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Grazina L, Mafra I, Monaci L, Amaral JS. Mass spectrometry-based approaches to assess the botanical authenticity of dietary supplements. Compr Rev Food Sci Food Saf 2023; 22:3870-3909. [PMID: 37548598 DOI: 10.1111/1541-4337.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
Dietary supplements are legally considered foods despite frequently including medicinal plants as ingredients. Currently, the consumption of herbal dietary supplements, also known as plant food supplements (PFS), is increasing worldwide and some raw botanicals, highly demanded due to their popularity, extensive use, and/or well-established pharmacological effects, have been attaining high prices in the international markets. Therefore, botanical adulteration for profit increase can occur along the whole PFS industry chain, from raw botanicals to plant extracts, until final PFS. Besides the substitution of high-value species, unintentional mislabeling can happen in morphologically similar species. Both cases represent a health risk for consumers, prompting the development of numerous works to access botanical adulterations in PFS. Among different approaches proposed for this purpose, mass spectrometry (MS)-based techniques have often been reported as the most promising, particularly when hyphenated with chromatographic techniques. Thus, this review aims at describing an overview of the developments in this field, focusing on the applications of MS-based techniques to targeted and untargeted analysis to detect botanical adulterations in plant materials, extracts, and PFS.
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Affiliation(s)
- Liliana Grazina
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Isabel Mafra
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Linda Monaci
- ISPA-CNR, Institute of Sciences of Food Production of National Research Council of Italy, Bari, Italy
| | - Joana S Amaral
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Bragança, Portugal
- Laboratório Associado para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, Bragança, Portugal
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2
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Rizzo S, Weesepoel Y, Erasmus S, Sinkeldam J, Piccinelli AL, van Ruth S. A multi-analyte screening method for the rapid detection of illicit adulterants in dietary supplements using a portable SERS analyzer. Heliyon 2023; 9:e18509. [PMID: 37520973 PMCID: PMC10382631 DOI: 10.1016/j.heliyon.2023.e18509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023] Open
Abstract
The popularity and number of dietary supplements on the health market have experienced an unprecedented boost in recent years. Simultaneously, their increased use has been accompanied by an increase in acute intoxication cases linked to the adulteration of these products with illicit and undeclared substances. In this study, a SERS-based screening methodology was developed to rapidly detect illegally added pharmaceutically active substances to dietary supplements. A portable analyzer and silver printed-SERS substrates were used to enhance the signal, requiring less than 20 min of sample preparation prior to the analysis. The method was successful in the qualitative identification of eleven out of twenty-three illicit adulterants in the dietary supplements; it could detect the target compounds at realistic adulteration levels (0.1-5.0% w/w), demonstrating the potential of SERS-based methodologies for forensic rapid screening applications. The developed method is quick, easy to use, requires no skilled technicians and little sample preparation, and allows in-situ analyses. For these reasons, it is suitable for quick screening to be performed by inspectors at customs. Moreover, the low specificity of spectroscopic methods, to which SERS belongs, would benefit the detection of newly synthesized analogues of the target adulterants, which would otherwise be more difficult using common mass spectrometry methods in absence of reference standards.
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Affiliation(s)
- Serena Rizzo
- Wageningen Food Safety Research, Wageningen University and Research, P.O. Box 230, 6700 AE, Wageningen, the Netherlands
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
- PhD Program in Drug Discovery and Development, University of Salerno, Via Giovanni Paolo II 132, Fisciano, SA, 84084, Italy
| | - Yannick Weesepoel
- Wageningen Food Safety Research, Wageningen University and Research, P.O. Box 230, 6700 AE, Wageningen, the Netherlands
| | - Sara Erasmus
- Food Quality and Design Group, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, the Netherlands
| | - Joost Sinkeldam
- Wageningen Food Safety Research, Wageningen University and Research, P.O. Box 230, 6700 AE, Wageningen, the Netherlands
| | - Anna Lisa Piccinelli
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, 84084 Fisciano, Salerno, Italy
| | - Saskia van Ruth
- Wageningen Food Safety Research, Wageningen University and Research, P.O. Box 230, 6700 AE, Wageningen, the Netherlands
- Food Quality and Design Group, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, the Netherlands
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Zhang J, Yu H, Sun J, Shen Y, Ran Y, Mao X, Hu Q, Ji S. Isolation and characterization of a new oxyphenisatin analogue, oxyphenisatin propionate, from a processed plum intended as a weight loss product. J Pharm Biomed Anal 2023; 230:115391. [PMID: 37059035 DOI: 10.1016/j.jpba.2023.115391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/29/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
A new oxyphenisatin analogue was detected from a processed plum claiming to be a weight loss product without any side effects during the daily inspecting and monitoring of illegal adulterants in health supplements. An abundant peak caused our interest firstly owing to its identical fragments of m/z 224 and 196 in the MS/MS experiments with those of oxyphenisatin acetate. The chemical structure of the unknown compound was characterized by ultra-high performance liquid chromatography equipped with diode array detector and quadrupole time-of-flight tandem mass spectrometry (UHPLC-DAD-Q-TOF/MS), followed by nuclear magnetic resonance (NMR) and infrared (IR) spectroscopy experiments. Based on the data, it was defined that the two symmetrical acetyl groups in oxyphenisatin acetate were replaced by two propionyl groups for the unknown structure. Finally, the new oxyphenisatin analogue was identified as 3,3-bis[4'-(propionyloxy)phenyl]-1,3-dihydroindole-2-one and designated as oxyphenisatin propionate. Thereafter, the content of the new analogue was quantitatively determined to be 681 mg/kg, which would inevitably cause adverse health effect because there was not specification for daily consumption of this product. To the best of our knowledge, this is the first report for identification of oxyphenisatin propionate.
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Affiliation(s)
- Jingxian Zhang
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China
| | - Hong Yu
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China
| | - Jian Sun
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China
| | - Yingying Shen
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China
| | - Yingying Ran
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China
| | - Xiuhong Mao
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China
| | - Qing Hu
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China.
| | - Shen Ji
- NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai Institute for Food and Drug Control, 1500 Zhangheng Road, Shanghai 201203, China.
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Thin Layer Chromatographic Method for Detection of Conventional Drug Adulterants in Herbal Products. SEPARATIONS 2022. [DOI: 10.3390/separations10010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Commercially available conventional drugs have been used to adulterate herbal products. Considering the rapid growth of herbal products’ market, it is essential to screen herbal products for the presence of conventional drugs. Simple analytical methods are needed for the rapid screening of conventional drugs that are likely to be adulterated in herbal products. Thin layer chromatography (TLC) methods for screening twelve conventional drugs in herbal products have been developed and applied. The analytes were extracted from herbal products using acetonitrile:methanol:acetic acid:water (4:4:1:1, v/v). Solvent mixture of dichloromethane:ethyl acetate:methanol (75:15:10, v/v) separated well trimethoprim, sildenafil, paracetamol, and sulfamethoxazole while pyrimethamine, metronidazole, and sulfadoxine were well separated by dichloromethane:ethyl acetate:methanol (77.5:12.5:10, v/v). In addition, acetyl salicylic acid, ibuprofen, diclofenac, quinine, and lumefantrine were well separated by ethyl acetate:methanol:30% ammonia (75:22.5:2.5, v/v). Chromatographic separations were found to be highly reproducible, and more than 10 samples can be analysed in one run. The method was applied in the screening of 229 herbal products. Consequently, 24.0% of the samples contained one adulterant, while 21.4% contained at least two adulterants. All conventional drugs detected in herbal products were not mentioned on the labels and therefore the consumers are kept unaware of their side effects and health problems. Further studies for confirming and quantitatively determining the adulterants in a wide range of products as well as a systematic toxicological analysis of the adulterants in herbal products are recommended.
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Dubey SK, Parab S, Achalla VPK, Narwaria A, Sharma S, Jaswanth Gowda BH, Kesharwani P. Microparticulate and nanotechnology mediated drug delivery system for the delivery of herbal extracts. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2022; 33:1531-1554. [PMID: 35404217 DOI: 10.1080/09205063.2022.2065408] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 06/14/2023]
Abstract
There has been a growing interest in the scientific community to explore the complete potential of phytoconstituents, herbal or plant-based ingredients owing to a range of benefits they bring along. The herbal plants accommodate many phytoconstituents that are responsible for various activities such as anti-oxidant, antimicrobial, anticancer, anti-inflammatory, anti-allergic, hepatoprotective, etc. However, these phytoconstituents are highly sensitive to several environmental and physiological factors such as pH, oxygen, heat, temperature, humidity, stomach acid, enzymes, and light. Hence, there is need for the development of a drug delivery system that can protect the phytoconstituents from both internal and external conditions. In this regard, a microparticulate drug delivery system is considered amongst the ideal choice owing to its small size, ability to protect the environment-sensitive active constituents, in achieving sustained drug delivery, targeted drug delivery, protection of the drug from physiological conditions, minimizing drug-related side effects, etc.
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Affiliation(s)
| | - Shraddha Parab
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani, India
| | | | | | - Swapnil Sharma
- Department of Pharmacy, Banasthali Vidyapith, Banasthali, India
| | - B H Jaswanth Gowda
- Department of Pharmaceutics, Yenepoya Pharmacy College & Research Centre, Yenepoya (Deemed to be University), Mangalore, India
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
- University Institute of Pharma Sciences, Chandigarh University, Mohali, India
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Jalil B, Naser AY, M Prieto J, Heinrich M. Herbal supplements in Jordan: a cross-sectional survey of pharmacists' perspectives and knowledge. BMJ Open 2022; 12:e057405. [PMID: 35896285 PMCID: PMC9335029 DOI: 10.1136/bmjopen-2021-057405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Pharmacists are ideal partners for engaging with the needs and expectations of patients. They can play a vital role by providing information and supplying herbal medicines. In some community settings, pharmacists are also the main first point of care. This study explored Jordanian community pharmacists' perspectives and knowledge of herbal medicines available in pharmacies. DESIGN A cross-sectional study using an online survey was developed, and it was distributed via social media platforms. The one-way analysis of variance (ANOVA) test was used to compare the mean knowledge scores between different demographic groups. Multiple linear regression analysis was used to identify predictors of herbal medicines knowledge. SETTING Jordanian community pharmacies. PARTICIPANTS 401 Jordanian community pharmacists. RESULTS Herbal supplements are sold in practically all pharmacies (98.5%). Slimming aids (14.7%), followed by sexual and sports enhancements (14%) and maintaining general health (12.1%) were most requested by Jordanian customers. While supplements for maintaining general health (12%), followed by slimming aids (11.4%) and skin conditions (9.3%) were most recommended by Jordanian pharmacists. 63.1% were not aware of potential herb-drug interactions, 95.6% did not receive complaints from customers about herbal medicines and 41.2% would not report adverse reactions to the national pharmacovigilance services. The mean knowledge score for knowledge of use, regulation, adverse reactions, and drug interactions was 3.7 (SD: 0.7), 3.5 (SD: 0.8), 3.6 (SD: 0.8), and 3.6 (SD: 0.8) (out of 5), respectively. ANOVA test showed that total pharmacists' knowledge scores significantly differed based on the length of time practising pharmacy (p<0.05). CONCLUSION This study highlights some key concerns relating to recommendations, awareness and reporting of herbal medicines among Jordanian community pharmacists. Pharmacists need enhanced education to provide objective and evidence-based information on the benefits-risks of herbal medicines. Future studies need to be carried out to confirm whether our findings are transferable to other Middle Eastern countries.
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Affiliation(s)
- Banaz Jalil
- Pharmacognosy and Phytotherapy, UCL School of Pharmacy, 29 - 39 Brunswick Sq, London, UK
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Isra University, Amman, Jordan
| | - Jose M Prieto
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Michael Heinrich
- Pharmacognosy and Phytotherapy, UCL School of Pharmacy, 29 - 39 Brunswick Sq, London, UK
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Thongkhao K, Tungphatthong C, Sukrong S. A PCR-lateral flow immunochromatographic assay (PCR-LFA) for detecting Aristolochia species, the plants responsible for aristolochic acid nephropathy. Sci Rep 2022; 12:12188. [PMID: 35842504 PMCID: PMC9288547 DOI: 10.1038/s41598-022-16528-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
Aristolochic acids (AAs), which are strong carcinogens, have caused dietary supplements with Aristolochia plants to be discontinued worldwide. Therefore, the development of a method to identify these herbs is critical for customer safety. To support the regulation of Aristolochia-free products, a PCR coupled with lateral flow immunochromatographic assay (PCR-LFA) that is specific to the nucleotide signature in plastid rbcL gene region of Aristolochia species was developed to detect Aristolochia plants and related herbal products. Triplex primers (A397F, C357F and R502) were designed based on specific nucleotides observed exclusively in the rbcL sequences of Aristolochia. Positive results for Aristolochia occur when the three pink lines are clearly developed on the developed lateral flow strip and can be seen by the naked eye. In this study, the lateral flow strip has sensitivity for detecting amplicons amplified from genomic DNA at the concentrations as low as 0.01 ng. Various kinds of samples, including purchased crude drugs and polyherbal samples, have been investigated, and the results showed that Aristolochia crude drugs and Aristolochia-containing products are still present in dispensaries. In conclusion, with the goal of protecting consumers from the health risks associated with Aristolochia contamination, PCR-LFA was developed and demonstrated to be efficient for detecting plants belonging to Aristolochia in various kinds of samples.
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Affiliation(s)
- Kannika Thongkhao
- Center of Excellence in DNA Barcoding of Thai Medicinal Plants, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chayapol Tungphatthong
- Center of Excellence in DNA Barcoding of Thai Medicinal Plants, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Suchada Sukrong
- Center of Excellence in DNA Barcoding of Thai Medicinal Plants, Chulalongkorn University, Bangkok, 10330, Thailand. .,Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, 10330, Thailand.
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Jairoun AA, Al Hemyari SS, Abdulla NM, Shahwan M, Jairoun M, Godman B, El-Dahiyat F, Kurdi A. Development and Validation of a Tool to Improve Community Pharmacists’ Surveillance Role in the Safe Dispensing of Herbal Supplements. Front Pharmacol 2022; 13:916223. [PMID: 35860014 PMCID: PMC9289787 DOI: 10.3389/fphar.2022.916223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background: There has been an appreciable increase in the use of herbal supplements, including immune boosters, during the current COVID-19 pandemic. However, there are concerns with falsified herbal supplements. Objectives: Developed a new questionnaire that can potentially help community pharmacists identify the extent of falsified herbal supplements. Methods: A 9-month cross sectional study was conducted among 500 community pharmacies across United Arab Emirates. A new 5-factor, 24-itmes scale was developed based on current labelling requirements across countries and piloted. This included seven items on identified uses and contraindication, seven items on hazard identification, four items on product identity, three items on packaging and product insert and three items on product handling and storage. The face and content validity of the scale was assessed via the content validity index (CVI). Its construct validity was tested using an exploratory factor analysis (EFA) via principally component analysis (PCA). The model was subsequently confirmed through partial confirmatory factor analysis (PCFA). Its reliability was assessed via test-retest reliability, internal consistency, item internal consistency (IIC), and intraclass correlation coefficients (ICCs). Results: The CVI of the finalized questionnaire was 0.843. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.891, and Bartlett’s test of sphericity indicated significance (p-value < 0.001). Confirmation of the subsequent 5-domains was achieved through PCFA using maximum likelihood analysis with oblimin rotation. The PCFA obtained values was 0.962 for NFI, 0.977 for CFI, and 0.987 for the Tucker Lewis Index. All values were greater than 0.95, and the RMSEA value was 0.03 (i.e., less than 0.06). Consequently, the model had a good fit. All domains demonstrated Cronbach’s alpha coefficients above 0.70, with 0.940 for the full instrument. Meanwhile, all items met the IIC correlation standard of ≥0.40. The instrument presented good ICC statistics of 0.940 (0.928–0.950) as well as statistical significance (p < 0.001). Community pharmacists with more than 10 experience years were more likely to identify falsified herbal supplements compared to those with 1–10 years experience (p < 0.001). Conclusion: This study developed and validated a new instrument to identify safe herbal supplements, which should enhance the role of the community pharmacists in the safe and effective treatment of suitable patients with herbal supplements.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- *Correspondence: Ammar Abdulrahman Jairoun, ; Moyad Shahwan,
| | - Sabaa Saleh Al Hemyari
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Naseem Mohammed Abdulla
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University (HBMSU), Dubai, United Arab Emirates
- Department of Environmental Health Sciences, Canadian University Dubai, Dubai, United Arab Emirates
| | - Moyad Shahwan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- *Correspondence: Ammar Abdulrahman Jairoun, ; Moyad Shahwan,
| | - Maimona Jairoun
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Brian Godman
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako -Makgatho Health Sciences University, Pretoria, South Africa
| | - Faris El-Dahiyat
- Clinical Pharmacy Program, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), University of Strathclyde, Glasgow, United Kingdom
- Center of Research and strategic studies, Lebanese French University, Erbil, Iraq
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
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Establishment of the thin-layer chromatography-surface-enhanced Raman spectroscopy and chemometrics method for simultaneous identification of eleven illegal drugs in anti-rheumatic health food. FOOD BIOSCI 2022. [DOI: 10.1016/j.fbio.2022.101842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Grundmann O, Kumar P, Rogge M. Regulation of Dietary Supplements and Nutraceutical Products in the United States: An Argument for Greater Oversight and Uniform Standards. J Clin Pharmacol 2021; 62:14-16. [PMID: 34648654 DOI: 10.1002/jcph.1982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
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Ajebli M, Eddouks M. Phytotherapy of Hypertension: An Updated Overview. Endocr Metab Immune Disord Drug Targets 2021; 20:812-839. [PMID: 31880255 DOI: 10.2174/1871530320666191227104648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiovascular disorders are the leading cause of morbidity and mortality throughout the globe. Hypertension is the main risk factor that contributes to the development of many diseases. The use of herbal therapies, medicinal plants and their derivatives for the remedy and management of hypertension is well-recognized and popular among a wide part of the world population. METHODS The aim of the current review was to collect, treat, and critically analyze the published research studies relative to experimental and clinical investigations which have studied the blood pressure lowering abilities of medicinal plant derivatives in the last decade. This review was organized into three principal axes; the first axis was attributed to the in vivo and in vitro experimental studies; the second treated the clinical trials; while, the last one is devoted to analyze the mechanisms of action underlying the therapeutic antihypertensive effectiveness of phytochemicals. RESULTS Different types of extracts and isolated molecules obtained from a large variety of species demonstrated their efficiency in improving the increase of blood pressure either experimentally or clinically. Medicinal species such as garlic (Allium sativum), celery (Apium graveolens), Black Cumin (Nigella sativa) and Ginseng (Panax) are among the most common and therapeutically used plant derivatives for controlling hypertension while Asteraceae, Apiaceae and Rosaceae are among the botanical families which were frequently studied in the last decade. Isolated compounds such as allicin and apigenin have received more interest in this field. Recent evidence from clinical trials suggests that a wide variety of herbal preparations and plant extracts or natural isolated compounds have a favorable therapeutic impact on blood flow. Interestingly, phytochemicals can either act directly on blood vessels via a vasorelaxant effect involving a variety of signaling cascades or indirectly through inhibiting or stimulating diversity of systems such as angiotensin-converting enzyme (ACE), renin-angiotensin system (RAS) or the diuretic activity. Hence, based on the findings of the present review medicinal plant derivatives could be used as preventive and curative agents in the case of cardiovascular disorders, particularly hypertension and could play a promoting function for the discovery of new antihypertensive agents. CONCLUSION The analysis of the published data shows that a great effort remains to be done to investigate the medicinal plants cited as antihypertensive through published ethnopharmacological surveys. The analysis of the literature in this field shows the lack of standardization at the level of experimental study methods as well as the need to study purified molecules. Moreover, the mechanistic studies when they exist remain in the whole partial. On the other hand, few advanced clinical studies have been conducted. Finally, the determination of the efficacy/safety ratio remains absent in almost all studies.
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Affiliation(s)
- Mohammed Ajebli
- Department of Biology, Faculty of Sciences and Techniques Errachidia, Team of Endocrine Physiology and Pharmacology, Moulay Ismail University of Meknes, BP 509, Boutalamine 52000, Errachidia, Morocco
| | - Mohamed Eddouks
- Department of Biology, Faculty of Sciences and Techniques Errachidia, Team of Endocrine Physiology and Pharmacology, Moulay Ismail University of Meknes, BP 509, Boutalamine 52000, Errachidia, Morocco
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12
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Mohd Yusop AY, Xiao L, Fu S. Liquid chromatography-high-resolution mass spectrometry analysis of erectile dysfunction drugs and their analogues in food products. Forensic Sci Int 2021; 322:110748. [PMID: 33711768 DOI: 10.1016/j.forsciint.2021.110748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/27/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
The presence of erectile dysfunction (ED) drugs in adulterated dietary supplements, mainly in pharmaceutical dosage forms, is frequently addressed in the literature. Little attention is given to food products despite their increasing adulteration trend. To address this knowledge gap targeted, suspected-target, and non-targeted strategies were utilised to analyse ED drugs and their analogues in powdered drink mix (PDM), honey, jelly, hard candy, and sugar-coated chewing gum using liquid chromatography-high-resolution mass spectrometry (LC-HRMS). The method was optimised and validated using 23 target analytes, representing different ED drugs with structural similarities. The modified quick, easy, cheap, effective, rugged, and safe (QuEChERS) extraction exhibited insignificant matrix effect (ME) within - 9.2-8.8% and provided complete coverage of target analytes with acceptable extraction recovery (RE) within 75.5-123.9%, except for carbodenafil in the PDM matrix. Based on the ME and RE performance, the analytical method was validated to analyse 25 food samples that claimed to enhance male sexual performance. The method exhibited good specificity and linearity with a limit of detection within 10-70 ng/mL and limit of quantification of 80 ng/mL. Similarly, the accuracy and precision were satisfactory within 77.4-122.0% and< 16.7%RSD, respectively. The LC-HRMS targeted analysis, together with suspected-target and non-targeted screenings, identified and detected ten ED drugs from 24 food samples. The modified QuEChERS extraction with LC-HRMS-based method was demonstrated to be universally applicable to various food products, covering an extensive range of known and potentially novel ED drugs, which is valuable for routine casework.
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Affiliation(s)
- Ahmad Yusri Mohd Yusop
- Centre for Forensic Science, University of Technology Sydney, Ultimo, NSW 2007, Australia; Pharmacy Enforcement Division, Ministry of Health, Petaling Jaya, Selangor 46200, Malaysia
| | - Linda Xiao
- Centre for Forensic Science, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Shanlin Fu
- Centre for Forensic Science, University of Technology Sydney, Ultimo, NSW 2007, Australia.
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Ippoliti I, Menniti-Ippolito F, Mazzanti G, Di Giacomo S. Suspected adverse reactions to performance enhancing dietary supplements: Spontaneous reports from the Italian phytovigilance system. Phytother Res 2021; 35:3246-3261. [PMID: 33569860 DOI: 10.1002/ptr.7040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
Herbal tonic and adaptogens are often used to improve overall well-being. However, few clinical evidence supports their use and their safety is not known before marketing. In this context, the aim of our study was to analyze the spontaneous reports of suspected adverse reactions (ARs) to performance enhancing herbal dietary supplements collected by the Italian Phytovigilance System. Between March 2002 and September 2020, 110 spontaneous reports were collected, 58 of which related to products containing botanicals, alone or in association. Twenty-three serious reactions were reported, 21 of which required hospitalization, one was life-threatening and another caused disability. Dermatological and cardiovascular reactions were the most frequent. Hepatic ARs were the most serious (9 out of 10). A positive dechallenge was indicated in 69% of cases, while a positive rechallenge occurred in 15%. Concomitant use of other products was present in 18 reports (31%), while predisposing conditions were indicated in 17 (29%). Present data highlight safety concerns on herbal dietary supplements used as cognitive and physical performance enhancers, mainly due to their quality and use without expert supervision. Considering that postmarketing surveillance is not required for these products, spontaneous reports represent the only tool to point out risks related to food supplements.
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Affiliation(s)
- Ilaria Ippoliti
- National Centre for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | | | - Gabriela Mazzanti
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
| | - Silvia Di Giacomo
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Rome, Italy
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Kumar S, Mittal A, Babu D, Mittal A. Herbal Medicines for Diabetes Management and its Secondary Complications. Curr Diabetes Rev 2021; 17:437-456. [PMID: 33143632 DOI: 10.2174/1573399816666201103143225] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 11/22/2022]
Abstract
Diabetic Mellitus (DM) is a metabolic disorder that is concerning for people all over the world. DM is caused due to lack of insulin or ineffective production of insulin in the pancreas. A total of 463 million people were reported to have diabetes mellitus in 2019 and this number is predicted to rise up to 578 million by the year 2030 and 700 million by 2045. High blood sugar gives rise to many complications like diabetic retinopathy, diabetic nephropathy, atherosclerosis, hypercoagulability, cardiovascular disease, coronary heart disease, abdominal obesity, hypertension, hyperlipidemia, cerebrovascular disease, coronary artery disease, foot damage, skin complications, Alzheimer's disease, hearing impairment, and depression. These life-threatening complications make diabetes more severe than other diseases. Many synthetic drugs have been developed, but still, a complete cure is not provided by any of the molecules. Continuous use of some synthetic agents causes severe side effects, and thus the demand for non-toxic, affordable drugs still persists. Traditional treatments have been an extremely valued source of medicine all over human history. These are extensively used throughout the world, indicating that herbs are a growing part of modern and high-tech medicines. The World Health Organization (WHO) has listed a total of 21,000 plants, which are used for medicinal purposes around the world. Among them, more than 400 plants are available for the treatment of diabetes. Despite the fact that there are many herbal drugs available for treating diabetes, only a small number of these plants have undergone scientific and medical evaluation to assess their efficacy. Trigonella foenum-graecum, Allium sativum, Caesalpinia bonduc, Ferula assafoetida,etc., are some of the medicinal plants used for antidiabetic therapy. The presence of phenolic compounds, flavonoids, terpenoids, and coumarins is responsible for the antidiabetic nature of the medicinal plants. These constituents have shown a reduction in blood glucose levels. Pycnogenol, acarbose, miglitol, and voglibose are some of the examples of marketed drugs, which are obtained from natural origin and used as antidiabetic drugs. The active principles derived from the plants work through many antidiabetic mechanisms, which include inhibition of α-glucosidase, α-amylase, and protein tyrosine phosphatase 1B activities. One of the major advantages of herbal drugs is the low level of side effects attributed to these medicines, and this attracted various researchers to develop new molecules for the treatment of diabetes. In this review, recent advances in the field of herbal drugs to treat diabetes, prevent secondary complications from arising due to diabetes, and various herbal molecules in different stages of clinical trials will be emphasized upon.
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Affiliation(s)
- Shubham Kumar
- Faculty of Pharmaceutical Sciences, PCTE Group of Institutes, Campus-2, Near Baddowal Cantt. Ferozepur Road, Ludhiana-142021, India
| | - Anu Mittal
- Department of Chemistry, Guru Nanak Dev University College, Patti, Distt. Tarn Taran, India
| | - Dinesh Babu
- Faculty of Pharmacy & Pharmaceutical Sciences, Katz Group-Rexall Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Amit Mittal
- Department of Pharmaceutical Chemistry, School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T. Road (NH-1), Phagwara (Punjab) 144411, India
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15
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Abualhasan MN, Nidal jaradat, Hawash M, Khayat R, Khatatbeh E, Ehmidan M, Al-Atrash M. Evaluation of Heavy Metal and Microbial Contamination in Green Tea and Herbal Tea Used for Weight Loss in the Palestinian Market. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:7631562. [PMID: 33299455 PMCID: PMC7707972 DOI: 10.1155/2020/7631562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/25/2020] [Accepted: 10/31/2020] [Indexed: 12/14/2022]
Abstract
The use of green tea and herbal tea for weight loss is increasing worldwide owing to the rising rates of obesity. There are concerns about the safety and quality of these herbal products owing to their increased consumption worldwide. In this study, we evaluated randomly collected samples of green tea and herbal tea and tested them for heavy metal and microbial contamination. Eighteen samples of green tea or herbal tea of widely used brands in Palestine were tested for heavy metal and microbial contamination. The results showed that 7 of the samples had toxic heavy metals such as chromium (Cr) and lead (Pb), and their concentrations were above the allowable limits set by the World Health Organization (WHO). Moreover, 6 of the samples that were tested had microbial contamination with high total aerobic microbial count (TAMC) and total yeast and mold count (TYMC). This could be due to improper handling and storage conditions of these herbal products. This study is the first of its kind in Palestine, and its results are forewarning to all the responsible authorities, including the Ministry of Health (MoH), to take immediate corrective actions such as quality control testing, auditing, and registration of marketed tea products.
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Affiliation(s)
- Murad N. Abualhasan
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, State of Palestine
| | - Nidal jaradat
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, State of Palestine
| | - Mohammed Hawash
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, State of Palestine
| | - Rama Khayat
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, State of Palestine
| | - Eman Khatatbeh
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, State of Palestine
| | - Malak Ehmidan
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, State of Palestine
| | - Munir Al-Atrash
- Jerusalem Pharmaceutical Company, Quality Control Department, Ramallah, State of Palestine
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16
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Wang Z, Cao Y, Lu Y, Zhang F, Su Y, Guo Y. Ultrasonic extraction and nebulization in real-time coupled with carbon fiber ionization mass spectrometry for rapid screening of the synthetic drugs adulterated into herbal products. Anal Chim Acta 2020; 1136:62-71. [DOI: 10.1016/j.aca.2020.08.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
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17
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Cogan PS. Reality and Legality: Disentangling What Is Actual from What Is Tolerated in Comparisons of Hemp Extracts with Pure CBD. J Diet Suppl 2020; 17:527-542. [DOI: 10.1080/19390211.2020.1790710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- P. S. Cogan
- Department of Pharmaceutical Sciences, Regis University School of Pharmacy, Denver, Colorado, USA
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18
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Muschietti L, Redko F, Ulloa J. Adulterants in selected dietary supplements and their detection methods. Drug Test Anal 2020; 12:861-886. [DOI: 10.1002/dta.2806] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Liliana Muschietti
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Farmacognosia, IQUIMEFA (UBA‐CONICET) Buenos Aires Argentina
| | - Flavia Redko
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Farmacognosia, IQUIMEFA (UBA‐CONICET) Buenos Aires Argentina
| | - Jerónimo Ulloa
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Farmacognosia, IQUIMEFA (UBA‐CONICET) Buenos Aires Argentina
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Chemometric Analysis of Low-field 1H NMR Spectra for Unveiling Adulteration of Slimming Dietary Supplements by Pharmaceutical Compounds. Molecules 2020; 25:molecules25051193. [PMID: 32155779 PMCID: PMC7179456 DOI: 10.3390/molecules25051193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/29/2022] Open
Abstract
The recent introduction of compact or low-field (LF) NMR spectrometers that use permanent magnets, giving rise to proton (1H) NMR frequencies between 40 and 80 MHz, have opened up new areas of application. The two main limitations of the technique are its insensitivity and poor spectral resolution. However, this study demonstrates that the chemometric treatment of LF 1H NMR spectral data is suitable for unveiling medicines as adulterants of slimming dietary supplements (DS). To this aim, 66 DS were analyzed with LF 1H NMR after quick and easy sample preparation. A first PLS-DA model built with the LF 1H NMR spectra from forty DS belonging to two classes of weight-loss DS (non-adulterated, and sibutramine or phenolphthalein-adulterated) led to the classification of 13 newly purchased test samples as natural, adulterated or borderline. This classification was further refined when the model was made from the same 40 DS now considered as representing three classes of DS (non-adulterated, sibutramine-adulterated, and phenolphthalein-adulterated). The adulterant (sibutramine or phenolphthalein) was correctly predicted as confirmed by the examination of the 1H NMR spectra. A limitation of the chemometric approach is discussed with the example of two atypical weight-loss DS containing fluoxetine or raspberry ketone.
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Banerjee M, Khursheed R, Yadav AK, Singh SK, Gulati M, Pandey DK, Prabhakar PK, Kumar R, Porwal O, Awasthi A, Kumari Y, Kaur G, Ayinkamiye C, Prashar R, Mankotia D, Pandey NK. A Systematic Review on Synthetic Drugs and Phytopharmaceuticals Used to Manage Diabetes. Curr Diabetes Rev 2020; 16:340-356. [PMID: 31438829 DOI: 10.2174/1573399815666190822165141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/15/2019] [Accepted: 08/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diabetes is a multifactorial disease and a major cause for many microvascular and macrovascular complications. The disease will ultimately lead to high rate mortality if it is not managed properly. Treatment of diabetes without any side effects has always remained a major challenge for health care practitioners. INTRODUCTION The current review discusses the various conventional drugs, herbal drugs, combination therapy and the use of nutraceuticals for the effective management of diabetes mellitus. The biotechnological aspects of various antidiabetic drugs are also discussed. METHODS Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was sorted in terms of various approaches that are used for the treatment of diabetes. RESULTS More than 170 papers including both research and review articles, were included in this review in order to produce a comprehensive and easily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose, mechanism of action and possible side effects. The article also focuses on combination therapies containing synthetic as well as herbal drugs to treat the disease. The role of pre and probiotics in the management of diabetes is also highlighted. CONCLUSION Oral antihyperglycemics which are used to treat diabetes can cause many adverse effects and if given in combination, can lead to drug-drug interactions. The combination of various phytochemicals with synthetic drugs can overcome the challenge faced by the synthetic drug treatment. Herbal and nutraceuticals therapy and the use of probiotics and prebiotics are a more holistic therapy due to their natural origin and traditional use.
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Affiliation(s)
- Mayukh Banerjee
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Ankit Kumar Yadav
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Devendra Kumar Pandey
- Department of Biotechnology, Lovely Faculty of Technology and Sciences, Lovely Professional University, Phagwara 144402, Punjab, India
| | - Pranav Kumar Prabhakar
- Department of Medical Laboratory Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Rajesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Omji Porwal
- Faculty of Pharmacy, Ishik University, Erbil, Iraq
| | - Ankit Awasthi
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Yogita Kumari
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Gurmandeep Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Clarisse Ayinkamiye
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Rahul Prashar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Diksha Mankotia
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
| | - Narendra Kumar Pandey
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara - 144411, Punjab, India
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Are There Adverse Events after the Use of Sexual Enhancement Nutrition Supplements? A Nationwide Online Survey from Japan. Nutrients 2019; 11:nu11112814. [PMID: 31752104 PMCID: PMC6893827 DOI: 10.3390/nu11112814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 11/27/2022] Open
Abstract
Dozens of safety alerts for sexual enhancement and weight loss dietary supplements have been launched from the government not only in Japan but also overseas. However, adverse events have been reported only for the use of weight loss supplements, and the prevalence of use and adverse events in sexual enhancement supplements is not known in Japan. To address this issue, we assessed the situation of sexual enhancement supplement use through a nationwide online survey. The prevalence of sexual enhancement supplement use among males was 23.0%. Use of these supplements was higher among younger people than among older people (p < 0.001). In total, 17.6% of users had experienced adverse events, but 58.3% of them did not consult about the events with anybody because of the temporality of their symptoms and their sense of shame. In addition, eight supplement products were found to be possible adulterated supplements in this survey. It is necessary to inform the public about the risk of sexual enhancement supplement use and also prepare a place for consultation on media channels that younger people are more familiar with, in order to monitor adverse events while also preserving their privacy.
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Khursheed R, Singh SK, Wadhwa S, Kapoor B, Gulati M, Kumar R, Ramanunny AK, Awasthi A, Dua K. Treatment strategies against diabetes: Success so far and challenges ahead. Eur J Pharmacol 2019; 862:172625. [DOI: 10.1016/j.ejphar.2019.172625] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022]
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