Methods for the induction of labor: efficacy and safety.

This review assessed the efficacy and safety of pharmacologic agents (prostaglandins, oxytocin, mifepristone, hyaluronidase, and nitric oxide donors) and mechanical methods (single- and double-balloon catheters, laminaria, membrane stripping, and amniotomy) and those generally considered under the rubric of complementary medicine (castor oil, nipple stimulation, sexual intercourse, herbal medicine, and acupuncture). A substantial body of published reports, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PGE1) when used for cervical ripening and labor induction. Misoprostol administered vaginally at doses of 50 µg has the highest probability of achieving vaginal delivery within 24 hours. Regardless of dosing, route, and schedule of administration, when used for cervical ripening and labor induction, prostaglandin E2 seems to have similar efficacy in decreasing cesarean delivery rates. Globally, although oxytocin represents the most widely used pharmacologic agent for labor induction, its effectiveness is highly dependent on parity and cervical status. Oxytocin is more effective than expectant management in inducing labor, and the efficacy of oxytocin is enhanced when combined with amniotomy. However, prostaglandins administered vaginally or intracervically are more effective in inducing labor than oxytocin. A single 200-mg oral tablet of mifepristone seems to represent the lowest effective dose for cervical ripening. The bulk of the literature assessing relaxin suggests this agent has limited benefit when used for this indication. Although intracervical injection of hyaluronidase may cause cervical ripening, the need for intracervical administration has limited the use of this agent. Concerning the vaginal administration of nitric oxide donors, including isosorbide mononitrate, isosorbide, nitroglycerin, and sodium nitroprusside, the higher incidence of side effects with these agents has limited their use. A synthetic hygroscopic cervical dilator has been found to be effective for preinduction cervical ripening. Although a pharmacologic agent may be administered after the use of the synthetic hygroscopic dilator, in an attempt to reduce the interval to vaginal delivery, concomitant use of mechanical and pharmacologic methods is being explored. Combining the use of a single-balloon catheter with dinoprostone, misoprostol, or oxytocin enhances the efficacy of these pharmacologic agents in cervical ripening and labor induction. The efficacy of single- and double-balloon catheters in cervical ripening and labor induction seems similar. To date, the combination of misoprostol with an intracervical catheter seems to be the best approach when balancing delivery times with safety. Although complementary methods are occasionally used by patients, given the lack of data documenting their efficacy and safety, these methods are rarely used in hospital settings.

Highly selective and sensitive molecularly imprinted sensors for the electrochemical assay of quercetin in methanol extracts of Rubus sanctus and Fragaria vesca.

Quercetin (QUE) is a powerful antioxidant and one of the common phenolic compounds found in plants, vegetables, and fruits, which has shown many pharmacological activities. The complex nature of the matrix in which QUE is found and its importance and potential uses in diverse applications force the researchers to develop selective and sensitive sensors. In the present work, a novel molecularly imprinted polymer (MIP)-based electrochemical sensor was fabricated for the selective and sensitive determination of the QUE in plant extracts and food supplements. Tryptophan methacrylate (TrpMA) was chosen as the functional monomer, whereas the photopolymerization (PP) method was applied using a glassy carbon electrode (GCE). Electrochemical and morphological characterizations of the developed sensor (TrpMA@QUE/MIP-GCE) were performed using cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), and scanning electron microscopy (SEM). The linear range of the developed sensor was determined to be in the range of 1.0-25 pM, while the limit of detection (LOD) was calculated to be 0.235 pM. In conclusion, The TrpMA@QUE/MIP-GCE sensor might be classified as a promising platform for selective and sensitive determination of QUE not only in plant extracts but also in commercial food supplements because of its reliability, reproducibility, repeatability, stability, and fast response time.

Saudi Healthcare Students' General Practices Applied to Protect Against COVID-19 and Their Beliefs Regarding the Use of Herbal Supplements as a Protection Method.

BACKGROUND: At the beginning of the COVID-19 pandemic, the absence of treatment increased the Saudi population's inquietude regarding the virus. Therefore, people were seeking alternative methods to protect themselves from disease's fast transmission, such as hand hygiene, social isolation, and the use of natural and dietary products. AIM: The main objective of this study is to assess healthcare students' general practices applied to protect against COVID-19 and their beliefs regarding the use of herbal supplements as a protection method. METHODOLOGY: All undergraduate healthcare students were eligible to participate, except pre-professional students. The estimated sample size was 371, which was calculated using Raosoft® software (Raosoft Inc., Seattle, WA). A cross-sectional online survey was distributed among the targeted population. The data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and transferred to be analyzed by JMP software (SAS Institute Inc., Cary, NC). RESULTS: A total of 441 healthcare students, who met the inclusion criteria, participated in this study. About 81.41% of the participants reported that they were completely committed to Saudi guidelines regarding preventive measures against COVID-19 transmission. Most of the participants were not using herbal supplements, while 17.1% of them used herbal products or dietary supplements during the COVID-19 pandemic. The participants who used herbal and dietary products commonly consumed ginger and vitamins C and D. In addition, a chi-square showed significant differences in gender and specialties regarding the usage of herbal supplements as a protective method against COVID-19 (P<0.05). CONCLUSION: The findings of our study exhibit the general practice of herbal products during the COVID-19 pandemic among Saudi healthcare students was low in comparison with their beliefs. In addition, the using of herbal supplements should be evidence-based to guarantee safe consumption.

Integrative Medicine for Cancer-Related Pain: A Narrative Review.

Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an "Integrative Oncology" (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations.

DNA barcoding of herbal supplements on the US commercial market associated with the purported treatment of COVID-19.

INTRODUCTION: The COVID-19 pandemic was associated with an increased global use of traditional medicines, including Ayurvedic herbal preparations. Due to their growing demand, their processed nature, and the complexity of the global supply chain, there is an increased risk of adulteration in these products. OBJECTIVES: The objective of this study was to assess the use of DNA barcoding for species identification in herbal supplements on the US market associated with the Ayurvedic treatment of respiratory symptoms. METHODS: A total of 54 commercial products containing Ayurvedic herbs were tested with four DNA barcoding regions (i.e., rbcL, matK, ITS2, and mini-ITS2) using two composite samples per product. Nine categories of herbs were targeted: amla, ashwagandha, cinnamon, ginger, guduchi, tribulus, tulsi, turmeric, and vacha. RESULTS: At least one species was identified in 64.8% of products and the expected species was detected in 38.9% of products. Undeclared plant species, including other Ayurvedic herbs, rice, and pepper, were detected in 19 products, and fungal species were identified in 12 products. The presence of undeclared plant species may be a result of intentional substitution or contamination during harvest or processing, while fungal DNA was likely associated with the plant material or the growing environment. The greatest sequencing success (42.6-46.3%) was obtained with the matK and rbcL primers. CONCLUSION: The results of this study indicate that a combination of genetic loci should be used for DNA barcoding of herbal supplements. Due to the limitations of DNA barcoding in identification of these products, future research should incorporate chemical characterization techniques.

Herbal Supplement Use Among Adolescent and Young Adult Women in a Family Planning Clinic.

STUDY OBJECTIVE: We aimed to evaluate herbal medicine and supplement use patterns among adolescent and young adult women at a clinic focused on family planning. METHODS: We conducted a cross-sectional survey of patients (age 14-25) at an adolescent Title X clinic. Participants completed an electronic survey that assessed herbal medicine and supplement use, baseline demographic characteristics, and current contraceptive method. We evaluated supplement-drug interactions using the Natural Medicines database Interaction Checker. Quantitative analyses were performed using χ2 and independent medians tests. RESULTS: We enrolled 99 participants with a median age of 20 (15-24) years. Overall, 42.4% of patients reported ever having used supplements or herbal medicines, with 29.9% of patients reporting current supplement or herbal medicine use. Patients with higher education and private insurance were more likely to report a history of and current supplement use (P < .05). The most common herbal supplements reported were green tea (n = 26), cannabidiol (n = 17), and cranberry (n = 16), with 29.6% of participants reporting use to their general health care provider. The most common reasons for use were general health and wellness (29.1%), immune support (23.2%), stress (16.8%), and menstrual irregularities (6.0%). We found 62 moderate risk supplement-drug interactions, with 50 interactions attributed to hormonal contraceptive therapies. The most common interactions were via cytochrome P450 enzyme (CYP3A4 or CYP1A2) inhibition, decreased caffeine clearance, and potential hepatotoxicity. CONCLUSION: Adolescent and young adult women frequently reported past and current herbal medicine and supplement use, with high rates of moderate-risk supplement-drug interactions. Further research is needed to better elucidate these clinically relevant supplement-contraception interactions.

Dietary and herbal supplement consumer health information for pain: A cross-sectional survey and quality assessment of online content.

Background: Patients are increasingly utilizing the internet to learn about dietary and herbal supplements (DHSs) for various diseases/conditions, including pain management. Online health information has been found to be inconsistent and of poor quality in prior studies, which may have detrimental effects on patient health. This study assessed the quality of online DHSs consumer health information for pain. Methods: Six search items related to DHSs and pain were used to generate the first 20 websites on Google across four English-speaking countries. The identified 480 webpages produced 68 eligible websites, which were then evaluated using the DISCERN tool. The mean scores and standard deviations (SD) of the reviewers' ratings on each of the 15 DISCERN instrument items as well as the overall total score were calculated. Results: The mean summed score for the 68 eligible websites was 46.6 (SD = 10.1), and the mean overall rating was 3.3 (SD = 0.8). Websites lacked information regarding areas of uncertainty, the effects of no treatment being used, and how treatments affect the overall quality of life. These shortcomings were especially apparent across commercial websites, which frequently displayed bias, failed to report the risks of DHS products, and lacked support for shared decision-making regarding the use of DHSs. Conclusion: Variability exists in the quality of online consumer health information regarding DHS use for pain. Healthcare providers should be aware of and provide guidance to patients regarding the identification of reliable online resources so that they can make informed decisions about DHS use for pain management.

Ischemic Colitis in a Young Female Following Herbal Supplement Ingestion.

Ischemic colitis is typically considered a disease of the elderly, given their atherosclerotic risk factors and other comorbidities. Ischemic colitis in the younger population is considered very uncommon. We present an interesting case of a young female presenting with abdominal pain and hematochezia found to have ischemic colitis on pathological biopsy results after a colonoscopy. She was an otherwise healthy female with no medical problems prior to her hospitalization but endorsed recent use of a bitter herbal tea to relieve her symptoms. Here, we review potential causes of ischemic colitis, including herbal remedies, which have been linked to causing hypercoagulable and hypotensive states.

Occurrence and associated health risks of pyrrolizidine alkaloids in supplements marketed in Ghana for improved sexual performance.

Pyrrolizidine alkaloids (PAs) are noted for their hepatotoxic, genotoxic, and carcinogenic effects in animals and humans following metabolic activation in the liver. In this study, herbal supplements sold in Ghana for sexual improvement were analysed for the presence of 64 PAs using LC-MS/MS analysis. Up to 17 different PAs were identified in 19 out of the 37 samples analysed. The sum of PAs in samples ranged from 5 to 3204 µg kg-1. Since the PA content in the herbal medicinal preparations was generally lower than in honey samples, their presence was mainly attributed to cross-contamination. The observed levels would result in estimated daily intakes from 0.01 to 12 µg per day or 0.0002 to 0.2 µg kg-1 bw day-1 for a person weighing 70 kg. The margins of exposure ranged from 1200 to 1,400,000 with eight samples showing values below 10,000, thus indicating a health concern.

Association of Drinking Herbal Tea with Activities of Daily Living among Elderly: A Latent Class Analysis.

The aim of this study was to explore whether drinking herbal tea and tea would positively benefit activities of daily living (ADL) in the elderly. We used data from the Chinese longitudinal healthy longevity survey (CLHLS) to explore the association. Drinking herbal tea and drinking tea were divided into three groups using latent class analysis (LCA): frequently, occasionally, and rarely. ADL disability was measured by the ADL score. Multivariate COX proportional hazards models with competing risks were used to explore the impact of drinking herbal tea and tea on ADL disability, statistically adjusted for a range of potential confounders. A total of 7441 participants (mean age 81.8 years) were included in this study. The proportions of frequently and occasionally drinking herbal tea were 12.0% and 25.7%, respectively. Additionally, 29.6% and 28.2% of participants reported drinking tea, respectively. Multivariate COX regression showed that compared with rarely drinking, frequently drinking herbal tea could effectively reduce the incidence of ADL disability (HR = 0.85, 95% CI = 0.77-0.93, p = 0.005), whereas tea drinking had a relatively weaker effect (HR = 0.92, 95% CI = 0.83-0.99, p = 0.040). Subgroup analysis found that frequently drinking herbal tea was more protective for males under 80 years old (HR = 0.74 and 0.79, respectively), while frequently drinking tea was somewhat protective for women (HR = 0.92). The results indicate that drinking herbal tea and tea may be associated with a lower incidence of ADL disability. However, the risks associated with using Chinese herb plants still deserve attention.

Pharmacist and Student Knowledge and Perceptions of Herbal Supplements and Natural Products.

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires-one focusing on pharmacists and the other focusing on pharmacy students-were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area.

Knowledge and attitudes towards herbal and dietary products use during the COVID-19 pandemic.

Background and aim: The outbreak of coronavirus (COVID-19) has made a global public health disaster. Little information is known about how to combat this infection. Therefore, preventive health measures that can reduce the severity and progression of this disease are needed. Some dietary supplements and herbal products have antiviral and anti-inflammatory effects. Thus, it may be used to enhance immunity and reduce the risk of COVID-19 infection. In this study, we reviewed selected supplements that may play a key role in the prevention and management of COVID-19 (e.g. vitamin D, vitamin C, and zinc), and that was to determine the level of knowledge and attitudes toward them by the adult population in Jordan. Methodology: This is a cross-sectional study design, in which an online questionnaire was conducted and distributed on different social media websites. People who are above 18 years old were included in this study. Demographic, Attitudes, and knowledge data were collected and then analyzed using the Statistical Package for Social Sciences (SPSS 23). Results: In this study, (62.8%) of participants became more concerned with their health during the COVID-19 pandemic, and (49.2%) of them used dietary and herbal supplements to protect themselves from the coronavirus. In addition, (18.5%) of participants reported that they had used these supplements for a while and then stopped. Conclusion: The findings of our study provided evidence that the general population in Jordan has a reasonable level of knowledge and acceptance of dietary and herbal supplements used during the COVID-19 pandemic.

Adaptogens on Depression-Related Outcomes: A Systematic Integrative Review and Rationale of Synergism with Physical Activity.

Depression is considered the most important disorder affecting mental health. The aim of this systematic integrative review was: (i) to describe the effects of supplementation with adaptogens on variables related to depression in adults; and (ii) to discuss the potential combination with physical exercise to aid planning and commissioning future clinical research. An integrative review was developed complementing the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PROSPERO registration: CRD42021249682). A total of 41 articles met the inclusion criteria. With a Price index of 46.4%, we found that: (i) Hypericum perforatum (St. John's Wort) is the most studied and supported adaptogen (17/41 [41.46%], three systematic reviews with meta-analysis) followed by Crocus sativus L. or saffron (6/41 [14.63%], three systematic reviews with meta-analysis and two systematic reviews); (ii) it is possible that the significantly better performance of adaptogens over placebo is due to the reduction of allostatic load via the action of secondary metabolites on BDNF regulation; and, (iii) the number of studies reporting physical activity levels is limited or null for those that combine an exercise program with the consumption of adaptogens. Aware of the need for a multidisciplinary approach for depression treatment, this systematic integrative review provides an up-to-date view for supporting the use of St. John's Wort and saffron as non-pharmacological strategies while also help commissioning future research on the efficacy of other adaptogens. It also contributes to the design of future clinical research studies that evaluate the consumption of herbal extracts plus physical exercise, mainly resistance training, as a potentially safe and powerful strategy to treat depression.

A Case of Acute Liver Failure Due to Artemisinin-Derived Herbal Supplements.

A 49-year-old female presented with malaise, nausea, vomiting, and discolored urine. She was found to have an acute liver failure with labs significant for aspartate aminotransferase (AST) of 2164, alanine aminotransferase (ALT) of 2425, alkaline phosphatase (ALP) of 106, total bilirubin of 3.6, and lactate dehydrogenase (LDH) of 2269. The international normalized ratio (INR) was also elevated at 1.9. All workup for acute liver failure was negative and it was found that she had started taking a new supplement called "Gut Health", which contained artemisinin, for weight loss and menopausal symptoms. After discontinuing the supplements and symptomatically treating her for acute liver failure, her transaminitis resolved.

Herbal Supplement Use for Evidence-Based Indications in US Adults: An Analysis of National Survey Data.

Objective: Understanding the changes in consumer use of herbal products and what has influenced these changes is key in the promotion of evidence informed use. The last analysis of evidence informed herbal supplement use involved the 2002 National Health Interview Survey (NHIS) analysis. This study reproduces and expands upon that earlier analysis, with the most recent NHIS dataset to report herb use patterns. It also explores the guiding resources consulted by consumers in their decision to use. Methods: Secondary analysis of cross-sectional data from the NHIS identified the 10 herbal supplements with the most reported use in 2012. The reasons reported by the NHIS for taking herbal supplements were compared with the 2019 Natural Medicines Comprehensive Database (NMCD) to determine whether reasons cited in consumption were supported by evidence. Logistic regression models were fit according to NHIS sampling weights to examine the relationship between evidence-based use and user characteristics, guiding resources, and health care professional engagement surrounding use. Results: Of the 181 reported uses of herb supplements for a specific health condition, 62.5% were for reasons supported by evidence-based indications (EBIs). The odds of herb use consistent with evidence significantly increased for those reporting higher education status (odds ratio [OR] = 3.01, 95% confidence interval [CI] [1.70-5.34]). Herbal supplement use consistent with EBIs was more likely among those who disclosed their herb use to a health care professional (OR = 1.77, 95% CI [1.26-2.49]). Evidence-based herb use was also less frequently informed by Media sources (OR = 0.43, 95% CI [0.28-0.66]) compared with non-EBI use. Conclusion: Approximately 62% of the reasons cited for taking the most consumed herbs in 2012 were in alignment with 2019 EBIs. This increase may be due to improved awareness of health care professionals and/or an increase of evidence for traditional uses of herbal products. Future research should explore the role of each of these stakeholders in improving evidence-based herb use in the general population.

Herbal supplements as treatment options for COVID-19: A call for clinical development of herbal supplements for emerging and re-emerging viral threats in Sub-Saharan Africa.

The advent of Corona virus Disease 2019 (COVID-19) distorted health systems of many countries. Efforts have been made to either develop new treatment solutions such as vaccines or repurpose previously adopted drugs. Challenges in accessing available treatment, inadequate, non-existent, or overstretched healthcare facilities, long COVID disease, cultural practices and beliefs about vaccination, vaccine hesitancy, availability, accessibility and perceived safety of herbal supplements seem to be major factors propelling individuals to use herbal supplements. Published reports advocating for clinical development of herbal supplements for COVID-19 and other emerging and re-emerging viral diseases are sparse. This paper aims to review the pathogenesis of COVID-19, use of herbal products during the pandemic and make case for clinical development of herbal supplements through the adoption of modern and acceptable technologies and research processes. This was a scoping review. Database searches of Google Scholar, PubMed and ResearchGate among others were performed using related keywords to identify relevant journals and lists of primary articles. Clinical trial databases:-Clinicaltrial.gov, Pan African Clinical Trial Registry (PACTR) and WHO international clinical trial registry (ICTRP) were reviewed to extract data. The use of herbal supplements during COVID-19 was not only peculiar to individuals living in Sub-Saharan Africa, but a global practice. Herbal supplements recommended to manage COVID-19 have not been validated using clinical trials. Available data showed that the number of herbal supplements undergoing clinical trial for COVID-19 indication in Africa was low. The availability of medicinal plants in Sub-Saharan Africa if well explored has great potentials to address various emerging and re-emerging viral diseases confronting the region. The economic potential of clinically validated herbal supplements are huge, and tapping into this opportunity created by preference of population to herbal supplement could increase export of herbal supplement and gross domestic product (GDP) of respective countries in Africa.

A review on Impact of dietary interventions, drugs, and traditional herbal supplements on the gut microbiome.

The gut microbiome is the community of healthy, and infectious organisms in the gut and its interaction in the host gut intestine (GI) environment. The balance of microbial richness with beneficial microbes is very important to perform healthy body functions like digesting food, controlling metabolism, and precise immune function. Alternately, this microbial dysbiosis occurs due to changes in the physiochemical condition, substrate avidity, and drugs. Moreover, various categories of diet such as "plant-based", "animal-based", "western", "mediterranean", and various drugs (antibiotic and common drugs) also contribute to maintaining microbial flora inside the gut. The imbalance (dysbiosis) in the microbiota of the GI tract can cause several disorders (such as diabetes, obesity, cancer, inflammation, and so on). Recently, the major interest is to use prebiotic, probiotic, postbiotic, and herbal supplements to balance such microbial community in the GI tract. But, there has still a large gap in understanding the microbiome function, and its relation to the host diet, drugs, and herbal supplements to maintain the healthy life of the host. So, the present review is about the updates on the microbiome concerns related to diet, drug, and herbal supplements, and also gives research evidence to improve our daily habits regarding diet, drugs, and herbal supplements. Because our regular dietary plan and traditional herbal supplements can improve our health by balancing the bacteria in our gut.

Herbal supplement use among reproductive-aged women in an academic infertility practice.

Objective: To address the knowledge gap surrounding herbal medicine and supplement usage patterns and supplement-prescription medication interactions among patients seeking treatment for infertility. Design: Cross-sectional survey study. Setting: Academic infertility practice. Patients: Ninety-five reproductive-aged patients. Interventions: Not applicable. Main Outcome Measures: Use of herbal medications and supplements, baseline demographics, history of infertility treatments, and potential supplement-medication interactions. Results: We surveyed 95 participants with a median age of 35 years. Overall, 68.4% of patients reported ever having used supplements or herbal medicines in the past. Current use of herbal supplements and vitamins was reported by 53.7% and 93.7% of participants, respectively, with a median of 2 (range 19) supplements used per person. There were no significant associations between patient demographics, comorbidities, or infertility treatments with increased rates of supplement use. The most commonly used herbal supplements were: green tea (n = 14), chamomile (n = 12), peppermint (n = 9), turmeric (n = 8), elderberry (n = 7), ginger (n = 7), maca (6) with the most common modalities being pills/capsules (23.8%) and tea (42.3%). The most common reasons for use were: general health and wellness (24.5%), immune support (16.2%), stress (14.0%), and fertility (15.0%). Patients used maca (n = 5), chasteberry (n = 3), goji berry (n = 2), ginger (n = 2), yam-based progesterone (n = 2), and combination product (n = 2) for fertility purposes. A total of 7.9% of patients learned about these products from their general health care provider, and 33.3% of supplements were disclosed by patients to their provider. We identified 41 moderate-risk supplement-drug interactions, with 12 of these interactions attributed to infertility therapies. Based on the interaction checker, the most commonly proposed mechanisms of interaction were CYP3A4 and CYP2C19 inhibition. In terms of safety in pregnancy, cannabidiol and chasteberry were suggested to be "possibly unsafe in pregnancy," and red raspberry leaf "likely unsafe in pregnancy" without direct medical supervision. Conclusions: We found over two thirds of women seeking treatment for infertility reported past and over half reported current herbal medicine and supplement use. Notably, the Natural Medicines Interaction Checker suggested high rates of moderate-risk supplement-drug interactions and possible harmful effects in early pregnancy. Our results call for further investigation of clinically relevant supplement interactions with infertility therapies.

Acute liver failure secondary to the use of unmonitored drugs and herbal supplements: an underreported and serious issue.

Acute liver failure (ALF) is a potentially fatal illness marked by the abrupt development of jaundice, coagulopathy, and hepatic encephalopathy (HE) in persons having no previous history of hepatic disease. It is a relatively uncommon illness, having an incidence of 1 to 8 per million people. Hepatitis A, B, and E viruses have been documented as the most prevalent etiologies of acute liver failure in Pakistan and other developing nations. However, ALF may also occur secondary to toxicity caused by the unmonitored overdosing and toxicity of traditional medicines, herbal supplements, and alcohol. Similarly, in some instances, the etiology remains unknown. Herbal products, alternative, and complementary therapies are frequently practiced across the globe for treating various illnesses. In recent times, their use has gained much popularity. Indications and the use of these supplementary drugs vary significantly. The majority of these products have not gained approval from Food and Drug Administration (FDA). Unfortunately, the incidence of documented adverse effects linked to the usage of herbal products has increased recently, but still, these events are underreported, and the condition is known as drug-induced liver injury (DILI) and herb-induced liver injury (HILI). The estimated total herbal retail sales increased from $4230 million in 2000 to $6032 million in 2013, representing a total of 42 and 3.3% per annum increase. To reduce the occurrence of HILI and DILI, physicians in general practice settings should inquire about patients' understanding of potential toxicity with the consumption of hepatotoxic and herbal medicines.

Herbal Supplement-Induced Liver Injury: A Case Report.

We present the case of a 45-year-old woman who arrived at the emergency department complaining of sudden epigastric pain. An inpatient evaluation revealed no evidence of viral or immunologic infection. Additionally, imaging did not elicit a clear cause for the patient's symptoms. Further examination revealed that the patient had recently begun using a herbal tea and that symptoms had completely resolved after discontinuation. Though rare, hepatotoxicity secondary to herbal supplement ingestion, or herbal supplement-induced liver injury, or HILI, should be considered in all patients presenting with abnormal liver function tests.