Interpretation on Consensus on drug-induced liver injury by CIOMS Working Group:liver injury attributed to herbal and dietary supplements / 中国中药杂志

With the increase in the medical level, the improvement of adverse drug reaction(ADR) monitoring systems, and the enhancement of public awareness of safe medication, drug safety incidents have been frequently reported. Drug-induced liver injury(DILI), especially liver injury attributed to herbal and dietary supplements(HDS), has globally attracted high attention, bringing great threats and severe challenges to the people for drug safety management such as clinical medication and medical supervision. Consensus on drug-induced liver injury had been published by the Council for International Organizations of Medical Sciences(CIOMS) in 2020. In this consensus, liver injury attributed to HDS was included in a special chapter for the first time. The hot topics, including the definition of HDS-induced liver injury, epidemiological history, potential risk factors, collection of related risk signals, causality assessment, risk prevention, control and management were discussed from a global perspective. Based on the previous works, some experts from China were invited by CIOMS to undertake the compilation of this chapter. Meanwhile, a new causality assessment in DILI based on the integrated evidence chain(iEC) method was widely recognized by experts in China and abroad, and was recommended by this consensus. This paper briefly introduced the main contents, background, and characteristics of the Consensus on drug-induced liver injury. Significantly, a brief interpretation was illustrated to analyze the special highlights of Chapter 8, "Liver injury attributed to HDS", so as to provide practical references for the medical staff and the researchers who worked on either Chinese or Western medicine in China.

Exploring the factors associated with the intention to assess customers’ herbal and dietary supplement use by community pharmacists in Kuala Lumpur, Malaysia

Community pharmacists (CPs) often stock herbal and dietary supplements (HDS) at their community pharmacies. Therefore, CPs should be held responsible for ensuring safe and appropriate use of HDS. The present study aims to investigate the factors associated with the intention (INT) of CPs to assess their customers’ HDS use. A crosssectional study using a self-completed questionnaire was employed. A questionnaire along with a cover letter and stamped envelope was sent to CPs at community pharmacies located in Kuala Lumpur, Malaysia. Only 70 out of 533 CPs responded to the survey (response rate = 13.13%). The results showed that 11.4% (8/70) of CPs always assess customers’ HDS use. The CPs, however, had positive and moderately high INT to assess customers’ HDS use (mean = 3.84 ± 0.70). Positive and significant correlations were noted between INT and belief about consequences, moral norms, belief of capabilities, and role and identity. The relationship between INT and social influences was statistically insignificant. Efforts to enhance the INT of CPs to assess customers’ HDS use should be warranted. This could be achieved by enhancing beliefs that are positively associated with the CPs’ INT to assess customers’ HDS use.

Drug induced liver damage in a universitary hospital / Lesão hepática induzida por drogas em um hospital universitário

Introdução: lesão hepática induzida por drogas (DILI) é responsável por um amplo espectro de lesão hepática. Clinicamente, esses eventos são apresentados de várias formas e, para alcançar um diagnóstico diferente, outras causas de lesões devem ser excluídas. Objetivo: identificar e caracterizar casos de hepatotoxicidade induzida por medicamentos, fitoterápicos e suplementos alimentares em Hospital Universitário no Brasil. Metodologia: estudo observacional, retrospectivo. Os dados foram coletados em prontuários do Hospital Universitário, entre agosto de 2009, em agosto de 2014. A causalidade das reações medicamentosas suspeitas foi avaliada pelo Conselho de Organizações Internacionais de Ciências Médicas (CIOMS). Resultados: foram selecionados 30 casos suspeitos, 50% do sexo feminino e média de 39 anos. As classes terapêuticas mais comuns foram: anti-infecciosos; agentes antineoplásicos; drogas do sistema nervoso central, esteroides anabolizantes e suplementos herbáceos e dietéticos (HDS). Lesão colestática ou mista foi observada em 73% desses casos; 60% eram altamente prováveis, de acordo com o CIOMS. Conclusão: DILI é causada por uma grande variedade de drogas, suplementos dietéticos e suplementos dietéticos. Anti-infecciosos e quimioterapia foram responsáveis por grande parte da resposta.

Background: drug Induced Liver Injury (DILI) is responsible for wide spectrum of liver injury. Clinically, these events are presented in various forms and for reaching a different diagnosis other injury causes must be excluded. Aim: identify and characterize cases of hepatotoxicity induced by drugs, herbal and dietary supplements in University Hospital in Brazil. Methodology: observational and retrospective study. Was collected in records of University Hospital, between August 2009 at August 2014. The causality of the drug reactions suspected were evaluated Council for International Organizations of Medical Sciences (CIOMS). Results: we selected 30 suspected cases, 50% was female and average was 39 years. the therapeutic classes most common was: anti-infectives; antineoplastic agents; central nervous system drugs, anabolic steroid and herbal and dietary supplements (HDS). Cholestatic or mixed injury was observed in 73% these cases; 60% were highly probable, according to CIOMS. Conclusion: DILI is caused by a wide variety of drugs, dietary supplements and dietary supplements. Anti-infectives and chemotherapy were responsible for much of the response.

Pattern of Herbal and Dietary Supplement Usage and Conventional Medication Adherence among Patients with Chronic Kidney Disease: A Survey Finding

@#Introduction: There is widespread use of herbal and dietary supplements worldwide among patients despite robust clinical evidence of its efficacy. This may lead to adverse effects, such as diabetes, hypertension, stroke, cardiovascular risk and kidney problems due to inappropriate self-prescription. This study was performed to determine the prevalence of herbal and dietary supplements usage among patients with chronic kidney disease and its association with the socio-demographic background and the conventional medication adherence. Materials and methods: A survey was conducted among 78 chronic kidney disease patients attending the Nephrology Clinic, Hospital Tengku Ampuan Afzan, Kuantan, Pahang. Data were collected using a questionnaire and analyzed using descriptive statistics, Chi Square Test and Fisher’s Exact Test. The p-value was set to be less 0.05 for its level of significance. Results: Most of the patients aged more than 50 years (89.7%), female (53.8%), unemployed (41%) and from lower socioeconomic earners (75.6%). Only 5.2% of respondents reported using herbal and dietary supplements. There was no association between socio-demographic background with the herbal and dietary supplements usage. Similarly, there was no association between herbal and dietary supplements usage and the conventional medication adherence. Conclusion: This study provides a good baseline on the usage of herbal and dietary supplements use among chronic disease patients. It can be concluded that the level of awareness among the patients is good. Nevertheless, a larger study shall be performed in the future to explore the pattern of association.

Drug-Induced Liver Injury: Pattern Recognition and Future Directions

Drug-induced liver injury (DILI) remains a significant clinical challenge and is the leading cause of acute liver failure in most countries. An aging population that uses more medications, a constant influx of newly developed drugs and a growing risk from unfamiliar herbal and dietary supplements will make DILI an increasing part of clinical practice. Currently, the most effective strategy for disease management is rapid identification, withholding the inciting agents, supportive care and having a firm understanding of the expected natural history. There are resources available to aid the clinician, including a new online "textbook" as well as causality assessment tools, but a heightened awareness of risk and the disease's varying phenotypes and good history-taking remain cornerstones to diagnosis. Looking ahead, growing registries of cases, pharmacoepidemiology studies and translational research into the mechanisms of injury may produce better diagnostic tools, markers for risk and disease, and prevention and therapeutics.