ABSTRACT
Hepatotoxicity related to HDS is a growing global health issue. We have undertaken a systematic review of published case reports and case series from LA from 1976 to 2020 to describe the clinical features of HDS related hepatotoxicity in this region. We search in PubMed, Web of Science, Scopus and specific LA databases according to PRISMA guidelines. Only HILI cases published in LA that met criteria for DILI definition were included. Duplicate records or reports that lacked relevant data that precluded establishing causality were excluded. Finally, 17 records (23 cases) were included in this review. Centella asiatica, Carthamus tinctorius, and Herbalife® were the most reported HDS culprit products, the main reason for HDS consumption was weight loss. The clinical characteristics of HDS hepatotoxicity in our study were compared to those of other studies in the USA, Europe and China showing a similar signature with predominance of young females, hepatocellular damage, a high rate of ALF and mortality, more frequent inadvertent re-challenge and chronic damage. This study underscores the challenge in causality assessment when multi-ingredients HDS are taken and the need for consistent publication practice when reporting hepatotoxicity cases due to HDS, to foster HDS liver safety particularly in LA.
Subject(s)
Centella/adverse effects , Chemical and Drug Induced Liver Injury, Chronic/etiology , Dietary Supplements/adverse effects , Herbal Medicine/methods , Adult , Child, Preschool , Data Collection , Female , Humans , Latin America , Male , Middle AgedABSTRACT
O uso de plantas diuréticas e laxativas é uma alternativa medicamentosa para muitas pessoas que objetivam o emagrecimento com menores efeitos adversos. A avaliação microbiológica é um requisito essencial para a garantia de qualidade dos produtos. A finalidade deste trabalho foi avaliar a qualidade microbiológica de cápsulas e chás de alcachofra (Cynara scolymus L.), centella asiática (Hydrocotile asiatica L.), fucus (Fucus vesiculosus L.), e sene (Cassia acutifolia Delile), através da contagem de micro-organismos viáveis totais e pesquisa de patógenos. Na contagem de micro-organismos viáveis, os chás analisados foram aprovados, pois apesar de apresentarem uma carga microbiana elevada, esta se encontrava dentro das especificações, entretanto, 16,66% e 66,66% das cápsulas analisadas foram reprovadas por apresentaram quantidades superiores de bactérias e fungos, respectivamente. Na pesquisa de patógenos, 76% das amostras (88% dos chás e 58% das cápsulas) apresentaram um ou mais de um tipo de micro-organismo. Salmonella sp. esteve presente em 33% das amostras evidenciando a qualidade microbiológica insatisfatória dos produtos encontrados no mercado. Estes resultados demonstram a necessidade da realização do controle de qualidade tanto das matérias-primas vegetais, quanto dos produtos acabados, através do controle e fiscalização rigorosa, com adoção de medidas regulamentadoras e educativas.
The use of laxative and diuretic herbal drugs is an alternative therapy for many people looking for loosing weight with fewer side effects. The microbiological evaluation is an essential requirement for the quality assurance of products. This study aimed to evaluate the microbial quality of artichoke (Cynara scolymus L.), centella (Hydrocotile asiatica L.), fucus (Fucus vesiculosus L.), and Senna (Cassia acutifolia Delile) capsules and teas, by counting the total viable aerobic microorganisms and through tests for specified microorganisms. On the total viable aerobic microorganisms count, the teas analyzed were approved, because although they had a high microbial load, this was in accordance with the specifications, however 16.66% and 66.66% of the capsules analyzed were rejected because they presented higher amounts of bacteria and fungi, respectively. In relation to the tests for specified microorganisms, 76% of the samples (88% of the teas and 58% of the capsules) presented one or more than one type of microorganisms. Salmonella sp. was present in 33% of the samples, showing the unsatisfactory microbial quality of the products in the market. These results demonstrate the necessity of performing quality control both on herbal raw material and finished products, through a rigorous control and inspection, adopting regulatory and educational measures.