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Carter RN, Gibbins MTG, Barrios-Llerena ME, Wilkie SE, Freddolino PL, Libiad M, Vitvitsky V, Emerson B, Le Bihan T, Brice M, Su H, Denham SG, Homer NZM, Mc Fadden C, Tailleux A, Faresse N, Sulpice T, Briand F, Gillingwater T, Ahn KH, Singha S, McMaster C, Hartley RC, Staels B, Gray GA, Finch AJ, Selman C, Banerjee R, Morton NM. The hepatic compensatory response to elevated systemic sulfide promotes diabetes. Cell Rep 2021; 37:109958. [PMID: 34758301 PMCID: PMC8595646 DOI: 10.1016/j.celrep.2021.109958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/06/2021] [Accepted: 10/15/2021] [Indexed: 12/12/2022] Open
Abstract
Impaired hepatic glucose and lipid metabolism are hallmarks of type 2 diabetes. Increased sulfide production or sulfide donor compounds may beneficially regulate hepatic metabolism. Disposal of sulfide through the sulfide oxidation pathway (SOP) is critical for maintaining sulfide within a safe physiological range. We show that mice lacking the liver- enriched mitochondrial SOP enzyme thiosulfate sulfurtransferase (Tst-/- mice) exhibit high circulating sulfide, increased gluconeogenesis, hypertriglyceridemia, and fatty liver. Unexpectedly, hepatic sulfide levels are normal in Tst-/- mice because of exaggerated induction of sulfide disposal, with associated suppression of global protein persulfidation and nuclear respiratory factor 2 target protein levels. Hepatic proteomic and persulfidomic profiles converge on gluconeogenesis and lipid metabolism, revealing a selective deficit in medium-chain fatty acid oxidation in Tst-/- mice. We reveal a critical role of TST in hepatic metabolism that has implications for sulfide donor strategies in the context of metabolic disease.
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Affiliation(s)
- Roderick N Carter
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Matthew T G Gibbins
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Martin E Barrios-Llerena
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Stephen E Wilkie
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK; Glasgow Ageing Research Network (GARNER), Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - Peter L Freddolino
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Marouane Libiad
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Victor Vitvitsky
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Barry Emerson
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | | | - Madara Brice
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Huizhong Su
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, UK
| | - Scott G Denham
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Natalie Z M Homer
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Clare Mc Fadden
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Anne Tailleux
- Université de Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U101-EGID, 59000, Lille, France
| | - Nourdine Faresse
- Physiogenex S.A.S, Prologue Biotech, 516 rue Pierre et Marie Curie, 31670 Labège, France
| | - Thierry Sulpice
- Physiogenex S.A.S, Prologue Biotech, 516 rue Pierre et Marie Curie, 31670 Labège, France
| | - Francois Briand
- Physiogenex S.A.S, Prologue Biotech, 516 rue Pierre et Marie Curie, 31670 Labège, France
| | - Tom Gillingwater
- College of Medicine & Veterinary Medicine, University of Edinburgh, Old Medical School (Anatomy), Teviot Place, Edinburgh EH8 9AG, UK
| | - Kyo Han Ahn
- Department of Chemistry, POSTECH, 77 Cheongam-Ro, Nam-Gu, Pohang, Gyungbuk 37673, South Korea
| | - Subhankar Singha
- Department of Chemistry, POSTECH, 77 Cheongam-Ro, Nam-Gu, Pohang, Gyungbuk 37673, South Korea
| | - Claire McMaster
- School of Chemistry, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - Richard C Hartley
- School of Chemistry, Joseph Black Building, University of Glasgow, Glasgow G12 8QQ, UK
| | - Bart Staels
- Université de Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U101-EGID, 59000, Lille, France
| | - Gillian A Gray
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK
| | - Andrew J Finch
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XR, UK
| | - Colin Selman
- Glasgow Ageing Research Network (GARNER), Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | - Ruma Banerjee
- Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Nicholas M Morton
- University/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, UK.
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Kojima A, Sato Y, Nishijima C, Umegaki K, Chiba T. Systematic Review of Case Reports on the Adverse Events Due to Health Food Intake by Cancer Patients. YAKUGAKU ZASSHI 2019; 139:1333-1347. [DOI: 10.1248/yakushi.19-00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ayako Kojima
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Yoko Sato
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Chiharu Nishijima
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Keizo Umegaki
- Department of Food Safety and Management, Showa Women's University
| | - Tsuyoshi Chiba
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
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Boháčová I, Procházková S, Halko R. Separation and determination of amygdalin and unnatural neoamygdalin in natural food supplements by HPLC-DAD. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2019; 36:1445-1452. [PMID: 31397641 DOI: 10.1080/19440049.2019.1650962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This work is focused on separation and determination of amygdalin and its unnatural form neoamygdalin in natural food supplements. Reversed-phase high-performance liquid chromatography with a high-stability silica-based column with C18 functional group has been used for solving this problem. The effect of the mobile phase composition as well as the column temperature on the separation of the amygdalin epimers has been investigated. Isocratic elution using a mobile phase composed of 0.05% aqueous formic acid and acetonitrile achieved the required separation within 17 min. Under optimum chromatographic conditions, the developed method was validated and was applied for the determination of amygdalin epimers in natural food supplements containing apricot or peach kernels. A simple extraction method using methanol as an extractant supported by an ultrasonic bath was used with recovery in the range of 94.8% to 104.3%. The limit of detection and limit of quantification values for R-amygdalin were 0.13 mg/L and 0.40 mg/L, respectively. The developed method proved to be precise with the intra-day and inter-day relative standard deviation values less than 2.23%.
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Affiliation(s)
- Iveta Boháčová
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Simona Procházková
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava , Slovak Republic
| | - Radoslav Halko
- Department of Analytical Chemistry, Faculty of Natural Sciences, Comenius University in Bratislava , Bratislava , Slovak Republic
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Liu C, Li S, Zhang Q, Guo F, Tong M, Martinez MFYM, Wang HH, Zhao Y, Shang D. Emerging Role of Chinese Herbal Medicines in the Treatment of Pancreatic Fibrosis. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:709-726. [PMID: 31091974 DOI: 10.1142/s0192415x1950037x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pancreatic fibrosis is the main pathologic characteristic in chronic pancreatitis (CP), a common disease that arises from surgery. Pancreatitis is caused by various etiologies, but the mechanism of fibrosis is not completely understood. Existing clinical approaches mainly focus on mitigating the symptoms and therefore do not cure the phenomena. In recent years, there has been a heightened interest in the use of Chinese herbal medicine (CHMs) in the prevention and cure of CP as expressed by increasing numbers of clinical and experimental research. Despite early cell culture and animal models, CHMs are able to interact with plenty of molecular targets involved in the pathogenesis of pancreatic fibrosis mostly via the TGF- β /Smads pathway; however, integrated and up-to-date communication in this domain is unavailable. This review focuses on the research progress of CHMs against pancreatic fibrosis due to CP in vitro and in vivo and summarizes the potential mechanisms. We also outlined the toxicology of some CHMs for fibrosis treatment in order to provide a fuller understanding of drug safety. This review may provide reference for further innovative drug research and the future development of treatments for CP with pancreatic fibrosis.
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Affiliation(s)
- Chang Liu
- * Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China.,† Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Shuang Li
- * Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China.,† Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Qingkai Zhang
- * Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China.,† Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Fangyue Guo
- * Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China.,† Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | - Mengying Tong
- ‡ Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
| | | | - Heather H Wang
- ¶ Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Yutong Zhao
- ¶ Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dong Shang
- * Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China.,† Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, P. R. China
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Leonard JB, Hines EQ, Anderson BD. Prime eligible poisons: identification of extremely hazardous substances available on Amazon.com ®. Clin Toxicol (Phila) 2019; 58:45-48. [PMID: 31035804 DOI: 10.1080/15563650.2019.1594870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Widespread use of the Internet has increased availability of numerous products. Multiple published cases highlight that toxic xenobiotics are available for purchase online. Most cases describe purchase from the deep web. We sought to identify extremely hazardous substances available from an online retailer.Methods: Over a 10-month period, the online retailer Amazon.com® was searched for each of the products listed by the Environmental Protection Agency's "List of Extremely Hazardous Substances." Product names, availability on Amazon Prime®, need for a business account, price, and quantity were collated.Results: We identified 79/340 (23.2%) of these substances were available on Amazon.com®. Almost one-third of the available substances were eligible for Amazon Prime®. Approximately one-third of the products were available in an amount that could be toxic by purchasing a single unit (31/79). Of these 31 products, only four required a business account, 18 were eligible for Amazon Prime®, and nine were neither eligible for Prime nor required a business account. Notable products include sodium azide, acrylamide, mercuric acetate, and hydrazine.Conclusions: The ease of purchase and ready availability of such highly toxic substances is concerning. Online retailers like Amazon.com® should consult with toxicologists or other qualified experts and governmental agencies to identify which products should be removed or restricted to business accounts.
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Affiliation(s)
- James B Leonard
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Elizabeth Quaal Hines
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Department of Pediatric Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bruce D Anderson
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Case Files of the University of Massachusetts Toxicology Fellowship: Does This Smoke Inhalation Victim Require Treatment with Cyanide Antidote? J Med Toxicol 2017; 12:192-8. [PMID: 26831054 DOI: 10.1007/s13181-016-0533-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Cyanide toxicity is common after significant smoke inhalation. Two cases are presented that provide framework for the discussion of epidemiology, pathogenesis, presenting signs and symptoms, and treatment options of inhalational cyanide poisoning. An evidence-based algorithm is proposed that utilizes point-of-care testing to help physicians identify patients who benefit most from antidotal therapy.
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Abstract
The concern of a terrorist attack using cyanide, as well as the gradual awareness of cyanide poisoning in fire victims, has resulted in a renewed interest in the diagnosis and treatment of cyanide poisoning. The formerly academic presentation of cyanide poisoning must be replaced by more useful knowledge, which will allow emergency physicians and rescue workers to strongly suspect cyanide poisoning at the scene. Human cyanide poisonings may result from exposure to cyanide, its salts, or cyanogenic compounds, while residential fires are the most common condition of exposure. In fire victims, recognition of the cyanide toxidrome has been hampered by the short half-life in blood and poor stability of cyanide. In contrast, carboxyhemoglobin, as a marker of carbon monoxide poisoning, is easily measured and long-lasting. No evidence supports the assumption of the arbitrary fixed lethal thresholds of 50% for carboxyhemoglobin, and 3 mg/L for cyanide, in fire victims. Preliminary data, drawn when comparing pure carbon monoxide and pure cyanide poisonings, suggest that a cyanide toxidrome can be defined considering signs and symptoms induced by cyanide and carbon monoxide, respectively. Prospective studies in fire victims may provide value in clarifying signs and symptoms related to both toxicants. Cyanide can induce a lifethreatening poisoning from which a full recovery is possible. A number of experimentally efficient antidotes to cyanide exist, whose clinical use has been hampered due to serious side effects. The availability of potentially safer antidotes unveils the possibility of their value as first-line treatment, even in a complex clinical situation, where diagnosis is rapid and presumptive.
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Affiliation(s)
- F J Baud
- Department of Medical and Toxicological Critical Care, University Paris 7, INSERM U705, Hôpital Lariboisiere, 2 rue Ambroise Paré, 75010 Paris, France.
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Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child. Wien Med Wochenschr 2015; 165:185-8. [DOI: 10.1007/s10354-014-0340-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022]
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Abstract
Consuming plants for their presumed health benefits has occurred since early civilizations. Phytochemicals are found in various plants that are frequently included in the human diet and are generally thought to be safe for consumption because they are produced naturally. However, this is not always the case and in fact many natural compounds found in several commonly consumed plants are potential carcinogens or tumor promoters and should be avoided.
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Affiliation(s)
- Ann M Bode
- The Hormel Institute, University of Minnesota, Austin, Minnesota
| | - Zigang Dong
- The Hormel Institute, University of Minnesota, Austin, Minnesota.
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Park JH, Seo BI, Cho SY, Park KR, Choi SH, Han CK, Song CH, Park SJ, Ku SK. Single oral dose toxicity study of prebrewed armeniacae semen in rats. Toxicol Res 2013; 29:91-8. [PMID: 24278634 PMCID: PMC3834446 DOI: 10.5487/tr.2013.29.2.091] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 11/20/2022] Open
Abstract
Armeniacae semen (AS) has been considered a toxic herb in the Korean medicine as it contains hydrogen cyanide and amygdalin, especially in its endocarp. Therefore, prebrewed AS that is devoid of endocarp has been traditionally used. In the present study, amygdalin content of the prebrewed AS was significantly lower (2.73 ± 0.32 μg/ml; p < 0.01) than the content in the extract that contained the endocarps (28.50 ± 6.71 μg/ml); amygdalin content corresponded to 10% of the extract in the present study. Because of single oral dose toxicity of prebrewed AS according to the recommendation of Korea Food and Drug Administration Guidelines (2009-116, 2009), which was based on single oral dose toxicity study of prebrewed AS, mortality due to toxic principles was significantly reduced. In this study, 2,000 mg/kg of prebrewed AS led to death of 1 female rat and 1 male rat at the end of 2 hr of administration. Based on these results, the 50% lethal dose in both male and female rats was determined to be 9279.5 mg/kg. Seizure, loss of locomotion, and increases in respiration and heart rate were observed as prebrewed AS treatment-related toxicological signs; these signs were restrictedly manifested in the prebrewed AS (2,000 mg/kg)-treated rats. In addition, no changes were observed in body weight, organ weight, gross features, and histopathological parameters with 2,000 mg/kg of AS in both male and female rats. These findings serve as direct evidence that amygdalin in AS is the toxic principle, which can be reduced by the traditional prebrewing method involving the exclusion of endocarp.
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Affiliation(s)
- Ji-Ha Park
- Department of Herbology, College of Oriental Medicine, Daegu Haany University, Gyeongsan, Korea
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Kwan D, Beyene J, Shah PS. Adverse Consequences of Internet Purchase of Pharmacologic Agents or Dietary Supplements. J Pharm Technol 2009. [DOI: 10.1177/875512250902500602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The Internet is commonly used to advertise and sell medications and dietary supplements directly to consumers. Prescriptions are often not needed, and consumers may engage in unmonitored and risky health practices. No systematic attempt has been made to evaluate reported cases of adverse events following such purchases. Objective: To systematically identify and examine reported cases of adverse events associated with the purchase of medications and dietary supplements from the Internet. Methods: MEDLINE (1990-June 2009), EMBASE (1990-June 2009), IBIDS (to June 2009), TOXNET (to June 2009), bibliographies of identified articles, and Web sites of relevant health ministries and professional associations in the US and Canada were reviewed to identify eligible articles that describe adverse events associated with the purchase of medications or dietary supplements from the Internet. Results: Thirty-two reports of 41 cases of adverse consequences of pharmaceutical products (n = 31) or dietary supplements (n = 10) were identified. Purchases were made by people in the 30- to 50-year-old age group in 36% of cases. Prescription medications were implicated in 27% of cases and narcotic and controlled drugs were implicated in 49% of cases. Drug abuse was responsible for harm in 73% of cases, whereas adverse drug reactions occurred in 27% of cases. Nine (22%) patients died as a result of adverse consequences following such purchases. The remaining patients suffered serious adverse events such as seizures, liver damage, and hallucinations. Conclusions: An unexpectedly large number of case reports were identified from the literature; however, these reports do not fully illustrate the magnitude of the problem. Life-endangering adverse consequences signify a need for increased regulation and control of Internet Web sites and a need for healthcare provider involvement. Pharmacists should know where their patients obtain medications, how to verify the validity of the sources of prescriptions, and how to report adverse consequences.
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Affiliation(s)
- Della Kwan
- DELLA KWAN BScPhm MSc, Graduate Student, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Beyene
- JOSEPH BEYENE MSc PhD, Associate Professor, Research Institute of the Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto
| | - Prakesh S Shah
- PRAKESH S SHAH MSc MBBS MD DCH MRCP MRCPCH FRCPC, Associate Professor, Department of Paediatrics and Department of Health Policy, Management and Evaluation, Mount Sinai Hospital and University of Toronto
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Bolderston A, Mitchell F, Cowan B, Mawson C. Radiation Therapists' Experiences with Complementary Alternative Medicine Use by their Patients: A Preliminary Study. J Med Imaging Radiat Sci 2008; 39:128-134. [PMID: 31051887 DOI: 10.1016/j.jmir.2008.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complementary and alternative medicine (CAM) is increasingly popular among patients receiving radiation therapy. However, there is little empirical evidence relating to the interactions of radiation therapists and their patients regarding the use of CAM during treatment. The study objectives were to quantify how often the issue of CAM use arises in the therapists' daily practice, to explore radiation therapists' knowledge and attitudes about CAM use by their patients, and to identify areas for future education and development for therapists. This article describes a two-centre survey conducted at the Vancouver Cancer Centre in British Columbia and Princess Margaret Hospital in Ontario. The survey used an email survey instrument, "SurveyMonkey," which was emailed to all therapists working at both centres (n = 230). The survey had a 5-point Likert scale ranging from "strongly disagree" to "strongly agree." There were also associated open-ended questions to allow for individual comments. The total response rate from the two centres was 49%. Results indicated that the topic of CAM does arise, although the frequency of interaction between patient and therapist varies between centres. Therapists reported feeling comfortable with their knowledge of 3 from a list of 27 common CAM therapies. They would recommend/support their patients' use of 11 CAM therapies in total. Therapists and patients use a variety of information sources about CAM, but would welcome more information/education in this area. Overall, therapists felt that the radiation oncologist was the most appropriate person to discuss the use of CAM with patients. Radiation therapists need more information about CAM in the form of continuing education to meet the needs of their patients. Further research is warranted, as this is a very preliminary look at a large and somewhat controversial topic.
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Affiliation(s)
- Amanda Bolderston
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario.
| | - Fiona Mitchell
- Radiation Therapy Department, Vancouver Cancer Centre, Vancouver, British Columbia
| | - Bonnie Cowan
- Medical Radiation Sciences Program, The Michener Institute, Toronto, Ontario
| | - Christie Mawson
- Radiation Therapy Department, R. S. McLaughlin Regional Cancer Centre, Oshawa, Ontario
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Abstract
INTRODUCTION The widespread availability of medications and herbal products on the Internet has increased the potential for poisonings. We are reporting a case of mild, acute lithium toxicity occurring after the intentional misuse of a lithium-containing "dietary supplement" (Find Serenity Now) obtained over the Internet. CASE REPORT An 18-year-old woman presented to our emergency department (ED) after ingesting 18 tablets of Find Serenity Now; each tablet contained, according to the listing, 120 mg of lithium orotate [3.83 mg of elemental lithium per 100 mg of (organic) lithium orotate compared to 18.8 mg of elemental lithium per 100 mg of (inorganic) lithium carbonate]. The patient complained of nausea and reported one episode of emesis. Her examination revealed normal vital signs. The only finding was a mild tremor without rigidity. Almost 90 minutes after the ingestion, her serum lithium level was 0.31 mEq/L, a urine drug screen was negative, and an electrocardiogram (ECG) showed a normal sinus rhythm. The patient received intravenous fluids and an anti-emetic; one hour later, her repeat serum lithium level was 0.40 mEq/L. After 3 hours of observation, nausea and tremor were resolved, and she was subsequently transferred to a psychiatric hospital for further care. Prior human and animal data have shown similar pharmacokinetics and shared clinical effects of these lithium salts. DISCUSSION Over-the-Internet dietary supplements may contain ingredients capable of causing toxicity in overdose. Chronic lithium toxicity from ingestion of this product is also of theoretical concern.
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Affiliation(s)
- D K Pauzé
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Plunkett P. Sharing knowledge: coincidences, cooperation and collegiality. Eur J Emerg Med 2005; 12:211-2. [PMID: 16175055 DOI: 10.1097/00063110-200510000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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