Dietary supplement administration has steadily increased in Korea, but evidence on administration of dietary supplements to infants remains limited. This study investigated the longitudinal trends and determinants of supplement administration in infants from birth to 24 months of age. A longitudinal birth cohort study enrolled 137 infants born at ≥28 weeks of gestation, and followed them at 2, 6, 12, and 24 months. Structured questionnaires assessed supplement administration, feeding methods, family history of allergic diseases, and demographics. Feeding was categorized as breastfeeding, formula feeding, or mixed feeding. Atopic dermatitis and food allergy were diagnosed using standardized criteria. Overall, 82% of infants were given supplements during the study period. Probiotics and vitamin D were the most frequently administered at all ages, while multivitamin administration increased markedly after 12-24 months (38.6%). Supplement administration differed by feeding method: breastfed (29.4%) and mixed-fed (5.0%) infants had a higher percentage of iron supplementation at 12 months compared with formula-fed (0%). Multivitamin administration was more common among infants without a family history of allergies (low-risk group: 32.6%) compared with those with a family history of allergies (high-risk group: 23.4%). Infants born via cesarean section were significantly more likely to be given dietary supplements at 2-6 months (OR = 8.09, 95% CI: 1.79-36.49), 6-12 months (OR = 14.88, 95% CI: 1.91-116.10), and 12-24 months (OR = 5.16, 95% CI: 1.09-24.35). This study found a high percentage of supplement administration among Korean infants, with frequent administration of probiotics and vitamin D from early infancy. Over time, supplement types became more diverse, with usage trends varying by feeding method and allergy risk. Cesarean-born infants were more likely to be given supplements. These findings provide descriptive data on how supplements are administered to Korean infants and suggest a basis for exploring the implications of early-life supplement administration.
Virtual patients (VPs) demonstrate effectiveness in improving clinical reasoning skills; however, traditional VP platforms often lack individualized feedback mechanisms. Advances in large language models (LLMs) enable automated analysis of student-VP interactions, providing scalable feedback on clinical performance. While artificial intelligence (AI)-enhanced social robotic VP platforms show promise for clinical reasoning training, no studies have examined whether AI-generated feedback integrated in such platforms improves clinical performance in standardized assessments. This study evaluated whether AI-generated postconsultation feedback integrated into social robotic VP interactions improves medical students' clinical performance, emphasizing medical history taking and communication. A quasi-experimental study with 115 sixth-semester medical students (N=157, 73.2% of eligible students) was conducted at Karolinska Institutet, Stockholm, Sweden, during spring 2025. Students were allocated by hospital site to receive (n=61, 53%) or not receive (n=54, 46.9%) AI-generated feedback following interactions with a Social AI-Enhanced Robotic Interface. All students completed 9 VP cases; the intervention group received approximately 1 page of structured feedback after each VP case. The feedback system used multiple LLMs following a 2-stage algorithm: assessing student-VP dialogues using an assessment rubric, then generating structured feedback on history-taking performance. Both groups participated in case-specific follow-up seminars led by consultant rheumatologists following each VP encounter. Clinical performance was assessed through an 8-minute objective structured clinical examination (OSCE)-based evaluation, with a standardized patient portraying axial spondylarthritis, evaluated by a blinded consultant rheumatologist using a 10-point rubric across 5 domains: communication at consultation start, generic medical history, targeted medical history, diagnostics and management reasoning, and communication at consultation end. Students receiving AI-generated feedback achieved significantly higher total OSCE scores (mean 7.39, SD 0.86 vs mean 6.68, SD 1.04 points; mean difference 0.70; 95% CI 0.35-1.06; P<.001; Cohen d=0.74). Domain-specific analysis revealed significant improvement in generic medical history after Bonferroni correction (mean 2.46, SD 0.65 vs mean 2.03, SD 0.79 points; P=.004; r=0.27), while other domains showed no significant differences: communication at start (P=.13; r=0.14), targeted medical history taking (P=.60; r=0.05), diagnostics and management (P=.14; r=0.14), and communication at consultation end (P=.31; r=0.09). Pass rates were significantly higher in the feedback group (96.7% vs 79.6%; odds ratio 7.55, 95% CI 1.51-72.2; P=.006), with a number needed to assess of 6 students, that is, for every 6 students receiving feedback, 1 additional student passed the assessment. AI-generated feedback following social robotic VP interactions significantly improved medical students' OSCE-based performance, particularly in generic medical history taking. These findings support integrating validated AI feedback systems as a supplement to expert-led teaching during VP simulations for clinical training and demonstrate the feasibility of scalable, automated feedback in medical education. The domain-specific improvements in generic medical history highlight the importance of targeted, competency-specific feedback design in VP platforms.
Dietary supplement use is common among breast cancer survivors, but studies on Asian populations remain limited. This study investigated dietary supplement use among Korean breast cancer survivors, distinguishing between vitamin/mineral (VM) and non-vitamin/non-mineral (NVNM) supplements. This cross-sectional study included 1,136 stage I-III breast cancer survivors from 12 Korean hospitals, who survived more than 6 mon post-surgery. The participants completed a questionnaire on post-diagnostic dietary supplement use. Stepwise logistic regression was applied, calculating odds ratios (ORs) and 95% confidence intervals (CIs) to identify the demographic and clinical factors associated with VM and NVNM use. Seventy percent of survivors reported supplement use, with 25% using a single product. The most common VM supplements were multivitamins/minerals, vitamin D, and vitamin C, while the most common NVNM supplements included omega-3 fatty acids, probiotics, and ginseng. Survivors with higher education and greater physical activity were more likely to use VM supplements (ORs [95% CIs], 2.74 [1.76-4.25] for college graduates or above vs. middle school or below; 1.38 [1.02-1.88] for the most active group vs. the least active group). NVNM use was associated with higher education, greater physical activity levels, and a history of smoking (ORs [95% CIs], 2.29 [1.46-3.58] for college graduates or above vs. middle school or below; 1.52 [1.13-2.06] for the most active group vs. the least active group; 2.00 [1.23-3.25] for ever smokers vs. never smokers). Survivors who had undergone chemotherapy were also more likely to use NVNM supplements than those who had not (OR [95% CI], 1.37 [1.02-1.84]). Seventy percent of Korean breast cancer survivors used dietary supplements in this study. VM use was associated with higher education and physical activity, while higher NVNM use was associated with higher education, greater physical activity, a history of smoking, and chemotherapy.
Vision is a key human sense affecting both social and occupational activities. Evidence on the role of nutrients and micronutrients in eye health remains inconsistent. This study aimed to assess self-reported knowledge of diet and eye health and to characterize the use of dietary supplements for vision support among adults in Poland. This cross-sectional questionnaire-based survey was conducted between 13 and 17 March 2026 on a nationwide sample of 1,090 adults in Poland. Self-reported questionnaire was used. Data were collected using Computer-Assisted Web Interviews (CAWI). Most respondents reported low or moderate self-reported knowledge of the impact of diet and lifestyle on eye health, with only 10.2% declaring good knowledge. Among the respondents, 27.9% declared use dietary supplements for eye health. Among users, supplementation was mainly driven by preventive decisions (38.8%) and medical recommendations (28.0%), with antioxidant vitamins and omega-3 fatty acids being the most commonly used ingredients. Female gender (aOR = 1.51; 95%CI:1.01-2.27) and residence in both small (<20,000) and large (≥500,000) cities (aOR = 2.76 and 3.01, respectively) were associated with higher odds of reporting good knowledge. Active occupational status (aOR:1.91; 95%CI:1.33-2.75; p < 0.001), wearing spectacles or contact lenses (aOR:1.76; 95%CI:1.22-2.53; p = 0.002), and history of eye conditions diagnosed by a doctor (aOR:3.25; 95%CI:2.41-4.38; p < 0.001) were significantly associated with higher odds of using dietary supplements for eye health in the past 12 months. This study shows that dietary supplement use for eye health is relatively common among adults in Poland despite low self-reported knowledge on diet and vision. Supplement use was more frequent among individuals with eye conditions, those wearing corrective lenses, and occupationally active participants, and was not fully aligned with self-reported knowledge. These findings highlight the need for improved public education and stronger involvement of healthcare professionals in promoting evidence-based supplement use.
A variety of etiologies can lead a patient to present with symptoms that appear manic. A wide differential should be considered, including delirium, which may in turn be caused by multiple etiologies. Substance ingestion, specifically of dietary supplements, is one potential trigger that is not always considered. A 40-year-old male patient with a history of long-standing attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression presented with anxiety, restlessness, memory gaps, nausea, low appetite, and insomnia. Prior to admission, the patient started taking an herbal supplement for 15 days and stopped taking lisdexamfetamine for 1.5 weeks. Upon initial presentation, the patient was hypertensive and tachycardic. The physical exam was significant for bilateral conjunctival injection and hand tremors. He was disoriented to time and had tangential, pressured speech. A comprehensive medical work-up was largely unremarkable. The urine drug screen was positive for amphetamines and marijuana. The Psychiatry Consultation and Liaison Service evaluated this patient and diagnosed him with delirium, possibly secondary to the supplement side effects. The supplement was discontinued, and the patient's symptoms resolved within 24 hours. While many diagnoses were considered for this patient, delirium, possibly triggered by starting a new herbal supplement, was determined to be the most likely etiology. Many supplements have not been well-studied and are inadequately regulated. This case highlights the potential for clinically significant adverse effects associated with supplement use and emphasizes the need for further research into their safety profiles, pharmacokinetics, and neuropsychiatric consequences to improve patient care and education.
Recognizing the crucial role of medicine in everyday life, it is unsurprising that medical literature in the Croatian language has been produced and studied for several centuries. To date, numerous studies have provided an overview of the history of Croatian medical literature, primarily focusing on lexicographical works, encyclopedias, and publications. Nevertheless, Croatian medical textbooks and manuals from the 19th century have been less systematically examined as a distinct corpus. This period is particularly significant in the history of Croatian scientific and cultural production: it was marked by intensified efforts to standardize the Croatian language, the development of scientific terminology, and Enlightenment-inspired initiatives aimed at making scientific knowledge accessible to the Croatian public in their native language. Works produced during this period bear witness to the development of medicine in the Croatian context and represent a valuable source for studying the history of Croatian scientific and professional terminology, as well as scientific style. The aim of this study is to provide an overview of selected Croatian medical textbooks and manuals from the 19th century, listing them and briefly describing their structure, content, and intended use. By doing so, the study seeks to supplement existing overviews of older Croatian medical literature and to highlight the significance of these works for interdisciplinary research, encompassing medical history, linguistic studies, and the broader cultural context of 19th-century Croatia. S obzirom na nužnost i važnost medicine u svakodnevnome životu, nije čudno što medicinsku literaturu na hrvatskome jeziku pratimo već nekoliko stoljeća. Do danas je većim brojem radova dan pregled povijesti medicinske literature na hrvatskome jeziku, mahom leksikografskih radova, enciklopedistike i publicistike. Unatoč tomu, hrvatska medicinska udžbenička i priručnička literatura 19. stoljeća rjeđe je sustavno proučavana kao zasebna cjelina. Devetnaesto je stoljeće u povijesti hrvatske znanstvene i kulturne produkcije iznimno važno: obilježeno je intenziviranjem rada na standardizaciji hrvatskoga jezika, jačanjem znanstvene terminologije te prosvjetiteljskim idejama da se znanost na hrvatskome jeziku približi javnosti. Djela nastala u tom razdoblju svjedoče o razvoju medicine na hrvatskome prostoru i vrijedan su izvor za proučavanje povijesti hrvatskoga znanstvenog i stručnog nazivlja, kao i znanstvenoga stila. Cilj je ovoga rada dati pregled odabranih hrvatskih medicinskih udžbenika i priručnika nastalih u 19. stoljeću, popisati ih te ukratko opisati njihovu strukturu, sadržaj i namjenu. Takvim se pristupom nastoji pridonijeti dopunjavanju postojećih pregleda starije hrvatske medicinske literature i ukazati na važnost tih djela za interdisciplinarna istraživanja.
Background/Objectives: Dietary supplements (DSs) are widely available on the pharmaceutical market. Their consumption frequency has been observed to increase over the years, especially with age. To the best of our knowledge, this is the first study in Poland and Central-Eastern Europe to analyze the use of dietary supplements (DSs) based on a nationally representative, random sample of the elderly population. Methods: We examined 5987 individuals aged 60 years and older to assess the prevalence and types of DSs they use, with particular attention to socio-economic factors associated with their consumption. It also aimed to determine whose recommendations were followed when choosing supplements. Results: The percentage of individuals taking any DSs was 32.1% (95% CI: 29.8-34.4), with a higher proportion among women (38.7% (95% CI: 35.7-41.7)) compared to men (22.8% (95% CI: 20.6-25.1)). A multivariable analysis showed that DSs were more likely to be used by individuals with higher education (Prevalence Ratio (PR) 1.74 (95% CI: 1.47-2.06) for individuals with higher education vs. those with primary education). A link between age and DSs consumption was also observed, with the highest consumption rates found among those in their 80s (PR 1.46 (95% CI: 1.30-1.63) vs. the 60-69 age group). The most commonly used ingredients were vitamins, taken by 76.2% (95% CI: 73.6-78.9) of respondents, minerals (55.9% (95% CI: 52.8-59)), and plant-based preparations (45.0% (95% CI: 42-48)). Although DSs were most often used based on a doctor's recommendation (58.5% (95% CI: 54.5-62.6)), over a third of patients initiated their use independently. Conclusions: This significant proportion of individuals taking dietary supplements in Poland, often without consultation with healthcare professionals, suggests that these products may be used in the absence of objective indications, which may be associated with adverse effects and potential drug-supplement interactions. This represents an important implication for clinicians, who should always extend the medical history to include information on DSs use. The findings also highlight the need to strengthen regulatory frameworks to ensure the safe use of these products and to optimally protect the health of older adults.
Body image preoccupation is increasingly common, particularly among Latin American women, influenced by societal beauty standards favoring thinness. This often drives individuals to use unregulated weight loss supplements, which can lead to serious health risks. This case reports a rare instance of acute diarrhea resulting from the unsupervised use of a Crataegus mexicana root-based supplement, a product frequently marketed for weight loss. A 41-year-old Hispanic woman presented to the emergency department with a 15-day history of daily diarrhea, epigastric pain, and malaise. She reported using the supplement for weight loss. Physical examination revealed moderate dehydration and localized tenderness in the precordial and epigastric regions. The diagnosis was acute diarrhea related to the herbal supplement, with moderate dehydration. The patient received intravenous saline and analgesics and was discharged in stable condition after 48 hours. Follow-up showed no recurrence of symptoms, but persistent body image concerns. This case highlights the dangers of unsupervised herbal supplement use for weight los and underscores the need for proper medical guidance when using supplements. La preocupación persistente por la imagen corporal es cada vez más común, particularmente entre las mujeres latinoamericanas, influenciadas por los estándares de belleza de la sociedad que favorecen la delgadez. A menudo, esto lleva a las personas a usar suplementos no regulados para bajar de peso, lo que puede conducir a graves riesgos para la salud. Se reporta un caso raro de diarrea aguda como resultado del uso no supervisado de un suplemento a base de raíz de Crataegus mexicana, un producto frecuentemente comercializado para la pérdida de peso. Una mujer hispana de 41 años acudió al servicio de urgencias con una historia de 15 días de diarrea diaria, dolor epigástrico y malestar general. Informó que usaba el suplemento para perder peso. En el examen físico se encontró deshidratación moderada y dolor localizado en la región precordial y en la epigástrica. Se diagnosticó diarrea aguda asociada con el consumo del suplemento, con deshidratación moderada. La paciente fue tratada con líquidos intravenosos y analgésicos, y fue dada de alta en condiciones estables tras 48 horas. El seguimiento mostró resolución clínica, aunque persistía la preocupación por la imagen corporal. Este caso evidencia los riesgos del uso de suplementos herbales sin control médico, y destaca la necesidad de regulación y orientación profesional.
The relationships between folic acid supplementation, folate intake, and GDM remain controversial. We conducted a preliminary investigation using a multimethod approach integrating a retrospective cohort study, Mendelian randomization, and dose-response analysis to explore this association. We examined the relationship between folic acid supplement use (including a combination preparation) and the GDM risk in a retrospective cohort of 10,479 pregnant women receiving care at Jiangsu Provincial People's Hospital using multivariable logistic regression analysis. MR analysis provides genetic support for a potential causal link between genetically predicted folic acid supplement use and GDM. A cross-sectional analysis of 3,680 pregnant women in the National Health and Nutrition Examination Survey (NHANES) evaluated total folate intake and dietary folate equivalents (DFEs) via 24-h dietary recall; multivariable logistic regression and restricted cubic spline models were used to characterize associations and generate dose-response curves. The models were adjusted for age, BMI, race or ethnic origin, education, and smoking history. Subgroup analyses were performed to assess potential effect modifications. In this retrospective cohort study, compared with non-users, folic acid supplement users had a 46.2% greater likelihood of having GDM (OR = 1.46, 95% CI: 1.339-1.595; p < 0.001). MR analysis supported a potential causal association between genetically predicted folic acid products and GDM risk (OR = 1.40, 95% CI 1.17-1.67, p < 0.001). In the NHANES cohort, higher total folate (OR = 1.42, 95% CI: 1.05-1.92, p = 0.02) and DFE intake (OR = 1.61, 95% CI: 1.23-2.10, p < 0.001) were linked to an increased GDM risk, with non-linear dose-response inflection points at approximately 445 μg/day and 582 μg/day, respectively. These associations were generally maintained after multivariable adjustment, and subgroup analyses revealed consistent trends toward an increased risk. This multimethod study indicates that both supplemental folic acid and dietary folate intake may be associated with an increased GDM risk. These observations support the need for additional research to better understand the potential impact of current recommendations on prenatal folate levels.
The United States Pharmacopeia (USP) Dietary Supplement Admission Evaluation and Labeling Expert Committee (DSAEL EC) routinely monitors safety‑related literature for dietary ingredients covered by USP monographs. Following multiple reports of hepatotoxicity associated with turmeric- or curcuminoid-containing products, the DSAEL EC conducted a comprehensive evaluation. To assess the safety of turmeric and curcuminoids and determine whether cautionary labeling should be added to the USP monographs for these ingredients. Following USP Guidelines, the DSAEL EC reviewed safety and toxicological information. Hepatotoxicity has been observed with high-dose turmeric rhizome powder or extract in a few rodent toxicology studies. Numerous clinical trials involving turmeric- or curcuminoid-containing supplements have not reported organ toxicity or serious adverse events. Published case reports of clinically apparent liver injury often involve concomitant medications or supplements. Reported hepatotoxicity typically occurs after 1 to 4 months of use and generally resolves upon discontinuation; cases of acute liver failure have been reported albeit rarely. Proposed mechanisms include idiosyncratic, immune-mediated injury, and emerging evidence suggests possible genetic susceptibility. The USP DSAEL EC recommends adding the following cautionary statement to its turmeric and curcuminoids monographs: Liver problems have been reported very rarely in people taking supplements containing turmeric and/or curcuminoids. Consult your health-care practitioner before using this product if you have a history of liver problems. Stop using this product if you develop symptoms such as abdominal pain, dark urine, or jaundice (yellowing of the skin or eyes), and seek medical advice.
Thyrotoxicosis refers to the clinical state resulting from elevated thyroid hormone levels and may occur with or without underlying hyperthyroidism. Recognizing non-thyroidal and iatrogenic causes is essential for accurate diagnosis and management. A 50-year-old woman presented to a cardiologist due to complaints of palpitations. Electrocardiogram and echocardiogram were performed showing sinus tachycardia. Beta-blocker therapy was prescribed with recommendations for thyroid function testing. The laboratory tests performed in a specialized endocrine clinic confirmed transient thyrotoxicosis without hyperthyroidism and a normal ultrasound image of the thyroid gland. Upon further assessment, an iatrogenic cause was suspected as the most plausible contributing factor-the use of a nutritional supplement for menopausal symptoms containing iodine and other active substances. We present a clinical case of transient most likely supplement-associated thyrotoxicosis without persistent hyperthyroidism with subsequent normalization of thyroid function after symptomatic therapy. Exogenous iodine intake in the form of a dietary supplement is discussed as a possible trigger. The article provides information about the diagnostic and therapeutic algorithm in patients with thyrotoxicosis in the light of real clinical practice and emphasizes the importance of detailed medication and supplement history.
Medical history-taking is a core clinical skill; yet, traditional teaching methods face challenges. We developed an artificial intelligence-powered medical history-taking training and evaluation system (AMTES) and established its technical feasibility as an extracurricular resource. Evidence on whether such tools improve learning outcomes when voluntarily embedded in routine curricula remains limited. This study aimed to evaluate the real-world educational effectiveness of AMTES as an opt-in extracurricular tool and examine whether learning gains vary by practice patterns and baseline academic ability. We conducted a retrospective cohort study of the 2024-2025 Diagnostics course cohort (N=478) at Shantou University Medical College, China, using total population sampling. Students were categorized as AMTES users (n=205, 42.9%; ≥1 sessions) and nonusers (n=273, 57.1%) based on their voluntary extracurricular adoption of the system during the month preceding a high-stakes final practical skills examination. To address selection bias, we performed 1:1 propensity score matching via logistic regression using age, sex, and 3 previous academic scores as covariates. The average treatment effect on the treated for final examination score (0-70) was estimated with paired t tests, and robustness to unobserved confounding was assessed via Rosenbaum sensitivity analysis. Among matched users, practice patterns were identified using K-means clustering on log-derived features, with cluster differences compared using Mann-Whitney U tests. Subsequently, we explored aptitude-treatment interaction by testing the interaction between practice intensity and baseline ability using linear and logistic regression models. Propensity score matching yielded 157 matched pairs (n=314) with excellent covariate balance (|standardized mean difference|<0.1). In the matched cohort, the users outperformed nonusers by 3% (average treatment effect on the treated=2.09, 95% CI 0.75-3.42; P=.002). This finding was robust to weak unmeasured confounding (Rosenbaum Γ=1.23). Among users (N=157), cluster analysis of usage logs revealed a low-intensity group (74/157, 47.1%) and a high-intensity group (83/157, 52.9%). The 2 groups reflected differences in both practice quantity and quality. However, the added efforts did not translate into higher scores (mean difference=1.6 points, 95% CI -0.5 to 3.6) or excellence probability (risk difference=7.7 percentage points, 95% CI -5.0 to 20.5). Exploratory aptitude-treatment interaction analyses suggested ability-dependent effects for excellence rate (β3=1.461; P=.04) and marginally for final score (β3=2.58; P=.07), but not for pass rate (P=.94). Building upon previous technical validation, this study contributes real-world effectiveness evidence by evaluating AMTES as a voluntary extracurricular supplement within an authentic, high-baseline curriculum. Unlike previous work focusing on technical feasibility or short-term controlled trials, voluntary extracurricular AMTES use was associated with modest yet meaningful improvements in summative history-taking performance. Exploratory analyses indicated that the added value of more intensive engagement may be moderated by baseline academic ability. These findings support the scalability of artificial intelligence-enabled supplementary training and inform precision-oriented instructional design.
To develop and evaluate a large language model (LLM)-based intelligent tutoring system for medical record writing in residency training and to assess its effectiveness in improving documentation quality and documentation-related learning outcomes. A single-center quasi-experimental controlled before-and-after educational evaluation was conducted from January to December 2025 at a tertiary teaching hospital. Residents (PGY1-PGY3) were allocated to the intervention cohort (LLM-based tutoring system plus conventional teaching) or the control cohort (conventional teaching alone) according to existing teaching arrangements. The system used pseudonymized historical real patient cases to provide structured documentation tasks, automated multidimensional assessment, and personalized feedback. The primary outcome was the overall medical record writing score (0-100). Secondary outcomes included domain-specific documentation scores, documentation error rates, completion time, and resident satisfaction. Statistical analyses included t tests, chi-square tests, effect-size estimation with 95% confidence intervals, and multivariable linear regression. A total of 240 residents were included in the analysis (120 per cohort), with comparable baseline characteristics. After 6 months, the intervention cohort demonstrated significantly greater improvement in overall medical record writing scores compared with the control cohort (between-group mean difference in change, 9.0 points; 95% CI, 7.5-10.5; Cohen's d = 1.56; P < 0.001). Improvements were also observed in documentation domains related to history taking, diagnostic analysis, differential diagnosis, and treatment planning. Documentation error rates decreased significantly in the intervention cohort, and residents reported high satisfaction with the system. The LLM-based intelligent tutoring system was associated with improved medical record writing quality, documentation efficiency, and resident satisfaction in a residency training setting. These findings support its use as a scalable supplement to conventional documentation training while requiring further validation for broader educational outcomes beyond documentation.
Drug-induced autoimmune-like hepatitis (DI-ALH) is a rare form of drug-induced liver injury (DILI) that mimics autoimmune hepatitis (AIH). Commonly implicated agents include minocycline, nitrofurantoin, and infliximab, though a wide range of other drugs has been reported. We report a 65-year-old woman with a history of suspected turmeric-induced liver injury six years prior who presented with nausea and painless jaundice two weeks after restarting the same turmeric supplement containing black pepper extract. She denied alcohol or hepatotoxic medication use, and family and personal history of autoimmune or liver disease were unremarkable. Laboratory evaluation revealed marked transaminase elevation (AST 4310 U/L, ALT >2500 U/L), total bilirubin 18.3 mg/dL, and INR 1.1. Autoimmune testing revealed positive smooth muscle antibodies and elevated IgG, while viral, metabolic, and genetic studies were negative. Imaging demonstrated periportal edema. Despite supplement discontinuation, liver enzymes worsened, prompting a liver biopsy, which demonstrated acute hepatitis with portal and lobular inflammation, plasma cell predominance, and canalicular cholestasis without fibrosis consistent with DI-ALH. Corticosteroid therapy led to biochemical improvement over three weeks. The temporal association with exposure, autoimmune serologies, characteristic histology, and steroid responsiveness supported the diagnosis of recurrent turmeric-induced DI-ALH, with more severe injury on re-exposure suggesting immune sensitization. Piperine, included to enhance curcumin bioavailability, may potentiate hepatotoxicity. DI-ALH should be considered in patients with liver injury and recent supplement use, as immunosuppressive therapy may be beneficial when injury persists after drug withdrawal.
Upper respiratory tract infections (URTIs) and exercise-induced immune perturbations are common in adults and may adversely affect quality of life, productivity, and physical performance. Immunoglobulin Y (IgY), a food-derived antibody with broad antimicrobial activity, has demonstrated immunomodulatory potential in preclinical and limited clinical studies. This study evaluated the effects of a multi-pathogen-specific IgY supplement (Muno-IgY) on respiratory health, immune and inflammatory markers, exercise-induced physiological stress, and gut microbiome composition in healthy adults. In this 12-week, double-blind, placebo-controlled trial, 28 healthy adults with a history of URTI were randomly allocated to receive Muno-IgY or placebo and URTI incidence, duration, and severity were recorded daily. Serum immune and inflammatory biomarkers were assessed longitudinally and in response to a standardized exercise challenge. Gut microbiome composition was analyzed using shotgun metagenomic sequencing at baseline and week 12. Safety and tolerability were assessed throughout the study. URTI incidence was lower in the Muno-IgY group compared with placebo (14.3% vs. 35.7%), with shorter average duration and fewer missed workdays, though differences were not statistically significant (p > 0.05). Following an acute exercise challenge, Muno-IgY supplementation resulted in a significant increase in serum IgA at 24 h post-exercise (p = 0.022) and a significantly greater reduction in lactate dehydrogenase at 1 h post-exercise compared with placebo (p < 0.0001). Exploratory gut microbiome analyses suggested favorable directional shifts, though these changes were not statistically tested. In this exploratory pilot study, Muno-IgY supplementation was safe and associated with significant improvements in selected markers of exercise-induced immune response and muscle damage. Numerical trends in URTI incidence and gut microbiome composition were observed but were not statistically significant. These findings are hypothesis-generating and support further evaluation of Muno-IgY in larger, adequately powered clinical trials.
Bee pollen has become an increasingly popular dietary supplement due to potential therapeutic effects. However, ingestion has been shown to trigger allergic responses as severe as anaphylaxis. This case highlights allergic asthma development in a 26-year-old female patient with subsequent anaphylaxis secondary to bee pollen ingestion. This patient presented to the emergency department with complaints of lip and tongue swelling, dyspnea, nausea, abdominal pain, and itching 4 h after bee pollen ingestion. Her medical history included seasonal allergic rhinitis and prior exercise-induced asthma that had not required treatment for 10 years. She was treated with a standard anaphylaxis pharmacological regimen and discharged. The patient then began to experience dyspnea and wheezing 1 month later during peak fall pollen levels. On allergy testing, the patient's total serum immunoglobulin E (IgE) was elevated at 189 kU/L. She also had elevated specific IgE to common ragweed, mugwort, and cocklebur, which are prominent allergens in the fall. Given the timing of onset of new symptoms, partial relief with an inhaled short-acting B2 agonist, and no pertinent findings for other causes, the patient was subsequently diagnosed with allergic asthma secondary to bee pollen ingestion. Although anaphylaxis to bee pollen is rare, it is becoming increasingly reported in literature and demonstrates an adverse effect that can occur when proper regulation and education are not performed. Dietary supplements like bee pollen need to have further testing and contain more thorough warnings on labels to decrease adverse events and protect people from undue harm.
 Herbal and dietary supplements (HDS) are widely used globally and across the Middle East, yet their hepatotoxic potential remains underrecognized in this region. Comparable Bahrain-specific prevalence data are limited. This study aimed to quantify the proportion of drug-induced liver injury (DILI) attributable to HDS in a Bahraini cohort and to compare the clinical features and outcomes of HDS-related versus conventional medication-related liver injury, with severe liver injury as the primary outcome. We hypothesized that HDS-related DILI would be associated with more severe clinical outcomes than conventional medication-related DILI.  We conducted a retrospective cohort study of adults admitted with suspected DILI to Bahrain Government Hospital in Manama, Bahrain, between January 2018 and December 2024. Cases underwent structured causality assessment using the updated Roussel Uclaf Causality Assessment Method (RUCAM), and patients with RUCAM scores ≥6 for at least one implicated agent were included. Patients were classified into HDS-related or conventional medication-related liver injury groups according to the agent with the highest RUCAM score; cases with equal scores or unresolved competing exposures were excluded. Alternative causes of liver injury, including viral hepatitis and autoimmune liver disease, were excluded through routine clinical evaluation and available laboratory and imaging data. The primary outcome was severe liver injury, defined as coagulopathy, hepatic encephalopathy, or liver transplantation. Multivariable logistic regression was performed to identify independent predictors of severe liver injury.  A total of 712 patients met the inclusion criteria, of whom 168 (23.6%) were attributed to HDS and 544 (76.4%) to conventional medications. Patients with HDS-related liver injury were younger (median age 34 vs. 52 years, p = 0.002) and more commonly female (63.2% vs. 41.1%, p < 0.001). Hepatocellular injury was more frequent in the HDS group (68.5% vs. 45.2%, p = 0.02). Severe liver injury occurred in 49/168 (29.2%) of HDS cases versus 79/544 (14.5%) of medication-related cases, corresponding to an absolute risk difference of 14.7% (95% CI 7.2-22.2). On multivariable analysis, HDS exposure remained independently associated with severe liver injury (adjusted OR 2.3, 95% CI 1.1-5.1, p = 0.03). Liver transplantation (7.7% vs. 1.7%, p = 0.08) and mortality (10.7% vs. 4.8%, p = 0.21) were numerically higher in the HDS group, although these differences did not reach statistical significance.  In this retrospective Bahraini cohort, HDS accounted for nearly one-quarter of RUCAM-confirmed DILI cases and was associated with a higher likelihood of severe liver injury than conventional medications. These findings support routine, structured inquiry about HDS exposure in patients presenting with liver injury and suggest that standardized medication and supplement history tools may improve early recognition. Larger prospective studies with product-level characterization are needed to better define the risks associated with HDS use in the region.
To investigate the supplemental role of dichoptic mobile video games in the treatment of adults with amblyopia. Patients aged 18 to 40 years with unilateral mild to moderate amblyopia and no prior history of amblyopia treatment were recruited after 6 weeks of optimal refractive correction. Patients were randomly assigned to two groups, each comprising 15 participants. The control group was prescribed 6 hours of daily patching. The study group played dichoptic mobile video games (stereoblocks) in addition to patching. They attended 2-hour sessions weekly for 12 weeks. Follow-up assessments included best corrected visual acuity (BCVA) for distance and near, as well as stereoacuity measurements at baseline and 1, 4, 8, and 12 weeks. The median age of patients was 21.5 years (range: 19.5 to 26.5 years). The distance and near BCVA in the amblyopic eye showed an improvement at the final follow-up visit (12 weeks) in both groups. There was a statistically significant difference in improvement between the two groups at the final follow-up visit, with the study group performing better (P = .04). There was no significant improvement in either of the groups in terms of stereoacuity (P = .29). In intergroup and subgroup analysis, patients with anisometropia showed a significantly better improvement compared to strabismic and mixed amblyopia. Video games as a supplement to patching have additional benefits to patching in terms of BCVA in adults with amblyopia. Patients with anisometropic amblyopia appear to benefit more from this combined approach compared to those with strabismic or mixed amblyopia.
暂无摘要（点击查看详情）
Substance-Induced Depressive Disorder (SIDD) accounts for a high health burden and requires new therapies. Bidirectional communications between the gut and the brain mediated by the microbiota point to a possible influence of probiotics as a tool for preserving mental health. Double-blind, placebo-controlled, randomized clinical trial on a sample of 40 patients with SIDD. Patients were then randomly assigned into probiotic and placebo arms and underwent interventions for four continuous weeks. The clinical assessment was done using BDI and HAM-A. Immunologic outcomes were measured through analysis of inflammatory markers, cytokines, and other immunological parameters. The trial was registered with ClinicalTrials.gov, under the identifier NCT06790823 (18/1/2025). The change in the intensity of depression and anxiety in both probiotic and placebo groups was statistically significant after intervention. No differences were also noted between the two groups. Immunologic results showed a suggestive changes in IL6 and INFG levels in the probiotic group as compared with placebo, which may indicate possible immune-modulating effects. In this randomized, double‑blind, placebo‑controlled pilot trial, both probiotic and placebo groups showed significant improvements in depressive and anxiety symptoms over time, with no significant between‑group differences. Probiotic supplementation was associated with non‑significant trends in selected inflammatory markers, suggesting possible immunological effects that warrant further investigation. Larger, multicenter trials with comprehensive microbiome and immunologic assessments are needed to clarify the potential role of probiotics as an adjunctive strategy in substance‑induced depressive disorder.