That well established data for Sapindaceae
That well-established data for Sapindaceae toxicity have long existed from clinical experience in Africa and the Caribbean is an important lesson for global health and neurotoxicology. A worldwide understanding of the adverse effects on the nervous system of both naturally occurring as well as synthetic chemicals will speed diagnosis and treatment of other mysterious epidemics of environmental molar solution calculator disease. The Indian subcontinent is no stranger to the neurological effects of toxins in plants—eg, food dependency on the grass pea or cassava resulting in the spastic parapareses of lathyrism and cassavism, respectively. Unlike these untreatable self-limiting neurological diseases, litchi and ackee encephalopathy can be arrested by restoring serum glucose concentrations. However, some children reportedly are left with cognitive deficits, muscle weakness, or movement disorder; the causes of which require investigation.
Why is seasonal litchi encephalopathy a relatively recent event in India, Bangladesh, and Vietnam? The most plausible explanation is the rapid expansion of commercial litchi production across Asia and beyond. Indian production is second only to China\'s, from where originates and its potential toxic effects are noted in ancient literature. Today, several Asian countries export litchi and other Sapindaceae, including rambutan ( and longan () for consumption abroad. In the USA for instance, unlike the regulated importation of canned ackee fruit, which must be screened for hypoglycin content, there are no restrictions on other members of the Soapberry family, including litchi. Fortunately, the high cost of these imported fruits and the likelihood that would be eaten in small quantities by well-nourished consumers, suggests there is little reason for concern in the USA.
There is, however, cause for major concern that litchi-induced seasonal toxic hypoglycaemic encephalopathy will not only continue to be mistaken for a viral disorder, specifically Japanese B encephalitis, but also affect other regions of Asia where commercial litchi production is increasing and poorly nourished children have access to dropped, damaged, or immature fruit that cannot be sold. Areas of concern include northwestern Bangladesh, southern China, northern India, the Terai of Nepal\'s Central and Eastern Development regions, the Cordillera Autonomous Region of the Philippines, northern Thailand, and northeastern Vietnam. Litchi cultivation is also increasing in southern Africa, Australia, and the Americas. Going forward, researchers need to work with the litchi industry to determine how levels of hypoglycaemic acids vary across cultivars, soil, climate, and harvest conditions. Guidance should be developed for the consumer, especially children but also adults who have a susceptible metabolic profile or who eat fruit after fasting. While resistance can be anticipated to the notion that litchi has potential toxicity, this might disappear when industry is informed of ongoing research to address the possible beneficial effects of litchi-derived glucose-lowering agents in the fight against metabolic syndrome and associated chronic health disorders. For good reason, perhaps, a song from Jamaica, where is held as the national fruit and regularly eaten with saltfish, contains the words: “an ackee a day keeps the doctor away”!
On Oct 20, 2016, a statement appeared on the WHO website, announcing that “An independent review commissioned by WHO has found that research ethics misconduct occurred in a study on foetal growth standards.” The study in question was the INTERGROWTH-21st study, led by researchers at the University of Oxford, UK, funded by the Bill & Melinda Gates Foundation (BMGF), and reported in several journals, including our own. Such a judgment by the world\'s foremost global health agency was serious, casting damaging light on a study of international importance.
The has engaged in international health activities for more than a century. With a budget request proposal of US$10·3 billion in 2017 in specified funding for global health, the USA is the world\'s largest source of global health financing and implementer of global health programmes. Under President George W Bush, the US government\'s funding for global health increased markedly, spawning major US funding initiatives, such as the President\'s Emergency Plan for AIDS Relief () and the President\'s Malaria Initiative (PMI), as well as support for the multilateral to Fight AIDS, Tuberculosis and Malaria, which receives its largest proportion of funding from the US government. Under the Obama administration, support for these initiatives increased, and the government also focused attention and funding on other global health programmes, including maternal and child health, neglected tropical diseases, and family planning and reproductive health. In 2015 alone, the USA provided more than 36% of all global development assistance for health. Such outreach has transformed the lives of millions of people around the globe and generated incalculable goodwill towards the USA and its people.