Study on health hazards through medicines purchased on the Internet: a cross-sectional investigation of the quality of anti-obesity medicines containing crude drugs as active ingredients.

BACKGROUND: Weight-loss medicines, including crude drugs and herbal supplements disguised as diet-aid products, are readily obtainable and distributed widely, especially in Southeast Asia. Even if such products are unapproved or prescription-only medicines, consumers can purchase them through an agency or directly on the Internet. We evaluated the quality and safety of herbal products purchased on the Internet to reveal their influence on public health. METHODS: Diet-aid products containing Bukuryo (Poria sclerotium), Bakumondo (Ophiopogonis tuber), or Daio (rhubarb rhizome) were purchased through websites that did not provide physical addresses or which advertised misleading medicines (e.g., unapproved Cialis 100 mg tablets, Viagra 100 mg tablets) on websites. We carefully noted details in the descriptions on package inserts or accompanying product characteristics and analyzed the ingredients using qualitative and quantitative methods, namely high-performance liquid chromatography equipped with a photodiode array detector. We requested the respective manufacturers to authenticate their products through a structured questionnaire. RESULTS: We purchased 15 items from 15 Internet sites and imported all 15 items to Japan. One item stated to contain rhubarb rhizome was identified as a prescription medicine; the others were dietary supplements and not medicines. Even though we did not analyze the constituents of all crude drugs, we found some active ingredients in the items. Sibutramine was detected in items confirmed to be supplements, including those containing Poria sclerotium and Ophiopogonis tuber. Each capsule contained ≈ 12 mg of sibutramine, which is the daily dose for anti-obesity medicines. Sibutramine is not approved for use in Japan and its sale has been suspended in Europe and the USA owing to serious adverse effects on the circulatory system. CONCLUSIONS: Our findings indicate that dietary supplements containing injurious ingredients are distributed to Japanese consumers and potentially to a broader international audience, and that purchasing them through unreliable websites bears potential health risks. To avoid potential adverse events, there should be adequate alerts about the risks of taking products without appropriate indications.

Antimicrobial therapy for water-associated wound infections in a disaster setting: gram-negative bacilli in an aquatic environment and lessons from Banda Aceh.

INTRODUCTION: As members of the Japan Disaster Relief (JDR) team in Banda Aceh, three of the authors treated 1,891 patients following the tsunami of 2004. Of the 367 cases with traumatic injuries, 216 cases required antimicrobial therapy. The medical services were continued by the Japan Self-Defense (JSD) Medical Team until mid-March 2005. Of the 216 cases initially treated by JDR, 54 required prolonged antimicrobial therapy for persistent symptoms despite repeated debridement. The aim of this study is to recommend an appropriate antimicrobial therapy for water-associated wound infections in the absence of laboratory services in disaster settings following tsunami. METHODS: The JDR and JSD treatment records were analyzed retrospectively. In August 2006, 19 months after the tsunami, the authors investigated pathogens in natural aquatic habitats in the affected area in Banda Aceh. At the same time, interviews with tsunami survivors were performed to determine the influential factors that facilitated wound infections after the tsunami. RESULTS: From the 49 water samples tested, Aeromonas sp., Vibrio sp., Klebsiella sp., and Proteus sp. were isolated from 24, 16, 15, and six samples, respectively. Regardless of the genus, almost all of the isolated gram-negative bacilli were sensitive to ciprofloxacin and gentamicin. CONCLUSIONS: From the microbiological test results and analyses of the medical records and interviews, the researchers recommend the following regimen when clinical microbiological tests are not available: initial treatment with beta"lactam penicillins for three days, followed, if the first antimicrobial is not effective, by ciprofloxacin or any other relevant new quinolones, with the addition of gentamicin if necessary.