Echinacea is an herbal supplement commonly used as an immune system stimulant to prevent infections, such as the common cold or flu. Echinacea has been documented as a cyctochrome P450 (CYP) 3A4 inhibitor in vitro, but no formal studies have been conducted in humans. Etoposide is a cytotoxic, topoisomerase II inhibitor, chemotherapeutic agent used in the treatment of lung cancer. Etoposide is primarily metabolized by CYP 3A4. We report the first possible drug–herbal interaction between Echinacea and etoposide. A 61-year-old gentleman newly diagnosed with nonsmall cell lung cancer began concurrent chemoradiation with cisplatin and etoposide. He was admitted to the hospital on day 8 of his first cycle and found to be thrombocytopenic. His platelet count eventually reached a nadir of 16 × 103/L, requiring platelet transfusion support. Upon admission, it was discovered he was taking Echinacea, which was discontinued. He received his next cycle of chemotherapy without taking Echinacea. His platelet count decreased to a nadir of 44 × 103/L, but he did not require platelet transfusions. Echinacea likely contributed to this patient's profound thrombocytopenia and should be avoided in patients receiving etoposide and possibly other chemotherapeutic drugs that are CYP 3A4 substrates.

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Background: Caffeine is added to dietary supplements to increase energy and suppress appetite. Many people take dietary supplements for weight loss. Patients may be unaware that supplements can contain caffeine, even if caffeine is not listed as an ingredient. Commonly used herbal dietary supplement ingredients, such as guarana, are natural sources of caffeine. Objective: To describe a case of possible caffeine-induced seizure in a patient taking an over-the-counter weight loss supplement. Case Report: A previously healthy 38-year-old female experienced blurring of vision and a new onset grand mal seizure. The patient had a two-month history of taking the dietary supplement, Zantrex - 3™. Zantrex - 3™ is advertised as a weight loss supplement which may provide rapid weight loss and extreme energy in one “power packed pill.” Conclusions/Summary: After discontinuation of Zantrex - 3™, the patient experienced no further seizure activity. Outpatient follow up at 2 and 6 weeks was noncontributory with follow up MRI and EEG both within normal limits.

Thesis (M.Sc.) --University of Limpopo, 2009 / Two experiments were conducted to determine the effect of dietary ascorbic acid supplementation levels on productivity, carcass characteristics and mortality of Venda chickens. The first experiment determined the effect of dietary ascorbic acid supplementation levels on productivity and mortality rate of 175 unsexed Venda chickens between 1 and 6 weeks old. The second experiment determined the effect of dietary ascorbic acid supplementation levels on productivity, carcass characteristics and mortality rate of 140 female Venda chickens between 8 and 13 weeks old. A Completely Randomized Design was used in both experiments. The treatments ranged from 0 to 2000 mg of ascorbic acid per kg DM feed. A quadratic equation was used to determine levels of ascorbic acid supplementation for optimum feed intake, feed conversion ratio, growth rate, live weight and breast meat yield. Feed conversion ratio, growth rate and live weight were optimized at different levels of 1050, 1301 and 1500 mg of ascorbic acid per kg DM feed, respectively, during the starter phase. Similarly, feed conversion ratio, growth rate, live weight and breast meat yield were optimized at different levels of 1000, 1250, 1482 and 769 mg of ascorbic acid per kg DM feed, respectively, during the grower phase. Dietary feed intake in both phases was not optimized within the range of values of ascorbic acid supplementation used in this experiment. The results indicate that at each growth phase, different levels of ascorbic acid supplementation optimized feed conversion ratio, growth rate and live weight of Venda chickens. However, level of ascorbic acid supplementation for optimum breast meat yield was lower than those for feed conversion ratio, growth rate and live weight. These findings have implications on ration formulation for Venda chickens.

Common methods for determining mineral absorption by the body are invasive and frequently utilize radioisotopes. In experiment one. rats were given a dose of radiolabeled ferrous sulfate. Relative absorption was estimated by changes in serum iron and by appearance of the radiotracer in the serum. There were no differences in relative absorption determined by the methods, although the low overall absorptions by the iron-replete rats may have decreased the sensitivity. In experiments two and three. iron and magnesium supplements were given orally to 12 women age 19-25. Each subject received iron and magnesium supplements once each week for 5 weeks. Blood samples were taken via venous catheter every 30 minutes for 2 hours and 30 minutes following dosing, and a urine sample was taken following the collection time period. Samples were analyzed for serum iron, serum magnesium, hematocrit, ferritin, urinary magnesium, and urinary creatinine. The increase in serum iron was evaluated from both the peak increase in serum iron and from the integrated increase in serum iron over the blood collection time. The data for each supplement were compared by analysis of variance. For the iron supplements. the taste-free iron supplement increased serum iron less than either the Ferrochel or the ferrous sulfate supplements. When the iron absorption was then compared to ferritin stores (low, medium, and high), the relative absorption of Ferrochel was higher in the low ferritin range (0-15 ng/ml) than in the upper ranges (P=.00l for peak and P=.0002 for area). Relative absorption from Ferrochel iron was also higher than the other supplements for subjects with low ferritin stores. Neither serum nor urinary magnesium values differed significantly among the three compounds examined. Serum magnesium values are stable in healthy individuals, and the urinary magnesium data were not evaluated over 24 h as in typical magnesium load tests. In summary, both the ferrous sulfate and Ferrochel supplements were absorbed more efficiently than the taste-free iron supplement. The Ferrochel was also absorbed more efficiently in individuals with low iron stores, demonstrating better regulation by the body than with the other supplements examined.

Graduation date: 2004

Mixed results, in terms of performance benefits, have been found when comparing carbohydrate (CHO) and carbohydrate-protein (CHO-P) supplementation during endurance exercise. Thus this study assessed performance from three different supplements (CHO-P, CHO, double carbohydrate [CHO-CHO]) as compared to a placebo (PLA) during a time trial (TT) run. Twelve male recreational runners (age = 32.4 ± 9.5 yrs; body mass index [BMI] = 22.7 ± 1.5 kg/m2; VO2max = 59.68 ± 7.53 mL/kg body weight; 100% white) individually completed four, 12-mile TT runs, 7-10 days apart, at about 75% of the their race pace. Dietary and physical activity consistency within the 24-hour time period prior to each run was controlled via individualized diet and activity prescriptions based off of the diet consumed and the physical activity engaged in prior to TT 1. Throughout each TT run, participants consumed a 600 mL load of one of the four aforementioned supplements. Supplement order was counterbalanced with a latin-square design. Endurance performance was measured by time to complete the 12-mile run, and time to complete the last 1.2 miles of the run, where participants were instructed to run at maximal effort, 100% race pace. A main effect of time occurred during the TTs for perceived exertion (RPE) and heart rate (HR). RPE (Borge 10-point scale) significantly increased from the mid-point of the TT to completion of the run (4.7 ± 0.7, 9.7 ± 0.9, p < 0.001); HR significantly increased from the start of the run to the start of the maximal effort, and was significantly higher at completion of the effort (84.4 ± 14.5 bpm, 166.0 ± 8.3 bpm, 178.8 ± 7.4 bpm, p < 0.001). No significant difference was found in overall time to complete the 12-mile run or maximal effort between the supplements (PLA = 88.6 ± 11.6 min, CHO = 89.1 ± 11.3 min, CHO-P = 89.1 ± 11.8 min, CHO-CHO = 89.6 ± 11.9 min; PLA = 8.3 ± 1.2 min, CHO = 8.2 ± 1.2 min, CHO-P = 8.2 ± 1.2 min, CHO-CHO = 8.4 ± 1.5 min). These findings suggest that type of supplementation (CHO, CHO-CHO, CHO-P) consumed during an endurance exercise bout has no influence on enhancing endurance performance in male recreational runners during TT runs less than 100 minutes in length.

This study is an attempt to analyse the newspaper supplements published by the Turkish printed press. An analysis of the qualitative and quantitative characteristics of the contents of the newspaper supplements selected due to the circulation numbers follows a brief history of the newspaper supplements. The study ends with the interviews made with the editor-in-chiefs of the weekend supplements. What results from these two analyses on different levels is that even though the basic aim of the daily newspaper supplements, mainly the weekend supplements is to increase the advertising revenues of the publishing companies, the content presented to the readers through these supplements also plays an important role in the social-ideological reproduction as the symbol of a specific life style. Therefore, this study also shows that critical political-economic approaches have to be completed with cultural analyses in the media studies.

Η παρούσα εργασία αποσκοπεί στο να διερευνήσει τις αντιλήψεις των φαρμακοποιών ως επιστημόνων υγείας απέναντι στα συμπληρώματα διατροφής, αλλά και τις πρακτικές επιλογής και προώθησης των σκευασμάτων αυτών στο φαρμακείο. Τα δεδομένα συλλέχθηκαν με τη βοήθεια ειδικά διαμορφωμένου ερωτηματολογίου που απευθυνόταν σε επαγγελματίες φαρμακοποιούς. Συγκεντρώθηκαν 100 ερωτηματολόγια από διάφορους νομούς της βόρειας Ελλάδας κυρίως, με προσωπική συνέντευξη, τηλεφωνική επικοινωνία καθώς και αποστολή στο χώρο εργασίας για τα πιο απομακρυσμένα φαρμακεία. Οι φαρμακοποιοί του δείγματος εμφανίστηκαν συγκρατημένοι όσον αφορά την ικανοποίηση απ’ τις πωλήσεις των συμπληρωμάτων διατροφής στα φαρμακεία τους. Εξίσου επιφυλακτικοί παρουσιάστηκαν και ως προς την τάση να συστήνουν κάποιο σκεύασμα με δική τους πρωτοβουλία σε περιπτώσεις που πιθανώς να αφορούν κάποιο πρόβλημα υγείας. Στοιχεία Μάρκετινγκ των συμπληρωμάτων διατροφής όπως η ισχύς της εμπορικής ονομασίας και η φήμη της παραγωγού εταιρίας φάνηκαν να επηρεάζουν καθοριστικά τόσο τις επιλογές των πελατών, κατά τη γνώμη των φαρμακοποιών, όσο και τις δικές τους επιλογές ως προς τα σκευάσματα που θα επιλέξουν να διαθέτουν στο φαρμακείο τους. Ως βασικότερος παράγοντας σύστασης κάποιου συγκεκριμένου σκευάσματος από τους φαρμακοποιούς αναδείχθηκε η πίστη στην αποτελεσματικότητά του. Γενικά το δείγμα εμφανίστηκε θετικό ως προς την αναγκαιότητα των συμπληρωμάτων διατροφής εξαιτίας των συνθηκών που επιβάλλει ο σύγχρονος τρόπος ζωής και συγκρατημένο ως προς την ανεπιφύλακτη σύσταση και προώθησή τους στο φαρμακείο. Επιπρόσθετα, σημείωσε ότι η συντριπτική πλειοψηφία των πελατών που έρχονται στο φαρμακείο αναζητώντας κάποιο συμπλήρωμα ζητούν τη συμβουλή του φαρμακοποιού ως προς την επιλογή τους, ενισχύοντας το συμβουλευτικό ρόλο του φαρμακοποιού στη διάθεσή τους. Τέλος, οι ερωτηθέντες δήλωσαν λιγότερο ενημερωμένοι σχετικά με τα συμπληρώματα διατροφής, απ’ ότι σίγουροι για τις σχετικές συμβουλές/ συστάσεις τους προς το κοινό. Αν και στη θεωρία τάχθηκαν υπέρ της αναγκαιότητας των συμπληρωμάτων διατροφής σε μια πληθώρα ανθρώπων λόγω του σύγχρονου τρόπου ζωής, εντούτοις οι φαρμακοποιοί του δείγματος εμφανίστηκαν πιο συντηρητικοί στην πράξη όσον αφορά την σύσταση και προώθηση τους. Όσο αντιλαμβάνονται να επηρεάζουν τα προϊόντικα στοιχεία των διαφόρων συμπληρωμάτων διατροφής τις επιλογές του αγοραστικού κοινού, άλλο τόσο φάνηκε να καθορίζουν τις επιλογές των φαρμακοποιών σχετικά με τα σκευάσματα που επιλέγουν να διαθέτουν στο φαρμακείο τους. Σημαντικό ρόλο στις επιλογές τους διαδραματίζει και η σχέση του φαρμακοποιού με την παραγωγό εταιρία (εμπιστοσύνη στο κύρος της εταιρίας και την αποτελεσματικότητα των σκευασμάτων της, ευελιξία της εταιρίας στη συνεργασία με τον φαρμακοποιό). Γενικά όσο πιο ικανοποιημένοι δήλωσαν οι φαρμακοποιοί απ’ τις πωλήσεις των συμπληρωμάτων διατροφής στο φαρμακείο, τόσο πιο ενημερωμένοι σχετικά εμφανίστηκαν. Η αυτοπεποίθηση των φαρμακοποιών για τις συμβουλές/ συστάσεις τους επηρεάζεται τόσο από την σχετική ενημέρωση τους όσο και από την επαγγελματική τους εμπειρία. / To explore the beliefs of pharmacists as health care professionals towards food supplements and their practices of choosing, recommending and promoting such products. Data was collected by administering a specially designed questionnaire to be completed by community pharmacists. 100 questionnaires were gathered coming from various areas, mostly in the north of Greece using personal interviews, phone interviews as well as by mailing the questionnaires to professionals based at distant areas. The pharmacists of the sample appeared merely satisfied from the sales of food supplements in their pharmacies. They also appeared reserved towards taking sole responsibility of suggesting a supplement, in cases that could involve some health problem. Certain Marketing elements such as the brand name and the prestige of the company seemed to play a key role in the buying decision of the customers from the pharmacists’ view, as well as in their own decisions over which supplements they will include for sale in the pharmacy. The belief in the effectiveness of the product was regarded as the most important reason for suggesting a certain supplement. Generally, the sample appeared more likely to believe in the necessity of food supplements as a result of the current way of living, though reserved as far as uninhibitedly suggesting and promoting their use. It was also noted that the majority of customers seeking to purchase a food supplement, ask for the pharmacist’s opinion and suggestion instead of picking one on their own, which reinforces the counseling role of the pharmacist in the buy. Finally, the pharmacists stated to be more confident over their advice/ suggestions, rather than well-informed as far as food supplements are concerned. The pharmacists included in the research seemed skeptical about the wide use and promotion of food supplements, though in theory they appeared to agree with the fact that they are necessary to various people due to the current way of living. The more they believe that certain marketing elements of these products affect the customers’ buying decisions, the more likely they are to be affected by these elements in deciding which supplements to include for sale in their pharmacies. As far as these decisions are concerned, the relationship with the producing company plays an important role (trust in the company’s credibility and its products’ effectiveness, flexibility of the company in terms of pharmacist’s needs). Generally, the more satisfied the pharmacist was from the sales of food supplements in the pharmacy, the more informed about them he/she stated to be. The confidence of the pharmacists as far as their suggestions are concerned is affected by how well-informed they are and by their experience behind the counter.

Background: Breastfeeding is known to have benefits both for maternal and child health. Some questions around the benefits and risks of breastfeeding in the presence of HIV infection still remain unclear. Aims: To study the effects of infant feeding mode by HIV-positive mothers, on maternal and child health. In addition, to assess the effect of nutritional supplementation to HIV-positive lactating mothers on nutritional and health status of mothers and their infants and on the quality of breastmilk. Methods: The study had 2 components; a prospective study to examine the impact of infant feeding mode on nutritional and health indices in mothers and their infants and within it a nested randomized controlled clinical trial to study the impact of a daily 50 g soya/peanut based supplement during breastfeeding on the above parameters. The measurements included anthropometry; body composition indicators (using both deuterium dilution and BIA); haematology and biochemical markers; as well as incidence rates of opportunistic infections and clinical disease progression. Breastmilk was analysed for both macro and micronutrients. Cervical screening was offered to all the women. Results: AFASS criteria were fulfilled by 38.7% of the formula feeding mothers. No significant differences between the formula feeding and breastfeeding groups in terms of haematological, immunological and body composition changes were seen. Breastfeeding mothers had significantly lower events with high depression scores (p=0.043). Longer duration of breastfeeding was observed to be significantly associated with a mean increase in CD4 count (74 cells/μL) and better health outcomes. The supplement made no significant impact on any maternal or child outcomes except for a limited effect on mothers with low BMI, where it was significantly associated with preventing loss of lean body mass (p=0.026). Breastfeeding infants had a significantly lower risk of diarrhoea and hospitalisation at 3 months (p=0.006 and 0.014 respectively). Both breastfeeding and longer duration of breastfeeding was significantly associated with better development scores and growth parameters. Supplementation made no impact on breastmilk composition. Of the 86 mothers who agreed for cervical screening, 27.6% had human papilloma virus infection. Conclusions: Breastfeeding is not harmful to the mother despite the presence of HIV infection. On the contrary we observed both breastfeeding and longer breastfeeding duration to be associated with better maternal and child outcomes. Mothers are still choosing formula feeding inappropriately presumably because of the availability of free formula and/or sub-optimal counseling. The new (2010) local PMTCT guidelines based on WHO recommendations should reverse this. Food insecurity was prevalent amongst 32% of our study population, highlighting the need to include sustainable and empowering solutions to encounter this problem. Less sustainable solutions such as nutritional supplementation should be targeted to the malnourished and in emergency situations. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2012.