Review on dietary supplements as an effective improvement of Alzheimer's disease:focus on structures and mechanisms

Alzheimer’s disease(AD),the major form of neurodegenerative diseases that can severely impede normal cognitive function,makes it one of the most common fatal diseases.There are currently over 50 million AD patients worldwide.The neuropathology of AD is perplexing and there is a scarcity of disease-modifying treatments.Currently,early diagnosis of AD has been made possible with the discovery of biological markers associated with pathology,providing strong support for the improvement of the disease status.The search for inhibitors of AD markers from dietary supplements(DSs)has become a major hot topic.Especially with the widespread use of DSs,DSs containing polyphenols,alkaloids,terpenes,polysaccharides and other bioactive components can prevent AD by reducing Aβdeposition,inhibiting tau protein hyperphosphorylation,reconstructing synaptic dysfunction,weakening cholinesterase activity,regulating mitochondrial oxidative stress,neuronal inflammation and apoptosis.This review summarizes the anti-AD effects of the main DSs and their bioactive constituents,as well as the potential molecular mechanisms covers from 2017 to 2023.Additionally,we discussed the opportunities and challenges faced by DSs in the process of AD prevention and treatment,aiming to further provide new perspectives for functional food development.

Severe liver injury due to herbal and dietary supplements and the role of liver transplantation

Herbal and dietary supplements(HDS)are increasingly used worldwide for numerous,mainly unproven health benefits.The HDS industry is poorly regulated compared to prescription medicines and most products are easily obtainable.Drug induced liver injury(DILI)is a well-recognized entity associated with prescription and over the counter medications and many reports have emerged of potential HDS-related DILI.There is considerable geographic variability in the risk and severity of DILI associated with HDS but the presentation of severe liver injury is similar with a hepatocellular pattern accompanied by jaundice.This type of injury can lead to acute liver failure and the need for liver transplantation.Patients will often fail to mention their use of HDS,considering it natural and therefore harmless.Hence physicians should understand that these products can be associated with DILI and explicitly ask about HDS use in any patient with otherwise unexplained acute liver injury.

Dietary supplements and pediatric non-alcoholic fatty liver disease: Present and the future

Non-alcoholic fatty liver disease(NAFLD) is the most common chronic liver disease in children.High prevalence of pediatric obesity and sedentary lifestyle has augmented the incidence of NAFLD in children.Obesity is associated with an increased risk of NAFLD through various mechanisms such as intensification of insulin resistance and increased levels of inflammatory markers.There is no approved medical intervention for treatment of pediatric NAFLD;the only proven strategy in management of pediatric NAFLD is lifestyle modification.Recently,the effects of nutritional supplements have been examined in the management of pediatric NAFLD.The purpose of this review is to summarize the studies evaluating the effects of nutritional supplements on pediatric NAFLD and explain the future direction in this field.

Dangerous dietary supplements: Garcinia cambogia-associated hepatic failure requiring transplantation

Commercial dietary supplements are marketed as a panacea for the morbidly obese seeking sustainable weight-loss. Unfortunately, many claims cited by supplements are unsupported and inadequately regulated. Most concerning, how ever, are the associated harmful side effects, often unrecognized by consumers. Garcinia cambogia extract and Garcinia cambogia containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we report the first known case of fulminant hepatic failure associated with this dietary supplement. One active ingredient in this supplement is hydroxycitric acid, an active ingredient also found in weight-loss supplements banned by the Food and Drug Administration in 2009 for hepatotoxicity. Heightened awareness of the dangers of dietary supplements such as Garcinia cambogia is imperative to prevent hepatoxicity and potential fulminant hepatic failure in additional patients.

Effects of dietary high dose DHA omega-3 supplement in dry eye with meibomian gland dysfunction

AIM:To evaluate the clinical efficacy of dietary supplement of high dose DHA omega-3 in dry eye with meibomian gland dysfunction(MGD).METHODS:Prospective randomized double-masked,placebo-controlled clinical trial was conducted in mild to moderate dry eye patients with MGD.Patients have no history of taking any dietary omega-3 supplements before 3 mo.Patients were divided into two groups:24 patients in the omega-3 group and 26 patients in the placebo group.The omega-3 group received two capsules of Easyeye Dry?,total containing 600 mg of EPA and 1640 mg of DHA,while the placebo group received two capsules containing 3000 mg of olive oil.All patients take two pills once a day.The examination of MGD scores,tear break-up time(TBUT),corneal staining test(NEI),strip meniscometry(SM tube),and ocular surface disease index(OSDI)scores were performed at baseline,after 4 and 8 wk.RESULTS:A total of 50 patients were included.There were no differences in baseline characteristics between the two groups,such as age,sex,and other ocular examination findings.The TBUT,NEI,and OSDI scores significantly improved after 4 and 8 wk in both groups.While after 8 wk TBUT(6.00±1.62 s vs 5.08±1.28 s,P=0.034)and MGD score(7.2±1.8 vs 8.1±2.6,P=0.033)in the omega-3 group was more significantly improved than that of the placebo group.CONCLUSION:Dry eye with the MGD patient,a high dose of DHA omega-3 dietary supplement can improve TBUT and MGD score after 8 wk,effective in stabilizing the tear film.

Recent advances in dietary supplementation, in treating non-alcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is currently known as the most common liver problem, characterized by excessive lipid accumulation in hepatocytes,which may progress to other liver diseases such as nonalcoholic steatohepatitis, hepatic tissue fibrosis, livercirrhosis, and failure or hepatocellular carcinoma. Since NAFLD is positively associated with the development of obesity, insulin resistance, and ultimately type 2 diabetes mellitus, it is often regarded as the hepatic manifestation of the metabolic syndrome. No pharmacologic treatment has yet been proven for this disease. For most patients with presumed or confirmed NAFLD, the only proven strategy is to offer lifestyle advice that can lead to sustained weight loss. Since insulin resistance, oxidative stress, inflammation, and necro-apoptosis are involved in NAFLD pathogenesis, it seems that every potential therapeutic agent should target one or some of these pathologic events. There are many well known anti-oxidants, anti-inflammatory, and insulin sensitizer dietary supplements which have shown beneficial effects on NAFLD improvement in animal and human studies. The purpose of this review is to explore the existing evidences on dietary supplements considered to have hepatoprotective properties, and to present some proposed mechanisms by which they may protect against NAFLD.

Dietary supplementation in patients with alcoholic liver disease: a review on current evidence

BACKGROUND：Alcoholic liver disease（ALD）is one of the main causes of liver disease worldwide.Although the pathogenesis of ALD has not yet been well elucidated,the oxidative metabolites of ethanol such as acetaldehyde and reactive oxygen species play a pivotal role in the clinical and pathological spectrum of the disease.This review summarizes the existing evidences on dietary supplements considered to have antioxidant,and/or anti-inflammatory properties,and their role in the management of ALD and the proposed mechanisms.DATA SOURCES：The present study reviewed all studies published in Pub Med,Science Direct and Scopus,from 1959 to2015,indicating the role of different dietary supplementation in attenuation of many pathophysiological processes involved in development and progression of ALD.Full-texts of citations were used except for those that were published in languages other than English.RESULTS：Significant progress has been made to understand the key events and molecular players for the onset and progression of ALD from both experimental and clinical studies;however,there is no successful treatment currently available.The present review discussed the role of a variety of dietary supplements（e.g.vitamin A,carotenoids,vitamins B3,C and E,in addition to antioxidants and anti-inflammatory agents）in treating ALD.It has been shown that supplementation with some carotenoids,vitamin B3,vitamin C,silymarin,curcumin,probiotics,zinc,S-adenosylmethionine and garlic may havepotential beneficial effects in animal models of ALD;however,the number of clinical studies is very limited.In addition,supplementation should be accompanied with alcohol cessation.CONCLUSIONS：Since oxidative stress and inflammation are involved in the pathogenesis of ALD,dietary supplements that can modulate these pathologies could be useful in the treatment of ALD.In addition to alcohol cessation,these supplements have shown beneficial effects on animal models of ALD.Clinical trials are needed to validate the beneficiary role of these supplements in patients with ALD.

Effect of a novel dietary supplement on pH levels of healthy volunteers:a pilot study

OBJECTIVE： To examine the effects of a greens alkalizing dietary supplement on urinary pH levels in individuals with lower-than-average pH levels. METHODS： The present study investigated the effects of an alkalizing formula （Reserveage Wholeganic GreensTM） on four individuals who had average urinary pH levels below 6.0 for three consecutive days. Following the three-day, baseline period, participants received Reserveage Wholeganic GreensTM for four consecutive days and were instructed to continue to measure their urine pH levels. Paired samples t-tests were used to examine pH levels before and after a four-day treatment period with Reserveage Wholeganic GreensTM. RESULTS： Compared to baseline, mean urine pH levels in all volunteers were significantly higher following the supplementation with Reserveage Wholeganic GreensTM （5.89 ±0.20 vs 5.56 ± 0.23; P〈0.01）. Participants＇ pH levels were also significantly higher than baseline on days 5, 6, and 7 of the treatment period （P 〈 0.05）. Noteworthy, on day 7, participants＇ mean pH levels were significantly higher than at the beginning of the treatment period （6.03 ± 0.15 at day 7 vs 5.65 ± 0.24 at day 4; P 〈 0.01）. CONCLUSION： The findings of this study suggest that supplementation with Reserveage Wholeganic GreensTM has an alkalizing effect on the body and can increase the urine pH levels in individuals with lower-than-average pH levels.

Detection of illegally added drugs in dietary supplements by near-infrared spectral imaging

The application to detect ilally added drugs in dietary supplerments by near-infrared spectral imaging was studied with the focus on nifedipine,diclofenac and metformin.The method is based on near-infrared spectral images correlation cofficient to detect ilally added drugs.The results comply 100%with HPLC methods test results with no false positive results.

Antioxidant Property of a Dietary Supplement of Moringa oleifera Leaves and Pleurotus ostreatus in Wistar Rats Subjected to Forced Swimming Endurance Test

The antioxidant property of Moringa oleifera leaves and Pleurotus ostreatus on swimming performance and related biochemical parameters were investigated in thirty adult male and female wistar rats. Purpose: The aim of the present study was to evaluate the antioxidant property of M. oleifera and P. ostreatus mixture in specific proportions in wistar rats. Material and Methods: The mushroom species and M. oleifera leaves were cultivated at the biotechnology laboratory of the University Cheikh Anta Diop de Dakar, Senegal. Oxidative stress in rats was induced by swimming. The dietary supplement was composed of a mixture of powders of Moringa oleifera and Pleurotus ostreatus in 2:1 ratio. Three groups received different doses of dietary supplements 500 mg/kg, 1000 mg/kg, and 1500 mg/kg, with one group being the stressed and the other the control group. Parameters in serum such as serum glutamyl oxaloacetate transaminase, serum glutamyl pyruvate transaminase, albumin, Testosterone, creatinine, and, oxidative stress parameters (catalase, reduced glutathione, and malondialdehyde) were measured. Results: Results showed that the dietary supplement has an effect on oxidative stress because it increases the activity of catalase and the level of cellular glutathione in rats. The 500 mg/kg dose would be the most appropriate dose for stressful conditions. The 1000 mg/kg dose would be the most appropriate dose for liver damage. Conclusion: This study shows that the antioxidant properties of M. oleifera leaves and Pleurotus ostreatus are demonstrated by their ability to improve body energy stores and tissue antioxidant capacity. The dietary supplement of M. oleifera leaves and P. ostreatus powders mixture could be good in stressful conditions.

FDA Approves First Dietary Supplement under New Drug Application with the Indication of Serious or Life-Threatening Illnesses

Background: Research began on botanical/herbal organisms to study plant cells. The idea behind this was that plant cells have basic similar actions as do animal cells (i.e., both are Eukaryotic cells). These cells can show what activity is produced from the Technology/Innovation behind ImunStem, without risk to animals or humans, and still retrieve data to verify the theory. By using plants and studying plant cell activity, then later comparing plant cell, animal cells, and human cell responses, it thus shows activity for all cell structures. The activity was also studied from patients taking ImunStem for the indication of Serious or Life-threatening conditions or diseases. Patient medical report results showed an overall improvement in bodily function as blood report results were compared. Patients that were administered ImunStem showed improvement in their overall health and patients with chronic disease had reduced pain as ImunStem was administered over time. The pain was reduced because the body was in the healing process and a reduction in inflammation would occur during healing and the patient’s health would improve. ImunStem was produced based on the theory that the product could rejuvenate the cell and bring the cell back to a homeostasis balance. This balance to the cell (through nutrition) can give the surrounding cells a homeostasis balance that may heal cells and tissues in the body. It is believed that the function of a Quantum Wave effect is explained through the discipline of Quantum Mechanics. The Quantum Wave may disrupt the subatomic particles that provide adhesion to allow the product through the cell wall and move to its target location. In Quantum Mechanics, particles have wavelike properties. The Schrödinger equation, for example, governs how these waves behave. Methods: Administration of ImunStem was given to patients in a life-threatening situation where no standard acceptable treatment was available and in which there was not sufficient time to obtain approval from the Institutional Review Board. Results: ImunStem showed positive medical results for patients with Serious or Life-threatening conditions or diseases, which prompted the US Food and Drug Administration (FDA) to move forward so patients could be provided treatment that was not otherwise available to them from their physicians/doctors. ImunStem was applied for and received its New Drug Application (NDA) No.: 204701 with the indication of Serious or Life-threatening conditions or diseases and National Drug Code (NDC) No.: 70642-001-01 on July 02, 2018. Golden Sunrise submitted an NDA application on January 07, 2013, November 05, 2018, and April 03, 2020 with a request for FDA Fast Track designation, Breakthrough Therapy designation, Accelerated Approval designation, and Priority Review program process are the pathway allowing the ImunStem product to receive acceptance by the FDA.

Pigmentation Restored in Mutant Laboratory Strain of the Lady Beetle Coleomegilla maculata through Dietary Supplementation

A laboratory colony of Coleomegilla maculata (DeGeer), ye, selected for a pigmentation deficiency, was restored to near wild type cuticle coloration by adding crushed heads and wings of the red colored parental strain to the diet. While the wings and other colored portions of the cuticle re-gained the red color, the eyes of the pigmentation deficient insects were not changed from the pale mutant form. Plant derived carotenes lycopene and beta-carotene did not restore the mutant beetles to a visibly distinguishable red color. An additional pigmentation deficient mutant strain, gold, partially recovered red cuticle color when provided with diet containing pigmented insect particles. This work represents the first rescue of a color phenotype in a lady beetle.

Self-reported dietary supplement use in deployed United States service members pre-deployment vs.during deployment,Afghanistan,2013-2014

Background: Dietary supplement use(protein/amino acids, weight-loss supplements, performance enhancers) is common among U.S. military members. Reported dietary supplement use in deployed troops is limited and is of concern in settings where troops are exposed to high ambient temperatures, increased physical demands, and dehydration. Our objective was to describe dietary supplement use and adverse events(AEs) among deployed U.S. service members compared with their pre-deployment use.Methods: We conducted an institutional review board(IRB) approved, descriptive study in Afghanistan using a written questionnaire and collected demographic information, dietary supplement use before and during deployment, AEs associated with supplement use, and physical workout routines. Participants were U.S. military personnel of all branches of service deployed to Afghanistan. They were recruited in high-traffic areas in the combat theater. We analyzed the data with descriptive statistics. Paired t-test/Wilcoxon signed-rank test was conducted to examine the before/during deployment changes for continuous data, and Mc Nemar's chi-square test was conducted for categorical data. We constructed separate logistic regression models to determine the best predictors of increases or decreases in dietary supplement use, with demographic information, reasons for using supplements, and education requested/received as covariates in each model. All statistical tests were two-sided at a significance level of 5%(P<0.05).Results: Data were collected on 1685 participants. Ninety-seven of the participants were in the Army or Air Force. The participants were more likely to work out daily or more than once a day during deployment. Thirty-five percent of the participants reported no supplement use before or during deployment. The remaining 65% of participants reported increased use and increased frequency of use of supplements(e.g., daily) during deployment compared with predeployment. Additionally, more people followed label instructions strictly during deployment vs. predeployment. Overall, the frequency of self-reported AEs among supplement users remained consistent before and during deployment. The only significant difference noted was in problems falling or staying asleep, which increased during deployment. In the adjusted logistic regression models, the level of formal education, military branch, occupational specialty, education about dietary supplements, and certain reasons for using supplements(to boost energy, lose weight, gain muscle strength and mass, and as a meal replacement) were significant predictors of changes in supplement use.Conclusion: Deployed U.S. service members were more likely to use dietary supplements, use more than one supplement and use supplements more frequently during deployment than pre-deployment. No serious AEs were reported, but problems falling or staying asleep increased during deployment.

A Dietary Supplement with a High Eicosapentaenoic Acid to Docosahexaenoic Acid Ratio Reduces Triglyceride Levels in Mildly Hypertriglyceridemic Subjects

There is compelling evidence that omega-3 long-chain polyunsaturated fatty acids (n-3 PUFA), eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3) provide cardioprotective benefits. This open-label study evaluated whether an omega-3 fatty acid dietary supplement with a high EPA to DHA ratio (2.3:1) reduces triglyceride (TG) levels in mildly hypertriglyceridemic subjects. Twenty subjects, with a mean baseline TG level of 321.7 ± 108.7 mg/dL, were administered 4 g/day of Ocean BlueProfessional Omega-3 2100TM (OB) supplements. Each gram of OB contains the ethyl esters of EPA (675 mg) and DHA (300 mg). Baseline and end of study blood values were collected to assess changes in fasting levels of TG, total cholesterol (TC), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C). Supplementation was provided for 30 to 228 days (mean = 106 ± 50 days). Mean age at enrollment was 50.3 ± 6.3 years. Compared with baseline values, mean TG levels decreased by 48% (p = 0.001). There were no changes in TC and HDL-C levels (p = NS);however, subjects had a significant increase in LDL-C levels (16.4%, p = 0.05). Results indicated that a high ratio of EPA to DHA (>2:1) had a statistically significant TG-lowering effect in mildly hypertriglyceridemic subjects. The lipid effects of OB are compared with those published in the literature for n-3 drugs indicated for hypertriglyceridemia (very high TG levels, > 500 mg/dL).

Impact of dietary supplementation of one-carbon metabolism on neural recovery

In the cell,one-carbon metabolism modulates nucleotide synthesis,DNA repair,as well as methylation through the reduction of homocysteine（Figure 1）.High levels of plasma homocysteine have been associated with negative health outcomes in humans（Murray et al.,2017）.Folates,B-vitamins,are a major component of one-carbon metabolism and play an important role in brain function.Specifically,they are involved in nucleotide synthesis,DNA repair,methylation,second messenger systems,ion channels,protein,

Antiamylase Potential of Telfairia occidentalis Leaves from Cameroon and Effect of Their Dietary Supplementation on Fasting Blood Glucose in Wistar Rats

The study of edible plants, especially in developing countries, might provide more affordable means for the management of diabetes. Telfairia occidentalis is one of the plants whose leaves are commonly consumed in Cameroon. This work hereby studied the antiamylasic potential of its aqueous leaves extract and the effect of its dietary supplementation on fasting blood glucose in Wistar rats. An aqueous extract (1:6) was prepared from shed-dried T. occidentalis leaves by maceration. Its antiamylase activity was evaluated in vitro and a phytochemical screening was realized. Its acute toxicity and its effect on an oral glucose tolerance test (OGTT) were evaluated in rats. The effect of T. occidentalis leaves dietary supplementation (10%) on fasting blood glucose was studied for 28 days in rats fed with carbohydrate enriched diet, using Glibenclamide (0.3 mg/kg body weight) as reference hypoglycemic drug. Results showed that there was total inhibition of α-amylase activity in vitro by T. occidentalis aqueous leaves extract at 0.075 mg/ml. The presence of tannins, flavonoids and anthocyanins was revealed by the phytochemical screening. No sign of toxicity was observed in rats after an oral administration of the extract at 2000 mg/kg body weight. The extract significantly hindered a rise in blood glucose at 400 mg/kg body weight during an oral glucose tolerance test. Dietary supplementation with T. occidentalis leaves caused a significant decrease (p < 0.05) in fasting blood glucose as compared to the positive control. Telfairia occidentalis leaves and their aqueous extract could be used in the management of hyperglycemia and diabetes.

Clinical Observations on the Effects of a Dietary Supplement (GI Regenerate^TM) on Patients’ Gastrointestinal Symptoms and Quality of Life Assessments

Background: Different treatments have been developed and used to control symptoms and improve quality of life in patients with digestive diseases and disorders. Although the use of drugs or alternative approaches has improved symptom severity in some but not all patients, often these improvements were not sustainable. Objectives: An open label clinical study was initiated to determine if oral capsules containing a dietary supplement of herbs and oils (GI RegenerateTM) could reduce self-reported gastrointestinal symptoms and improve quality of life (QOL) indicators in patients with gastrointestinal conditions. Methods: Participants included 50 patients (40 females and 10 males) of mean age of 51.1 ± 12.7 years (range, 24 - 77 years) with a diagnosis of a gastrointestinal disorder or gastrointestinal symptoms. These patients consumed five soft-gels containing the test supplement 30 minutes before each meal for 90 days. Symptoms were evaluated by medical staff, and patient health status was self-reported using a validated quality of life questionnaire (Quality of Life Digestive Survey) designed for functional digestive disorders. Exit interviews (Patient Global Impression of Change, PGIC) were conducted by the medical staff. Results: Participants in the study responded with improved symptom severities and QOL scores to the test dietary supplement within the 90 day period;most improvements occurred within 20 days on the test dietary supplement. By the end of the study there were significant overall global improvements in the symptoms and QOL health surveys (p = 0.0183), with significant improvements in symptom discomfort (p = 0.0004), daily activities (p = 0.029) and anxiety (p = 0.018). In contrast, there were insignificant improvements in diet (p = 0.398), sleep (p = 0.136), health perception (p = 0.686), coping with the disease (p = 0.309) and impact of stress (p = 0.785). Using the PGIC exit interview that measured each patient’s impression of overall global change in symptoms and QOL these data also indicated overall significant improvements in symptoms and in satisfaction with the test supplement (moderately better improvements in symptoms and QOL or score of 4.8 ± 0.169, p 50 years) versus younger (Conclusions: The GI RegenerateTM natural dietary supplement safely and significantly reduced gastrointestinal symptoms and improved quality of life in subjects with a broad spectrum of gastrointestinal disorders and symptoms.

Beyond Nutrition Recommendations: What Healthcare Professionals Should Know about Dietary Supplements to Best Serve Their Patients

Although whole food nutrition will likely influence physical health more than any other lifestyle component besides exercise, the use of dietary supplements among men and women continues to be high. Due to this fact, it is imperative that healthcare professionals understand how supplements may impact overall health and wellness of their patients. With the majority of adults taking some form of dietary supplements and many concomitantly taking prescription medications, healthcare providers should be conscientious of adverse effects and interactions that may occur between dietary supplements and prescription drugs. As many consumers are misled by false marketing, healthcare providers should encourage them to be wary of exaggerated claims and direct them to products that are scientifically supported and safe. Continuing education for healthcare providers on dietary supplements is crucial, with new dietary supplement products constantly reaching the markets, in addition to new findings being made through clinical research and case studies. While some dietary supplements provide no meaningful benefit, many dietary supplements have been identified that can be used to ameliorate nutritional deficiencies and reduce the risk of some common health conditions. Others can serve to improve mental and physical performance, while truly enhancing health. This article presents relevant information on dietary supplements that will be useful to the healthcare professional.

Drug and herbal/dietary supplements-induced liver injury:A tertiary care center experience

BACKGROUND Drug-induced liver injury(DILI)and herbal/dietary supplements(HDS)related liver injury present unique diagnostic challenges.Collaboration between the clinician and the pathologist is required for an accurate diagnosis and management.AIM To report our experience on the clinical-pathological findings of hepatic injury caused by drugs/HDS.METHODS A retrospective review of clinically proven cases of DILI/HDS who presented to our institution from January 1,2013 to December 31,2017 was performed.Slides were reviewed for histopathological patterns of injury and correlated with the causative agent.Out of 600 patients presenting with unexplained rise in liver enzymes undergoing biopsy,107 were suspected to have DILI/HDS.Of these,53 had a directly linked exposure to drug/herbal supplements.Fifteen patients were excluded for concurrent known liver disease.Thirty-eight patients with clinically proven DILI/HDS were finally included.RESULTS Thirty-eight cases of DILI/HDS with a male:female of 1:1.5 and mean age of 51±3 years were identified.DILI was identified in 84.2%cases while HDS injury in 15.8%.Acute hepatitis(42.1%)was the most common pattern of injury while granulomatous hepatitis(2.6%)was the least common.We found one case of acute-cholestasis due to rivaroxaban and two cases of cholestatic-hepatitis due to rizatriptan and trimethobenzamide-hydrochloride that,to the best of our knowledge,have not been previously reported.One case of steatohepatitis due to trimethoprim-sulfamethoxazole and three unusual cases of cholestatic-hepatitis with bile duct injury and steatosis due to dronedarone,C4-Extreme and hydroxycut,were also seen.Of our cohort,81.6%of the patients fared well with discontinuation of drug and 18.4%underwent transplant;of which 42.9%were deceased.CONCLUSION We describe the clinical findings,histopathological patterns of injury and clinical outcomes caused by drugs.In particular,we report a few previously unreported/rarely observed clinical and histopathological patterns of hepatic injury.

Anxiety-Inducing Dietary Supplements: A Review of Herbs and Other Supplements with Anxiogenic Properties

Anxiety disorders comprise the most common group of mental disorders to affect the general population in the United States. These disorders are heterogeneous in nature, highly comorbid with one another, and pose a degree of difficulty regarding diagnosis and management. The exact etiology and pathophysiology of anxiety remains to be elucidated;however, it is likely that it is multifactorial, and all potential causes of anxiety must be investigated, including substance-induced anxiety. Among substances that may induce anxiety are dietary supplements. As utilization of these products appears to be high in the US population, it is important to identify which of available supplements may cause anxiety. Objective: To review the scientific literature to identify dietary supplements associated with induction of anxiety and related symptoms. Methods: A search of Natural Medicines Comprehensive Database, MedlinePlus Herbs and Supplements, and Natural Standard was performed to identify dietary supplements with anxiogenic properties. Dietary supplements were included based on product availability, utilization trends, and if there was sufficient evidence that the substance could elicit anxiety via direct pharmacologic effects. Agents were excluded from the review if anxiety was solely due to withdrawal from the substance or only occurred in the setting of intoxication. A search of MEDLINE and PUBMED was performed to identify relevant peer reviewed publications concerning induction of anxiety and/or its associated symptoms by those dietary supplements chosen for review. Conclusions: Dietary supplements can contribute to and cause anxiety and its related symptoms via overstimulation of the Central Nervous System. Healthcare professionals should screen all patients presenting with symptoms consistent with anxiety for recent or current use of all products capable of inducing anxiety, including dietary supplements.