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ISSN 2347-954X (Print) An Observational Study on the Etiopathological Factors of Pandu roga in the Patients of Various Anemias

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Abstract

Anemias have got a very high prevalence rate in the world over and in spite of the massive efforts of modern medical science; good control has not been achieved. Recent studies have shown the involvement of other factors too in the pathogenesis, besides the causes established to date. Such new associations are reflecting the need to study the association of other unexplored factors also in anemia and incorporate them into the treatment module to combat anemias more successfully. Some hints about these aetiological factors can be obtained from the study of Pandu roga of Ayurveda, as these two diseases bear great resemblance clinically and in treatment. This study aimed to explore the association of the aetiological factors of Pandu roga in the patients of various anemias. The study revealed a significant association for the aetiological factors of Pandu roga in anemic patients and demonstrated that the consideration and avoidance of these aetiological factors also need to be done along with the treatment module to combat anemias still more effectively.

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... The problem becomes more severe as more women are affected with it as compared to men (Malhotra et al., 2004). Anaemia has got a very high prevalence rate the world over and in spite of the massive efforts of the modern medical science, a good control has not been achieved (Rai & Kar, 2015). Iron deficiency anaemia (inadequate amount of red blood cells caused by lack of iron) is not only highly prevalent in the developing countries, but also remains a noticeable problem in the developed countries. ...
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Anaemia is a major public health problem in India. According to the World Health Organization (WHO), there are two billion people with anaemia in the world and half of anaemia cases is due to iron deficiency. Unani Medicine has a treasure of single drugs and compound formulations for the treatment of anaemia. Among the compound formulations, Sharbat Fawläd is one of the famous Unani medicines and has various pharmacological actions like Muwallid-i-Dam (hemopoietic), Muqawwé-i-Mi'da (stomachic), and Muqawwé-i-Kabid (hepatotonic). It has been traditionally used for the treatment of anaemia (Faqr al-Dam) since ages. Sharbat Fawläd has been reported for its haematinic effect in recent years. This review has been contemplated to highlight the beneficial effects of Sharbat Fawläd for the treatment of anaemia and other disorders.
... Such new associations in the treatment module to combat anaemia's more successfully. 7 Many drugs are available in the modern science for combating anemia but they are costly and therefore out of reach of poor people who are the major sufferers of the ailment 8 , moreover the other modern drugs to treat anemia produce gastric irritants and have side effects like nausea, constipation, diarrhea etc. which further deteriorates the health of the patient. 9 Thus, it is the need of time to use herbal drugs which are easily available, effective and low in cost from Ayurveda were description of single herbal drugs as well as formulations for the management of Panduroga are available. ...
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Anemia is considered a severe public health problem by World Health Organization when anemia prevalence is equal to or greater than 40% in the population. The purpose of this study was to determine the anemia prevalence with the associated factors in pregnant women and to determine the serum iron, folate and B12 vitamin status in anaemic pregnants in Malatya province. This is a cross-sectional survey. A multi-sage stratified probability-proportional-to-size cluster sampling methodology was used. A total of 823 pregnant women from sixty clusters were studied. Women were administered a questionnaire related with the subject and blood samples were drawn. Total blood count was performed within four hours and serum iron, folate and B12 vitamin were studied after storing sera at -20 C for six months. Anemia prevalence was 27.1% (Hb < 11.0 gr/dl). Having four or more living children (OR = 2.2), being at the third trimester (OR = 2.3) and having a low family income (OR = 1.6) were determined as the independent predictors of anemia in pregnancy. Anemia was also associated with soil eating (PICA) in the univariate analysis (p < 0.05). Of anaemic women, 50.0% had a transferrin saturation less than 10% indicating iron deficiency, 34.5% were deficient in B12 vitamin and 71.7% were deficient in folate. Most of the anemias were normocytic-normochromic (56.5%) indicating mixed anemia. In Malatya, for pregnant women anemia was a moderate public health problem. Coexisting of iron, folate and B vitamin deficiencies was observed among anaemics. To continue anemia control strategies with reasonable care and diligence was recommended.
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Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal morbidity and mortality and to low birthweight. To determine the prevalence of anemia and the dietary and socioeconomic factors associated with anemia in pregnant women living in an urban community setting in Hyderabad, Pakistan. This was a prospective, observational study of 1,369 pregnant women enrolled at 20 to 26 weeks of gestation and followed to 6 weeks postpartum. A blood sample was obtained at enrollment to determine hemoglobin levels. Information on nutritional knowledge, attitudes, and practice and dietary history regarding usual food intake before and during pregnancy were obtained by trained interviewers within 1 week of enrollment. The prevalence of anemia (defined by the World Health Organization as hemoglobin < 11.0 g/dL) in these subjects was 90.5%; of these, 75.0% had mild anemia (hemoglobin from 9.0 to 10.9 g/dL) and 14.8% had moderate anemia (hemoglobin from 7.0 to 8.9 g/dL). Only 0.7% were severely anemic (hemoglobin < 7.0 g/ dL). Nonanemic women were significantly taller, weighed more, and had a higher body mass index. Multivariate analysis after adjustment for education, pregnancy history, iron supplementation, and height showed that drinking more than three cups of tea per day before pregnancy (adjusted prevalence odds ratio [aPOR], 3.2; 95% confidence interval [CI], 1.3 to 8.0), consumption of clay or dirt during pregnancy (aPOR, 3.7; 95% CI, 1.1 to 12.3), and never consuming eggs or consuming eggs less than twice a week during pregnancy (aPOR, 1.7; 95% CI, 1.1 to 2.5) were significantly associated with anemia. Consumption of red meat less than twice a week prior to pregnancy was marginally associated with anemia (aPOR, 1.2; 95% CI, 0.8 to 1.8) but was significantly associated with lower mean hemoglobin concentrations (9.9 vs. 10.0 g/dL, p = .05) during the study period. A subanalysis excluding women with mild anemia found similar associations to those of the main model, albeit even stronger. A high percentage of women at 20 to 26 weeks of pregnancy had mild to moderate anemia. Pica, tea consumption, and low intake of eggs and red meat were associated with anemia. Women of childbearing age should be provided nutritional education regarding food sources of iron, especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron absorption.
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To give an overview of the association between tea consumption and iron status. A PUBMED search was performed (up to June 2001) for all publications containing the words: tea and ferritin, h(a)emoglobin, iron status or an(a)emia. Sixteen studies were evaluated in groups with high (infants, children and premenopausal women) or low prevalence of iron deficiency (men and the elderly). Of the 16 studies reviewed, six included infants and children, six premenopausal women, two men and two the elderly. In study groups with high prevalence of iron deficiency, tea consumption was inversely associated with serum ferritin and/or haemoglobin. The association disappeared when adjusting for confounding (dietary) factors, except for one study including 40% of iron deficient women. In groups with low prevalence of iron deficiency, tea consumption was not inversely associated with serum ferritin and/or haemoglobin. In those at risk for iron overload, such as middle-aged men, tea consumption may lower serum ferritin concentrations as reported in one study. This finding awaits further confirmation. This overview shows that tea consumption does not influence iron status in Western populations in which most people have adequate iron stores as determined by serum ferritin concentrations. Only in populations of individuals with marginal iron status does there seem to be a negative association between tea consumption and iron status.
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In marathon runners changes in red blood cell count, haematocrit and haemoglobin in relation to haemodilution have been reported. Moreover, it has been hypothesized that strenuous exercise induces oxidant stress through several different mechanisms. This study investigated the haematological variables, iron status and oxidative indices before, immediately and 48 h after a race in 8 healthy trained males aged 33-44 years running a 21-km marathon in 79 +/- 3 min. The haematological parameters were determined by standard procedures. Erythropoietin and soluble-transferrin receptor were evaluated immunoenzymatically. Nontransferrin-bound iron (NTBI) was assayed by high-performance liquid chromatography after nitrilotriacetic acid chelation. Malonyldialdehyde (MDA) concentration was assayed colorimetrically. The total number of reticulocytes rose significantly after the run with a significant increase in the high-RNA-content fraction (14 +/- 5, p < 0.0006). Erythropoietin rose by 26% (15.0 +/- 2.8 mU/ml, p < 0.004) and by 25% (14.9 +/- 2.13 mU/ml, p < 0.02) immediately and 48 h after the race, respectively. Serum iron and serum ferritin remained unchanged but NTBI and serum MDA increased significantly immediately after running (1.16 +/- 0.40 mmol/l, p < 0.0008; 0.76 +/- 0.16 mmol/l, p < 0.0001). Significant positive correlations at any time between MDA and polymorphonuclear neutrophils (p = 0.0005), MDA and NTBI (p = 0.0018), polymorphonuclear neutrophils and NTBI (p = 0.0008) and between lactate dehydrogenase and NTBI (p = 0.0212) were observed. The erythropoietic changes observed in marathon runners are the results of several interacting mechanisms that involve either the haemopoietic system per se or erythrocyte haemolysis and oxidative stress.
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A number of potential health effects have lately been accorded to tea consumption. It is, however, not clear whether an increase in tea consumption increases the risk of iron depletion in a normal apparently healthy adult population. We have therefore evaluated this. Cross-sectional study. A total of 954 men (aged 52-68 years) and 1639 women (aged 42-68 years), who were participants of SU.VI.MAX Study, completed a detailed questionnaire on tea consumption. To determine the iron status of the participants, a venous blood sample was drawn and serum-ferritin was measured. Iron depletion was defined as a serum ferritin concentration <16 microg/l. Three 1-day food records were used to estimate the intake of other dietary enhancing or inhibiting factors of iron absorption, which were included in the logistic regression models. The mean serum-ferritin concentration was not related to black, green and herbal tea consumption in men, pre- or postmenopausal women. Also the risk of iron depletion was in the multivariate model not related to any kind of tea drinking or to the strength of tea, the infusion time or the time of tea drinking. The data suggest that normal apparently healthy adults are not at risk of iron depletion owing to any kind of tea drinking.
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Iron deficiency anemia poses an important public health problem for women of reproductive age living in developing countries. We assessed the prevalence of iron deficiency and anemia and associated risk factors in a community-based sample of women living in a rural province of northwest Vietnam. A cross-sectional survey, comprised of written questionnaires and laboratory analysis of hemoglobin (Hb), ferritin, transferrin receptor, and stool hookworm egg count, was undertaken, and the soluble transferrin receptor/log ferritin index was calculated. Of 349 non-pregnant women, 37.53% were anemic (Hb < 12 g/dL), and 23.10% were iron deficient (ferritin < 15 ng/L). Hookworm infection was present in 78.15% of women, although heavy infection was uncommon (6.29%). Iron deficiency was more prevalent in anemic than non-anemic women (38.21% versus 14.08%, P < 0.001). Consumption of meat at least three times a week was more common in non-anemic women (51.15% versus 66.67%, P = 0.042). Mean ferritin was lower in anemic women (18.99 versus 35.66 ng/mL, P < 0.001). There was no evidence of a difference in prevalence (15.20% versus 17.23%, P = 0.629) or intensity (171.07 versus 129.93 eggs/g, P = 0.412) of hookworm infection between anemic and non-anemic women. Although intensity of hookworm infection and meat consumption were associated with indices of iron deficiency in a multiple regression model, their relationship with hemoglobin was not significant. Anemia, iron deficiency, and hookworm infection were prevalent in this population. Intake of meat was more clearly associated with hemoglobin and iron indices than hookworm. An approach to addressing iron deficiency in this population should emphasize both iron supplementation and deworming.
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Interleukin 6 (IL-6) is a pleiotropic cytokine produced by the cells of immune and nonimmune origin. Increased production of IL-6 is associated with disturbances of homeostasis, such as trauma, sepsis, or inflammatory diseases. Endotoxemia, tissue injury, or immune inflammatory reactions as well as physical or psychological stress are known to cause increased production of IL-6. We have confirmed this by showing that rats exposed to electric footshock, physical restraint, or a conditioned aversive stimulus have increased levels of plasma IL-6. Interestingly, the kinetics of the increase in plasma IL-6 resembled that of increase in plasma corticosterone. As no detectable endotoxin was found in the plasma samples from stressed and nonstressed rats and there is no evidence of tissue damage and inflammation in situations of restraint or conditioned aversive stimulus, a nonimmune origin of IL-6 is possible. Thus, the releasing of IL-6 into plasma may be under the regulation of neural and endocrine responses to stress. This hypothesis is supported by the decreased production of IL-6 in cultures of splenic cells and peripheral blood mononuclear cells from stressed animals. Furthermore, substantial attenuation of increased plasma IL-6 was achieved by adrenalectomy but not by pretreatment with the beta-receptor antagonist propranolol. The important role of the adrenal gland in the IL-6 response to stress suggests that increased plasma IL-6 may be part of the hormonal responses to stress. As IL-6 induces acute-phase proteins along with glucocorticoids from the adrenal, and regulates the secretion of various hormones from neuroendocrine and endocrine tissues, it is possible that stress-induced increase in plasma IL-6 contributes to the maintenance of homeostasis.
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Elevations in hepatic iron content occur with aging and physiological stressors, which may promote oxidative injury to the liver. Since dysregulation of the iron regulatory hormone, hepcidin, can cause iron accumulation, our goal was to characterize the regulation of hepcidin in young (6 mo) and old (24 mo) Fischer 344 rats exposed to environmental heat stress. Liver and blood samples were taken in the control condition and after heating. Hepcidin expression did not differ between young and old rats in the control condition, despite higher levels of hepatic iron and IL-6 mRNA in the latter. Following heat stress, pSTAT3 increased in both groups, but C/EBPα and hepcidin mRNA increased only in old rats. Despite this, serum iron decreased in both age groups 2h after heat stress, suggesting hepcidin-independent hypoferremia in the young rats. The differential regulation of hepcidin between young and old rats after hyperthermia may be due to the enhanced expression of C/EBPα protein in old rats. These data support the concept of "inflammaging" and suggest that repeated exposures to stressors may contribute to the development of anemia in older individuals.
This is the first experiment to investigate the effect of heat and cold stress on glutathione metabolism in human erythrocytes. We immersed men at three different water temperatures for 10 min. At 39C, no remarkable changes were observed. Levels of glutathione (GSH) decreased from 2.44 (0.14) to 1.80 (0.10) molml red blood cells–1 [molml RBC–1; mean (SEM);P<0.0005] and those of lipid peroxides increased from 1.87 (0.03) to 2.06 (0.04) nmol ml RBC–1 (P<0.01) after the immersion at 42C. In contrast, levels of GSH increased from 2.46 (0.17) to 2.91 (0.17) mol ml RBC–1 (P<0.05) and those of lipid peroxides did not change after the immersion at 25C. The activities of glutathione peroxidase decreased from 35.90 (1.83) to 34.33 (1.66) IU g Hb–1 (P < 0.01) after the immersion at 42C; however, these activities did not change after the immersion at 25C. The activities of glutathione reductase (both active and inactive forms) showed no changes at any temperatures. These changes indicate that heat stress causes oxidative stress in the human body; however, cold stress is thought to augment the activity of the antioxidative defence system. It is suggested that body exposure to hot environmental conditions should not be recommended for patients suffering from a damaged antioxidative defence system.
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To investigate haematological variations and iron related changes in the serum of participants in a 1600 kilometre ultramarathon run. Seven male and two female participants in a 1600 km foot race. Blood samples were obtained from the participants before, after four and 11 days of running, and at the end of the event. Samples were analysed by standard methods for haemoglobin, packed cell volume, total red cell count, mean red cell volume, mean red cell haemoglobin, total white cell count and differential, platelets, reticulocytes, iron, ferritin, total iron binding capacity, percentage transferrin saturation, haptoglobin, and bilirubin and corrected for changes in plasma volume. The following variables decreased during the event (p < 0.05): haemoglobin, packed cell volume, mean red cell volume, percentage lymphocytes, percentage monocytes, serum iron, total iron binding capacity, and percentage transferrin saturation. Increases (p < 0.05) were found in plasma volume, total red cell count (day 4 only), total white cell count, percentage and absolute numbers of neutrophils and reticulocytes, absolute numbers of lymphocytes and monocytes (day 4 only), absolute numbers of eosinophils (day 11 and race end), absolute numbers of basophils (race end only), platelets, ferritin, haptoglobin, and bilirubin (day 4 only). Ultramarathon running is associated with a wide range of changes in haematological parameters, many of which are related to the normal acute phase response to injury. These should not be confused with indicators of disease.
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Iron deficiency is a major world health problem, that is, to a great extent, caused by poor iron absorption from the diet. Several dietary factors can influence this absorption. Absorption enhancing factors are ascorbic acid and meat, fish and poultry; inhibiting factors are plant components in vegetables, tea and coffee (e.g., polyphenols, phytates), and calcium. After identifying these factors their individual impact on iron absorption is described. Specific attention was paid to the effects of tea on iron absorption. We propose a calculation model that predicts iron absorption from a meal. Using this model we calculated the iron absorption from daily menus with varying amounts of enhancers and inhibitors. From these calculations we conclude that the presence of sufficient amounts of iron absorption enhancers (ascorbic acid, meat, fish, poultry, as present in most industrialized countries) overcomes inhibition of iron absorption from even large amounts of tea. In individuals with low intakes of heme iron, low intakes of enhancing factors and/or high intakes of inhibitors, iron absorption may be an issue. Depletion of iron stores enhances iron absorption, but this effect is not adequate to compensate for the inhibition of iron absorption in such an inadequate dietary situation. For subjects at risk of iron deficiency, the following recommendations are made. Increase heme-iron intake (this form of dietary iron present in meat fish and poultry is hardly influenced by other dietary factors with respect to its absorption); increase meal-time ascorbic acid intake; fortify foods with iron. Recommendations with respect to tea consumption (when in a critical group) include: consume tea between meals instead of during the meal; simultaneously consume ascorbic acid and/or meat, fish and poultry.
Article
The aim of this study was to determine the iron status, and the risk factors for iron deficiency (ID) and iron-deficiency anaemia (IDA), of non-pregnant adult women working in a fruit-packing factory. A cross-sectional analytical study was done on 338 women, 18 to 55 years of age. Information on demographic data, risk factors for ID, smoking, and the consumption of red meat, chicken and fish was collected by questionnaire. Height and weight were measured and the body mass index (BMI) calculated. A non-fasting venous blood sample was analysed for haemoglobin (Hb), serum ferritin (SF), serum iron, serum transferrin and C-reactive protein; transferrin saturation (TFS) was calculated. Fruit-packing factory in the Western Cape, South Africa. The mean value for Hb was 13.06 (standard deviation (SD) 1.16) g dl-1 and for SF 48.0 (SD 47.8) microg l-1 (geometric mean 26.44 microg l-1). Women were categorised on the basis of iron status: 60% had a normal iron status (NIS); 12.6% had low TFS (<16%) but normal Hb (>or=12 g dl-1) and SF (>or=12 microg l-1) concentrations (LTS); and 27.4% had low iron status (LIS), defined as combinations of low SF (<12 microg l-1 or <20 microg l-1), low TFS (<16%) and low Hb (<12 g dl-1). More than 30% of the women were obese The risk ratio for LIS (LIS vs. NIS) was 3.8 (95% confidence interval (CI) 1.9-7.6) if women were still menstruating or 3.2 (95% CI 1.6-6.2) if they were pregnant during the past 12 months. Women with LIS consumed significantly smaller portions of red meat, chicken and fish than did women in the other two groups. IDA (low Hb, SF and TFS) and ID (low SF and TFS) did not seem to be a major problem. Women who were still menstruating or were pregnant during the past 12 months were at greater risk for ID. The consumption of smaller portions of red meat, chicken and fish was related to LIS. A high prevalence of obesity, which demonstrated the coexistence of both under- and overnutrition, was observed.
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Anemia is a widespread public health problem. The psychological stress decreases serum iron level and inhibits erythropoiesis. However, the molecular mechanisms involved, leading to iron mal-regulation are not well known. We used a communication box paradigm to induce psychological stress and found that serum iron level decreased after 3d while liver iron storage increased after 7d. Moreover, psychological stress up-regulated expressions of interleukin-6 (IL-6) and hepcidin, while down-regulating ferroportin expression after 3d. These changes were blocked by the injection of IL-6 monoclonal antibody. In conclusion, the IL-6-hepcidin axis is up-regulated by psychological stress in rats, resulting in hypoferremia and increase of hepatic iron storage.
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There are about one billion patients with iron deficiency anaemia all over the world. Recently, researchers have reported successively that stress can cause decrease of serum iron, in consistent with our studies showing that heat exposure and acceleration stress led to significant decrease of serum iron in rats. However, so far whether pure psychological stress can cause decrease of serum iron and consequently affect erythropoiesis has not been reported. To study the characteristic effects of psychological stress on serum iron and erythropoiesis, and to establish an useful experimental basis for further study involving how sufficient intake of dietary iron causes decrease of serum iron and the consequent effects on physiological function of the human body. Psychological stress was administered to 20 rats with Communication Box system. On the 7th and 14th day after administration, 10 rats were executed, respectively, and the rat blood and femoral bone marrow were collected for analysis of serum iron (SI), serum ferritin (SF), serum transferrin receptor (sTfR), haemoglobin (Hb), red blood cell count (RBC), RBC distribution width (RDW), mean corpuscular volume (MCV), serum erythropoietin (EPO) and bone marrow iron. Experimental data were statistically analysed with SPSS 11.0. For rats analysed on the 7th and 14th day in psychological stress group, (1) femoral bone marrow iron was significantly decreased; (2) serum iron was decreased by 28.6% (P < 0.01) and 27.5% (P < 0.01); (3) Hb was decreased by 10.0% (P < 0.01) and 12.8% (P < 0.01), RBC count was decreased by 5.1% (P < 0.05) and 9.8% (P < 0.01), MCV was decreased by 1.7% (P < 0.05) and 7.3% (P < 0.01), RDW was increased by 10.7 and 22.5%; (4) serum ferritin, transferrin receptor and EPO showed no significant changes in comparison with controls after 7-day administration, but serum ferritin and EPO were decreased by 23.8 and 12.3% while transferrin receptor increased by 31.5% after 14-day administration. For rats receiving different period of pure psychological stress: (1) serum iron and bone marrow iron showed significant decrease compared with the controls; (2) erythropoiesis was significantly inhibited; however, (3) how psychological stress affects serum iron and erythropoiesis need to be further investigated.
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Previous in vitro studies using Caco-2 cell monolayers suggested a possible interaction between green and black tea and folic acid at the level of intestinal absorption. The main purpose of the present study was to investigate a possible pharmacokinetic interaction between tea and folic acid in healthy volunteers. In an open-labeled randomized cross-over study, the pharmacokinetic interaction between tea and folic acid (0.4 mg and 5 mg) was investigated in healthy volunteers. Water was used as the reference drink. Subjects ingested 0.4 mg folic acid tablets with water, green or black tea (0.3 g extract/250 ml) or 5 mg folic acid tablets with water or green tea (0.3 g extract/250 ml). Blood samples were collected over a period of 8 h. Serum folate analysis was carried out by a competitive immunoassay which uses direct chemiluminescent technology. At the 0.4 mg folic acid dose, green and black tea reduced the mean C(max) of serum folate by 39.2% and 38.6%, and the mean AUC(0 --> infinity) by 26.6% and 17.9%, respectively. At the 5 mg folic acid dose, the mean C(max) of serum folate was reduced by 27.4% and the mean AUC(0 --> infinity) was decreased significantly by 39.9% by the co-application of green tea. The present results suggest an in vivo interaction between tea and folic acid with even low concentrations of green and black tea extracts yielding decreased bioavailabilities of folic acid.
  • A D Shashtri
Shashtri AD; Sushrutakrita Sushruta Samhita Ayurveda tatvasandipika Commentary, Uttatra Tantra Sthana, chapter 44, verse no.3, 10th edition, Varanasi, Chowkambha Sanskrit Sansthan, 2002: 284.
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The Clinical Effects of Fermented Papaya Preparation® (FPP®) on Oxidative Stress in Patients with HbE/ β -Thalassaemia
  • S S Jamuar
  • E S Tan
  • L Sun
  • H Y Law
  • Ahm Lai
  • Isl Ng
Jamuar SS, Tan ES, Sun L, Law HY, Lai AHM, Ng ISL; The Clinical Effects of Fermented Papaya Preparation® (FPP®) on Oxidative Stress in Patients with HbE/ β -Thalassaemia. Proceedings of Singapore Healthcare, 2010; 19(2): 101-106.