined the association between predominant vegetable oil consumed and BMI of adult women and men in India, with emphasis on predominant consumption of mustard oil.

DESIGN

Two nationally representative data, the consumer expenditure survey of National Sample Survey Office (NSSO)-68th round (2011-2012) for food consumption and National Family Health Survey-4 (2015-2016) for weight status, were analysed. Data from both surveys were combined by matching households through common matching variables ('family size', 'religion', etc.) using Nearest-Neighbour Hot-Deck matching. The association of overweight/obesity with predominant mustard oil consumption in the household was examined using logistic regression adjusted for confounders. The NSSO reports household consumption of mustard, groundnut, coconut, refined oils (sunflower, safflower, soyabean) and all other edible oils.

SETTING

Two nationally representative surveys from India.

PARTICIPANTS

Total of 638 445 women and 92 312 men, respectively.

RESULTS

Mustard oil was the most predominantly consumed oil (51 %) followed by refined oils (32·4 %). Prevalence of overweight/obesity in women and men was lower in households with predominant mustard oil consumption (17 and 15 %) v. all other refined and other oils combined (27 and 26 %). The adjusted OR for predominant mustard oil use was 0·88 (95 % CI 0·86, 0·87) for women and 0·80 (95 % CI 0·76, 0·83) for men. A similar analysis with predominant groundnut oil consumption showed no association with overweight/obesity.

CONCLUSIONS

The data from a large national level survey suggest an inverse association between mustard oil consumption and overweight/obesity which needs to be explored with further research studies.

Epidemic dropsy toxin, sanguinarine chloride, stimulates sucrose-sensitive hemolysis and breakdown of membrane phospholipid asymmetry in human erythrocytes

Sanguinarine (SGN) is a benzophenathridine alkaloid extracted from Sanguinaria canadensis plant. SGN is incriminated in epidemic dropsy (ED) characterized by multiple-organ failure and anemia. Nevertheless, how SGN leads to anemia of ED remains poorly understood. This study was thus initiated to investigate the interaction of SGN with human red blood cells (RBCs) and to delineate associated molecular mechanisms. Heparin- and EDTA-anticoagulated blood was collected from healthy participants and whole blood was analyzed for a complete blood count, while isolated RBCs were examined for hemolytic and eryptotic markers following exposure to 1-100 μM SGN for 24 h at 37 °C. Calcium was measured by Fluo4/AM, hemolysis by hemoglobin leakage, membrane scrambling by Annexin V-FITC, cell size by forward scatter (FSC), cell granularity by side scatter (SSC), and oxidative stress by H₂DCFDA. SGN led to increased Fluo4 fluorescence and dose-dependent hemolysis which was not ameliorated by exclusion of extracellular Ca²⁺ but was nevertheless sensitive to hyperosmotic conditions and to the presence of aspirin. SGN also caused significant increase in Annexin V-positive cells, decreased FSC and SSC values, and elevated DCF fluorescence. Moreover, significantly reduced lymphocyte and basophil percentages along with selective toxicity to platelets was noted. Collectively, SGN possesses sucrose- and cyclooxygenase-sensitive hemolytic potential and elicits eryptosis characterized by Ca²⁺ accumulation, phosphatidylserine externalization, morphological alterations including cell shrinkage and loss of granularity, and oxidative stress. In conclusion, this report reveals a novel activity of SGN against human RBCs and informs prospective policies in ED prevention and management.

Honest nutraceuticals, cosmetics, therapies, and foods (NCTFs): standardization and safety of natural products

With the increasing demand for natural products by the consumer in the marketplace it is necessary to see a proportional increase in behind-the-scenes science to ensure that the ideology of safety and honesty, that is justifiably expected by the wider public, is adequately satisfied. It is of essence to have a fair yet firm governance of nutraceuticals, cosmetics, therapies, and foods. However, with increasing sophistications in adulteration and "claim" loopholes that make it easier for adulterated or counterfeited natural products to be "fudged" to meet the pharmacopeia standards, governance protocols must utilize an "identification and authentication" approach that goes beyond the Pharmacopeia standards to help regulate and transparently communicate natural products in the commercial context. While it is becoming a rat race in keeping commercial natural products honest, modern technology can support authenticators and adequately defeat these challenges.

Pattern recognition based on machine learning identifies oil adulteration and edible oil mixtures

Previous studies have shown that each edible oil type has its own characteristic fatty acid profile; however, no method has yet been described allowing the identification of oil types simply based on this characteristic. Moreover, the fatty acid profile of a specific oil type can be mimicked by a mixture of 2 or more oil types. This has led to fraudulent oil adulteration and intentional mislabeling of edible oils threatening food safety and endangering public health. Here, we present a machine learning method to uncover fatty acid patterns discriminative for ten different plant oil types and their intra-variability. We also describe a supervised end-to-end learning method that can be generalized to oil composition of any given mixtures. Trained on a large number of simulated oil mixtures, independent test dataset validation demonstrates that the model has a 50^th percentile absolute error between 1.4–1.8% and a 90^th percentile error of 4–5.4% for any 3-way mixtures of the ten oil types. The deep learning model can also be further refined with on-line training. Because oil-producing plants have diverse geographical origins and hence slightly varying fatty acid profiles, an online-training method provides also a way to capture useful knowledge presently unavailable. Our method allows the ability to control product quality, determining the fair price of purchased oils and in-turn allowing health-conscious consumers the future of accurate labeling.

Fraudulent adulteration of edible oils is based on the fact that their characteristic fatty acid profile can be mimicked with mixtures of other oil types. Here, the authors use a deep learning method to uncover fatty acid patterns discriminative for ten different plant oil types and to discern composition of mixtures.

Mustard oil consumption, cooking method, diet and gallbladder cancer risk in high- and low-risk regions of India

The current study aimed to investigate the role of cooking with mustard oil and other dietary factors in relation to gallbladder cancer (GBC) in high- and low-incidence regions of India. A case-control study was conducted including 1,170 histologically confirmed cases and 2,525 group-matched visitor controls from the largest cancer hospital in India. Dietary data were collected through a food frequency questionnaire. For oil consumption, we enquired about monthly consumption of 11 different types of cooking oil per family and the number of individuals usually sharing the meal to estimate per-individual consumption of oil. Information about method of cooking was also requested. Odds ratios (ORs) and 95% confidence intervals (CIs) quantifying the association of GBC risk consumption of different types of oil, method of cooking, and dietary food items, were estimated using logistic regression models, after adjusting for potential confounders. High consumption of mustard oil was associated with GBC risk in both high- and low-risk regions (OR = 1.33, 95% CI = 0.99-1.78; OR = 3.01, 95% CI = 1.66-5.45), respectively. An increased risk of GBC was observed with deep frying of fresh fish in mustard oil (OR = 1.57, 95% CI = 0.99-2.47, p-value = 0.052). A protective association was observed with consumption of leafy vegetables, fruits, onion and garlic. No association was observed between consumption of meat, spicy food, turmeric, pulses or with any other oil as a cooking medium. The effect of high consumption of mustard oil on GBC risk, if confirmed, has implications for the primary prevention of GBC, via a reduced consumption.

In Vitro Effect of Methanolic Extract of Argemone mexicana against Trichomonas vaginalis

Infections caused by Trichomonas vaginalis in humans are one of the main public health problems caused by sexually transmitted diseases. Objective of this study was to evaluate potential biological activity of the medicinal plant Argemone mexicana (Mexican poppy) on T. vaginalis. Methanolic extracts of the stems and leaves of A. mexicana, and different fractions were prepared with solvents of different polarities. The extracts and functional groups were detected containing sterols, triterpenes, quinones, flavonoids and, alkaloids. Extracts from both the stems and leaves of A. mexicana inhibited the growth of T. vaginalis with half-maximal inhibitory concentration value of 70.6 and 67.2 μg/ml, respectively. In the active fractions, the most abundant compounds were berberine and jatrorrhizine, with presumed antiparasitic activity.

In Vitro Study of Antiamoebic Activity of Methanol Extracts of Argemone mexicana on Trophozoites of Entamoeba histolytica HM1-IMSS

Infections caused by parasites in humans represent one of the main public health concerns. Amoebiasis, a parasitic infection caused by Entamoeba histolytica (E. histolytica), is considered endemic in Mexico, where Argemone mexicana (A. mexicana) has been used in traditional medicine to treat intestinal parasitic diseases. The objective of this work was to evaluate the potential biological activity of A. mexicana on E. histolytica. For this purpose, a methanolic extract was prepared from A. mexicana leaves, and a differential fractionation was carried out with solvents of different polarities. The inhibitory capacities of the extract and its fractions were evaluated in vitro using HM1-IMSS, a strain of Entamoeba histolytica. A. mexicana extract was found to have a growth-inhibiting activity for E. histolytica, showing IC50 = 78.39 μg/mL. The extract was characterized phytochemically, and the methanolic extract fractions were analyzed by liquid chromatography (HPLC) and mass spectrometry (MS). Berberine and jatrorrhizine were present in the active fractions, and these compounds may be responsible for the antiparasitic activity. The identification of amoebicidal activity of A. mexicana on E. histolytica gives support to the traditional use. Further studies with berberine and jatrorrhizine will be carried out to understand the mechanism involved.

Argemone oil, an edible oil adulterant, induces systemic immunosuppression in Balb/c mice in an oral 28 days repeated dose toxicity study

Consumption of edible oils contaminated with Argemone oil (AO) leads to a clinical condition called "Epidemic dropsy". Earlier studies have reported that metabolism and oxidative stress primarily contributes to AO toxicity, however, the involvement of immune system has not been assessed so far. Therefore, the present study was undertaken to systematically assess the effect of AO exposure on the function of immune system in Balb/c mice. The repeated exposure of AO for 28 days caused prominent regression of spleen and thymus; severe inflammatory changes in spleen depicted by the loss of distinct follicles, increased megakaryocyte infiltration, and enhanced expression levels of inflammatory markers (iNOS & COX-2). At the functional level, AO exposure significantly abrogated the mixed lymphocyte reaction and mitogen-stimulated lymphoproliferative activity of T and B cells, which is reflective of profound lymphocyte dysfunction upon antigen exposure. In concordance with the loss in functional activity of lymphocytes in AO exposed animals, it was found the AO altered the relative percentage of CD3⁺, CD4⁺, and CD28 ⁺ T cells. Further, there was a marked decrease in the relative distribution of cells with prominent MHC I and CD1d expression in AO exposed splenocytes. Moreover, reduced levels of immune stimulatory cytokines (TNF-α, IFN-γ, IL-2, IL-4, and IL-6), and increased levels of immunosuppressive cytokine IL-10 were detected in the serum of AO treated mice. Along with T and B cells, AO exposure also affected the phenotype and activation status of macrophages suggesting the inclination towards "alternative activation of macrophages". Altogether, these functional changes in the immune cells are contributing factors in AO induced immunosuppression.

Case Study

Epidemic dropsy is a multi-system disease involving the cardiovascular, hepatic, renal, ocular and other systems. Onset is usually subacute or insidious with watery diarrhea and vomiting. This lasts from a few days to more than a week. Bilaterally symmetrical pitting edema of the lower limbs extending from the ankles up to the scrotum and abdominal wall is a constant feature. It is a toxic disease caused by the unintentional ingestion of Argemone mexicana (prickly yellow poppy) seeds as an adulterant of wheat flour, or more commonly, of cooking oil such as mustard oil. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil. It is a rare phenomenon for practicing ophthalmologists to observe cases of epidemic dropsy, and the possibility of glaucoma should be kept in mind in cases of epidemic dropsy, when members of same family or village report with raised IOP, pedal edema and history of use of mustard oil for cooking or massage. Glaucoma is hypersecretory in nature; prostaglandin and histamine release may have significant roles in its pathogenesis. The disease has self limiting course but needs good control of intraocular pressure (IOP) medically till it returns to normal and visual field changes have stabilized. Its early diagnosis is very important to prevent grievous complications; hence, all cases should be followed up regularly for IOP measurement and visual field analysis up to 8-12 weeks, because, if ignored, optic atrophy may develop.

Exploratory studies of some Mexican medicinal plants: Cardiovascular effects in rats with and without hypertension

Background:

Papaveraceae Argemone mexicana L., Burseraceae Bursera simaruba (L.) Sarg., Acanthaceae Justicia spicigera Schltdl. and Selaginellaceae Selaginella lepidophylla (Hook. & Grev.) Spring., have been used in Mexican traditional medicine to treat hypertension. The objective of this study was to further characterize the cardiovascular effects of the methanol extracts of such plants.

Methods:

The medicinal plants were collected and taxonomically identified; the methanol extract of each explored plant were administrated to conscious and unconscious male Wistar rats with and without glucose-induced hypertension. The blood pressure (BP) and heart rate (HR) were evaluated before and after the extract administration. Vascular reactivity experiments were conducted in rat aortic rings obtained from rats with and without sugar-induced hypertension, a model widely used to study such effects with cardiovascular agents.

Results:

After oral administration in normotensive conscious rats all tested extracts decreased the HR, such effect was only observed in hypertensive conscious rats after the administration of B. simaruba; only A. mexicana and B. simaruba decreased the BP after oral administration. All extracts administrated by intravenous injection diminished the mean arterial pressure. Dose-response curves to cumulative concentrations of all the extracts promote vascular relaxation in precontracted aortas from rats with and without sugar-induced hypertension.

Conclusions:

The present study indicated that B. simaruba is worthy of further investigation as a potential phytotherapeutic agent for treating hypertension.

Sanguinarine and Its Role in Chronic Diseases

The use of natural products derived from plants as medicines precedes even the recorded human history. In the past few years there were renewed interests in developing natural compounds and understanding their target specificity for drug development for many devastating human diseases. This has been possible due to remarkable advancements in the development of sensitive chemistry and biology tools. Sanguinarine is a benzophenanthridine alkaloid derived from rhizomes of the plant species Sanguinaria canadensis. The alkaloid can exist in the cationic iminium and neutral alkanolamine forms. Sanguinarine is an excellent DNA and RNA intercalator where only the iminium ion binds. Both forms of the alkaloid, however, shows binding to functional proteins like serum albumins, lysozyme and hemoglobin. The molecule is endowed with remarkable biological activities and large number of studies on its various activities has been published potentiating its development as a therapeutic agent particularly for chronic human diseases like cancer, asthma, etc. In this article, we review the properties of this natural alkaloid, and its diverse medicinal applications in relation to how it modulates cell death signaling pathways and induce apoptosis through different ways, its utility as a therapeutic agent for chronic diseases and its biological effects in animal and human models. These data may be useful to understand the therapeutic potential of this important and highly abundant alkaloid that may aid in the development of sanguinarine-based therapeutic agents with high efficacy and specificity.

Ethnopharmacological survey of medicinal plants used by traditional healers and indigenous people in chittagong hill tracts, bangladesh, for the treatment of snakebite

Snakebites are common in tropical countries like Bangladesh where most snakebite victims dwell in rural areas. Among the management options after snakebite in Bangladesh, snake charmers (Ozha in Bengali language) are the first contact following a snakebite for more than 80% of the victims and they are treated mostly with the help of some medicinal plants. Our aim of the study is to compile plants used for the treatment of snakebite occurrence in Bangladesh. The field survey was carried out in a period of almost 3 years. Fieldwork was undertaken in Chittagong Hill Tracts, Bangladesh, including Chittagong, Rangamati, Bandarban, and Khagrachari. Open-ended and semistructured questionnaire was used to interview a total of 110 people including traditional healers and local people. A total of 116 plant species of 48 families were listed. Leaves were the most cited plant part used against snake venom. Most of the reported species were herb in nature and paste mostly used externally is the mode of preparation. The survey represents the preliminary information of certain medicinal plants having neutralizing effects against snake venoms, though further phytochemical investigation, validation, and clinical trials should be conducted before using these plants as an alternative to popular antivenom.

Epidemic dropsy 2013: case series

Epidemic dropsy (ED) is caused due to intoxication with Argemone mexicana. Here we report a case series of three families, all of whom were residents of Uttar Pradesh, India, who presented in August 2013 with all the classical features of ED. We aim to highlight the importance of this malady even though the sale of unbottled mustard oil is illegal in India.

Dropsy outbreak in a single family in Punjab, India

Epidemic dropsy is caused by consumption of mustard oil contaminated with argemone oil. It usually occurs in outbreaks with acute manifestation of bilateral pitting edema, erythema, and local tenderness along with cardiac and respiratory problems in severe cases leading to death. We report an outbreak that is unusual because of its gradual onset, clustering in a single family, and with major manifestation of gastrointestinal illness mimicking acute gastroenteritis, hence leading to delayed diagnosis and high mortality. Thus, the diagnosis of epidemic dropsy should be considered as a strong possibility when there is clustering of cases in a single family with on and off gastrointestinal symptoms of vomiting and diarrhea in a mustard oil consuming belt.

Ethnopharmacological survey of medicinal plants used by traditional healers in Bangladesh for gastrointestinal disorders

ETHNOPHARMACOLOGICAL RELEVANCE

Gastrointestinal diseases are common worldwide, including Bangladesh where majority of the rural people depend on water from unprotected sources. The people from Bangladesh use medicinal plants as their first line of health care to cure and prevent different types of gastrointestinal disorders.

AIM OF THE STUDY

To compile plants used for the treatment of different gastrointestinal disorders in Bangladesh.

MATERIALS AND METHODS

The field survey was carried out in a period of 18 months. Fieldwork was undertaken in total of eleven districts of Bangladesh. Open-ended and semi structured questionnaire were used to interview a total of 1280 people including traditional healers, Ayurvedic/Unani drug manufacturers and local people.

RESULTS

A total of 250 plant species of 93 families were listed. Leaves were the most cited plant part used against gastrointestinal disorders. Most of the reported species were tree in nature and decoction is the mode of preparation of major portions of the plant species. Most of the plant species were very common and were cultivated or planted in homestead or roadsides. The doses of the plants for different treatments varied widely.

CONCLUSION

In view of the fact that the plants were selected based on their medicinal usage for treating different kinds of gastrointestinal diseases including diarrhoea, the activities reported here need more works for validation and could be rationalised by the presence of active compounds found in those plants. The documentation represents the preliminary information in need of future phytochemical investigation and is important for the conservation of these plants.

Unusual association of epidemic dropsy with brachial neuritis and palatal palsy

Epidemic dropsy (ED) results from accidental ingestion of adulterated mustard oil with argemone oil. Chief organs involved in this disease are heart, subcutaneous tissue, eyes and kidneys. Nervous system involvement is very rare. Objective manifestation of neurological involvement is even rarer. The authors report two cases from the same family, who were victims of epidemic dropsy along with their parents. One of them showed objective neurologic involvement in the form of brachial neuritis and another showed palatal palsy.

Benzylisoquinoline alkaloid metabolism: a century of discovery and a brave new world

Benzylisoquinoline alkaloids (BIAs) are a structurally diverse group of plant specialized metabolites with a long history of investigation. Although the ecophysiological functions of most BIAs are unknown, the medicinal properties of many compounds have been exploited for centuries. These include the narcotic analgesics codeine and morphine, the antimicrobial agents sanguinarine and berberine, and the antitussive and anticancer drug noscapine. BIA biosynthesis involves a restricted number of enzyme types that catalyze landmark coupling reactions and subsequent functional group modifications. A pathogenesis-related (PR)10/Bet v1 'Pictet-Spenglerase', several O-methyl-, N-methyl- and O-acetyltransferases, cytochromes P450, FAD-dependent oxidases, non-heme dioxygenases and NADPH-dependent reductases have been implicated in the multistep pathways leading to structurally diverse alkaloids. A small number of plant species, including opium poppy (Papaver somniferum) and other members of the Ranunculales, have emerged as model systems to study BIA metabolism. The expansion of resources to include a wider range of plant species is creating an opportunity to investigate previously uncharacterized BIA pathways. Contemporary knowledge of BIA metabolism reflects over a century of research coupled with the development of key innovations such as radioactive tracing, enzyme isolation and molecular cloning, and functional genomics approaches such as virus-induced gene silencing. Recently, the emergence of transcriptomics, proteomics and metabolomics has expedited the discovery of new BIA biosynthetic genes. The growing repository of BIA biosynthetic genes is providing the parts required to apply emerging synthetic biology platforms to the development of production systems in microbes as an alternative to plants as a commecial source of valuable BIAs.

The cause of endomyocardial fibrosis in Uganda

Summary

The cause of endomyocardial fibrosis in Uganda remains unknown in spite of studies dating back to 1948. Herbal decoctions have been used by traditional healers for countless generations to treat many complaints, especially fever. We present evidence – ethnic, geographical, tribal, pathological and distribution by age – that the toxic herbal decoctions taken as medicines in Uganda can cause endomyocardial fibrosis.

Outbreak of beriberi among African Union troops in Mogadishu, Somalia

Context and Objectives

In July 2009, WHO and partners were notified of a large outbreak of unknown illness, including deaths, among African Union (AU) soldiers in Mogadishu. Illnesses were characterized by peripheral edema, dyspnea, palpitations, and fever. Our objectives were to determine the cause of the outbreak, and to design and recommend control strategies.

Design, Setting, and Participants

The illness was defined as acute onset of lower limb edema, with dyspnea, chest pain, palpitations, nausea, vomiting, abdominal pain, or headache. Investigations in Nairobi and Mogadishu included clinical, epidemiologic, environmental, and laboratory studies. A case-control study was performed to identify risk factors for illness.

Results

From April 26, 2009 to May 1, 2010, 241 AU soldiers had lower limb edema and at least one additional symptom; four patients died. At least 52 soldiers were airlifted to hospitals in Kenya and Uganda. Four of 31 hospitalized patients in Kenya had right-sided heart failure with pulmonary hypertension. Initial laboratory investigations did not reveal hematologic, metabolic, infectious or toxicological abnormalities. Illness was associated with exclusive consumption of food provided to troops (not eating locally acquired foods) and a high level of insecurity (e.g., being exposed to enemy fire on a daily basis). Because the syndrome was clinically compatible with wet beriberi, thiamine was administered to ill soldiers, resulting in rapid and dramatic resolution. Blood samples taken from 16 cases prior to treatment showed increased levels of erythrocyte transketolase activation coefficient, consistent with thiamine deficiency. With mass thiamine supplementation for healthy troops, the number of subsequent beriberi cases decreased with no further deaths reported.

Conclusions

An outbreak of wet beriberi caused by thiamine deficiency due to restricted diet occurred among soldiers in a modern, well-equipped army. Vigilance to ensure adequate micronutrient intake must be a priority in populations completely dependent upon nutritional support from external sources.

Quantitative liquid chromatographic determination of sanguinarine in cell culture medium and in rat urine and plasma

Sanguinarine is a quaternary benzo[c]phenanthridine alkaloid, extracted from the argemone oil, which produced severe human intoxications. To investigate the sanguinarine biotransformation, we develop a simple extraction process and a high performance liquid chromatographic separation coupled to a sensitive fluorometric detection of sanguinarine in cell culture medium, as well as in rat urine and plasma. After extraction with an acidified organic solvent, sanguinarine elution is performed within 15 min on a Nucleosil C18 column with a gradient using 0.2% formic acid/water/acetonitrile as mobile phase. Extracted and standard sanguinarine are characterized by mass spectrometry. The extraction recovery of sanguinarine is about 80% in cell culture medium and in rat urine, but lower in plasma. This convenient high performance liquid chromatography (HPLC) method allows to quantify sanguinarine over concentrations ranged 10-2000 ng ml(-1). The limit of fluorometric detection is 0.5 ng. Under these conditions, the lower limit of quantification of sanguinarine is 50 ng ml(-1) in cell culture medium and in rat urine and 100 ng ml(-1) in rat plasma. This analytical HPLC method is specific, linear and reproducible in all media and is suitable for quantitative determination of sanguinarine in biological fluids.