Drug interactions in HIV treatment: complementary & alternative medicines and over-the-counter products

Introduction: Use of complementary and alternative medicines (CAMs) and over-the-counter (OTC) medications are very common among HIV-infected patients. These products can cause clinically significant drug-drug interactions (DDIs) with antiretroviral (ARV) medications, thereby increasing risk for negative outcomes such as toxicity or loss of virologic control.

Areas covered: This article provides an updated review of the different mechanisms by which CAM and OTC products are implicated in DDIs with ARV medications.

Expert commentary: Much of the literature published to date involves studies of CAMs interacting with older ARV agents via the cytochrome P450 (CYP450) system. However, the HIV treatment and prevention arsenal is continually evolving. Furthermore, our elucidation of the role of non-CYP450 mediated DDIs with ARV medications is greatly increasing. Therefore, clinicians are well served to understand the various mechanisms and extent by which new ARV therapies may be involved in drug interactions with CAMs and OTC medications.     

我国居民中药材中铅暴露的风险评估

目地:评估我国居民中药材铅暴露量及其潜在的健康风险,评价我国当前执行的中药材中铅限量标准的适宜性。方法2008-2016年在全国采集各类中药材2056份,检测铅含量水平。采用多阶段分层随机抽样方法,在黑龙江、辽宁、江西、贵州和甘肃5省份采用入户面对面问卷方式调查5739名18岁及以上成年人中药材消费情况。结合中药材中铅含量水平和中药材消费量数据,采用确定性评估方法,对我国居民中药材中铅暴露风险进行评估。并对我国当前执行的中药材中铅限量标准的适宜性进行评价。结果检测的2056份中药材样本,铅平均含量为1.04mg/kg,超标率3.79%,其中动物类药材铅平均含量2.96mg/kg,高于植物类药材平均含量0.97mg/kg。暴露评估结果显示,常规服用中药材人群铅暴露的健康风险较低;但对于作为药膳食用中药材的人群和长期以较高剂量服用/食用中药材者,铅暴露导致的健康风险相对较高。结论在当前中药材铅残留量水平下,我国大部分居民因中药材导致铅暴露的健康风险较低,但对于终生长期服用或作为药膳大量食用中药材者,铅暴露导致的健康风险需要关注。     

近红外光谱技术鉴定中药的进展

作者综述了近红外光谱技术(near infrared spectoscopy,NIRS)在中药真伪优劣应用研究的现状和最新进展。一方面,NIRS以其非破坏性、快速、便捷等特点显示出在中药鉴定中应用的优势。另一方面,NIRS的实际应用也还存在样品代表性和模型的稳定性等问题。为了跟上NIRS在其他领域普及化的形势,建议对NIRS用于贵重药材和成药鉴定、中药添加西药的监测、大品种中成药从原料到最终产品生产过程的在线质量控制等给予优先关注。     

拉曼与近红外、中红外光谱在药品掺杂筛选应用中的前景分析

目的通过比较分析光谱法的原理、应用与药品快速检测需求,筛选最适合的快速检测信号采集方法。方法对比分析各类光谱定性分析基础、光谱数据信息采集手段、不同用户群的需求。结果红外、拉曼光谱比近红外光谱在定性鉴别方面更具优势,红外光谱可以作为实验室使用的初筛方法,拉曼光谱可以作为普筛方法使用。结论拉曼光谱为药品掺杂筛选一线首选信息采集方法。     

物种特异性基因扩增鉴别掺假食用植物油

目的:建立特异的掺假食用植物油鉴定方法。方法:以掺假食用油中掺入的低价值食用油相应油料作物物种特异性基因为靶标,采用普通PCR(Polymerase Chain Reaction)方法鉴定掺入一种低价值食用油的混合油样,双重PCR技术鉴定掺入两种低价值食用油的混合油样。结果:在8个按2/3量掺入一种低价值食用油的混合油样中至少在一个平行样中检出低价值食用油相应的物种特异性基因,而按1/2比例掺入低价值食用油的8个油样中有5个检出混入的低价值食用油;3个按照1∶1∶1掺入两种低价值食用油的混合油样,其掺假检出率及平行样之间重现性均较差。结论:本研究选定的掺假植物油的检测靶标具有较强特异性,可有效鉴别大量掺入低价值食用植物油的掺假油品,但对于掺假量低于50%的油品,其掺假鉴别能力尚待提高。     

生物纳米硒饲料添加剂对淡水养殖鱼类影响的研究

通过投加生物纳米硒饲料添加剂,进行鲤鱼、鲫鱼、白鲢和鳙鱼的含硒量、体重、产量、成活率、饵料系数、抗病力、色泽和肉质的对比试验,说明生物纳米硒的影响作用。结果表明,投加生物纳米硒饵料4个月,鲤鱼、鲫鱼、白鲢和鳙鱼的含硒量明显增加,分别为0.424,0.453,0.285和0.306 mg/kg,分别是对照样的1.64、1.66、1.22和1.28倍。鲤鱼和鲫鱼的体重、产量、成活率分别增加0.085 kg,6298 kg,2.5%和0.015 kg,699kg,3.0%,投药量大大减少,抗病力增强,饵料系数减少,鳞片呈金黄色,具有肉质较紧、肉层厚等优点。     

补气生血精治疗放、化疗后骨髓抑制临床观察

目的：观察补气生血精胶囊治疗恶性肿瘤放化疗后骨髓抑制的有效性和安全性。方法：治疗组60例口服补气生血精胶囊,对照组30例口服贞芪扶正胶囊,疗程均为30天。结果：治疗后治疗组与对照组相比外周血白细胞、血红蛋白明显提高（P〈0．05）,血小板提高程度差异无统计学意义（P〉0．05）。骨髓抑制程度比较：白细胞、血红蛋白抑制明显改善（P〈0．05）,血小板抑制改善程度差异无统计学意义（P〉0．05）。结论：补气生血精胶囊对放化疗后骨髓抑制具有防治作用。     

蒙药配合物理疗法治疗哺乳期急性乳腺炎97例疗效观察

目的探讨蒙药结合超短波、超声波治疗哺乳期急性乳腺炎的效果。方法 97例哺乳期急性乳腺炎病人随机分成对照组（48例）和治疗组（49例）：对照组给予口服蒙药,治疗组口服蒙药同时结合超短波、超声波治疗,连续10d。结果联合治疗组,显效39例（占79.59%）,有效10例占（20.41%）,无效0例（占0%）,总有效率100%,明显高于对照组（P〈0.05）。结论蒙药结合超短波、超声波治疗哺乳期急性乳腺炎疗效显著。     

空调器隔尘网灰尘中发现棕脊足螨

目的了解芜湖地区不同场所空调器隔尘网中棕脊足螨的污染情况。方法于2013年6-9月采集芜湖市食堂、商场、酒店和家庭的空调器隔尘网灰尘,检获其中的棕脊足螨。结果共收集430份空调器隔尘网积尘样本,其中阳性标本98份,阳性率22.79%,不同场所的空调器隔尘网中棕脊足螨的孳生率差异有统计学意义(χ2=18.294,P0.05);样本总重量为510.5 g,共检出棕脊足螨783只,平均孳生密度为1.53只/g。结论芜湖地区空调器隔尘网中有棕脊足螨孳生,且孳生情况较严重。     

Alternative medicines and the liver

Complementary and Alternative Medicine (CAM) is a heterogeneous group of theories and practices that are becoming increasingly popular in the West - between 20% and 65% of patients use CAM on a regular basis. In the UK, CAM is provided by over a third of general practitioners as well as by hospitals. The subject of much debate in both the lay and medical press, CAM is subject to increasing scrutiny from clinical research. In this review, we discuss the available evidence for herbal medicines, including that for silymarin, glycyrrhizin, Chinese herbal medicines and other herbal mixtures. We also review evidence regarding the safety of herbal medicines, both in terms of hepatotoxicity and drug interactions. We conclude that although CAM may be of benefit in the treatment of liver disease, the available evidence is insufficient to recommend any of the available therapies. CAM has not yet been well studied in liver disease and rigorous evaluation with well-designed double-blind randomised controlled trails is required. Doctors need to be aware of the widespread use of CAM, ask their patients specifically regarding their use of CAM and be aware of the potential for hepatotoxicity and interactions.