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Lim MA, Pranata R. The insidious threat of jamu and unregulated traditional medicines in the COVID-19 era. Diabetes Metab Syndr 2020; 14:895-896. [PMID: 32563942 PMCID: PMC7291970 DOI: 10.1016/j.dsx.2020.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/30/2022]
Affiliation(s)
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
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2
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Byard RW. Is voluntary envenomation from the kambô ritual therapeutic or toxic? Forensic Sci Med Pathol 2019; 16:205-206. [PMID: 31630322 DOI: 10.1007/s12024-019-00192-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Roger W Byard
- Adelaide Medical School, The University of Adelaide, Level 2 Helen Mayo Building North, Frome Road, Adelaide, SA, 5005, Australia.
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Kempegowda P, Quinn L, Shepherd L, Kauser S, Johnson B, Lawson A, Bates A. Adrenal insufficiency from steroid-containing complementary therapy: importance of detailed history. Endocrinol Diabetes Metab Case Rep 2019; 2019:1-4. [PMID: 31352697 PMCID: PMC6685090 DOI: 10.1530/edm-19-0047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 62-year-old Asian British female presented with increasing tiredness. She had multiple co-morbidities and was prescribed steroid inhalers for asthma. She had also received short courses of oral prednisolone for acute asthma exacerbations in the last 2 years. Unfortunately, the frequency and dose of steroids for asthma was unclear from history. Her type 2 diabetes mellitus (DM) control had deteriorated over a short period of time (HbA1c: 48–85 mmol/mol). Blood tests revealed undetectable cortisol and ACTH (<28 mmol/L, <5.0 ng/L). Renin, electrolytes and thyroid function were within normal limits. A diagnosis of secondary adrenal insufficiency, likely due to long-term steroid inhaler and recurrent short courses of oral steroids for asthma exacerbations was made. Patient was commenced on hydrocortisone 10 mg, 5 mg and 5 mg regimen. Steroid inhaler was discontinued following consultation with respiratory physicians. Despite discontinuation of inhaled steroids, patient continued not to mount a response to Synacthen®. Upon further detailed history, patient admitted taking a ‘herbal’ preparation for chronic osteoarthritic knee pain. Toxicology analysis showed presence of dexamethasone, ciprofloxacin, paracetamol, diclofenac, ibuprofen and cimetidine in the herbal medication. Patient was advised to discontinue her herbal preparation. We believe the cause of secondary adrenal insufficiency in our patient was the herbal remedy containing dexamethasone, explaining persistent adrenal suppression despite discontinuation of all prescribed steroids, further possibly contributing to obesity, hypertension and suboptimal control of DM. In conclusion, a comprehensive drug history including herbal and over-the-counter preparations should be elucidated. Investigation for the presence of steroids in these preparations should be considered when patients persist to have secondary adrenal insufficiency despite discontinuation of prescribed steroid medications.
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Affiliation(s)
- Punith Kempegowda
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Laren Quinn
- Department of Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lisa Shepherd
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Samina Kauser
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Briony Johnson
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alex Lawson
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Bates
- Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Xu Y, Patel DN, Ng SLP, Tan SH, Toh D, Poh J, Lim AT, Chan CL, Low MY, Koh HL. Retrospective Study of Reported Adverse Events Due to Complementary Health Products in Singapore From 2010 to 2016. Front Med (Lausanne) 2018; 5:167. [PMID: 29946545 PMCID: PMC6006675 DOI: 10.3389/fmed.2018.00167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 01/16/2023] Open
Abstract
The objective of this study is to collate and analyse adverse event reports associated with the use of complementary health products (CHP) submitted to the Health Sciences Authority (HSA) of Singapore for the period 2010-2016 to identify various trends and signals for pharmacovigilance purposes. A total of 147,215 adverse event reports suspected to be associated with pharmaceutical products and CHP were received by HSA between 2010 and 2016. Of these, 143,191 (97.3%) were associated with chemical drugs, 1,807 (1.2%) with vaccines, 1,324 (0.9%) with biological drugs (biologics), and 893 (0.6%) with CHP. The number of adverse event reports associated with Chinese Proprietary Medicine, other complementary medicine and health supplements are presented. Eight hundred and ninety three adverse event reports associated with CHP in the 7-year period have been successfully collated and analyzed. In agreement with other studies, adverse events related to the "skin and appendages disorders" were the most commonly reported. Most of the cases involved dermal allergies (e.g., rashes) associated with the use of glucosamine products and most of the adulterated products were associated with the illegal addition of undeclared drugs for pain relief. Dexamethasone, chlorpheniramine, and piroxicam were the most common adulterants detected. Reporting suspected adverse events is strongly encouraged even if the causality is not confirmed because any signs of clustering will allow rapid regulatory actions to be taken. The findings from this study help to create greater awareness on the health risks, albeit low, when consuming CHP and dispelling the common misconception that "natural" means "safe." In particular, healthcare professionals and the general public should be aware of potential adulteration of CHP. The analysis of spontaneously reported adverse events is an important surveillance system in monitoring the safety of CHP and helps in the understanding of the risk associated with the use of such products. Greater collaboration and communication between healthcare professionals, regulators, patients, manufacturers, researchers, and the general public are important to ensure the quality and safety of CHP.
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Affiliation(s)
- Yimin Xu
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- Applied Sciences Group, Pharmaceutical Division, Health Sciences Authority, Singapore, Singapore
| | - Dhavalkumar N. Patel
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Suet-Leng P. Ng
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Siew-Har Tan
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Dorothy Toh
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Jalene Poh
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Adena Theen Lim
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Cheng-Leng Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Min-Yong Low
- Applied Sciences Group, Pharmaceutical Division, Health Sciences Authority, Singapore, Singapore
| | - Hwee-Ling Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Nieman LK. Recent Updates on the Diagnosis and Management of Cushing's Syndrome. Endocrinol Metab (Seoul) 2018; 33:139-146. [PMID: 29947171 PMCID: PMC6021313 DOI: 10.3803/enm.2018.33.2.139] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 04/23/2018] [Accepted: 05/16/2018] [Indexed: 12/31/2022] Open
Abstract
Cushing's syndrome, a potentially lethal disorder characterized by endogenous hypercortisolism, may be difficult to recognize, especially when it is mild and the presenting features are common in the general population. However, there is a need to identify the condition at an early stage, as it tends to progress, accruing additional morbidity and increasing mortality rates. Once a clinical suspicion is raised, screening tests involve timed measurement of urine, serum or salivary cortisol at baseline or after administration of dexamethasone, 1 mg. Each test has caveats, so that the choice of tests must be individualized for each patient. Once the diagnosis is established, and the cause is determined, surgical resection of abnormal tumor/tissue is the optimal treatment. When this cannot be achieved, medical treatment (or bilateral adrenalectomy) must be used to normalize cortisol production. Recent updates in screening for and treating Cushing's syndrome are reviewed here.
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Affiliation(s)
- Lynnette K Nieman
- Diabetes, Endocrine and Obesity Branch, The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, 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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