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Luo Y, Yang H, Tao G. Systematic review on fingerprinting development to determine adulteration of Chinese herbal medicines. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 129:155667. [PMID: 38728918 DOI: 10.1016/j.phymed.2024.155667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/19/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND It has been a current research hospots using fingerprinting technology for quality control of Chinese herbal medicines (CHMs), which provides a scientific basis for establishment of overall quality control in accordance with the characteristics of CHMs. The fingerprinting technology for CHMs is diverse, and the research field covers many disciplines, such as analytical chemistry, pharmacology, pharmaceutics, biochemistry, and molecular biology. PURPOSE To effectively understand the key areas and future directions of research regarding the fingerprint and adulteration of CHMs. METHODS/RESULTS this paper analyzed 879 articles in this field in the Web of Science Core Collection from 2000 to 2023 with CiteSpace and VOSviewer, and systematically assessed the research process, hotspots, topic distribution among disciplines, etc. The most prominent contributors of fingerprint and adulteration of CHMs research are mainly from China, India, the United States, England, and Brazil. The knowledge domains of fingerprint and adulteration of CHMs research focus mainly on the topics of molecular authentication, DNA barcoding, HPLC, near-infrared spectroscopy, manage data, chemometrics, and electrochemical fingerprinting. Most countries have recognized the pharmaceutical potential of natural products, and have paid more attention to the fingerprint and adulteration of CHMs in the past decade. Future the research tends to focus more on molecular identification and authentication, and electrochemical and chromatographic fingerprinting in controlling the adulteration of CHMs. CONCLUSION This research provides a valuable reference for scholars in related fields to analyze existing research results, understand the development trend, and explore new research directions.
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Affiliation(s)
- Yongdi Luo
- School of Food Science and Engineering, Guiyang University, Guiyang, China; School of Public Health, Guizhou Medical University, Guiyang, China
| | - Hongbo Yang
- School of Public Health, Guizhou Medical University, Guiyang, China.
| | - Guangcan Tao
- School of Food Science and Engineering, Guiyang University, Guiyang, China; School of Public Health, Guizhou Medical University, Guiyang, China.
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Philips CA, Theruvath AH, Ravindran R, Augustine P. Complementary and alternative medicines and liver disease. Hepatol Commun 2024; 8:e0417. [PMID: 38563584 PMCID: PMC10990366 DOI: 10.1097/hc9.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
Complementary and alternative medicines (CAM) include conventional medical treatments. Patients worldwide use CAM at alarming rates; thus, reports of CAM-related DILI have been on the rise. The clinical presentations include asymptomatic liver test abnormalities, acute hepatitis with or without jaundice, acute cholestatic liver disease (bland or with hepatitis), acute liver failure, severe hepatitis with features of portal hypertension, and acute decompensation of known or unknown cirrhosis that can lead to acute-on-chronic liver failure. Acute hepatitis with or without necrosis, hepatocellular and canalicular cholestasis, herb-induced or CAM-triggered autoimmune hepatitis, granulomatous hepatitis, severe steatohepatitis, and vanishing bile duct syndrome are common liver biopsy findings in CAM-DILI. The presence of preexisting liver disease predicts severe liver injury, risk of progression to liver failure, and decreased transplant-free survival in patients with CAM-DILI. This review discusses global epidemiology and trends in CAM-DILI, clinical presentation, assessment and outcomes, commonly emerging threats in the context of hepatotoxic herbs, pragmatic assessment of "liver beneficial" herbs and health care myths, patient communication, regulatory framework, and future directions on research in CAM.
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Affiliation(s)
- Cyriac Abby Philips
- Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
- Department of Clinical Research, Division of Complementary and Alternative Medicine (AYUSH) and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Arif Hussain Theruvath
- Department of Clinical Research, Division of Complementary and Alternative Medicine (AYUSH) and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Resmi Ravindran
- Department of Clinical Research, Division of Complementary and Alternative Medicine (AYUSH) and the Liver, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
| | - Philip Augustine
- Gastroenterology and Advanced G.I Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva, Kerala, India
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Cho KH, Kim JE, Komatsu T, Uehara Y. Protection of Liver Functions and Improvement of Kidney Functions by Twelve Weeks Consumption of Cuban Policosanol (Raydel ®) with a Decrease of Glycated Hemoglobin and Blood Pressure from a Randomized, Placebo-Controlled, and Double-Blinded Study with Healthy and Middle-Aged Japanese Participants. Life (Basel) 2023; 13:1319. [PMID: 37374102 DOI: 10.3390/life13061319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Policosanol consumption has been associated with treating blood pressure and dyslipidemia by increasing the level of high-density lipoproteins-cholesterol (HDL-C) and HDL functionality. Although policosanol supplementation also ameliorated liver function in animal models, it has not been reported in a human clinical study, particularly with a 20 mg doage of policosanol. In the current study, twelve-week consumption of Cuban policosanol (Raydel®) significantly enhanced the hepatic functions, showing remarkable decreases in hepatic enzymes, blood urea nitrogen, and glycated hemoglobin. From the human trial with Japanese participants, the policosanol group (n = 26, male 13/female 13) showed a remarkable decrease in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) from baseline up to 21% (p = 0.041) and 8.7% (p = 0.017), respectively. In contrast, the placebo group (n = 26, male 13/female 13) showed almost no change or slight elevation. The policosanol group showed a 16% decrease in γ-glutamyl transferase (γ-GTP) at week 12 from the baseline (p = 0.015), while the placebo group showed a 1.2% increase. The policosanol group exhibited significantly lower serum alkaline phosphatase (ALP) levels at week 8 (p = 0.012), week 12 (p = 0.012), and after 4-weeks (p = 0.006) compared to those of the placebo group. After 12 weeks of policosanol consumption, the ferric ion reduction ability and paraoxonase of serum were elevated by 37% (p < 0.001) and 29% (p = 0.004) higher than week 0, while placebo consumption showed no notable changes. Interestingly, glycated hemoglobin (HbA1c) in serum was lowered significantly in the policosanol group 4 weeks after consumption, which was approximately 2.1% (p = 0.004) lower than the placebo group. In addition, blood urea nitrogen (BUN) and uric acid levels were significantly lower in the policosanol group after 4 weeks: 14% lower (p = 0.002) and 4% lower (p = 0.048) than those of the placebo group, respectively. Repeated measures of ANOVA showed that the policosanol group had remarkable decreases in AST (p = 0.041), ALT (p = 0.008), γ-GTP (p = 0.016), ALP (p = 0.003), HbA1c (p = 0.010), BUN (p = 0.030), and SBP (p = 0.011) from the changes in the placebo group in point of time and group interaction. In conclusion, 12 weeks of 20 mg consumption of policosanol significantly enhanced hepatic protection by lowering the serum AST, ALT, ALP, and γ-GTP via a decrease in glycated hemoglobin, uric acid, and BUN with an elevation of serum antioxidant abilities. These results suggest that improvements in blood pressure by consumption of 20 mg of policosanol (Raydel®) were accompanied by protection of liver function and enhanced kidney function.
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Affiliation(s)
- Kyung-Hyun Cho
- Raydel Research Institute, Medical Innovation Complex, Daegu 41061, Republic of Korea
| | - Ji-Eun Kim
- Raydel Research Institute, Medical Innovation Complex, Daegu 41061, Republic of Korea
| | - Tomohiro Komatsu
- Center for Preventive, Anti-Aging and Regenerative Medicine, Fukuoka University Hospital, 8-19-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
- Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
| | - Yoshinari Uehara
- Center for Preventive, Anti-Aging and Regenerative Medicine, Fukuoka University Hospital, 8-19-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
- Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan
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Eigenschink M, Bellach L, Leonard S, Dablander TE, Maier J, Dablander F, Sitte HH. Cross-sectional survey and Bayesian network model analysis of traditional Chinese medicine in Austria: investigating public awareness, usage determinants and perception of scientific support. BMJ Open 2023; 13:e060644. [PMID: 36863740 PMCID: PMC9990654 DOI: 10.1136/bmjopen-2021-060644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVES Despite the paucity of evidence verifying its efficacy and safety, traditional Chinese medicine (TCM) is expanding in popularity and political support. Decisions to include TCM diagnoses in the International Classification of Diseases 11th Revision and campaigns to integrate TCM into national healthcare systems have occurred while public perception and usage of TCM, especially in Europe, remains undetermined. Accordingly, this study investigates TCM's popularity, usage and perceived scientific support, as well as its relationship to homeopathy and vaccinations. DESIGN/SETTING We performed a cross-sectional survey of the Austrian population. Participants were either recruited on the street (in-person) or online (web-link) via a popular Austrian newspaper. PARTICIPANTS 1382 individuals completed our survey. The sample was poststratified according to data derived from Austria's Federal Statistical Office. OUTCOME MEASURES Associations between sociodemographic factors, opinion towards TCM and usage of complementary medicine (CAM) were investigated using a Bayesian graphical model. RESULTS Within our poststratified sample, TCM was broadly known (89.9% of women, 90.6% of men), with 58.9% of women and 39.5% of men using TCM between 2016 and 2019. Moreover, 66.4% of women and 49.7% of men agreed with TCM being supported by science. We found a positive relationship between perceived scientific support for TCM and trust in TCM-certified medical doctors (ρ=0.59, 95% CI 0.46 to 0.73). Moreover, perceived scientific support for TCM was negatively correlated with proclivity to get vaccinated (ρ=-0.26, 95% CI -0.43 to -0.08). Additionally, our network model yielded associations between TCM-related, homeopathy-related and vaccination-related variables. CONCLUSIONS TCM is widely known within the Austrian general population and used by a substantial proportion. However, a disparity exists between the commonly held public perception that TCM is scientific and findings from evidence-based studies. Emphasis should be placed on supporting the distribution of unbiased, science-driven information.
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Affiliation(s)
- Michael Eigenschink
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Wien, Austria
| | - Luise Bellach
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Wien, Austria
| | - Sebastian Leonard
- Institute of Microbiology and Infection, University of Birmingham School of Dentistry, Birmingham, UK
| | - Tom Eric Dablander
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Wien, Austria
| | - Julian Maier
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Wien, Austria
| | - Fabian Dablander
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Harald H Sitte
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University of Vienna, Wien, Austria
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Mwankuna CJ, Kiros F, Mariki EE, Mabiki FP, Malebo HM, Mdegela RH, Styrishave B. Optimization of HPLC-MS/MS method for determination of antimalarial adulterants in herbal products. ANAL SCI 2023; 39:407-416. [PMID: 36633808 DOI: 10.1007/s44211-022-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
The use of herbal products is booming all over the world because of being believed as safer than conventional drugs and free of side effects. However, there are untrustworthy manufacturers who adulterate herbal products by adding conventional drugs which might eventually lead to microbial resistance and herb-to-drug interactions. There is a need to develop methods for detecting adulterants in herbal products. A high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method for simultaneous identification and determination of conventional antimalarials (chloroquine, quinine, sulfadoxine, pyrimethamine, mefloquine, lumefantrine, amodiaquine, artemisinin, dihydroartemisinin, artesunate and artemether) in herbal products was developed. Stable isotopically labelled compounds (artemether-d3, quindine-d3, and sulfadoxine-d3) were used as internal standards (ISs) for quantitative analysis. Extraction of analytes was performed using methanol: water: formic acid (90:10:0.1, v/v) and chromatographic separation was done in a gradient mode using mobile phase A: Ultrapure water containing 0.1% formic acid and 1 mM ammonium formate and mobile phase B: Acetonitrile/methanol (50:50) containing 0.1% formic acid and 1 mM ammonium formate. The calibration curves were linear (r2 ≥ 0.991) over the range of 0.001-0.3 µg mL-1 for all compounds. The limit of detection (LOD) ranged from 0.002 to 0.02 μg mL-1 while the limit of quantification (LOQ) ranged from 0.006 to 0.08 μg mL-1. Accuracy, expressed as recovery of spiked herbal products ranged from 52 to 128%. The precision, expressed as percent relative standard deviation (%RSD) at two concentration levels, ranged from 1.0 to 13.8%. The matrix effect expressed as the matrix factor (MF) ranged from 0.77 to 0.97. The developed method was used to identify and quantify conventional antimalarials in herbal product samples from Tanzania. Ten out of 50 herbal products were found to contain amodiaquine, sulfadoxine, pyrimethamine, mefloquine, dihydroartemisinin, artemether and lumefantrine. The developed method is considered a valuable tool for getting a better understanding of the adulteration of conventional antimalarials in herbal products.
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Affiliation(s)
- Christopher J Mwankuna
- Department of Chemistry and Physics, College of Natural and Applied Sciences, Sokoine University of Agriculture, P.O. Box 3038, Morogoro, Tanzania.
| | - Feven Kiros
- Toxicology Laboratory, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark Universitetsparken 2, DK-2100, Copenhagen, Denmark
| | - Eliapenda E Mariki
- Department of Chemistry and Physics, College of Natural and Applied Sciences, Sokoine University of Agriculture, P.O. Box 3038, Morogoro, Tanzania
| | - Faith P Mabiki
- Department of Chemistry and Physics, College of Natural and Applied Sciences, Sokoine University of Agriculture, P.O. Box 3038, Morogoro, Tanzania
| | - Hamisi M Malebo
- UNESCO National Commission of the United Republic of Tanzania, 7 Magogoni Street, P.O. Box 20384, Dar Es Salaam, Tanzania
| | - Robinson H Mdegela
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, P.O. Box 3015, Morogoro, Tanzania
| | - Bjarne Styrishave
- Toxicology Laboratory, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark Universitetsparken 2, DK-2100, Copenhagen, Denmark
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Utility of Therapeutic Drug Monitoring in Identifying Clinically Significant Interactions Between St. John's Wort and Prescription Drugs. Ther Drug Monit 2023; 45:35-44. [PMID: 36624575 DOI: 10.1097/ftd.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The general population widely uses herbal medicines, as they are regarded as effective and safe. St. John's wort, which is an effective herbal antidepressant, exhibits both pharmacokinetic and pharmacodynamic interactions with several drugs. The aim of this review was to highlight the clinically significant interactions of St. John's wort with drugs that require to be monitored to assess their therapeutic effect. METHODS Published literature was searched using electronic databases, such as MEDLINE, PubMed, and Elsevier ScienceDirect using terms such as "herbal medicine," "herbal toxicity," "legislation herbal medicine," "drug-herb interactions," "St. John's wort," and "St. John's wort-drug interactions." Searches were limited to the English language, and there was no restriction on the date of publication. RESULTS St. John's wort exhibits a number of pharmacokinetic and pharmacodynamic interactions with drugs. The most dangerous interactions occurred when used concurrently with the immunosuppressants, cyclosporine, and tacrolimus (treatment failure or organ rejection) or warfarin (treatment failure resulting in thromboembolic events) or antiretroviral agents (treatment failure and the emergence of new viral variants that are resistant to conventional drugs). CONCLUSIONS Patients should consult their health care providers before consuming herbal supplements, especially St. John's wort, to avoid potentially dangerous drug-herb interactions.
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Jongbloed WM, Brown SM. Allergies and Natural Alternatives. Otolaryngol Clin North Am 2022; 55:965-982. [PMID: 36088149 DOI: 10.1016/j.otc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Complementary and integrative medicine therapies in the treatment of allergy and allergic rhinitis (AR) are divided broadly into the categories of nutritional supplements, herbal supplements, Ayurvedic, and Chinese traditional medicine. Some therapies are likely completely safe, such as Manuka honey, with no known side effects. Others have significant risks, such as ephedra, which was ultimately banned for use by the Food and Drug Administration. The efficacy of these therapies is varied and under-researched. The therapies with the strongest evidence in the treatment of allergy and AR are Manuka honey, butterbur, and Sinupret.
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Affiliation(s)
- Walter M Jongbloed
- Division of Otolaryngology, Department of Surgery, University of Connecticut, School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA
| | - Seth M Brown
- Division of Otolaryngology, Department of Surgery, University of Connecticut, School of Medicine, 263 Farmington Ave., Farmington, CT 06030, USA.
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Orman E, Bekoe SO, Jato J, Spiegler V, Asare-Nkansah S, Agyare C, Hensel A, Bekoe EO. Quality assessment of African herbal medicine: A systematic review and the way forward. Fitoterapia 2022; 162:105287. [PMID: 36031027 DOI: 10.1016/j.fitote.2022.105287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND In Africa, herbalism supplements allopathic medicine's efforts to ensure Universal Health Coverage attainment. This review was conducted to identify and to summarise current literature on methodological approaches used for quality control of herbal medicines in Africa, to evaluate the gaps associated with existing strategies within context of best practices, and make recommendations for future improvements. METHODS A systematic search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were screened and assessed for eligibility. RESULTS 118 articles were included into the study. There was a high preference for impurity profiling tests (77%) indicating the prioritization for tests that guarantee safety despite the limited analytical resources available. Other classes of tests reported included identification tests (29%), physicochemical tests (18%), and content assays (12%). Although standard methods exist in preparing samples for impurity tests, different techniques were observed in different studies, and this could lead to differences in analytical outcomes. Content assays focused on single marker assessments, which may be inadequate to comprehensively assess the quality of products. CONCLUSION This review provides knowledge of existing strengths and challenges for herbal medicine quality assessments in Africa. For future it is recommended to implement more studies on contaminants (e.g. mycotoxins) and pharmaceutical adulterants. The use of chemometrics to develop analytical methods should be promoted. Also, stakeholders in the medicine quality industry in Africa need to effectively collaborate to establish a well co-ordinated and harmonized system to provide a sustainable framework for the GACP and GMP guided production and quality assurance of herbal medicines.
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Affiliation(s)
- Emmanuel Orman
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany; Department of Pharmaceutical Chemistry, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana; Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Oppong Bekoe
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jonathan Jato
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany; Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Verena Spiegler
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany
| | - Samuel Asare-Nkansah
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Agyare
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Andreas Hensel
- Institute of Pharmaceutical Biology and Phytochemistry, University of Münster, Corrensstraße 48, D-48149 Münster, Germany.
| | - Emelia Oppong Bekoe
- Department of Pharmacognosy and Herbal Medicine, School of Pharmacy, University of Ghana, Accra, Ghana
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Jalil B, Naser AY, M Prieto J, Heinrich M. Herbal supplements in Jordan: a cross-sectional survey of pharmacists' perspectives and knowledge. BMJ Open 2022; 12:e057405. [PMID: 35896285 PMCID: PMC9335029 DOI: 10.1136/bmjopen-2021-057405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Pharmacists are ideal partners for engaging with the needs and expectations of patients. They can play a vital role by providing information and supplying herbal medicines. In some community settings, pharmacists are also the main first point of care. This study explored Jordanian community pharmacists' perspectives and knowledge of herbal medicines available in pharmacies. DESIGN A cross-sectional study using an online survey was developed, and it was distributed via social media platforms. The one-way analysis of variance (ANOVA) test was used to compare the mean knowledge scores between different demographic groups. Multiple linear regression analysis was used to identify predictors of herbal medicines knowledge. SETTING Jordanian community pharmacies. PARTICIPANTS 401 Jordanian community pharmacists. RESULTS Herbal supplements are sold in practically all pharmacies (98.5%). Slimming aids (14.7%), followed by sexual and sports enhancements (14%) and maintaining general health (12.1%) were most requested by Jordanian customers. While supplements for maintaining general health (12%), followed by slimming aids (11.4%) and skin conditions (9.3%) were most recommended by Jordanian pharmacists. 63.1% were not aware of potential herb-drug interactions, 95.6% did not receive complaints from customers about herbal medicines and 41.2% would not report adverse reactions to the national pharmacovigilance services. The mean knowledge score for knowledge of use, regulation, adverse reactions, and drug interactions was 3.7 (SD: 0.7), 3.5 (SD: 0.8), 3.6 (SD: 0.8), and 3.6 (SD: 0.8) (out of 5), respectively. ANOVA test showed that total pharmacists' knowledge scores significantly differed based on the length of time practising pharmacy (p<0.05). CONCLUSION This study highlights some key concerns relating to recommendations, awareness and reporting of herbal medicines among Jordanian community pharmacists. Pharmacists need enhanced education to provide objective and evidence-based information on the benefits-risks of herbal medicines. Future studies need to be carried out to confirm whether our findings are transferable to other Middle Eastern countries.
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Affiliation(s)
- Banaz Jalil
- Pharmacognosy and Phytotherapy, UCL School of Pharmacy, 29 - 39 Brunswick Sq, London, UK
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Amman, Jordan
| | - Jose M Prieto
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Michael Heinrich
- Pharmacognosy and Phytotherapy, UCL School of Pharmacy, 29 - 39 Brunswick Sq, London, UK
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Lateral flow immunoassay for small-molecules detection in phytoproducts: a review. J Nat Med 2022; 76:521-545. [PMID: 35171397 PMCID: PMC9165253 DOI: 10.1007/s11418-022-01605-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022]
Abstract
Phytoproducts are involved in various fields of industry. Small-molecule (Mw < 900 Da) organic compounds can be used to indicate the quality of plant samples in the perspective of efficacy by measuring the necessary secondary metabolites and in the perspective of safety by measuring the adulterant level of toxic compounds. The development of reliable detection methods for these compounds in such a complicated matrix is challenging. The lateral flow immunoassay (LFA) is one of the immunoassays well-known for its simplicity, portability, and rapidity. In this review, the general principle, components, format, and application of the LFA for phytoproducts are discussed.
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Development and Validation of an Ion-Pair HPLC-UV Method for the Quantitation of Quinoline and Indoloquinoline Alkaloids in Herbal and Pharmaceutical Antimalarial Formulations. J CHEM-NY 2022. [DOI: 10.1155/2022/4625954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Quinine- and cryptolepine-based antimalarials serve as valuable alternatives to artemisinin-based combination therapies (ACTs) in Ghana. Their use, however, is associated with adulteration and substandard quality challenges. An HPLC method targeting quinoline and indoloquinoline antimalarial alkaloids was developed, validated, and applied to evaluate herbal and pharmaceutical antimalarial formulations (HPAFs) and starting materials (APIs). The separation/quantitation of the alkaloids (including quinine, quinidine, cinchonine, cinchonidine, dihydroquinine, dihydroquinidine, and cryptolepine) was achieved on a Zorbax SB-CN column (250 mm × 4.6 mm, 5 μm), with an isocratic elution system of methanol: trifluoroacetic acid (0.1%, v/v) (15 : 85, v/v) at 1.5 mL/min and 223 nm. Method validation was according to ICH Q2(R1) guidelines. It was then used to assess the quality of APIs (n = 3) and HPAFs (n = 44) including quinine-based pharmaceutical antimalarial formulations (QBPAFs) (n = 23) and herbal antimalarial products (HAMPs). The method was found to be specific, selective, accurate, precise, and robust toward the alkaloids with linearity achieved within specified concentration ranges (r2 > 0.995 for all analytes). Analyte stability ranged between 6 and 12 hours. All the APIs contained quinine <99.0%–101.0%, with dihydroquinine and cinchonidine at levels compliant with the established acceptance criteria. The QBPAFs had quinine content ranging between 50.2% and 151.2%, with 43.5% (n = 10/23) of them complying with the acceptance criteria. The related alkaloids observed in the QBPAFs included quinidine (56.5%, n = 13/23), dihydroquinine (100%, n = 23/23), dihydroquinidine (21.7%, n = 5/23), cinchonine (17.4%, n = 4/23), and cinchonidine (95.7%, n = 22/23). For the HAMPs, 81.0% (n = 17/21) were adulterated with quinine (0.59 ± 0.04 mg/10 mL–86.03 ± 0.02 mg/10 mL). Cryptolepine was identified in 19% (n = 4/21) of the HAMPs with concentration ranging between 43.99 ± 0.43 μg/mL and 747.86 ± 0.34 μg/mL. In conclusion, the application of the ion-pair HPLC method targeting quinoline and indoloquinoline antimalarials has demonstrated the presence of quality and poor-quality HPAFs on the Ghanaian market.
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Jairoun AA, Al-Hemyari SS, Shahwan M, Zyoud SH. Adulteration of Weight Loss Supplements by the Illegal Addition of Synthetic Pharmaceuticals. Molecules 2021; 26:molecules26226903. [PMID: 34833995 PMCID: PMC8621677 DOI: 10.3390/molecules26226903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 02/07/2023] Open
Abstract
Weight loss supplements that have illegal additives of pharmaceutical drugs or analogues have additional health risks, and customers may not be aware of what they are taking. This research is an essential investigation and quantification of illegally added pharmaceuticals or prescription medications, specifically fluoxetine, phenolphthalein, and sibutramine, in herbal weight loss supplements offered for sale in the United Arab Emirates (UAE). In this case, 137 weight loss supplements were collected and analyzed in this study. Reversed-phase high-performance liquid chromatography with UV absorption detection coupled to tandem mass spectrometry (RP-HPLC-MS/MS) analyses were used to determine the presence of the pharmaceutical chemicals. Among the weight loss supplements, 15.3% (95% CI: 9.2-21.4) contained undeclared sibutramine, 13.9% (95% CI: 8.01-19.7) contained undeclared phenolphthalein, and 5.1% (95% CI: 1.4-8.8) contained undeclared fluoxetine. Amongst all weight loss supplements, 17.5% (95% CI: 11.07-24) contained significant concentrations of either sibutramine, phenolphthalein, or fluoxetine. Whilst weight loss herbal supplements offered for sale in the UAE have relatively low percentages of undeclared pharmaceuticals, many people take several different supplements daily and may encounter quite high levels of combined exposure to toxic compounds.
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Affiliation(s)
- Ammar A. Jairoun
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Pulau Pinang 1800, Malaysia;
- Health and Safety Department, Dubai Municipality, Dubai P.O. Box 67, United Arab Emirates
- Correspondence: or
| | - Sabaa Saleh Al-Hemyari
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Pulau Pinang 1800, Malaysia;
- Pharmacy Department, Emirates Health Services Establishment, Dubai P.O. Box 1853, United Arab Emirates
| | - Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman P.O. Box 346, United Arab Emirates;
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Sa’ed H. Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus 44839, Palestine;
- Clinical Research Centre, An-Najah National University Hospital, Nablus 44839, Palestine
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13
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Tan C, Chen H, Lin Z. Detection of glibenclamide adulterated in antidiabetic Chinese patent medicine by attenuated total reflectance -infrared spectroscopy and chemometrics. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2021; 255:119723. [PMID: 33780893 DOI: 10.1016/j.saa.2021.119723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/05/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
There have been many reports of adulterated Chinese patent medicine with synthetic prescription that are claimed to be "pure natural". The present work investigates the feasibility of combining attenuated total reflectance-Mid-infrared (ATR-MIR) spectroscopy and several interval-based PLS algorithms for detecting the glibenclamide illegally adulterated in antidiabetic Chinese patent medicine (Jiangtangning). The full-spectrum PLS, four kinds of traditional interval PLS algorithms (iPLS, biPLS, siPLS and mwPLS) and a modified algorithm, i.e., a combination of mwPLS and window size optimization, named cmwPLS, were used for building calibration models. A total of 21 samples adulterated with 0-3.5% glibenclamide were prepared. The dataset was equally split into a training set and a test set for building and testing the prediction models, respectively. For those interval-based PLS, the whole wavenumber axis was divided into 20 sub-intervals. In terms of the prediction on the test set, the new cmwPLS produce the best model, followed by mwPLS. The modified algorithm can optimize automatically the window width (i.e., the number of adjacent variables used for modeling) and position. It can be concluded that cmwPLS coupled with ATR-MIR technique is a good alternative to other traditional chemical analysis for detecting the adulteration of Chinese patent medicine.
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Affiliation(s)
- Chao Tan
- Key Lab of Process Analysis and Control of Sichuan Universities, Yibin University, Yibin, Sichuan 644000, China.
| | - Hui Chen
- Key Lab of Process Analysis and Control of Sichuan Universities, Yibin University, Yibin, Sichuan 644000, China; Hospital, Yibin University, Yibin, Sichuan 644000, China
| | - Zan Lin
- Key Lab of Process Analysis and Control of Sichuan Universities, Yibin University, Yibin, Sichuan 644000, China; Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan 610041, China
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Suryoprabowo S, Xu X, Kuang H, Liu L, Xu C. Methods for quantifying phenolphthalein in slimming tea. J Mater Chem B 2021; 9:3856-3862. [PMID: 33908585 DOI: 10.1039/d1tb00510c] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Because of increasing levels of obesity and the development of social network platforms, the online sale of slimming beverages has become very common. However, such beverages are often reported to contain hazardous drugs, such as phenolphthalein. In the present study, we established a rapid and sensitive immunochromatography gold-labeled monoclonal antibody (mAb) (IGM) method and a fluorescence-labeled mAb (IFM) method for determining phenolphthalein in ten types of slimming tea. The monoclonal antibodies and coating antigens were produced in our laboratory. Under optimal conditions, the cut-off limits were 250 ng mL-1 (IFM strip) and 500 ng mL-1 (IGM strip) in both 0.01 M phosphate-buffered saline (PBS) and samples of slimming tea. The mean recoveries were 96.2 to 104.7% for the IGM strip and 90.7 to 104.7% for the IFM strip. The data showed that the IFM strip was more sensitive than the IGM strip and that results could be generated within 10 min. Consequently, this novel technique represents a rapid and convenient method with which to detect phenolphthalein.
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Affiliation(s)
- Steven Suryoprabowo
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Xinxin Xu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Hua Kuang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Liqiang Liu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Chuanlai Xu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
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15
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Zakaria NF, Mohd Noor MT, Abdullah R. Traditional and complementary medicine use among chronic haemodialysis patients: a nationwide cross-sectional study. BMC Complement Med Ther 2021; 21:94. [PMID: 33726722 PMCID: PMC7967981 DOI: 10.1186/s12906-021-03268-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In the era of digital and improved conventional medicine, many continue to use traditional and complementary medicine (TCM). The prevalence of its usage is not well reported, especially in patients with end-stage kidney disease (ESKD) receiving haemodialysis, thus its benefits and adverse effects are not widely known. This study determines the prevalence, types, perceptions and factors associated with TCM use by chronic haemodialysis patients in Malaysia. METHODS This is a multi-centre cross-sectional study involving patients undergoing haemodialysis treatment in Malaysia. A validated face-to-face questionnaire-based interview was conducted. Sociodemographic and clinical profiles of the patients, factors associated with TCM use, perceptions, sources of information, and disclosures to treating doctors were obtained. Data were analysed using SPSS software. RESULTS A total of n = 329 participants were recruited. The mean age of the participants was 54.9 ± 12.5 years. The majority were Malays (72%) and females (54.7%). A total of 64.7% (n = 213) reported TCM use; n = 132 used TCM before the initiation of dialysis, while n = 81 used TCM after initiation. In the post-hoc analysis, patients who had never used TCM had a higher mean age (56.7 ± 12.3 years) than the patients who used TCM (51.1 ± 13.1) (p = 0.015) and were likely to have received primary education (p = 0.011). Unemployment was more likely to be associated with non-TCM use; with odds ratio 1.85 (95% CI: 1.15, 2.98). Biologically based therapy was found to be the most popular (97.2%) type of TCM, including herbal medicine (67.6%) and supplements (58.0%). Most respondents did not disclose their TCM use to their doctors (72.3%), and 41.8% had the perception that they felt better. CONCLUSIONS TCM is widely used among chronic haemodialysis patients in Malaysia, mainly herbal medicine and supplements. Non-disclosure to healthcare professionals and a poor monitoring and regulation of its use in ESKD patients could be detrimental. Awareness needs to be raised among healthcare professionals and the general population. TRIAL REGISTRATION The Ethics Committee for Research, University Putra Malaysia (13th March 2019). Reference: UPM/TNCPI/RMC/1.4.18.2 ( JKEUPM ).
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Affiliation(s)
- Nor Fadhlina Zakaria
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Mohd Tawfeq Mohd Noor
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Rafidah Abdullah
- Putrajaya Hospital, Jalan P9, Presint 7, 62250, Putrajaya, Malaysia
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Alwhaibi M, Asser WM, A Al Aloola N, Alsalem N, Almomen A, Alhawassi TM. Evaluating the frequency, consumers' motivation and perception of online medicinal, herbal, and health products purchase safety in Saudi Arabia. Saudi Pharm J 2021; 29:166-172. [PMID: 33679178 PMCID: PMC7910136 DOI: 10.1016/j.jsps.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives Purchasing medicinal products from the internet has become more popular in the last three decades. Understanding consumers’ use and perception of the safety of medicinal products obtained online is essential. Therefore, this study aims to evaluate the extent of medicines purchased from the internet in Saudi Arabia, types of products, sources of information, the satisfaction, the motivational factors, and estimate consumers’ vigilance and tendency to report ADRs if occurred. Design A prospective cross-sectional study using a custom-designed questionnaire was conducted among community adults in Saudi Arabia, age ≥ 18. Setting Evaluation of community subjects' perception towards buying medicinal products was done through the internet in Saudi Arabia from 1st July 2020 until the end of August 2020. Main outcome measure(s) The main outcome of the study was purchasing medicinal products from the internet (Yes, No). Results Overall, 36% of the study participants (n = 643) have ever bought medicinal products from the internet (Table 2). Of those, the most obtained was herbal medicine, supplements, or cosmetics (61.3%). Motivational factors towards purchasing medicinal products from the internet were mostly positive, with the most commonly reported agreed motivational factors were lower cost (55.7%), easy online access (54.1%), a wide variety of products (52.6%), and more privacy (43.6%). Around 60.4% of participants believed that buying medicinal products from the internet can be safe. The most perceived risk was the difficulty of distinguishing between registered online pharmacies and other unlicensed commercial websites, with only 32.7% of the participants distinguishing between registered and unlicensed commercial websites. Conclusions This study sheds light on the consumers’ use and perception of the safety and risks of medicinal products purchased from the internet. The study findings noticeably describe the great need to increase safety awareness about obtaining medicinal products from the internet among the Saudi community.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Wesam M Asser
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Noha A Al Aloola
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Nouf Alsalem
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aliyah Almomen
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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17
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Kalumbi MH, Likongwe MC, Mponda J, Zimba BL, Phiri O, Lipenga T, Mguntha T, Kumphanda J. Bacterial and heavy metal contamination in selected commonly sold herbal medicine in Blantyre, Malawi. Malawi Med J 2021; 32:153-159. [PMID: 33488987 PMCID: PMC7812145 DOI: 10.4314/mmj.v32i3.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background There has been an increase in use of herbal medicine worldwide. It is either used as a stand-alone or complementary therapy to conventional medicine due to past good experience, poverty and family traditions. In Malawi, there are no regulations governing the supply, acquisition, marketing and quality enforcement of herbal medicine. This compromises its safety thereby exposing consumers to avoidable bacteria and heavy metals leading to various adverse health effects. Methods Cross-sectional laboratory experiments were conducted to determine bacterial and heavy metal contamination of herbal medicine commonly sold in Blantyre, Malawi. A total of 47 samples which were in three formulations namely liquid, powder and tablet were used in the experiments. 29 samples were used for bacterial limit tests and 18 samples were used for heavy metal analysis. Bacterial contamination was determined by streak plate method and biochemical tests while heavy metals were determined by atomic absorption spectroscopy. Descriptive statistics and t-tests were calculated using Microsoft excel and SPSS software programs. Results Twenty out of the 29 samples (68.9%) were contaminated with Bacillus, coagulase negative Staphylococcus, Klebsiella, Enterobacter, Citrobacter and other-Coliform bacterial species. Most isolated microorganism was Citrobacter spp. (30%), followed by Bacillus spp. (25%). Out of 20 contaminated samples, 75% were contaminated with coliforms. From these 75% which were contaminated with coliforms, 93.3% of them exceeded WHO regulatory limit (103 CFU/g for enterobacteria). Although liquid samples had the highest level of bacterial contaminants, the count was not statistically different from other formulations (P = 0.058). For heavy metals, lead and cadmium were detected and 67% of the samples had lead levels exceeding regulatory limits. Conclusion Levels of bacterial and lead contamination in herbal medicine from Blantyre markets are far above acceptable limits set by WHO and Canadian guidelines. The use of these herbal medicines is a major risk to the health of consumers.
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Affiliation(s)
- Martin Henderson Kalumbi
- Malawi Adventist University, Malamulo College of Health Sciences Campus, Biomedical Science Department, Microbiology Research Group
| | | | - John Mponda
- University of Ibadan, Faculty of Pharmacy, Nigeria. Africa Centre of Excellence in Public Health and Herbal Medicine, University of Malawi. Department of Pharmacy, College of Medicine, University of Malawi, Malawi
| | | | - Odala Phiri
- Malawi Adventist University, Malamulo College of Health Sciences Campus, Biomedical Science Department, Microbiology Research Group
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18
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Chen W, Tong J, He R, Lin Y, Chen P, Chen Z, Liu X. An easy method for identifying 315 categories of commonly-used Chinese herbal medicines based on automated image recognition using AutoML platforms. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Konakci G, Ozgursoy Uran BN, Erkin O. In the Turkish News: Coronavirus and "Alternative & complementary" medicine methods. Complement Ther Med 2020; 53:102545. [PMID: 33066867 PMCID: PMC7437440 DOI: 10.1016/j.ctim.2020.102545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/25/2022] Open
Abstract
Recommendations and advice have increase. There were very little information about the effect of CAM. There weren’t any scientific articles. There was a serious increase in the number of news. The content and sources of the news were insufficient.
Background and Object The object of this study is to analyze the complementary and alternative treatments for the prevention of COVID-19/Coronavirus in the Turkish news. Material and Method The sample of this descriptive study consisted of 160 news articles published between 11 March and 11 April 2020 on the websites of the three highest-circulating newspapers throughout the nation. A quantitative media context analysis method, consisting of 14 questions and 2 sections was employed to evaluate news on the newspapers. The data was analyzed using SPSS 21.0 statistical package program using numbers and percentages. Results Forty percent of the news analyzed within the scope of the study were obtained from the newspaper’s own news, reporter or columnist, 56.9 % were informative, 6.3 % were advisory and critical against the CAT methods. 95 % of the news included preventive or protective methods against COVID-19. 77.5 % of the complementary and alternative medicine methods mentioned in the news were biologically-based, 20.6 % were mind-body practices. It was determined that 85.0 % of the benefits, harm and side effects of the methods mentioned in the news were announced, but their impact on COVID-19 is not clarified (78.1 %), and there was insufficient information provided about the method and dosage of the method. It was seen that all news contained information on protection against COVID-19 or prevention of COVID19. Conclusion It was concluded that the sources and methods and the number of news items changed from one newspaper to another, the news lacked a scientific basis, and as a result, it might lead to misinterpretations among the public. There were different opinions among the experts in the proposed or criticized complementary and alternative medicine methods. It was observed that there was an increase in the number of news items related to using complementary and alternative medicine methods for the treatment of COVID19, a clear and easily understandable language was used in the news, but the content and sources of the news were insufficient in conveying the correct and scientific information. It was reported by previous literature potential interactions between herbal remedies/dietary supplements and prescribed drugs, complications of medical conditions and some adverse effects cause of CAM usage
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Affiliation(s)
- Gulbin Konakci
- Izmir Democracy University Health Science Faculty, Izmir, Turkey.
| | | | - Ozum Erkin
- Izmir Democracy University Health Science Faculty, Izmir, Turkey
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20
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Eigenschink M, Dearing L, Dablander TE, Maier J, Sitte HH. A critical examination of the main premises of Traditional Chinese Medicine. Wien Klin Wochenschr 2020; 132:260-273. [PMID: 32198544 PMCID: PMC7253514 DOI: 10.1007/s00508-020-01625-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/26/2020] [Indexed: 12/19/2022]
Abstract
Traditional Chinese Medicine (TCM) consists of a plethora of therapeutic approaches aiming to both characterize and treat diseases. Its utilization has gained significant popularity in the western world and is even backed by the World Health Organization's decision to include TCM diagnostic patterns into the new revision of the International Classification of Diseases code, the global standard for diagnostic health information. As these developments and potentially far-reaching decisions can affect modern healthcare systems and daily clinical work as well as wildlife conservation, its underlying factual basis must be critically examined. This article therefore provides an overview of the evidence underlying the basic TCM concepts, such as Qi, meridians, acupuncture, pulse and tongue diagnostics as well as traditional herbal treatments. Moreover, it discusses whether scientific literature on TCM reflects the current standard for evidence-based research, as described in good scientific practice and good clinical practice guidelines. Importantly, misinformation regarding the therapeutic efficacy of animal-derived substances has lead and currently leads to problems with wildlife preservation and animal ethics. Nevertheless, the (re-)discovery of artemisinin more than 50 years ago introduced a novel development in TCM: the commingling of Eastern and Western medicine, the appreciation of both systems. The need for more rigorous approaches, fulfilment of and agreement to current guidelines to achieve high-quality research are of utmost relevance. Thereby, ancient knowledge of herbal species and concoctions may serve as a possible treasure box rather than Pandora's box.
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Affiliation(s)
| | - Lukas Dearing
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Tom E Dablander
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Julian Maier
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria
| | - Harald H Sitte
- Institute of Pharmacology, Medical University Vienna, Vienna, Austria.
- Center for Physiology and Pharmacology, Institute of Pharmacology, Medical University Vienna, Waehringer Straße 13A, 1090, Vienna, Austria.
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21
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A case of unexplained duodenal ulcer and massive gastrointestinal bleed. Clin Chim Acta 2020; 506:188-190. [PMID: 32234495 DOI: 10.1016/j.cca.2020.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/22/2022]
Abstract
A 73-year-old man was displaying symptoms of massive gastrointestinal (GI) bleed. Surgical actions were performed to control the bleed caused by an erosive duodenal ulcer with duodenal perforation. When investigating the culprit of this case, the pain medications prescribed two weeks prior by a traditional Chinese medicine doctor raised attention. The patient's admission serum sample and the pain medications from unknown sources were analyzed using a clinically validated liquid chromatography-high-resolution mass spectrometry (LC-HRMS) method. The NSAIDs diclofenac, piroxicam, and indomethacin were identified, as well as some other synthetic drugs and natural products. The patient's concurrent exposure to multiple NSAIDs significantly increased the risk of upper GI complications. It is reasonable to argue that the high-dose use of the NSAIDs was a major cause of the duodenal ulcer and GI bleed. In addition, the identified natural products such as atropine and ephedrine have well-documented toxicities. It is important to increase the visibility of unregulated medications, and the capability to perform untargeted mass spectrometry analysis provides a unique diagnostic advantage in cases where exposure to toxic substances is possible.
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Li FF, Guo CC, Zhang YL, Wang N, Shi Y, Wang SQ. A screening method based on 1D CSSF-TOCSY for the identification and quantification of 11 illegal adulterants in herbal medicines. Microchem J 2020. [DOI: 10.1016/j.microc.2019.104495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Shaikh Abdul Rahman S, Aziz Z. Complementary and alternative medicine: Pharmacovigilance in Malaysia and predictors of serious adverse reactions. J Clin Pharm Ther 2020; 45:946-958. [DOI: 10.1111/jcpt.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/13/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Sameerah Shaikh Abdul Rahman
- Department of Pharmacy Faculty of Medicine University Malaya Kuala Lumpur Malaysia
- School of Pharmacy Monash University Selangor Malaysia
| | - Zoriah Aziz
- Department of Pharmacy Faculty of Medicine University Malaya Kuala Lumpur Malaysia
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Abstract
This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.
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Affiliation(s)
- Amita Jain
- HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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25
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Xu M, Huang B, Gao F, Zhai C, Yang Y, Li L, Wang W, Shi L. Assesment of Adulterated Traditional Chinese Medicines in China: 2003-2017. Front Pharmacol 2019; 10:1446. [PMID: 31849686 PMCID: PMC6895211 DOI: 10.3389/fphar.2019.01446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022] Open
Abstract
Traditional Chinese medicines (TCMs) represent one form of complementary and alternative medicine. The popularity and complexity in production make them attractive and vulnerable to adulteration in stages ranging from planting to production. Adulteration refers to the addition of extraneous, improper, or inferior ingredients that should not be present in TCMs. To detect and combat adulterated TCMs, supplementary testing methods (STMs), which expand the capability of routine testing standards, have been applied in China since 2003. From 2003 to 2017, a total of 184 STMs for TCMs were approved by the Chinese national drug regulatory authority. By assessing these STMs, this research intends to identify those TCMs vulnerable to adulteration, to list common adulterants, and to characterize the techniques of analysis. The results show that adulteration of TCMs can be classified into three main categories: the addition of undeclared drugs/chemical substances, substitution with non-drug components, and the addition of foreign non-drug materials. The top five therapeutic areas of TCMs vulnerable to adulteration are diabetes, calm and sleep, sexual dysfunction, pain relief, and rheumatism. A total of 166 adulterants were detected in the adulterated TCM preparations and herbal products studied here, with 158 adulterants in TCM preparations and 43 in herbal products, with 35 adulterants in common. Each STM consists of different pharmaceutical analysis techniques, including tests for physical-chemical properties, chromatography, spectroscopic techniques, and mass spectrometry. The analytical methodology of STMs relies on the combination of these techniques, with HPLC ranking the highest percentage (76.1%) and physical-chemical techniques the lowest percentage (11.4%). This research shows that STMs have played a crucial role in combating adulterated TCMs. However, STMs represent merely a product testing-centered regulatory strategy. The inspection of cultivation and manufacturing processes should also be strengthened. More importantly, the awareness and self-discipline of TCM manufacturers in implementing good manufacturing practices and regulating the planting and cultivation of raw materials should be improved.
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Affiliation(s)
- Mingzhe Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,Departmet of General Management, National Institutes for Food and Drug Control, Beijing, China
| | - Baobin Huang
- Departmet of General Management, National Institutes for Food and Drug Control, Beijing, China
| | - Fang Gao
- Departmet of General Management, National Institutes for Food and Drug Control, Beijing, China
| | - Chenchen Zhai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yueying Yang
- Departmet of General Management, National Institutes for Food and Drug Control, Beijing, China
| | - Lulu Li
- Departmet of General Management, National Institutes for Food and Drug Control, Beijing, China
| | - Wenya Wang
- School of Pharmaceutical Science, Tsinghua University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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Kellogg JJ, Paine MF, McCune JS, Oberlies NH, Cech NB. Selection and characterization of botanical natural products for research studies: a NaPDI center recommended approach. Nat Prod Rep 2019; 36:1196-1221. [PMID: 30681109 PMCID: PMC6658353 DOI: 10.1039/c8np00065d] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Covering: up to the end of 2018 Dietary supplements, which include botanical (plant-based) natural products, constitute a multi-billion-dollar industry in the US. Regulation and quality control for this industry is an ongoing challenge. While there is general agreement that rigorous scientific studies are needed to evaluate the safety and efficacy of botanical natural products used by consumers, researchers conducting such studies face a unique set of challenges. Botanical natural products are inherently complex mixtures, with composition that differs depending on myriad factors including variability in genetics, cultivation conditions, and processing methods. Unfortunately, many studies of botanical natural products are carried out with poorly characterized study material, such that the results are irreproducible and difficult to interpret. This review provides recommended approaches for addressing the critical questions that researchers must address prior to in vitro or in vivo (including clinical) evaluation of botanical natural products. We describe selection and authentication of botanical material and identification of key biologically active compounds, and compare state-of-the-art methodologies such as untargeted metabolomics with more traditional targeted methods of characterization. The topics are chosen to be of maximal relevance to researchers, and are reviewed critically with commentary as to which approaches are most practical and useful and what common pitfalls should be avoided.
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Affiliation(s)
- Joshua J. Kellogg
- Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
| | - Mary F. Paine
- Department of Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, Washington, USA
| | - Jeannine S. McCune
- Department of Population Sciences, City of Hope, Duarte, California, USA
| | - Nicholas H. Oberlies
- Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
| | - Nadja B. Cech
- Department of Chemistry & Biochemistry, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
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Hubbard TD, Hsieh JH, Rider CV, Sipes NS, Sedykh A, Collins BJ, Auerbach SS, Xia M, Huang R, Walker NJ, DeVito MJ. Using Tox21 High-Throughput Screening Assays for the Evaluation of Botanical and Dietary Supplements. APPLIED IN VITRO TOXICOLOGY 2019; 5:10-25. [PMID: 30944845 PMCID: PMC6442399 DOI: 10.1089/aivt.2018.0020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction: Recent nationwide surveys found that natural products, including botanical dietary supplements, are used by ∼18% of adults. In many cases, there is a paucity of toxicological data available for these substances to allow for confident evaluations of product safety. The National Toxicology Program (NTP) has received numerous nominations from the public and federal agencies to study the toxicological effects of botanical dietary supplements. The NTP sought to evaluate the utility of in vitro quantitative high-throughput screening (qHTS) assays for toxicological assessment of botanical and dietary supplements. Materials and Methods: In brief, concentration-response assessments of 90 test substances, including 13 distinct botanical species, and individual purported active constituents were evaluated using a subset of the Tox21 qHTS testing panel. The screen included 20 different endpoints that covered a broad range of biologically relevant signaling pathways to detect test article effects upon endocrine activity, nuclear receptor signaling, stress response signaling, genotoxicity, and cell death signaling. Results and Discussion: Botanical dietary supplement extracts induced measurable and diverse activity. Elevated biological activity profiles were observed following treatments with individual chemical constituents relative to their associated botanical extract. The overall distribution of activity was comparable to activities exhibited by compounds present in the Tox21 10K chemical library. Conclusion: Botanical supplements did not exhibit minimal or idiosyncratic activities that would preclude the use of qHTS platforms as a feasible method to screen this class of compounds. However, there are still many considerations and further development required when attempting to use in vitro qHTS methods to characterize the safety profile of botanical/dietary supplements.
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Affiliation(s)
- Troy D. Hubbard
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | | | - Cynthia V. Rider
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Nisha S. Sipes
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | | | - Bradley J. Collins
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Scott S. Auerbach
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Menghang Xia
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland
| | - Ruili Huang
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland
| | - Nigel J. Walker
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Michael J. DeVito
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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28
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Zhou X, Li CG, Chang D, Bensoussan A. Current Status and Major Challenges to the Safety and Efficacy Presented by Chinese Herbal Medicine. MEDICINES 2019; 6:medicines6010014. [PMID: 30669335 PMCID: PMC6473719 DOI: 10.3390/medicines6010014] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/21/2022]
Abstract
Traditional Chinese medicine (TCM) is not only used prevalently in Asian countries but has also gained a stable market globally. As a principal form of TCM, Chinese herbal medicine (CHM) is comprised of treatments using multiple Chinese herbs which have complex chemical profiles. Due to a lack of understanding of its modality and a lack of standardization, there are significant challenges associated with regulating CHM’s safety for practice and understanding its mechanisms of efficacy. Currently, there are many issues that need to be overcome in regard to the safety and efficacy of CHM for the further development of evidence-based practices. There is a need to better understand the mechanisms behind the efficacy of CHM, and develop proper quality standards and regulations to ensure a similar safety standard as Western drugs. This paper outlines the status of CHM in terms of its safety and efficacy and attempts to provide approaches to address these issues.
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Affiliation(s)
- Xian Zhou
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Chun-Guang Li
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia.
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29
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Singh P, Tiwari D, Mishra M, Kumar D. Molecular Mechanisms of Heavy Metal Toxicity in Cancer Progression. NETWORKING OF MUTAGENS IN ENVIRONMENTAL TOXICOLOGY 2019. [DOI: 10.1007/978-3-319-96511-6_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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30
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Gini J, Amara A, Penchala SD, Back DJ, Else L, Egan D, Chiong J, Harri BI, Kabilis ED, Pama PP, Stephen M, Khoo SH. Widespread use of herbal medicines by people living with human immunodeficiency virus and contamination of herbal medicines with antiretrovirals in Nigeria. Int J STD AIDS 2018; 30:371-377. [PMID: 30501368 DOI: 10.1177/0956462418809749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Herbal medication use amongst people living with human immunodeficiency virus (PLWH) is widespread and understudied. This study aimed to evaluate the prevalence of herbal medicine use amongst PLWH and possible contamination with antiretrovirals (ARVs). Countrywide collection of herbal samples sold by street vendors in Nigeria for the following indications: human immunodeficiency virus (HIV), acquired immune deficiency syndrome, fever and general weakness. Samples were screened using a validated liquid chromatography-mass spectrometry/mass spectrometry method for the presence of the following ARVs: efavirenz, nevirapine, lopinavir, darunavir, ritonavir, atazanavir, emtricitabine, tenofovir and lamivudine. A survey was conducted among 742 PLWH attending four HIV clinics in Nigeria. Data were collected using a structured questionnaire and analysed using IBM SPSS statistics version 22.0 (IBM Corp., 2013, Armond, NY). Of the 138 herbal medicines sampled, three (2%) contained detectable levels of tenofovir, emtricitabine and/or lamivudine. Additionally, of the 742 PLWH surveyed, 310 (41.8%) reported herbal medicine use. Among the users, 191 (61.6%) started taking herbals after commencing HIV therapy while herbal medicine use preceded ARVs treatment in 119 (38.4%) PLWH. We found herbal use to be widespread among PLWH in Nigeria, with increasing use after commencing ARV. Three herbal preparations were also found to contain detectable levels of ARVs. This is a concern and should be studied widely across the region and countries where herbal medicine use is prevalent and poorly regulated.
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Affiliation(s)
- J Gini
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A Amara
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sujan D Penchala
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - David J Back
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - L Else
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - D Egan
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J Chiong
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Bala I Harri
- 2 Dalhatu Araf Specialist Hospital, Lafia, North-central Nigeria
| | | | - Paul P Pama
- 4 Federal Medical Centre, Katsina, North-west Nigeria
| | - M Stephen
- 5 Faith Alive Foundation Hospital and PMTCT Centre, Jos, Nigeria
| | - Saye H Khoo
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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31
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Ekar T, Kreft S. Common risks of adulterated and mislabeled herbal preparations. Food Chem Toxicol 2018; 123:288-297. [PMID: 30339960 DOI: 10.1016/j.fct.2018.10.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/08/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Due to the growing trend of returning to nature and the fear of adverse reactions from conventional medicines, people are increasingly resorting to the use of herbal preparations. Because of long-term use and natural origin these preparations give a sense of security. But herbal formulations also possess undesirable effects and, among other dangers, present a risk connected with deliberate addition of synthetic compounds, deliberate or unintentional replacement of the plant species or simply a risk of mislabeling. While the replacement of the plant species occurs in a very different groups of herbal products, reports of added illicit synthetic substances often include groups of herbal weight-loss preparations, sexual enhancers, preparations for treatment of rheumatic and inflammatory diseases, antidiabetic and blood pressure lowering preparations. In the world of Internet ordering, these are the dangers that everyone should be aware of. In this article, we reviewed the safety issues related to adulterated or mislabeled herbal products.
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Affiliation(s)
- Tjaša Ekar
- Public Institution Gorenjske Lekarne, Kranj, Slovenia
| | - Samo Kreft
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia.
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32
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Lin YP, Lee YL, Hung CY, Chang CF, Chen Y. Detection of adulterated drugs in traditional Chinese medicine and dietary supplements using hydrogen as a carrier gas. PLoS One 2018; 13:e0205371. [PMID: 30304050 PMCID: PMC6179279 DOI: 10.1371/journal.pone.0205371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/23/2018] [Indexed: 11/24/2022] Open
Abstract
Helium, a minor component of natural gas and radioactive minerals, is most commonly used as a carrier in gas chromatography-mass spectrometry (GC-MS). Its scarcity leads to limited availability and higher costs. In this experiment, hydrogen from a safe source of a hydrogen generator was tested as a substitutive carrier gas for the detection of adulterant in traditional Chinese medicine (TCM) and food supplements by GC-MS analysis. We found that the limits of detection (LODs) of using hydrogen were from 10 to 1000 μg/g. The levels of LODs tested among 170 drugs remain the same whether hydrogen or helium was used as a carrier gas with the exception of 7 drugs—benzbromarone, estradiol benzoate, bezafibrate, mefenamic acid, oxymetholone, piperidenafil and cetilistat. The real sample analysis results using hydrogen were as satisfactory as those using helium. In addition, the retention time was shortened after the chromatographic performance was optimized. In summary, it is worth considering hydrogen as a carrier gas due to its affordable costs, energy efficiency, carbon reduction and chromatographic advantages to detect adulterated drugs in TCM and dietary supplement using GC-MS.
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Affiliation(s)
- Yen-Ping Lin
- Public Health Bureau, Tainan City Government, Tainan, Taiwan, R.O.C
- * E-mail: (YPL); (YLL); (CFC)
| | - Ying-Lin Lee
- Public Health Bureau, Tainan City Government, Tainan, Taiwan, R.O.C
- * E-mail: (YPL); (YLL); (CFC)
| | - Chien-Ya Hung
- Public Health Bureau, Tainan City Government, Tainan, Taiwan, R.O.C
| | - Chuan-Fa Chang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (YPL); (YLL); (CFC)
| | - Yi Chen
- Public Health Bureau, Tainan City Government, Tainan, Taiwan, R.O.C
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33
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Bukhsh A, Gan SH, Goh BH, Khan TM. Complementary and alternative medicine practices among type 2 diabetes patients in Pakistan: A qualitative insight. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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Simmler C, Graham JG, Chen SN, Pauli GF. Integrated analytical assets aid botanical authenticity and adulteration management. Fitoterapia 2018; 129:401-414. [PMID: 29175549 PMCID: PMC5963993 DOI: 10.1016/j.fitote.2017.11.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 12/30/2022]
Abstract
This article reviews and develops a perspective for the meaning of authenticity in the context of quality assessment of botanical materials and the challenges associated with discerning adulterations vs. contaminations vs. impurities. Authentic botanicals are by definition non-adulterated, a mutually exclusive relationship that is confirmed through the application of a multilayered set of analytical methods designed to validate the (chemo)taxonomic identity of a botanical and certify that it is devoid of any adulteration. In practice, the ever-increasing sophistication in the process of intentional adulteration, as well as the growing number of botanicals entering the market, altogether necessitate a constant adaptation and reinforcement of authentication methods with new approaches, especially new technologies. This article summarizes the set of analytical methods - classical and contemporary - that can be employed in the authentication of botanicals. Particular emphasis is placed on the application of untargeted metabolomics and chemometrics. An NMR-based untargeted metabolomic model is proposed as a rapid, systematic, and complementary screening for the discrimination of authentic vs. potentially adulterated botanicals. Such analytical model can help advance the evaluation of botanical integrity in natural product research.
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Affiliation(s)
- Charlotte Simmler
- Center for Natural Product Technologies (CENAPT), United States; UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences (PCRPS), Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, United States
| | - James G Graham
- Center for Natural Product Technologies (CENAPT), United States
| | - Shao-Nong Chen
- Center for Natural Product Technologies (CENAPT), United States; UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences (PCRPS), Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, United States
| | - Guido F Pauli
- Center for Natural Product Technologies (CENAPT), United States; UIC/NIH Center for Botanical Dietary Supplements Research, Program for Collaborative Research in the Pharmaceutical Sciences (PCRPS), Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, United States.
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35
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Li L, Liang X, Xu T, Xu F, Dong W. Rapid Detection of Six Glucocorticoids Added Illegally to Dietary Supplements by Combining TLC with Spot-Concentrated Raman Scattering. Molecules 2018; 23:molecules23071504. [PMID: 29933599 PMCID: PMC6100086 DOI: 10.3390/molecules23071504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to establish a novel method for rapid detection of six glucocorticoids (prednisone, prednisone acetate, prednisolone, hydrocortisone, hydrocortisone acetate, and dexamethasone) added illegally in dietary supplements simultaneously by combining thin layer chromatography (TLC) with spot-concentrated Raman scattering (SCRS). The doping ingredients were separated by TLC, and viewed and located with UV light (254 nm), enriched by chromatography, then Raman spectra were directly detected by a Raman Imagine microscope with 780 nm laser source. This method had complementary advantages of TLC and Raman spectroscopy, which enhanced the specificity of the test results. The limit of detection (LOD) of the reference substances were 4 μg, 4 μg, 4 μg, 6 μg, 6 μg, and 4 μg, respectively. The method was used to study the six glucocorticoids added illegally in five dietary supplements. Fake drugs had been detected. The study showed that the TLC-SCRS method is simple, rapid, specific, sensitive, and reliable. The method could be used for effective separation and detection of six chemical components used in dietary supplement products, and would have good prospects for on-site qualitative screening of dietary supplement products for adulterants.
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Affiliation(s)
- Li Li
- School of Pharmacy, Qiqihar Medical University, Qiqihar 161006, China.
| | - Xin Liang
- School of Pharmacy, Qiqihar Medical University, Qiqihar 161006, China.
| | - Tao Xu
- School of Pharmacy, Qiqihar Medical University, Qiqihar 161006, China.
| | - Feng Xu
- School of Pharmacy, Qiqihar Medical University, Qiqihar 161006, China.
| | - Wei Dong
- School of Pharmacy, Qiqihar Medical University, Qiqihar 161006, China.
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36
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Chugh NA, Bali S, Koul A. Integration of botanicals in contemporary medicine: road blocks, checkpoints and go-ahead signals. Integr Med Res 2018; 7:109-125. [PMID: 29989061 PMCID: PMC6035497 DOI: 10.1016/j.imr.2018.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 01/14/2023] Open
Abstract
The use of botanicals for maintaining good health and preventing diseases is undisputed. The claimed health benefits of natural health products and herbal medicines are based on traditional claims, positive results obtained in preclinical studies and early phase clinical trials that are not backed by safety and efficacy evidences approved by regulatory agencies. Although, the popularity of botanicals is growing, health care practitioners of modern medicine seldom recommend their use because of ill equipped database of their safety and potency. This review discusses problems that preclude botanicals from integrating into the mainstream contemporary therapeutics and cues that provide impetus for their realisation.
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Affiliation(s)
| | | | - Ashwani Koul
- Department of Biophysics, Panjab University, Chandigarh, India
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37
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Azanu D, Styrishave B, Darko G, Weisser JJ, Abaidoo RC. Occurrence and risk assessment of antibiotics in water and lettuce in Ghana. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 622-623:293-305. [PMID: 29216470 DOI: 10.1016/j.scitotenv.2017.11.287] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 05/07/2023]
Abstract
Hospital wastewater and effluents from waste stabilization ponds in Kumasi, Ghana, are directly discharged as low quality water into nearby streams which are eventually used to irrigate vegetables. The presence of 12 commonly used antibiotics in Ghana (metronidazole, ciprofloxacin, erythromycin, trimethoprim, ampicillin, cefuroxime, sulfamethoxazole, amoxicillin, tetracycline, oxytetracycline, chlortetracycline and doxycycline) were investigated in water and lettuce samples collected in three different areas in Kumasi, Ghana. The water samples were from hospital wastewater, wastewater stabilization ponds, rivers and irrigation water, while the lettuce samples were from vegetable farms and market vendors. Antibiotics in water samples were extracted using SPE while antibiotics in lettuce samples were extracted using accelerated solvent extraction followed by SPE. All extracted antibiotics samples were analyzed by HPLC-MS/MS. All studied compounds were detected in concentrations significantly higher (p=0.01) in hospital wastewater than in the other water sources. The highest concentration found in the present study was 15μg/L for ciprofloxacin in hospital wastewater. Irrigation water samples analyzed had concentrations of antibiotics up to 0.2μg/L. Wastewater stabilization ponds are low technology but effective means of removing antibiotics with removal efficiency up to 95% recorded in this study. However, some chemicals are still found in levels indicating medium to high risk of antibiotics resistance development in the environment. The total concentrations of antibiotics detected in edible lettuce tissues from vegetable farms and vegetable sellers at the markets were in the range of 12.0-104 and 11.0-41.4ng/kg (fresh weight) respectively. The antibiotics found with high concentrations in all the samples were sulfamethoxazole, erythromycin, ciprofloxacin, cefuroxime and trimethoprim. Furthermore, our study confirms the presence of seven antibiotics in lettuce from irrigation farms and markets, suggesting an indirect exposure of humans to antibiotics through vegetable consumption and drinking water in Ghana. However, estimated daily intake for a standard 60kg woman was 0.3ng/day, indicating low risk for human health.
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Affiliation(s)
- David Azanu
- Department of Chemistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Bjarne Styrishave
- Toxicology Laboratory, Analytical Biosciences, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Godfred Darko
- Department of Chemistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Johan Juhl Weisser
- Toxicology Laboratory, Analytical Biosciences, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Robert Clement Abaidoo
- Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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38
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Amadi CN, Orisakwe OE. Herb-Induced Liver Injuries in Developing Nations: An Update. TOXICS 2018; 6:toxics6020024. [PMID: 29673137 PMCID: PMC6027193 DOI: 10.3390/toxics6020024] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/03/2018] [Accepted: 04/14/2018] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Cecilia Nwadiuto Amadi
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria.
| | - Orish Ebere Orisakwe
- Department of Experimental Pharmacology & Toxicology, Faculty of Pharmacy, University of Port-Harcourt, PMB, 5323 Port Harcourt, Rivers State, Nigeria.
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Dzeparoski M, Trajkovic-Jolevska S. Impact of regulation on advertising and promotion of traditional herbal medicines and food supplements. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2018. [DOI: 10.1108/ijphm-10-2016-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to show that advertising as part of product promotion is in strict correlation with the specific regulation of each product category, food supplements and herbal/over-the-counter medicines. Main contributions of the paper are two-fold. First, it demonstrates that there are products when certain botanical is registered according to legislation as herbal medicine, but at the same time it can be found in sales as food supplement. This can happen within the same country, but it is more frequent within different countries. Second, the possibility for regulation harmonization is discussed.
Design/methodology/approach
In this paper, a comparative analysis of regulation for concerned products in European Union and countries of interest is made. In two case studies, a comparative analysis of marketing of the products in Macedonia and Serbia is made.
Findings
Food supplements are subject to more liberal regulation in comparison with herbal/over-the-counter medicines, but should not be attributed indications and properties that they do not possess. Regulation is stricter and more complex for over-the-counter medicines as a separate class of medicines, these must be correlated with registered properties and indications and are subject to approval by regulatory bodies (print media: advertisement in newspaper/magazine, poster, brochure, flyer, banner and billboard and electronic media: TV spot, radio advertising and internet advertisement).
Research limitations/implications
Countries of interest: EU, Macedonia, Serbia, Montenegro, Albania, Kosovo, Bosnia and Herzegovina.
Practical implications
The paper will contribute toward the creation of promotional and marketing steps in placement of these products on the market in countries of interest, based on regulation of the product category.
Social implications
The discussed opportunities for harmonization are applicable and realistic and can positively contribute for better flow and placement of food supplements and herbal/over-the-counter medicines in different countries. The results of the case studies can also be used for regulatory activities and preparation of marketing materials for other products on other markets of interest with same or similar regulation.
Originality/value
For the first time, a comparative analysis of regulation is made for concerned products in countries of interest. Possibility for regulation harmonization is discussed.
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Wang JB, Zhu Y, Bai ZF, Wang FS, Li XH, Xiao XH. Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury. Chin J Integr Med 2018. [PMID: 29542018 DOI: 10.1007/s11655-018-3000-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Herb-induced liver injury (HILI) is a type of adverse drug reactions related to using Chinese medicine (CM) or herbal medicine (HM), and is now a growing segment of drug-induced liver injury (DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM, it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine (CACM), the authors present an evidence chain-based workflow with 9 structured judgment criteria for diagnosing HILI. The 3 diagnostic ending points-suspected diagnosis, clinical diagnosis, and confirmed diagnosis-could be reached according to the length of the evidence chain acquired in the structured diagnostic workflow. Either identifying the species of CM or HM or excluding adulterations and toxin contaminants was strongly recommended to improve the level of evidence for a clinical diagnosis of HILI. In addition, the authors report that the improper use of CM, which violates the general law of CM theory, is one of the most important factors that contributes to HILI and should be avoided. By contrast, based on syndrome differentiation, some CM can also be used to treat HILI if used in accordance with the general law of CM theory. Therefore, 9 recommendations are put forward in this guideline.
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Affiliation(s)
- Jia-Bo Wang
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China
| | - Yun Zhu
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China
| | - Zhao-Fang Bai
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China
| | - Fu-Sheng Wang
- Research Center for Biological Therapy, 302 Military Hospital of China, Beijing, 100039, China
| | - Xiu-Hui Li
- Integrative Medical Center, Beijing YouAn Hospital, Capital Medical University, Beijing, 100069, China.
| | - Xiao-He Xiao
- Integrative Medical Center, 302 Military Hospital of China, Beijing, 100039, China.
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Raclariu AC, Heinrich M, Ichim MC, de Boer H. Benefits and Limitations of DNA Barcoding and Metabarcoding in Herbal Product Authentication. PHYTOCHEMICAL ANALYSIS : PCA 2018; 29:123-128. [PMID: 28906059 PMCID: PMC5836936 DOI: 10.1002/pca.2732] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Herbal medicines play an important role globally in the health care sector and in industrialised countries they are often considered as an alternative to mono-substance medicines. Current quality and authentication assessment methods rely mainly on morphology and analytical phytochemistry-based methods detailed in pharmacopoeias. Herbal products however are often highly processed with numerous ingredients, and even if these analytical methods are accurate for quality control of specific lead or marker compounds, they are of limited suitability for the authentication of biological ingredients. OBJECTIVE To review the benefits and limitations of DNA barcoding and metabarcoding in complementing current herbal product authentication. METHOD Recent literature relating to DNA based authentication of medicinal plants, herbal medicines and products are summarised to provide a basic understanding of how DNA barcoding and metabarcoding can be applied to this field. RESULTS Different methods of quality control and authentication have varying resolution and usefulness along the value chain of these products. DNA barcoding can be used for authenticating products based on single herbal ingredients and DNA metabarcoding for assessment of species diversity in processed products, and both methods should be used in combination with appropriate hyphenated chemical methods for quality control. CONCLUSIONS DNA barcoding and metabarcoding have potential in the context of quality control of both well and poorly regulated supply systems. Standardisation of protocols for DNA barcoding and DNA sequence-based identification are necessary before DNA-based biological methods can be implemented as routine analytical approaches and approved by the competent authorities for use in regulated procedures. © 2017 The Authors. Phytochemical Analysis Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Ancuta Cristina Raclariu
- Natural History MuseumUniversity of OsloP.O. Box 1172, Blindern0318OsloNorway
- Stejarul Research Centre for Biological SciencesNational Institute of Research and Development for Biological SciencesAlexandru cel Bun Street, 6610004Piatra NeamtRomania
| | - Michael Heinrich
- Research Group of Pharmacognosy and Phytotherapy, Research Cluster ‘Biodiversity and Medicines’, UCL School of PharmacyUniversity of London29–39 Brunswick SqLondonWC1N 1AXUK
| | - Mihael Cristin Ichim
- Stejarul Research Centre for Biological SciencesNational Institute of Research and Development for Biological SciencesAlexandru cel Bun Street, 6610004Piatra NeamtRomania
| | - Hugo de Boer
- Natural History MuseumUniversity of OsloP.O. Box 1172, Blindern0318OsloNorway
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Toward Evidence-Based Chinese Medicine: Status Quo, Opportunities and Challenges. Chin J Integr Med 2018; 24:163-170. [PMID: 29340887 DOI: 10.1007/s11655-017-2795-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 02/05/2023]
Abstract
How to test the treatments of Chinese medicine (CM) and make them more widely accepted by practitioners of Western medicine and the international healthcare community is a major concern for practitioners and researchers of CM. For centuries, various approaches have been used to identify and measure the efficacy and safety of CM. However, the high-quality evidence related to CM that produced in China is still rare. Over the recent years, evidence-based medicine (EBM) has been increasingly applied to CM, strengthening its theoretical basis. This paper reviews the past and present state of CM, analyzes the status quo, challenges and opportunities of basic research, clinical trials, systematic reviews, clinical practice guidelines and clinical pathways and evidence-based education developed or conducted in China, pointing out how EBM can help to make CM more widely used and recognized worldwide.
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Byard RW, Musgrave I, Maker G, Bunce M. What risks do herbal products pose to the Australian community? Med J Aust 2017; 206:86-90. [PMID: 28152355 DOI: 10.5694/mja16.00614] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/15/2016] [Indexed: 11/17/2022]
Abstract
Traditional herbal products are widely used in Australia to treat a broad range of conditions and diseases. It is popularly believed that these products are safer than prescribed drugs. While many may be safe, it is worrying that the specific effects and harmful interactions of a number of their components with prescription medications is not well understood. Some traditional herbal preparations contain heavy metals and toxic chemicals, as well as naturally occurring organic toxins. The effects of these substances can be dire, including acute hepatic and renal failure, exacerbation of pre-existing conditions and diseases, and even death. The content and quality of herbal preparations are not tightly controlled, with some ingredients either not listed or their concentrations recorded inaccurately on websites or labels. Herbal products may also include illegal ingredients, such as ephedra, Asarum europaeum (European wild ginger) and endangered animal species (eg, snow leopard). An additional problem is augmentation with prescription medications to enhance the apparent effectiveness of a preparation. Toxic substances may also be deliberately or inadvertently added: less expensive, more harmful plants may be substituted for more expensive ingredients, and processing may not be adequate. The lack of regulation and monitoring of traditional herbal preparations in Australia and other Western countries means that their contribution to illness and death is unknown. We need to raise awareness of these problems with health care practitioners and with the general public.
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Affiliation(s)
| | | | | | - Michael Bunce
- Trace and Environmental DNA Laboratory (TrEnD), Curtin University, Perth, WA
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Jin P, Liang X, Wu X, He X, Kuang Y, Hu X. Screening and quantification of 18 glucocorticoid adulterants from herbal pharmaceuticals and health foods by HPLC and confirmed by LC-Q-TOF-MS/MS. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2017; 35:10-19. [PMID: 29095118 DOI: 10.1080/19440049.2017.1400184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pengfei Jin
- Department of Pharmaceutical Science, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Xiaoli Liang
- Department of Pharmaceutical Science, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Xuejun Wu
- Department of Pharmaceutical Science, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Xiaorong He
- Department of Pharmaceutical Science, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Yongmei Kuang
- Department of Pharmaceutical Science, Beijing Hospital, National Center of Gerontology, Beijing, PR China
| | - Xin Hu
- Department of Pharmaceutical Science, Beijing Hospital, National Center of Gerontology, Beijing, PR China
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Melchart D, Hager S, Albrecht S, Dai J, Weidenhammer W, Teschke R. Herbal Traditional Chinese Medicine and suspected liver injury: A prospective study. World J Hepatol 2017; 9:1141-1157. [PMID: 29085558 PMCID: PMC5648988 DOI: 10.4254/wjh.v9.i29.1141] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/21/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze liver tests before and following treatment with herbal Traditional Chinese Medicine (TCM) in order to evaluate the frequency of newly detected liver injury.
METHODS Patients with normal values of alanine aminotransferase (ALT) as a diagnostic marker for ruling out pre-existing liver disease were enrolled in a prospective study of a safety program carried out at the First German Hospital of TCM from 1994 to 2015. All patients received herbal products, and their ALT values were reassessed 1-3 d prior to discharge. To verify or exclude causality for suspected TCM herbs, the Roussel Uclaf Causality Assessment Method (RUCAM) was used.
RESULTS This report presents for the first time liver injury data derived from a prospective, hospital-based and large-scale study of 21470 patients who had no liver disease prior to treatment with herbal TCM. Among these, ALT ranged from 1 × to < 5 × upper limit normal (ULN) in 844 patients (3.93%) and suggested mild or moderate liver adaptive abnormalities. However, 26 patients (0.12%) experienced higher ALT values of ≥ 5 × ULN (300.0 ± 172.9 U/L, mean ± SD). Causality for TCM herbs was RUCAM-based probable in 8/26 patients, possible in 16/26, and excluded in 2/26 cases. Bupleuri radix and Scutellariae radix were the two TCM herbs most commonly implicated.
CONCLUSION In 26 (0.12%) of 21470 patients treated with herbal TCM, liver injury with ALT values of ≥ 5 × ULN was found, which normalized shortly following treatment cessation, also substantiating causality.
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Affiliation(s)
- Dieter Melchart
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, CH-8091 Zurich, Switzerland
- Competence Centre for Complementary Medicine and Naturopathy (CoCoNat), University Hospital Munich rechts der Isar, Technical University of Munich, D-80801 Munich, Germany
| | - Stefan Hager
- Hospital for Traditional Chinese Medicine, D-93444 Bad Kötzting, Germany
| | - Sabine Albrecht
- Hospital for Traditional Chinese Medicine, D-93444 Bad Kötzting, Germany
| | - Jingzhang Dai
- Hospital for Traditional Chinese Medicine, D-93444 Bad Kötzting, Germany
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wolfgang Weidenhammer
- Competence Centre for Complementary Medicine and Naturopathy (CoCoNat), University Hospital Munich rechts der Isar, Technical University of Munich, D-80801 Munich, Germany
| | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty of the Goethe University, D-63450 Hanau, Frankfurt/Main, Germany
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Brown AC. Cancer Related to Herbs and Dietary Supplements: Online Table of Case Reports. Part 5 of 5. J Diet Suppl 2017; 15:556-581. [PMID: 28981366 DOI: 10.1080/19390211.2017.1355865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A current listing of potentially life-threatening, cancer-related dietary supplements (DSs; includes herbs) based on PubMed case reports was summarized in online tables that can now be updated continually to forewarn United States consumers, clinicians, and DS companies. Documented PubMed case reports were used to create a "Toxic Table" related to cancer (1966 to April 2016, and cross-referencing). Keywords included "herb" or "dietary supplement" combined with "cancer" as well as the specific herb "name" combined with "cancer" and sometimes "toxicity." Excluded were herb combinations (some exceptions), Chinese herb mixtures, teas of mixed herb contents, fungi (mycotoxins from molds and mushrooms), poisonous plants, self-harm, excessive doses (except vitamins/minerals), legal or illegal drugs, drug-herb interactions, and confounders of drugs or diseases related to cancer. Also included were a few foods related to cancer. Over the past 50+ years, PubMed case reports revealed an increased risk of cancer related to approximately one herb (guang fang ji), no dietary supplements (except those containing guang fang ji or aristolochic acid), and two foods (bracken fern, which is sometimes sold as an herbal supplement, and hot maté). This online "Toxic Table" can now be continually updated to assist researchers and clinicians in preventing serious adverse events from DSs related to cancer.
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Affiliation(s)
- Amy C Brown
- a Department of Complementary and Alternative Medicine, John A. Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
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Ching CK, Chen SPL, Lee HHC, Lam YH, Ng SW, Chen ML, Tang MHY, Chan SSS, Ng CWY, Cheung JWL, Chan TYC, Lau NKC, Chong YK, Mak TWL. Adulteration of proprietary Chinese medicines and health products with undeclared drugs: experience of a tertiary toxicology laboratory in Hong Kong. Br J Clin Pharmacol 2017; 84:172-178. [PMID: 28965348 DOI: 10.1111/bcp.13420] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/19/2017] [Indexed: 11/29/2022] Open
Abstract
AIMS Proprietary Chinese medicines (pCMs) and health products, generally believed to be natural and safe, are gaining popularity worldwide. However, the safety of pCMs and health products has been severely compromised by the practice of adulteration. The current study aimed to examine the problem of adulteration of pCMs and health products in Hong Kong. METHODS The present study was conducted in a tertiary referral clinical toxicology laboratory in Hong Kong. All cases involving the use of pCMs or health products, which were subsequently confirmed to contain undeclared adulterants, from 2005 to 2015 were reviewed retrospectively. RESULTS A total of 404 cases involving the use of 487 adulterated pCMs or health products with a total of 1234 adulterants were identified. The adulterants consisted of approved drugs, banned drugs, drug analogues and animal thyroid tissue. The six most common categories of adulterants detected were nonsteroidal anti-inflammatory drugs (17.7%), anorectics (15.3%), corticosteroids (13.8%), diuretics and laxatives (11.4%), oral antidiabetic agents (10.0%) and erectile dysfunction drugs (6.0%). Sibutramine was the most common adulterant (n = 155). The reported sources of these illicit products included over-the-counter drug stores, the internet and Chinese medicine practitioners. A significant proportion of patients (65.1%) had adverse effects attributable to these illicit products, including 14 severe and two fatal cases. Psychosis, iatrogenic Cushing syndrome and hypoglycaemia were the three most frequently encountered adverse effects. CONCLUSIONS Adulteration of pCMs and health products with undeclared drugs poses severe health hazards. Public education and effective regulatory measures are essential to address the problem.
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Affiliation(s)
- Chor Kwan Ching
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Sammy Pak Lam Chen
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Hencher Han Chih Lee
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Ying Hoo Lam
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Sau Wah Ng
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Mo Lung Chen
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | | | - Suzanne Suk San Chan
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Candy Wai Yan Ng
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Jana Wing Lan Cheung
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Tina Yee Ching Chan
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Nike Kwai Cheung Lau
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Yeow Kuan Chong
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
| | - Tony Wing Lai Mak
- Hospital Authority Toxicology Reference Laboratory, Princess Margaret Hospital, Hong Kong
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Putthapiban P, Sukhumthammarat W, Sriphrapradang C. Concealed use of herbal and dietary supplements among Thai patients with type 2 diabetes mellitus. J Diabetes Metab Disord 2017; 16:36. [PMID: 28852643 PMCID: PMC5569552 DOI: 10.1186/s40200-017-0317-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/16/2017] [Indexed: 12/29/2022]
Abstract
Background Diabetes mellitus (DM) has been one of the most common chronic diseases that create great impacts on both morbidities and mortalities. Many patients who suffering from this disease seek for complementary and alternative medicine. The aim of this study was to determine the prevalence and related factors of herbal and dietary supplement (HDS) use in patients with DM type 2 at a single university hospital in Thailand. Methods A cross-sectional study was performed in 200 type 2 DM patients via face-to-face structured interviews using developed questionnaires comprised of demographic data, diabetes-specific information, details on HDS use, and medical adherence. Results From the endocrinology clinic, 61% of total patients reported HDS exposure and 28% were currently consuming. More than two-thirds of HDS users did not notify their physicians, mainly because of a lack of doctor concern; 73% of cases had no awareness of potential drug-herb interaction. The use of drumstick tree, turmeric and bitter gourd and holy mushroom were most frequently reported. The main reasons for HDS use were friend and relative suggestions and social media. Comparisons of demographic characteristics, medical adherence, and hemoglobin A1c among these non-HDS users, as well as current and former users, were not statistically significantly different. Conclusions This study revealed a great number of DM patients interested in HDS use. The use of HDS for glycemic control is an emerging public health concern given the potential adverse effects, drug interactions and benefits associated with its use. Health care professionals should aware of HDS use and hence incorporate this aspect into the clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s40200-017-0317-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prapaipan Putthapiban
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road Bangkok, Bangkok, 10400 Thailand.,Faculty of Science, Mahidol University, Bangkok, 10400 Thailand
| | - Weera Sukhumthammarat
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road Bangkok, Bangkok, 10400 Thailand.,Faculty of Dentistry, Mahidol University, Bangkok, 10400 Thailand
| | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road Bangkok, Bangkok, 10400 Thailand
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A strategy to identify and quantify closely related adulterant herbal materials by mass spectrometry-based partial least squares regression. Anal Chim Acta 2017; 977:28-35. [DOI: 10.1016/j.aca.2017.04.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/31/2017] [Accepted: 04/18/2017] [Indexed: 01/24/2023]
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50
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The application of metabolomics for herbal medicine pharmacovigilance: a case study on ginseng. Essays Biochem 2016; 60:429-435. [PMID: 27980093 DOI: 10.1042/ebc20160030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022]
Abstract
Herbal medicines are growing in popularity, use and commercial value; however, there remain problems with the quality and consequently safety of these products. Adulterated, contaminated and fraudulent products are often found on the market, a risk compounded by the fact that these products are available to consumers with little or no medical advice. Current regulations and quality control methods are lacking in their ability to combat these serious problems. Metabolomics is a biochemical profiling tool that may help address these issues if applied to quality control of both raw ingredients and final products. Using the example of the popular herbal medicine, ginseng, this essay offers an overview of the potential use of metabolomics for quality control in herbal medicines and also highlights where more research is needed.
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