Potential deleterious effects of paracetamol dose regime used in Nigeria versus that of the United States of America.

Paracetamol, also known as acetaminophen (N-acetyl-para-aminophenol, APAP) is the world's most used over-the-counter analgesic-antipyretic drug. Despite its good safety profile, acetaminophen can cause severe hepatotoxicity in overdose, and poisoning from paracetamol has become a major public health concern. Paracetamol is now the major cause of acute liver failure in the United States and Europe. This systematic review aims at examining the likelihood of paracetamol use in Nigeria causing more liver toxicity vis-à-vis the reduced maximum recommended daily adult dose of 3 g for the 500 mg tablet. Online searches were conducted in the databases of PubMed, Google Scholar and MEDLINE for publications using terms like "paracetamol toxicity," "acetaminophen and liver toxicity," "paracetamol and liver diseases in Nigeria," and other variants. Further search of related references in PubMed was carried out, and synthesis of all studies included in this review finalized. There were 94 studies that met the inclusion criteria. Evaluation of hepatic disorder was predicated mostly on a constellation of clinical features and limited clinical laboratory investigations. Determination of blood paracetamol concentration was rarely reported, thus excluding paracetamol poisoning as one of the likely causes of liver disorders in Nigeria. In Nigeria and elsewhere, several factors are known to increase paracetamol's predisposition to liver injury. They include: the over-the-counter status of paracetamol, use of fixed-dose combinations of paracetamol with other drugs, malnutrition, dose miscalculations, and chronic alcohol consumption. The tendency to exceed the new paracetamol maximum daily dose of 3 g in Nigeria may increase its risk for hepatotoxicity than observed in the United States of America known for emphasizing lower dose of the drug. In addition to recommending the new maximal daily paracetamol dose allowance, the historical maximum daily adult dose of 4 g should be de-emphasized in Nigeria.

Mechanistic considerations and biomarkers level in nickel-induced neurodegenerative diseases: An updated systematic review.

The environment has been implicated to be a strong determinant of brain health with higher risk of neurodegeneration. The drastic rise in the prevalence of neurodegenerative diseases (NDDs) including Alzheimer's disease (AD), Parkinson's disease (PD), autism spectrum disorder (ASD), multiple sclerosis (MS) etc., supports the idea that environmental factors may play a major role in NDDs aetiology. Nickel is one of the listed environmental metals reported to pose a serious threat to human health. This paper reported available studies on nickel level in NDDs covering both animal and human studies. Different databases were searched for articles reporting the main neurotoxicity mechanisms and the concentration of nickel in fluids and tissues of NDDs patients compared to controls. Data were extracted and synthesized by ensuring the articles were related to nickel and NDDs. Various mechanisms were reported as oxidative stress, disturbances in mitochondrial membrane potential, trace elements homeostasis destabilization, etc. Nickel was found elevated in biological fluids as blood, serum/plasma and CSF and in the brain of NDDs, as a consequence of unintentional exposure thorough nickel-contaminated air, food, water, and skin contact. In addition, after exposure to nickel, the concentration of markers of lipid peroxidation were increased, while some antioxidant defence systems decreased. Thus, the reduction in the exposure to nickel contaminant may hold a promise in reducing the incidence of NDDs.

Human dietary exposure to metals in the Niger delta region, Nigeria: Health risk assessment.

The contamination profile and the human health risk assessment of various heavy metals (Cd, Cr, Mn, Ni and Pb) in vegetable oils, palm oils, butter and shea butter purchased from the Nigerian market were evaluated. Univariate and multivariate analyses including the principal component analysis (PCA), hierarchical cluster analysis (HCA) and heat map visualization were used to evaluate correlation, similarity and source of metals. Dietary intake and dermal absorption through the application in skin were also assessed. The heavy metals 5th and 95th percentile interval range (in mg/kg) were 0.003-0.208, 0.003-0.392, 0.003-1.344, 0.003-0.369 and 0.006-0.531 for Cd, Cr, Mn, Ni and Pb, respectively. Concentrations of Cr and Mn were significantly different across sample categories, being the levels of Mn and Ni positively correlated in both oil and butter samples. The result of PCA, HCA and heat map revealed the profile of heavy metals in oils was different from that of butters, with Pb mainly associated to oils, and Cd, Cr, Mn and Ni to butters. In some samples, the international maximum levels for Cd, Ni and Pb in edible oils were exceeded. Cadmium and Pb dietary intake through Nigerian oils and butters should not be considered negligible for human health protection.

Management of Iron Overload in Resource Poor Nations: A Systematic Review of Phlebotomy and Natural Chelators.

Iron is an essential element and the most abundant trace metal in the body involved in oxygen transport and oxygen sensing, electron transfer, energy metabolism, and DNA synthesis. Excess labile and unchelated iron can catalyze the formation of tissue-damaging radicals and induce oxidative stress. English abstracts were identified in PubMed and Google Scholar using multiple and various search terms based on defined inclusion and exclusion criteria. Full-length articles were selected for systematic review, and secondary and tertiary references were developed. Although bloodletting or phlebotomy remains the gold standard in the management of iron overload, this systematic review is an updated account of the pitfalls of phlebotomy and classical synthetic chelators with scientific justification for the use of natural iron chelators of dietary origin in resource-poor nations.

Sentinel species for biomonitoring and biosurveillance of environmental heavy metals in Nigeria.

Nigeria receives copious annual precipitation to nourish its forests and agriculture, it has an extensive river drainage system, and it possesses valuable mineral deposits that stimulate both commercial and artisan mining activities. The combination of these features complicates Nigeria's efforts to produce adequate amounts of healthy foods to support its population. Toxic heavy metals like lead, cadmium, and mercury, and toxic metalloids such as arsenic, are also present in its mineral deposits and they migrate gradually into the soil and water of Nigeria by natural means. However, mining activities can liberate higher levels of toxic metals, which adversely affect Nigerian ecosystems and its food chains. Thus, environmental pollution due to anthropogenic activities is a major public health concern in Nigeria. This review covers the importance of native Nigerian and African wild and cultivated plants along with livestock and wild animals as sentinel species to evaluate heavy metals as environmental stressors and the use of sentinel species for food safety monitoring and for predicting potential risks to human health.

Nigerian foods of probiotics relevance and chronic metal exposure: a systematic review.

Probiotics are functional foods with a wide armamentarium of health benefits in man including metal chelation. Given the unacceptable blood lead levels and the near ignorance or negligence of heavy metals in both diagnoses and management of diseases in Nigeria, it is feared that these metals are involved in the aetiogenesis of several ailments from preeclampsia, metabolic syndrome, cancer, etc. This is an insight on Nigerian fermented foods and their possible role as metal chelators in the management of the chronic heavy metal exposure in Nigeria. One hundred and five articles fulfilled the inclusion criteria. Google scholar, PubMed and SCOPUS were searched for articles reporting fermented foods and probiotics in Nigeria. Only studies published in English Language were included, but there was no limitation in year of study. One hundred and five articles fulfilled the inclusion criteria. Studies from some African countries suggest that fermented foods of probiotics relevance have effectively shown metal chelation properties. Consumption of Nigerian fermented foods may hold a promise in checking the high body burden of heavy metals in Nigeria. Graphic abstract.

Safety of honey consumed in Enugu State, Nigeria: a public health risk assessment of lead and polycyclic aromatic hydrocarbons

Background: Information about lead (Pb) and polycyclic aromatic hydrocarbons (PAHs) concentrations in honey and their dietary intake is very important in human health risk assessment. Currently, there are paucity of data on the risk assessment and concentrations of lead and PAHs in honey in Nigeria. Objective: This study has determined the potential human health risk of lead and PAHs associated with the consumption of honey in Enugu state, Nigeria. Materials and methods: Lead and US EPA 16 priority PAHs in honey harvested from rural and urban communities in March 2016 were determined using Atomic Absorption Spectrometer and Gas Chromatograph respectively. Carcinogenic and non-carcinogenic risk assessments were carried. Results: The mean concentration of Pb in honey ranged from 0.005 mg/kg ­ 0.08 mg/kg. The mean concentrations of 16 PAHs in honey ranged from 4.71E-03 ­ 2.72 mg/kg. The dietary intake of the PAHs for adults and children ranged from 0.0021 ­ 0.0259 mg/kg/day and 0.0011 ­ 0.0129 mg/kg/day respectively. The levels of BaPeq and their margin of exposure MOE suggest non-significant health risk. The incremental life cancer risk ILCR of Pb were within safe range of <1E-04. Conclusion: Consumption of honey from Enugu State, Nigeria may not pose a significant health risk_

The effects of oral administration of Cola nitida on the pharmacokinetic profile of metoclopramide in rabbits.

BACKGROUND: Cola nitida is commonly chewed in many West African cultures to ease hunger pangs and sometimes for their stimulant and euphoriant qualities. Metoclopramide is a known substrate for P-gp, SULT2A1 and CYP2D6 and studies have revealed that caffeine- a major component of Cola nitida can induce P-glycoprotein (P-gp), SULT2A1 and SULT1A1, hence a possible drug interaction may occur on co-administration. The aim of this study was to investigate the pharmacokinetic interactions of Cola nitida and metoclopramide in rabbits. METHODS: The study was performed in two stages using five healthy male rabbits with a 1-week washout period between treatments. Stage one involved oral administration of metoclopramide (0.5 mg/kg) alone while in the second stage, metoclopramide (0.5 mg/kg) was administered concurrently with Cola nitida (0.7 mg/kg). Blood samples were collected after each stage at predetermined intervals and analyzed for plasma metoclopramide concentration using HPLC. RESULTS: Compared with control, the metoclopramide/Cola nitida co-administration produced a decrease in plasma concentration of metoclopramide at all the time intervals except at the 7th hour. The following pharmacokinetic parameters were also decreased: area under the curve (51%), peak plasma concentration (39%), half-life (51%); while an increase in elimination rate constant (113%) and clearance rate (98%) were noted indicating rapid elimination of the drug. A minimal decrease in absorption rate (10%) was also observed. CONCLUSIONS: The results of this study reveal a possible herb-drug interaction between Cola nitida and metoclopramide.

Unsafe herbal sex enhancement supplements in Nigerian markets: a human risk assessment.

High rates of irreversible oligo- or azoospermia are found among Nigerian men, leading many to consume herbal male sex enhancement products. The possibility of reproductive toxicity due to heavy metal contamination (Cr, As, Co, Hg, Cd, and Pb) of herbal products commonly used to boost libido or treat erectile dysfunction necessitated this study. In this study, herbal sex enhancement supplements were bought from pharmaceutical shops in Port Harcourt, Nigeria, and analyzed for heavy metals (Cr, As, Co, Hg, Cd, and Pb) contents using atomic absorption spectroscopy. The estimated daily metal intake (EDImetal), target hazard quotients (THQ), and total target hazard quotients (TTHQ) were determined. All the herbal sex enhancers used in this study contained heavy metals in these ranges: lead (0.032-0593), cobalt (0.025-0.075), cadmium (0.0011-0.048), and chromium (0.016-0.49) mg/kg. About 24.32% of the samples had TTHQ greater than 1. The EDImetal, THQ, and TTHQ of herbal sex enhancement supplements suggest that the use of some of these herbal sex enhancement supplements may not be risk-free after chronic exposure. Herbal sex enhancement supplements sold in Nigeria contain high levels of lead and cadmium. Since these metals are known to have male reproductive toxicity, these supplements may be adding to both the body burden of these metals and also implicated in the increasing incidence of male infertility in Nigeria.

Natural antidotes and management of metal toxicity.

The global burden of heavy metal especially mercury, arsenic, lead, and cadmium toxicities remains a significant public health challenge. Developing nations are particularly at high risk and carry the highest burden of this hazard. Chelation therapy has been the mainstay for treatment of heavy metal poisoning where the chelating agent binds metal ions to form complex ring-like structures called "chelates" to enhance their elimination from the body. Metal chelators have some drawbacks such as redistribution of some heavy metals from other tissues to the brain thereby increasing its neurotoxicity, causing loss of essential metals such as copper and zinc as well as some serious adverse effects, e.g., hepatotoxicity. The use of natural antidotes, which are easily available, affordable, and with little or no side effects compared to the classic metal chelators, is the focus of this review and suggested as cheaper options for developing nations in the treatment of heavy metal poisoning.

Herb-Induced Liver Injuries in Developing Nations: An Update.

The last few decades have seen a rise in the use of herbal supplements, natural products, and traditional medicines. However, there are growing concerns related to the safety and toxicities of these medicines. These herbal medicines are associated with complications such as liver damage with a high incidence of mortalities and morbidities. Clinical manifestations range from asymptomatic cases with abnormal liver functions tests to sudden and severe liver failure necessitating liver transplantation. This work aimed to review the etiology, risk factors, diagnosis, clinical manifestations and selected clinical case reports of herbal hepatotoxicity in developing nations. PubMed and Google Scholar searches were undertaken to identify relevant literature. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches. Little data exists on clinical cases of herb-induced liver injury in some developing countries such as Nigeria, as most incidences are either not reported to health care providers or reports from hospitals go unpublished. Studies in Nigeria have highlighted a possible correlation between use of herbs and liver disease. In Uganda, and association between the use of traditional herbal medicine with liver fibrosis in HIV-infected and non-HIV patients was demonstrated. Reports from China have revealed incidences of acute liver failure as a result of herbal medicine use. The actual incidence and prevalence of HILI in developing nations remain largely unknown due to both poor pharmacovigilance programs and non-application of emerging technologies. Improving education and public awareness of the potential risks of herbals and herbal products is desirable to ensure that suspected adverse effects are formally reported. There is need for stricter regulations and pre-clinical studies necessary for efficacy and safety.

Blood Lead Levels in Women of Child-Bearing Age in Sub-Saharan Africa: A Systematic Review.

This paper reported available studies on blood lead level of childbearing age in Sub-Saharan African women. PubMed and Google scholar databases were searched for original articles reporting blood lead levels of women of childbearing age in Sub-Saharan Africa. Searches were not limited to year of study but limited to studies published in English Language. Data were extracted and synthesized by estimating the weighted mean of the reported blood lead levels. Fifteen papers fulfilled the inclusion criteria. Mean blood lead levels of women in the studies ranged from 0.83 to 99 µg/dl. The overall weighted mean of blood lead levels was 24.73 µg/dl. The weighted mean from analyses of data on blood lead levels of pregnant women alone was 26.24 µg/dl. Identified sources of lead exposure included lead mine, informal lead-acid battery recycling, leaded gasoline and piped water. Elevated BLLs were associated with incidence of preeclampsia, hypertension, and malaria. Important contributing factors for elevated blood lead levels (BLL) in these women include poverty, high environmental lead burden, low awareness on lead exposure hazards and lack of regulation for lead in consumer products. BLLs of women of childbearing age in SSA are unacceptably high. There is need therefore, for aggressive programs to address lead exposure in this population.

Cosmetic Use in Nigeria May Be Safe: A Human Health Risk Assessment of Metals and Metalloids in Some Common Brands.

Twenty different brands of cosmetic products were purchased from supermarkets in Port Harcourt, Rivers State, Nigeria, with the aims to determine the levels of metals and assess the health risk to humans through long-term usage. The concentration of metals (arsenic, lead, mercury, cadmium, and nickel) in the cosmetic samples was measured with atomic absorption spectrophotometry after acid digestion. The concentration of metals in these brands of cosmetic studied ranged from As: 0.001-0.0161 mg/kg, Pb: 0.289-2.873 mg/kg, Hg: 0.001-0.0014 mg/kg, Cd: 0.001-0.334 mg/kg, and Ni: 0.007-2.748 mg/kg. The metal and metalloid contents were less than the regulatory limits set for both metal impurities and as color additives. The target hazard quotient, hazard index, and cancer risk were less than the acceptable limit, indicating a measure of safety. Cosmetics sold in Nigeria may not add to the body burden of metals and metalloids.

Heavy metals health risk assessment for population via consumption of food crops and fruits in Owerri, South Eastern, Nigeria.

BACKGROUND: This study assessed lead, cadmium, and nickel level in food crops, fruits and soil samples from Ohaji and Umuagwo and Owerri in South Eastern Nigeria and estimated the potential health risks of metals. Samples were washed, oven-dried at 70-80°C for 24 h and powdered. Samples were digested with perchloric acid and nitric acid. Metals were analysed with Unicam Atomic Absorption Spectrophotometer. RESULT: The concentration of Pb, Cd, and Ni in Ohaji exceeded the maximum allowable concentrations for agricultural soil as recommended by EU. Lead, Cd, and Ni in the food crops were highest in Oryza sativa, Glycine max, and Pentabacta microfila respectively. Highest levels of Pb, Cd, and Ni, in fruits were detected in Canarium schweinfurthii, Citrus reticulata, Ananas comosus respectively. The true lead and cadmium intake for the rice based meal were 3.53 and 0.034 g/kg respectively. Whereas the true intake of lead and cadmium for the cassava based meal were 19.42 and 0.049 g/kg respectively. CONCLUSION: Local food stuff commonly available in South Eastern Nigeria villages may contribute to the body burden of heavy metal. This is of public health importance.