Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review.

BACKGROUND AND AIMS: The use of herbs and dietary supplements (HDS) alone or concomitantly with medications can potentially increase the risk of adverse events experienced by the patients. This review aims to evaluate the documented HDS-drug interactions and contraindications. METHODS: A structured literature review was conducted on PubMed, EMBASE, Cochrane Library, tertiary literature and Internet. RESULTS: While 85 primary literatures, six books and two web sites were reviewed for a total of 1,491 unique pairs of HDS-drug interactions, 213 HDS entities and 509 medications were involved. HDS products containing St. John's Wort, magnesium, calcium, iron, ginkgo had the greatest number of documented interactions with medications. Warfarin, insulin, aspirin, digoxin, and ticlopidine had the greatest number of reported interactions with HDS. Medications affecting the central nervous system or cardiovascular system had more documented interactions with HDS. Of the 882 HDS-drug interactions being described its mechanism and severity, 42.3% were due to altered pharmacokinetics and 240 were described as major interactions. Of the 152 identified HDS contraindications, the most frequent involved gastrointestinal (16.4%), neurological (14.5%), and renal/genitourinary diseases (12.5%). Flaxseed, echinacea, and yohimbe had the largest number of documented contraindications. CONCLUSIONS: Although HDS-drug interactions and contraindications primarily concerned a relatively small subset of commonly used medications and HDS entities, this review provides the summary to identify patients, HDS products, and medications that are more susceptible to HDS-drug interactions and contraindications. The findings would facilitate the health-care professionals to communicate these documented interactions and contraindications to their patients and/or caregivers thereby preventing serious adverse events and improving desired therapeutic outcomes.

Kimura's disease mimicking an earlobe keloid.

Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown aetiology. It usually presents as soft-tissue masses predominantly in the head or neck region. We report a case of an asymptomatic tumour on the left earlobe mimicking a keloid. The tumour was histopathologically diagnosed as KD. This case suggests the importance of conducting skin biopsies of keloidal lesions on head and neck regions, particularly in patients who have peripheral eosinophilia and increased IgE levels.

Comparison of Liver Function, Emotional Status, and Quality of Life of Living Liver Donors in Taiwan.

BACKGROUND: Living donor liver transplantation may put the donor at risk of physical and psychological impacts. Recovery of physical and psychological function as well as quality of life (QOL) in living liver donors warrants investigation. OBJECTIVES: This study aims to examine the recovery of liver function, emotional status, and QOL in living liver donors through a comparison with the general population and reference values. METHODS: This descriptive, comparative study included 97 living liver donors who underwent surgery from 2008 to 2012 and were divided into 4 groups according to their postoperative period (1 year [n = 31], 2 years [n = 31], 3 years [n = 21], and 4 years above [n = 14]). Data were collected retrospectively in a medical center in northern Taiwan. RESULTS: The mean aspartate aminotransferase level was 20.2-32.1 U/L, the mean alanine aminotransferase level was 14.7-33.5 U/L, and the mean total bilirubin level was 10.8-15.5 µmol/L among the 4 groups. Among donors of the 4 groups, 23.8%-51.6% and 0%-29% were defined as having a mild level of anxiety and depression, respectively. Donors in the 1- and 2-year groups had poorer QOL in the physical function, role physical, vitality, and mental health domains than did the general population of Taiwan (P < .05). CONCLUSIONS: Liver function was at normal levels in all 4 groups. The emotional and psychological function of living liver donors should be monitored and health-related QOL should be promoted during the first and second year after liver donation.

The graded effect of hyperhomocysteinemia on the severity and extent of coronary atherosclerosis.

It is not clear to what extent methylenetetrahydrofolate reductase (MTHFR) gene and hyperhomocysteinemia effect the severity and extent of coronary atherosclerosis in Asian populations. We examined the MTHFR genotypes and plasma homocysteine (HCY) concentrations in 192 Taiwanese and investigated their relationship with coronary artery disease (CAD), and the severity and extent of coronary atherosclerosis. The distribution of MTHFR genotypes was similar in 116 CAD patients and 76 non-CAD subjects. Homozygosity was noted in 8% of CAD patients and 13% of non-CAD subjects (P=0.33; 95% CI, 0. 2-1.6). The geometric mean of HCY values was higher in CAD patients (11.10+/-1.51 micromol/l) than in non-CAD subjects (9.21+/-1.55 micromol/l) (P=0.003). HCY levels were higher in patients with multi-vessel disease (P<0.05) or in patients with > or = 90% stenotic lesions (P=0.005), compared with non-CAD subjects. The CAD risks in the top two HCY quartiles (> or = 14.0 and 10.1-13.9 micromol/l) were 4.0 (95% CI, 1.7-9.2) and 3.2 (95% CI, 1.4-7.4) times higher than in the lowest quartile (< or = 7.9 micromol/l) (P=0.001 and 0.007, respectively). Linear regression analysis showed significant correlations between HCY concentrations and the severity and extent of atherosclerosis (P=0.0001 for both). In conclusion, hyperhomocysteinemia appears to have a graded effect on the risk of CAD as well as the severity and extent of coronary atherosclerosis. Our findings do not support the homozygous genotype of MTHFR as a genetic risk factor for CAD in this Taiwanese population. Perhaps a further study including assessment of vitamin status is needed to better clarify the relationship between MTHFR genotypes and CAD.

Twenty-four-hour intragastric acidity in duodenal ulcer patients during dosing with placebo, and 150 mg ranitidine twice or four times daily.

Twenty-four-hour intragastric acidity was measured in 10 patients with a past history of duodenal ulcer on the fourth day of dosing with placebo, and either 150 mg ranitidine given twice or four times daily. The order of the treatments was randomized and a double-blind design was employed. Ranitidine (150 mg) b.d. decreased median integrated 24-h intragastric acidity by 65.1%, nocturnal acidity by 89.1%, and daytime acidity by 54.6% (all P less than 0.01 compared to placebo). The corresponding decreases with 150 mg ranitidine q.d.s. were 62.3, 89.9 and 48.8%, respectively (all P less than 0.01) compared to placebo). There were no significant differences between the two dosage regimens of ranitidine (P greater than 0.05). This study shows that giving extra doses of 150 mg ranitidine during the day does not increase the degree of suppression of intragastric acidity.

Esomeprazole 20 mg on-demand is more acceptable to patients than continuous lansoprazole 15 mg in the long-term maintenance of endoscopy-negative gastro-oesophageal reflux patients: the COMMAND Study.

BACKGROUND: Symptom relief, through adherence to appropriate maintenance therapy, is the sole objective of treatment for patients with endoscopy-negative gastro-oesophageal reflux disease. AIM: To compare the efficacy of 'on-demand' treatment with esomeprazole 20 mg vs. continuous treatment with lansoprazole 15 mg daily in patients with endoscopy-negative gastro-oesophageal reflux disease. METHODS: Endoscopy-negative gastro-oesophageal reflux disease patients who achieved complete resolution of heartburn after short-term (2-4 weeks) treatment with esomeprazole 20 mg (n = 774) were randomized to receive either esomeprazole 20 mg on-demand (n =311) or lansoprazole 15 mg continuous daily treatment (n = 311) for 6 months. RESULTS: Significantly more patients were willing to continue taking esomeprazole on-demand than lansoprazole continuous therapy after 6 months (93% vs. 88%; P = 0.02). This superior outcome was achieved despite patients on esomeprazole requiring medication only 38% as often as those on lansoprazole, leading to direct cost savings of more than one-third (36%). Furthermore, patients receiving esomeprazole 20 mg on-demand were more satisfied with their treatment after 1 month compared with patients taking lansoprazole 15 mg continuously. CONCLUSIONS: In patients with endoscopy-negative gastro-oesophageal reflux disease, esomeprazole 20 mg on-demand is more acceptable to patients and is an economically more effective treatment than lansoprazole 15 mg continuously.

The production of neuraminidase and fucosidase by Helicobacter pylori: their possible relationship to pathogenicity.

The pathogenicity of enterobacteria often correlates with their production of neuraminidase (sialidase). Forty-nine Helicobacter pylori isolates have therefore been examined for their production of neuraminidase and other glycosidases. All 49 isolates produced considerable neuraminidase (median 228 IU/microg protein, interquartile range 121-370), pH optimum 7.5. Nine of the 49 also produced fucosidase (median 23 IU/microg protein, interquartile range 12-39), pH optimum 7.0. Production of these enzymes did not correlate with bacterial Cag A expression or duodenal ulceration. Neutrophils exposed to neuraminidase show increased adherence to endothelium so the neuraminidase production by H. pylori could partly explain the predominant neutrophil inflammatory infiltrate seen in H. pylori-associated gastritis. Inhibition of this enzyme by use of neuraminidase-inhibitors could be a useful therapeutic approach.

Vasculitic small bowel perforation masquerading as spontaneous bacterial peritonitis in a patient with decompensated liver disease.

We report on a young patient with decompensated alcohol-induced liver disease (Child-Pugh score C) who presented with clinical, biochemical and radiological evidence suggestive of spontaneous bacterial peritonitis. She was however subsequently found to have multiple small bowel perforations, which were diagnosed only at laparotomy. The histology of the bowel showed evidence of vasculitis. This case illustrates two important points. Firstly, even if a patient has all the prerequisites to develop spontaneous bacterial peritonitis, a secondary cause of peritonitis (eg. bowel perforation or intra-abdominal abscess) must always be considered as a differential diagnosis and a repeat ascitic tap is mandatory after 48 h of antibiotic therapy to confirm a decrease in the white cell count. Secondly, it shows the rare co-existence of alcoholic liver disease and vasculitis.

Reaction of cyclohexylamine with hypochlorite and enhancement of oxidation of plasma sulfhydryl groups by hypochlorite in vitro.

In this study we investigated the reaction of cyclamate and its major metabolite, cyclohexylamine (CyhNH2), with NaOCl. NaOCl at 100 microM was allowed to react with various concentrations of cyclamate and CyhNH2, and the reactivity was compared with those of reduced glutathione (GSH) and ascorbic acid. The results showed that CyhNH2 was less reactive with NaOCl than GSH but was slightly more reactive than ascorbic acid at concentrations below 50 microM. CyhNH2 at 75 and 100 microM did not further decrease NaOCl. Cyclamate was much less reactive than CyhNH2, with only 43% loss in NaOCl at 100 microM cyclamate. When human blood plasma was incubated with 0.75 microM NaOCl, inclusion of CyhNH2 enhanced oxidation of sulfhydryl groups in a concentration-dependent manner, with complete oxidation of SH groups at 7.5 mM CyhNH2. Cyclamate had no effect. This enhancement by CyhNH2 suggests the formation of reactive products from the reaction of CyhNH2 with NaOCl. Absorption spectra demonstrated that reaction of CyhNH2 with NaOCl at pH 7.4 produced N-monochloramine, as evidenced by the appearance of a new peak at 245 nm and by the disappearance of the 292-nm peak of NaOCl. Cyclamate, which contains a sulfamic acid instead of a primary amine, also reacted with NaOCl at pH 7.4, but the reaction was much less pronounced and the product was probably not monochloramine since the peak was at 270 nm rather than at 245 nm. Because cyclamate is an important sweetener in many countries for people with diabetes mellitus, the possibility exists that CyhNH2 may enhance oxidation of important proteins by HOCl/OCl-.

On the optimal design of fuzzy neural networks with robust learning for function approximation.

A novel robust learning algorithm for optimizing fuzzy neural networks is proposed to address two important issues: how to reduce the outlier effects and how to optimize fuzzy neural networks, in the function approximation. This algorithm is able to reduce the outlier effects by cooperating with a conventional robust approach, and then to optimize fuzzy neural networks by determining the optimal learning rates which can minimize the next-step mean error at each iteration of our algorithm.

Scottish women medical pioneers: Manchuria 1894-1912.

In Edwardian Britain, less than 2% of all registered medical practitioners were women. Yet during that era, women played a significant role in providing medical care and education in what were lonely, harrowing and difficult conditions in the Third World. This is the story of how a group of Scottish women doctors brought Western medicine to a remote region of Manchuria between 1894 and 1912.

Probable Crohn's colitis mimicking ischaemic colitis in a young adult.

The features on barium enema of ischaemic colitis is characteristic and the radiological sign of "thumb printing" thought to be almost pathognomonic of the condition. We report a case of inflammatory bowel disease, probably Crohn's disease mimicking these radiological features. This has not to our knowledge been previously documented.

Treatment of anterior crossbite with bilateral posterior crossbite in early mixed dentition: a case report.

A case report of a 7-year-old boy who had Class III skeletal pattern is presented. The maxilla was deficient in anteroposterior and transverse dimensions, causing a slightly concave profile, a crossbite relationship of most of the anterior and posterior teeth, and upper anterior crowding. The rapid palatal expansion therapy effectively uprighted the posterior segments and developed the arches. Alignment, leveling and development of a good functional occlusion was accomplished with the .022" x .028" standard edgewise appliance.

Cephalometric studies of children with long and short faces.

The purpose of this study was to investigate the facial morphologic characteristics in children with long and short faces. Lateral cephalometric radiographs of 46 children with long faces and 42 children with short faces were used. Both boys and girls with long faces exhibited upright incisors, excessive upper dentoalveolar development, shorter posterior face height, shorter ramus height and mandibular body, greater gonial angle and backward rotation of mandible when compared with those with short faces.

Morphological characteristics of the deciduous teeth.

The morphology of the deciduous teeth was investigated. The mean mesiodistal crown dimensions of the deciduous canine, first and second molars and the mean buccolingual crown dimensions of the deciduous second molars in both dental arches of boys were significantly larger than that of girls. The upper deciduous first molar of girls was slender buccolingually and the lower deciduous second molar of boys was slender mesiodistally.

Localization of first permanent molars in lateral cephalometric and panoramic radiographs from early mixed dentition to early permanent dentition.

Changes in position and mesiodistal angulations of maxillary and mandibular first permanent molars from early mixed dentition to early permanent dentition were measured on panoramic radiographs and compared with the values measured on lateral cephalometric radiographs. It was found that the maxillary and mandibular first permanent molars were uprighted gradually, drifted mesially and vertically, and that the changes in mesiodistal angulations were clearly on the panoramic radiographs in comparison with the cephalometric radiographs.

Eruption process of upper permanent canine.

The purpose of this study was to investigate normal eruptive pattern of upper permanent canine. One hundred and fifty-one panoramic radiographs were used. Inclination of upper canine and lateral incisor, length and horizontal and vertical positions of cusp and root apex of the canine were evaluated. The canine erupted with increasing distal inclination and with no significant changes of the lateral incisor. Developmental changes of the canines relative to palatal plane and midline were shown by figures.

Developmental changes of mandibular permanent canines and premolars in early mixed dentition.

This study investigated the developmental changes of mandibular permanent canines and premolars in early mixed dentition using panoramic radiographs. Positions of cusps and root apices of the teeth relative to the inferior border of mandible were evaluated. The developmental stages of the teeth were divided into three stages. There were few changes in the inclination of the three teeth. The permanent canine began to erupt before stage 2 and the second premolar began to erupt after stage 2. The distance between the inferior border of the mandible and apices of the three teeth was almost fixed in early mixed dentition.

[Factors that affect alignment of upper permanent lateral incisors in early mixed dentition].

The purpose of the present study was to find the factors that affect the alignment of the upper permanent lateral incisors in early mixed dentition. The materials, consisting of dental casts and lateral cephalograms which were taken from 30 children (15 males and 15 females) who had normal occlusion in deciduous dentition and normal permanent central incisor relationship, were divided into three groups, according to the bilateral symmetry alignment of the upper permanent lateral incisors (Group A: Normal alignment, Group B: Linguoversion, Group C: Mesiolinguotorsiversion). The principal component analysis was carried out to clarify the characteristics among the multi-variates, which are upper incisor shape, dental arch form, craniofacial morphology and amount of dento-craniofacial development, in Groups A, B and C. The results obtained were as follows: Group A shows a tendency to be harmonious in upper permanent incisor shape, dental arch form, craniofacial morphology and dento-craniofacial development. Group B shows a tendency to have a larger labio-lingual width of the upper permanent incisors, less anterior arch length development and less forward movement of the upper permanent lateral incisor in the maxilla before eruption. Group C shows a tendency to have a larger mesio-distal width of the upper permanent incisors, less anterior arch width development, longer distance between the upper permanent lateral incisor edge and the nasal floor and more forward and descent movement of the upper permanent lateral incisor in the maxilla before eruption.