Thesis (Ph. D.)--University of Wisconsin, 1954. / Typescript (carbon copy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [53]-[60]).

Thesis (M. Med. Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 55-61).

Thesis (Ph. D.)--University of Wisconsin--Madison, 1939. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaf [15]).

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 203-212). Available also in a digital version from Dissertation Abstracts.

Thesis (M.Med.Sc.)--University of Hong Kong, 2002. / Includes bibliographical references (leaves 55-61). Also available in print.

Thesis (Ph. D.)--School of Pharmacy and Dept. of Chemistry. University of Missouri--Kansas City, 2004. / "A dissertation in pharmaceutical science and chemistry." Advisor: Ashim K. Mitra. Typescript. Vita. Description based on contents viewed Feb. 27, 2006; title from "catalog record" of the print edition. Includes bibliographical references (leaves 175-199). Online version of the print edition.

Background Empirical research on how and why nutritional supplements (including vitamin/mineral supplements and herbal supplements) are being taken by middle-income populations in South Africa is lacking. This study quantifies the types of nutritional supplements being taken. It unpacks beliefs regarding benefits and risks. This information is useful for healthcare practitioners in similar settings as it could affect their practice of history taking and alert practitioners to the need to know more about nutritional supplement benefits and risks. The information could be used to influence policy regarding advertising and labelling of nutritional supplements. Method The study was a cross-sectional survey. An anonymous self-completed structured questionnaire was completed by 123 participants attending a medical centre during the data collection period. Face-to-face semi-structured interviews were conducted on 16 participants to gather qualitative information. Results Nutritional supplements were widely taken in this questionnaire sample (59%). Consumption was not related to age, language, ethnic group, education and smoking, but nutritional supplements were more commonly used by women and higher income groups. Women who felt they had fair/poor health, women with chronic medical conditions, especially those with depression or women on chronic prescription medication were more likely to take nutritional supplements than those without these characteristics. Wellness, treating tiredness and short-term disease prevention were the most common reasons for taking the supplements, although research proving these benefits is lacking. Chronic disease prevention was an uncommon reason for consumption. Participants were mostly unaware of possible drug interactions and side-effects and therefore felt it unnecessary to inform their practitioner of consumption habits. Conclusion Healthcare professionals should include a nutritional supplement question in their routine history taking, especially when prescribing chronic medication and in the presence of chronic conditions. They should be knowledgeable regarding efficacy, safety, possible side-effects and drug interactions of commonly consumed nutritional supplements in order to advise patients appropriately. Further empirical research is needed into proven benefits of nutritional supplements.

Drug Interactions and potentially inappropriate medications at an oncology ward Objectives: this study aimed to quantify the prevalence of clinically significant interactions and potentially inappropriate medication (PIM) use through involving a pharmacist among the cancer patients at an oncology ward and an oncology day- unit. Materials and Methods: Prospective study in patients taking more than 5 drugs who had been admitted to Harzklinikum, Wernigerode, Germany between August 2016 and February 2017. The pharmacist conducts a complete comprehensive medication review including over-the-counter drugs and herbal medications. Besides, she took into consideration the intake of grapefruit juice. This information together with the information in the patient's medical history permits identifying critical drug-drug interactions using the mediQ interaction analysis program as well as PIMs using the Beers, Forta, Priscus and STOPP lists. Results: One hundred and eighty-five cancer patients (mean age ± SD = 70 ± 11 years) were included in the study. The interaction analysis program identified 177 potentially interactions. These interactions were evaluated by the pharmacist and 34 interactions for 31 patients (17 %) were considered clinically significant or critical. After the pharmacist interventions, these interactions were resolved in 51 percent. 123 patients aged over 65 years old were enrolled in the study for PIM. By using the four lists (Beers, Forta, Priscus, STOPP) 52 PIMs at 41 elderly persons (33%) were identifies. 11 recommendations in 10 elderly patients (8 %) were made by the pharmacist and result in 55 % of the cases in a prescription change. Conclusion: the use of an interaction analysis program and the lists of inappropriate medications allowed the pharmacist to identify clinically relevant interactions and PIMs and result in prescription change in agreement with the oncologist.

Leflunomide is widely prescribed for Rheumatoid Arthritis (RA) patients in China. However, a number of RA patients still demonstrated progressive bone erosion (PBE+) after receiving Leflunomide in our clinical data. Moreover, the PBE+ is predicted by high baseline serum CRP level (CRPBH). Further, the changes of serum bone resorption marker (Tartrate-resistant acid phosphatase 5b, TRAP5b) strongly correlated with those of CRP in PBE+ RA patients during Leflunomide treatment. Those were consistently observed in collagen-induced-arthritis (CIA) rats. To precisely address the issue, we screened a series of marketed drugs combined with Leflunomide to inhibit CRP production and CRP-related osteoclastic signaling pathway using bioinformatics analysis. Ligustrazine was postulated as an optimal candidate drug. In vitro studies demonstrated that the combination of Ligustrazine and Leflunomide not only suppressed hepatic CRP production, but also suppressed CRP-related osteoclastic signaling and osteoclast activities. In vivo studies showed that the combination attenuated bone erosion in CIA rats. Further, the randomized parallel controlled clinical trial in 120 CRPBH RA patients showed that the combination therapy reduced serum CRP levels and attenuated bone erosion in those patients (ChiCTR-TRC-10001014). Together, this work presents a precision combination therapy for PBE+ in CRPBH RA patients.

In response to the urgent call for investigations into antiretroviral (ARV)-African traditional medicine (ATM) interactions, this research was undertaken to ascertain whether chronic administration of the ATM, Sutherlandia frutescens (SF) may alter the bioavailability of the protease inhibitor (PI), atazanavir (ATV), which may impact on the safety or efficacy of the ARV. Prior to investigating a potential interaction between ATV and SF in vitro and in vivo, a high performance liquid chromatography method with ultraviolet detection (HPLC-UV) was developed and validated for the bioanalysis of ATV in human plasma and liver microsomes. An improved and efficient analytical method with minimal use of solvents and short run time was achieved in comparison to methods published in the literature. In addition, the method was selective, linear, accurate and precise for quantitative analysis of ATV in these studies. Molecular docking studies were conducted to compare the binding modes and affinities of ATV and two major SF constituents, Sutherlandioside B and Sutherlandin C, with the efflux transporter, P-glycoprotein (P-gp) and the CYP450 isoenzyme, CYP3A4 to determine the potential for these phytochemicals to competitively inhibit the binding of ATV to these two proteins, which are mediators of absorption and metabolism. These studies revealed that modulation of P-gp transport of ATV by Sutherlandioside B and Sutherlandin C was not likely to occur via competitive inhibition. The results further indicated that weak competitive inhibition of CYP3A4 may possibly occur in the presence of either of these two SF constituents. The Caco-2 cell line was used as an in vitro model of human intestinal absorption. Accumulation studies in these cells were conducted to ascertain whether extracts and constituents of SF have the ability to alter the absorption of ATV. The results showed that the aqueous extract of SF significantly reduced ATV accumulation, suggesting decreased ATV absorption, whilst a triterpenoid glycoside fraction isolated from SF exhibited an opposing effect. Analogous responses were elicited by the aqueous extract and a triterpenoid glycoside fraction in similar accumulation studies in P-gp overexpressing Madin–Darby Canine Kidney Strain II cells (MDCKII-MDR1), which signified that the effects of this extract and component on ATV transport in the Caco-2 cells were P-gp-mediated. The quantitative analysis of ATV in human liver microsomes after co-incubation with extracts and components of SF was conducted to determine the effects of SF on the metabolism of ATV. The aqueous and methanolic extracts of SF inhibited ATV metabolism, whilst the triterpenoid glycoside fraction had a converse effect. Analogous effects by the extracts were demonstrated in experiments conducted in CYP3A4-transfected microsomes, suggesting that the inhibition of ATV metabolism in the liver microsomes by these SF extracts was CYP3A4-mediated. A combination of Sutherlandiosides C and D also inhibited CYP3A4-mediated ATV metabolism, which was in contrast to the response elicited by the triterpenoid fraction in the liver microsomes, where other unidentified compounds, shown to be present therein, may have contributed to the activation of ATV metabolism. The in vitro studies revealed the potential for SF to alter the bioavailability of ATV, therefore a clinical study in which the effect of a multiple dose regimen of SF on the pharmacokinetics (PK) of a single dose of ATV was conducted in healthy male volunteers. The statistical analysis showed that the 90 % confidence intervals around the geometric mean ratios (ATV + SF/ATV alone) for both Cmax and AUC0-24 hours, fell well below the lower limit of the "no-effect" boundary of 0.8 – 1.25, implying that the bioavailability of ATV was significantly reduced in this cohort of subjects. It may thus be concluded that if the reduction in bioavailability observed in this clinical study is found to be clinically relevant, co-administration of SF commercial dosage forms and ATV in HIV/AIDS patients may potentially result in subtherapeutic ATV levels, which may in turn contribute to ATV resistance and/or treatment failure. This research has therefore highlighted the potential risk for toxicity or lack of efficacy of ARV regimens which may result when ATMs and PIs are used concurrently and that patients and health care practitioners alike should be aware of these perils.