Herbal Dietary Supplements Research Articles

The opinion of pharmacists about the pharmaceutical category of herbal medicines. Survey of pharmacy retail employees

Abstract. The category of herbal medicines is represented in the domestic pharmaceutical market in the form of two main groups of pharmacy product assortment – herbal medicinal preparations (HMP) and dietary supplements (DS). They often have similarities in terms of composition, dosage form, and scope of application. Hence, attitude of professional specialists that influence consumer demand and choice, to these groups of pharmacy products is important to be considered. Aim. The purpose of the study is to assess the level of knowledge, prevailing ideas, differences in the perception of HMP and DS among pharmacists working in pharmacy retail. Materials and methods. The survey of pharmacists was conducted using a specially designed questionnaire using the Google forms electronic resource. 162 specialists with at least 1 year of experience in the pharmacy sector participated in the study. The study was conducted on the basis of the “Evalar Pharmacy” pharmacy network, specializing in the sale of herbal medicines. Results. The majority of the surveyed specialists noted urological (54.0%) and neurological diseases (52.1%) as therapeutic areas where herbal medicines have real clinical value. The leading role of retail pharmacists in the choice of products by consumers was noted by 40.1% of respondents. The possibility of replacing HMP with DS in 38.0% of cases is completely denied by them, in 50.0% and 12,0% it is allowed if desired by the patient himself or in any case respectively. 59.3% of specialists point out the difference in the regulatory status of HMP and DS to consumers in their practice. In the majority of cases, they need reliable information about clinical trials on efficacy (73.6%), as well as the quality and safety of products (52.1%). Conclusions. The results of the survey show that pharmaceutical specialists are well aware of the scope, advantages and disadvantages of the phytopreparation category, see differences in HMP and DS, but in their professional activities they are more guided by the opinion of consumers.

S1898 Impact of Herbal Dietary Supplements on Liver Enzyme Levels: A Systematic Review and Meta-Analysis

S1898 Impact of Herbal Dietary Supplements on Liver Enzyme Levels: A Systematic Review and Meta-Analysis

Preconditioning with Ginsenoside Rg3 mitigates cardiac injury induced by high-altitude hypobaric hypoxia exposure in mice by suppressing ferroptosis through inhibition of the RhoA/ROCK signaling pathway

Ethnopharmacological relevanceGinseng has historically been utilized as a conventional herbal remedy and dietary supplement to enhance physical stamina and alleviate fatigue. The primary active component of Ginseng, Ginsenoside Rg3 (GS-Rg3), possesses diverse pharmacological properties including immune modulation and anti-inflammatory effects. Furthermore, GS-Rg3 has demonstrated efficacy in mitigating tissue and organ damage associated with metabolic disorders such as hypertension, hyperglycemia, and hyperlipidemia. Nevertheless, its potential impact on high-altitude cardiac injury (HACI) remains insufficiently explored. Aim of the studyThe aim of this study was to examine the potential cardioprotective effects of Ginsenoside Rg3, and to investigate how Ginsenoside Rg3 preconditioning can enhance high-altitude cardiac injury by inhibiting the RhoA/ROCK pathway and ferroptosis in cardiac tissue. The findings of this study may contribute to the development of novel therapeutic strategies using traditional Chinese medicine for high-altitude cardiac injury, based on experimental evidence. Materials and methodsA hypobaric hypoxia chamber was employed to simulate hypobaric hypoxia conditions equivalent to an altitude of 6000 m. Through a randomization process, groups of six male mice were assigned to receive either saline, Ginsenoside Rg3 at doses of 15 mg/kg or 30 mg/kg, or lysophosphatidic acid (LPA) at 1 mg/kg. The impact of Ginsenoside Rg3 on high altitude-induced arrhythmias was evaluated using electrocardiography. Cardiac pathology sections stained with hematoxylin and eosin were evaluated for damage, with the extent of cardiomyocyte damage observed via transmission electron microscopy. The impact of Ginsenoside Rg3 on high-altitude cardiac injury was investigated through analysis of serum biomarkers for cardiac injury (CK-MB, BNP), inflammatory cytokines (TNF, IL-6, IL-1β), reactive oxygen species (ROS) and glutathione (GSH). The expression levels of hypoxia and hypoxia-related proteins in myocardial tissues from each experimental group were assessed using Western blot analysis. Following a review of the existing literature, the traditional regulatory mechanisms of ferroptosis were examined. Immunofluorescence staining of cardiac tissues and Western blotting techniques were utilized to investigate the impact of Ginsenoside Rg3 on cardiomyocyte ferroptosis through the RhoA/ROCK signaling pathway under conditions of hypobaric hypoxia exposure. ResultsPre-treatment with Ginsenoside Rg3 improved high altitude-induced arrhythmias, reduced cardiomyocyte damage, decreased cardiac injury biomarkers and inflammatory cytokines, and lowered the expression of hypoxia-related proteins in myocardial tissues. Both Western blotting and immunofluorescence staining of cardiac tissues demonstrated that exposure to high-altitude hypobaric hypoxia results in elevated expression of ferroptosis and proteins related to the RhoA/ROCK pathway. Experimental validation corroborated that the role of the RhoA/ROCK signaling pathway in mediating ferroptosis. ConclusionsThe findings of our study suggest that preconditioning with Ginsenoside Rg3 may attenuate cardiac injury caused by high-altitude hypobaric hypoxia exposure in mice by inhibiting ferroptosis through the suppression of the RhoA/ROCK signaling pathway. These findings contribute to the current knowledge of Ginsenoside Rg3 and high-altitude cardiac injury, suggesting that Ginsenoside Rg3 shows potential as a therapeutic agent for high-altitude cardiac injury.

Knowledge, Attitude, Usage Types, and Factors Affecting Dietary Herbal Supplements’ Usage Pattern among Chronic Disease Patients

Knowledge, Attitude, Usage Types, and Factors Affecting Dietary Herbal Supplements’ Usage Pattern among Chronic Disease Patients

Investigating Trace and Macro-element Composition of Herbal and Nutraceutical Dietary Supplements Marketed in Oman: Insights into Safety and Labeling.

With the global increase in the use of dietary supplements to provide nutrients in one's regular diet, these supplements' potential health risks and benefits have become a topic of significant interest. Interestingly, as dietary supplements, the Food and Drug Administration (FDA) in the United States (USA), Europe, and most countries do not require manufacturers and distributors to obtain approval or provide safety assessments before marketing those products. This research explores for the first time 16 heavy, trace and macro-elemental contents, namely, As, Ni, Cd, Pb, Cu, Co, Mn, Cr, Zn, V, Fe, Al, K, Na, Mg, and Ca, within 24 nutraceutical and herbal supplements marketed in Oman. The research is focusing on ensuring their compositions, concentrations, and freedom of toxic elements. ICP-OES was utilized, preceded by a microwave digestion technique to digest the samples in concentrated HNO3 and HCl (3:1, v/v). The method was validated within linear ranges of 0.03-5.00ppm and 1.0-200.0ppm for micro- and macro-elements, respectively, with %recoveries ranging from 90 to 104%. The limits of detection ranged from 0.01 to 0.09 and 0.14 to 0.30ppm, while the limits of quantification ranged from 0.03 to 0.28 and 0.46 to 0.91ppm for micro- and macro-elements, respectively. The detected levels were compared to online databases for risk assessment. Although As and Cd were not detected in all samples, Pb was found in nine samples, with some exceeding regulated limits of exposure. About 80% of the samples contained Al, of which two samples were susceptible to serious health risks of exceeding exposure limits in their compiled doses. The locally harvested Omani herbal supplements revealed significant amounts of Zn, Mg, Mn, and Cu. The results highlighted the potential risks associated with both dosage compliance and labeling discrepancies.

New Sweet-Tasting Gypenosides from "Jiaogulan" (Gynostemma pentaphyllum) and Their Interactions with the Homology Model of Sweet Taste Receptors.

Gynostemma pentaphyllum has been used as an herbal tea, vegetable, and dietary supplement for hundreds of years in East Asia. The sweet variety, grown in large areas in Fujian Province, China, is an essential source of "Jiaogulan" herbal tea. However, its sweet components are unknown. To investigate the sweet constituents of Fujian "Jiaogulan" and discover new natural high-potency sweeteners, phytochemical and sensory evaluations were combined to obtain 15 saponins, of which 11 (1-11) were sweet-tasting, including 2 new ones with sweetness intensities 20-200 times higher than that of sucrose, and four (12-15) were bitter-tasting. Their structures were elucidated using spectroscopic methods (NMR, MS, IR, UV), hydrolysis, and comparison with literature data. The contents of the 15 saponins were quantitatively analyzed using UPLC-MS/MS in multiple reaction monitoring mode. The contents of 1 and 2 sweet-tasting gypenosides were 9.913 ± 1.735 and 35.852 ± 1.739 mg/kg, respectively. The content of the sweetest compound (6) was 124.969 ± 0.961 mg/kg. Additionally, compound 4 was the most abundant sweet component (422.530 ± 3.702 mg/kg). Furthermore, molecular docking results suggested interactions of sweet saponins with sweet taste receptors. In general, this study revealed the material basis of the Fujian "Jiaogulan" taste.

Herbal and Non-Herbal Dietary Supplements for Psychiatric Indications: Considerations in Liver Transplantation.

Traditional, complementary, and integrative medicine (TCIM) modalities are widely employed. However, TCIM, specifically herbal and non-herbal dietary supplements, can pose challenges in the context of organ transplantation. In this review, we discuss common supplements used for psychiatric purposes and highlight important considerations for candidates and recipients of liver transplants. Ashwagandha, kava kava, green tea extract, skullcap, turmeric, and valerian have known idiosyncratic hepatotoxic potential and may complicate the liver transplantation course. Multiple supplements reportedly carry a lower risk of hepatotoxicity, though evidence for widespread use in those at risk for or with hepatic impairment is limited. Psychiatrists caring for candidates and recipients of liver transplants must recognize that patients may find supplements helpful in alleviating psychiatric symptoms, despite an overall limited evidence base. Evaluating benefit versus risk ratios and reviewing drug-drug interactions is essential to promote transplant candidacy and mitigate the possibility of native or graft liver dysfunction.

Identification of metabolite changes and evaluation of biological activities in edible flowers of Magnolia kobus at different developmental stages

BackgroundMagnolia kobus belongs to the Magnoliaceae family and the genus Magnolia. The flowers are widely used in herbal tea and dietary supplements. It is effectively used in traditional medicines and its chemical constituents have various biological activities, such as anti-obesity, antioxidant, anticancer, anti-inflammatory, and anti-hyperlipidaemic activities. The flower developmental process of M. kobus involves a complex regulatory network and is intensively related to the quality and relative composition of primary and secondary metabolites of the flower. Hence, the identification of metabolic changes during different developmental stages of the flower was important for enhancing organoleptic and nutritional characteristics. To our knowledge, to date, none of the studies has investigated the relationship between metabolic changes (primary and secondary metabolites) during different developmental stages of the M. kobus flower.ResultsThis study investigated metabolic changes in 47 hydrophilic and 13 lipophilic compounds and biological activities in Magnolia kobus flowers during four developmental stages. Metabolites were identified using HPLC, GC–qMS, and GC–TOFMS. Throughout flower development, metabolite accumulation showed significant differences based on metabolomics approaches. The dynamic changes of 21 differential metabolites occurred between the young and mature stages. Flower buds exhibited high levels of phenylpropanoids and phytosterols. The total phenolic and flavonoid contents were most abundant in the buds and decreased from the bud to the old stages. Flower bud extracts showed the most powerful effects in three antioxidant assays and antibacterial effects against 10 pathogenic bacterial strains.ConclusionsThese findings emphasise the value of M. kobus flower buds as an edible natural source and provide valuable insight into the metabolic changes that occur in M. kobus flowers during development.Graphical

Garlic ameliorates atherosclerosis by regulating ferroptosis pathway: an integrated strategy of network pharmacology, bioinformatic and experimental verification.

Atherosclerosis (AS) is a chronic arterial pathology and a leading cause of vascular disease-related mortality. Fatty streaks in the arterial wall develop into atherosclerosis and characteristic plaques. Clinical interventions typically involve lipid-lowering medications and drugs for stabilizing vulnerable plaques, but no direct therapeutic agent specifically targets atherosclerosis. Garlic, also locally known as DASUAN, is recognized as a widely sold herbal dietary supplement esteemed for its cardiovascular benefits. However, the specific mechanisms of garlic's anti-atherosclerotic effects remain unclear. This study aims to elucidate the pharmacological mechanisms through which garlic ameliorates atherosclerosis. The study identified the major active components and targets of garlic by screening the TCMSP, TCM-ID, and, ETCM databases. Atherosclerosis-associated targets were obtained from the DisGeNET, GeneCards, and DiGSeE databases, and garlic intervention targets were determined through intersection. Utilizing the intersected genes, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted using R software. A garlic component-disease target network was constructed using Cytoscape. RNA-seq datasets from the GEO database were utilized to identify differentially expressed genes (DEGs) associated with atherosclerosis. The target genes were intersected with DEGs and the FerrDb (ferroptosis database). Molecular docking predicted the binding interactions between active components and the core targets. In vitro and in vivo experiments validated the identified core targets. The integration of garlic drug targets with atherosclerotic disease targets identified 230 target genes. Intersection with RNA-seq DEGs revealed 15 upregulated genes, including 8 target genes related to ferroptosis. Molecular docking indicated favorable affinities between garlic active components [Sobrol A, (+)-L-Alliin, Benzaldoxime, Allicin] and target genes (DPP4, ALOX5, GPX4). Experimental validation showed that GARLIC reduces the expression of ferroptosis-related genes in AS, suggesting its therapeutic potential through the regulation of ferroptosis. Garlic ameliorates atherosclerosis by targeting intra-plaque ferroptosis and reducing lipid peroxidation. These findings provide novel insights into the pharmacological mechanisms underlying the efficacy of garlic in treating AS.

Application of Herbal Dietary Supplements in Aquaculture – A Review

Abstract Livestock farming is considered one relevant cause of global warming. The aim of this article is to show that the environmental footprint of broilers and laying hens is small among farmed animal species. Author examines the increase in the production of broilers and laying hens over the past decades as a result of genetic selection, and as a consequence their greenhouse gas emissions, land, water and energy use have decreased. It was evidenced that with the increase of production the environmental footprint per unit of product decreases. On the other hand, in alternative housing systems, especially in free-range and organic production, all indicators deteriorate. Supplying the Earth’s ever-growing population with a sufficient amount of high-quality food of animal origin, in such a way that the environmental footprint of poultry farming is reduced, can be achieved with intensive production taking into account animal welfare. New tools and methods such as genomic selection, gene editing or precision poultry breeding will help in this.

A randomized, double-blind, parallel and placebo-controlled clinical study to evaluate the efficacy and safety of KaraCalm™: a dietary supplement to support sleep and manage stress

Background: KaraCalm™ is a novel polyherbal formulation obtained from the combination of Valeriana officinalis extract, Passiflora incarnata extract, Ocimum sanctum extract, Ziziphus jujuba extract, Rosmarinus officinalis extract, and Nigella sativa extract. The objective of the present investigation was to assess the efficacy and safety of KaraCalm™ to manage stress and improve sleep in healthy subjects in a randomized, double-blind, placebo-controlled clinical study. Methods: A total of 60 healthy volunteers were randomized into two groups, with 30 subjects in the KaraCalm™ group and 30 in the placebo group. Participants were asked to take KaraCalm™ 500 mg or placebo once daily for 56 days. As primary outcomes, sleep analysis was performed by using Actiwatch, while stress level was evaluated with the Perceived Stress Scale (PSS) scores from baseline to the end of the study period. Serum cortisol, and hs-CRP from baseline to the end of the study period were assessed as secondary endpoints. Results: An increase in overall sleep quality was observed in the KaraCalm™ group compared to the placebo as measured by total sleep time, onset latency, wake after sleep onset minutes, and number of awakenings. There was also a reduction in PSS scores in the KaraCalm™ group from baseline to the end of the study, indicating reduced stress levels. A significant reduction in Serum cortisol and hs-C-reactive protein (CRP) levels in the KaraCalm™ group from baseline to the end of the study further supported the effectiveness of KaraCalm™ in reducing stress. There was no significant change in the safety analyses of the patients in the intervention group when assessed from the start of the study to the end. Conclusions: KaraCalm™ can be considered a safe and effective dietary herbal Supplement to reduce stress and improve sleep quality.

Age-related differences in drug-induced liver injury: a retrospective single-center study from a large liver disease specialty hospital in China, 2002–2022

Background and aimsDrug-induced liver injury (DILI) is a prevalent adverse reaction in clinical settings. However, there is limited research on age-related differences in DILI. We performed a large-scale retrospective study to delineate the characteristics of DILI across different age groups.MethodsWe collected data on a total of 17,946 patients with confirmed DILI hospitalized at the Fifth Medical Center of the People’s Liberation Army (PLA) General Hospital in Beijing, China, from January 1, 2002, to December 31, 2022. The patients were stratified based on age into the following groups: children (< 18 years), young adults (18–44 years), middle-aged individuals (45–64 years), and elderly individuals (≥ 65 years). We gathered demographic information, medical histories, laboratory results, disease severity assessments, and mortality statistics for all patients.ResultsOverall, the distribution of DILI cases across different age groups was as follows: 6.57% were children, 24.82% were young adults, 49.06% were middle-aged individuals, and 19.54% were elderly individuals. The percentage of females increased with age, rising from 36.47% in the pediatric group to 60.51% in the elderly group. Notably, central nervous system agents (15.44%) and anti-infectious agents (21.80%) were more commonly associated with DILI in children, while cardiovascular agents (10.58%) and herbal dietary supplements or traditional medicines (H/TMs) (26.29%) were more prevalent among elderly people with DILI. Among all age groups, hepatocellular-type DILI was more common in the pediatric group (p < 0.001), whereas cholestatic-type DILI and chronic DILI were more prevalent in the elderly group (p < 0.001). Acute liver failure (ALF) and fatal outcomes were more prevalent in the pediatric and elderly groups, particularly in the pediatric group (2.04%, p = 0.041; 0.85%, p = 0.007, respectively).ConclusionsChildren and elderly individuals face a higher risk of adverse outcomes following DILI.Graphical

Sustainable analytical method for determination of bioactive compounds in solid oral formulations (capsules and tablets) containing green tea (Camellia sinensis) marketed in Brazil

This study presents the development of a sustainable analytical method using high-performance liquid chromatography (HPLC) for determination and quantification of bioactive compounds in Herbal Dietary Supplements (HDS) solid oral formulations containing green tea (Camellia sinensis). Four compounds [gallic acid, (+)-catechin, caffeine and caffeic acid] were determined in fifteen HDS samples (capsules and tablets) containing green tea marketed in Brazil. After optimizing the extraction process using factorial planning and response surface analysis, it was possible to develop the method. Methanol and acetic acid (0.25%) were components of the mobile phase, showing it as a more sustainable alternative to the use of acetonitrile. The samples evaluated demonstrated a lack of standardization in the concentrations (in mg g−1) of the chemical markers studied gallic acid (<LOD to 1.39), (+)-catechin (<LOD to 13.8), caffeine (<LOQ to 22) and caffeic acid (<LOD to 1.7). This concern has driven significant scientific research on the topic. The chromatographic method proved to be effective, sensitive and robust for qualification and quantification of the 4 chemical markers studied. This study found variations in the levels of chemical markers in HDS containing green tea sold in Brazil. Therefore, it can contribute to the regulation and quality control of these solid oral products (capsules and tablets) containing this plant.

A Multi-Digestive Enzyme and Herbal Dietary Supplement Reduces Bloating in a Single Use in Healthy Adults: A Randomized, Placebo-Controlled, Cross Over Study

A Multi-Digestive Enzyme and Herbal Dietary Supplement Reduces Bloating in a Single Use in Healthy Adults: A Randomized, Placebo-Controlled, Cross Over Study

Analysis of phosphodiesterase type 5 inhibitors and analogues as adulterants in herbal dietary food supplements in Saudi market using green UPLC-MS/MS method: Assessment of the greenness and whiteness profiles

Herbal dietary supplements are popular alternatives to oral phosphodiesterase type 5 inhibitors (PDE5Is) for treating Erectile Dysfunction (ED), yet concerns arise regarding their adulteration with undeclared synthetic PDE5Is or analogues, posing health risks. The aim of this study was to develop and validate a green UPLC-MS/MS method for sensitive and rapid detection of PDE5Is and analogues in sexual enhancement herbal dietary supplements marketed in Saudi Arabia. Method validation revealed good linearity with determination coefficients (r2) ≥ 0.9990, and LODs and LOQs in the range of 0.4 – 32 ng g−1 and 1––96 ng g−1, respectively. The accuracy ranged from 80.8 % to 103.4 % while inter-day precision was ≤ 8.6 % and intra-day precision was ≤ 8.4 %. The method was successfully utilized to analyze 32 herbal dietary supplements. The results revealed that 18 samples (56.3 %) tested positive for at least one of the target analytes. Sildenafil emerged as the most frequently detected analyte, found in 15 samples (20.1 µg g−1 to 37,492 µg g−1). Tadalafil was detected in 7 samples, with concentrations ranging from 4.46 µg g−1 to 19,986 µg g−1. Yohimbine was detected in only 4 samples, while icariin was detected at lower concentrations in 3 samples. Furthermore, the method greenness and whiteness profiles were evaluated using four metrics including the Analytical Eco-Scale, Green Analytical Procedure Index (GAPI), Analytical GREEnness (AGREE) metric, and Red-Green-Blue 12 (RGB 12) metric.This study provides foundational data on the adulteration of dietary supplements in Saudi Arabia and offers insights for future interventions to promote consumer safety and awareness regarding herbal dietary supplement consumption.

Detection and Quantification of Cyproheptadine and Dexamethasone as Adulterants in Herbal Medicines and Dietary Supplements Marketed for Weight Gain

Detection and Quantification of Cyproheptadine and Dexamethasone as Adulterants in Herbal Medicines and Dietary Supplements Marketed for Weight Gain

Mycotoxins and pyrrolizidine alkaloids in herbal dietary supplements

ABSTRACT The market demand for herbal dietary supplements is rapidly growing and such products are becoming more common and accessible to consumers. However, the knowledge about their safety remains incomplete. Herbal dietary supplements are one of the food groups that can contribute significantly to human health concerns arising from chronic exposure to pyrrolizidine alkaloids and mycotoxins. This study aimed to simultaneously determine 79 natural contaminants, including mycotoxins, as well as pyrrolizidine and tropane alkaloids in herbal dietary supplements in one analytical run. Exposure assessment and human health risks were assessed for all compounds included in this study. The total concentration of naturally occurring contaminants in herbal dietary supplements reached 5.3 mg kg−1 and the most frequently detected mycotoxins were tentoxin and alternariol monomethyl ether. The latter was detected with the highest frequency, reaching concentrations up to 2.5 mg kg−1. The obtained results indicate a potential risk to public health related to herbal dietary supplement consumption.

Advancing botanical safety: A strategy for selecting, sourcing, and characterizing botanicals for developing toxicological tools

Increases in botanical use, encompassing herbal medicines and dietary supplements, have underlined a critical need for an advancement in safety assessment methodologies. However, botanicals present unique challenges for safety assessment due to their complex and variable composition arising from diverse growing conditions, processing methods, and plant varieties. Historically, botanicals have been largely evaluated based on their history of use information, based primarily on traditional use or dietary history. However, this presumption lacks comprehensive toxicological evaluation, demanding innovative and consistent assessment strategies. To address these challenges, the Botanical Safety Consortium (BSC) was formed as an international, cross-sector forum of experts to identify fit-for purpose assays that can be used to evaluate botanical safety. This global effort aims to assess botanical safety assessment methodologies, merging traditional knowledge with modern in vitro and in silico assays. The ultimate goal is to champion the development of toxicity tools for botanicals. This manuscript highlights: 1) BSC's strategy for botanical selection, sourcing, and preparation of extracts to be used in in vitro assays, and 2) the approach utilized to characterize botanical extracts, using green tea and Asian ginseng as examples, to build confidence for use in biological assays.

Saudi Healthcare Students' General Practices Applied to Protect Against COVID-19 and Their Beliefs Regarding the Use of Herbal Supplements as a Protection Method.

At the beginning of the COVID-19 pandemic, the absence of treatment increased the Saudi population's inquietude regarding the virus. Therefore, people were seeking alternative methods to protect themselves from disease's fast transmission, such as hand hygiene, social isolation, and the use of natural and dietary products. The main objective of this study is to assess healthcare students' general practices applied to protect against COVID-19 and their beliefs regarding the use of herbal supplements as a protection method. All undergraduate healthcare students were eligible to participate, except pre-professional students. The estimated sample size was 371, which was calculated using Raosoft® software (Raosoft Inc.,Seattle, WA). A cross-sectional online survey was distributed among the targeted population. The data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and transferred to be analyzed by JMP software (SAS Institute Inc., Cary, NC). A total of 441 healthcare students, who met the inclusion criteria, participated in this study. About 81.41% of the participants reported that they were completely committed to Saudi guidelines regarding preventive measures against COVID-19 transmission. Most of the participants were not using herbal supplements, while 17.1% of them used herbal products or dietary supplements during the COVID-19 pandemic. The participants who used herbal and dietary products commonly consumed ginger and vitamins C and D. In addition, a chi-square showed significant differences in gender and specialties regarding the usage of herbal supplements as a protective method against COVID-19 (P<0.05). The findings of our study exhibit the general practice of herbal products during the COVID-19 pandemic among Saudi healthcare students was low in comparison withtheir beliefs. In addition, the using of herbal supplements should be evidence-based to guarantee safe consumption.

A complex case of severe acute hepatitis with cholestasis in a genetically predisposed woman: Could curcumin be the trigger?

Drug-Induced Liver Injury (DILI) can present as cholestatic hepatitis and differential diagnosis with other etiologies is often challenging. The established trend of growth in consumption of Herbal Dietary Supplements (HDS) by the general population underlines the necessity