Herb-drug interactions: a literature review

Herbs are often administered in combination with therapeutic drugs, raising the potential of herb-drug interactions. An extensive review of the literature identified reported herb-drug interactions with clinical significance, many of which are from case reports and limited clinical observations.
Cases have been published reporting enhanced anticoagulation and bleeding when patients on long-term warfarin therapy also took Salvia miltiorrhiza (danshen). Allium sativum (garlic) decreased the area under the plasma concentration-time curve (AUC) and maximum plasma concentration of saquinavir, but not ritonavir and paracetamol (acetaminophen), in volunteers. A. sativum increased the clotting time and international normalised ratio of warfarin and caused hypoglycaemia when taken with chlorpropamide. Ginkgo biloba (ginkgo) caused bleeding when combined with warfarin or aspirin (acetylsalicylic acid), raised blood pressure when combined with a thiazide diuretic and even caused coma when combined with trazodone in patients. Panax ginseng (ginseng) reduced the blood concentrations of alcohol (ethanol) and warfarin, and induced mania when used concomitantly with phenelzine, but ginseng increased the efficacy of influenza vaccination. Scutellaria baicalensis (huangqin) ameliorated irinotecan-induced gastrointestinal toxicity in cancer patients.
Piper methysticum (kava) increased the 'off' periods in patients with parkinsonism taking levodopa and induced a semicomatose state when given concomitantly with alprazolam. Kava enhanced the hypnotic effect of alcohol in mice, but this was not observed in humans. Silybum marianum (milk thistle) decreased the trough concentrations of indinavir in humans. Piperine from black (Piper nigrum Linn) and long (P. longum Linn) peppers increased the AUC of phenytoin, propranolol and theophylline in healthy volunteers and plasma concentrations of rifamipicin (rifampin) in patients with pulmonary tuberculosis. Eleutheroccus senticosus (Siberian ginseng) increased the serum concentration of digoxin, but did not alter the pharmacokinetics of dextromethorphan and alprazolam in humans. Hypericum perforatum (hypericum; St John's wort) decreased the blood concentrations of ciclosporin (cyclosporin), midazolam, tacrolimus, amitriptyline, digoxin, indinavir, warfarin, phenprocoumon and theophylline, but did not alter the pharmacokinetics of carbamazepine, pravastatin, mycophenolate mofetil and dextromethorphan. Cases have been reported where decreased ciclosporin concentrations led to organ rejection. Hypericum also caused breakthrough bleeding and unplanned pregnancies when used concomitantly with oral contraceptives. It also caused serotonin syndrome when used in combination with selective serotonin reuptake inhibitors (e.g. sertraline and paroxetine).
In conclusion, interactions between herbal medicines and prescribed drugs can occur and may lead to serious clinical consequences. There are other theoretical interactions indicated by preclinical data. Both pharmacokinetic and/or pharmacodynamic mechanisms have been considered to play a role in these interactions, although the underlying mechanisms for the altered drug effects and/or concentrations by concomitant herbal medicines are yet to be determined. The clinical importance of herb-drug interactions depends on many factors associated with the particular herb, drug and patient. Herbs should be appropriately labeled to alert consumers to potential interactions when concomitantly used with drugs, and to recommend a consultation with their general practitioners and other medical carers.

Amiodarone, anticoagulation, and clinical events in patients with atrial fibrillation: insights from the ARISTOTLE trial

Amiodarone is an effective medication in preventing atrial fibrillation (AF), but it interferes with the metabolism of warfarin.

International comparisons of rural-urban educational attainment : data and determinants

We study cross-country differences in rural and urban educational attainment by using a data set comprising 56 countries. We focus on the determinants of rural–urban educational inequality, which is measured by the ratio of rural to urban average years of schooling within each country. We find that riskier human capital investment, less credit availability, a colonial heritage, a legal system of French origin and landlockedness of nations are all associated with relatively lower rural educational levels and greater rural–urban educational inequality. Conversely, larger formal labor markets, better infrastructure and a legal system of British origin are associated with relatively higher rural educational levels and lower rural–urban educational inequality. We also identify an interaction effect between economic development level and some of these factors. In particular, we find that as development level increases, the negative (positive) relationship between French (British) legal systems and rural–urban educational inequality is reversed and becomes positive (negative).

Combustion simulations for a self controlling variable compression ratio connecting rod

Variable compression ratio enables an engine to achieve increased efficiency at part loads, where the majority of driving occurs, without sacrificing full load power requirements or increasing the risk of engine knock. Although over 100 patents and patent applications exist none of these systems has been commercialized yet due to issues related to feasibility, cost and frictional loss. A new approach of a self controlling variable compression ratio connecting rod is presented that does not need a friction intensive external activation and that could even be retrofitted. The potential in fuel consumption and exhaust emission reduction as well as increased power and torque output for this concept has been verified in combustion simulations utilizing the latest research results related to the dynamic heat transfer in the combustion chamber from Professor Kleinschmidt from the University of Siegen, Germany. The self controlling variable compression ratio connecting rod allows the con rod to compress at high load conditions thereby increasing cylinder volume to alleviate combustion pressures and temperatures and therefore limit knock onset. The biggest efficiency gains can be achieved at medium load where the reduction of heat loss during the compression of the connecting rod plays a major role additional to the well known efficiency gains of an increased compression ratio. The combustion simulation results shows fuel consumption can be reduced by between 3% and 5% during part load and wide open throttle operation at various engine speeds. Emissions are also reduced significantly; particularly NOx and CO emissions were reduced by up to 35%.The self controlling variable compression ratio connecting rod allows the con rod to compress at high load conditions thereby increasing cylinder volume to alleviate combustion pressures and temperatures and therefore limit knock onset. The biggest efficiency gains can be achieved at medium load where the reduction of heat loss during the compression of the connecting rod plays a major role additional to the well known efficiency gains of an increased compression ratio.The combustion simulation results shows fuel consumption can be reduced by between 3% and 5% during part load and wide open throttle operation at various engine speeds. Emissions are also reduced significantly; particularly NOx and CO emissions were reduced by up to 35%.

The next step in energy rating: the international ETTV method vs. BCA Section-J glazing calculator

The most important prevention in minimizing energy transfer in commercial buildings is the treatment of glazing in the building facade. In a commercial building, while the impacts of roof, walls and floors on the overall heating and cooling loads of the building have low effects, glazing is likely to be the most important factor. This paper investigates the BCA Section-J glazing calculator and the ETTV (Envelope Thermal Transfer Value) methods and tries to look for differences as well as similarities in calculation of building envelopes energy performance. For this investigation, a hypothetical high-rise commercial building in Melbourne, Australia is considered when evaluating the energy performance of the envelope through these two methods. Both methods consider the U-Value of glass and wall materials as well as Solar Heat Gain Coefficient (SHGC) and Shading Coefficient (SC) of the glass. Findings in this research project indicate differences and significant discrepancies between the BCA Section-J and ETTV methods in evaluating the energy performance of commercial building façades. Issues of calculation weaknesses are identified with the lack of air leakage and infiltration of a particular façade design or window to wall ratio (WWR). Suggestions have been made where improvement to the overall energy calculation through facades of a commercial building is needed.

Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study

BACKGROUND: The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. METHODS: Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. RESULTS: EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). CONCLUSIONS: In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study.

BACKGROUND: We sought to provide a contemporary picture of the presentation, etiology, and outcome of infective endocarditis (IE) in a large patient cohort from multiple locations worldwide. METHODS: Prospective cohort study of 2781 adults with definite IE who were admitted to 58 hospitals in 25 countries from June 1, 2000, through September 1, 2005. RESULTS: The median age of the cohort was 57.9 (interquartile range, 43.2-71.8) years, and 72.1% had native valve IE. Most patients (77.0%) presented early in the disease (<30 days) with few of the classic clinical hallmarks of IE. Recent health care exposure was found in one-quarter of patients. Staphylococcus aureus was the most common pathogen (31.2%). The mitral (41.1%) and aortic (37.6%) valves were infected most commonly. The following complications were common: stroke (16.9%), embolization other than stroke (22.6%), heart failure (32.3%), and intracardiac abscess (14.4%). Surgical therapy was common (48.2%), and in-hospital mortality remained high (17.7%). Prosthetic valve involvement (odds ratio, 1.47; 95% confidence interval, 1.13-1.90), increasing age (1.30; 1.17-1.46 per 10-year interval), pulmonary edema (1.79; 1.39-2.30), S aureus infection (1.54; 1.14-2.08), coagulase-negative staphylococcal infection (1.50; 1.07-2.10), mitral valve vegetation (1.34; 1.06-1.68), and paravalvular complications (2.25; 1.64-3.09) were associated with an increased risk of in-hospital death, whereas viridans streptococcal infection (0.52; 0.33-0.81) and surgery (0.61; 0.44-0.83) were associated with a decreased risk. CONCLUSIONS: In the early 21st century, IE is more often an acute disease, characterized by a high rate of S aureus infection. Mortality remains relatively high.

Implementing the international benchmarking labour productivity theoretical model

Purpose – Building upon the results of a critical review of previous studies, the purpose of this paper is to present a framework to enhance the reliability of the theoretical model for international benchmarking of labour productivity (TMIBLP) method for construction project activities. The next part of the paper presents the results of implementing the proposed framework for construction activities in the Iranian construction industry. Design/methodology/approach – This paper draws upon a critical review of the literature to highlight the drawbacks of the previous studies concerning implementing TMIBLP within the construction industry. Identifying these shortcomings, the authors propose a framework for construction projects, which presents the procedure for deploying TMIBLP for construction activities in a reliable manner. The final section of the paper demonstrates the empirical implementation of the proposed framework within the Iranian construction industry. Findings – The primary contributions of the paper include: identifying the drawbacks of previous studies within the construction context, the framework that would lead construction managers towards more reliable implementation of benchmarking for construction projects, and determining the baseline of erecting steel structures in a developing country. Practical implications – A practical implementation of the TMIBLP method was presented to address the lack of research in Iran and to show the feasibility of using the framework developed. The authors investigated the daily labour productivity for the activity of structural steel erection for six projects in Tehran in order to determine the values of the baseline productivity for each project. Accordingly, the disruption index, performance ratio and project management index as the project benchmarks were calculated for all six projects. Originality/value – Underlining the necessity of implementing methods such as TMIBLP, this study outlines the outcomes of the first study on the benchmarking of construction activities deploying the proposed framework and using the data on erecting steel structures from six construction projects in Iran. The discussions provide guidelines for construction project managers regarding benchmarking labour productivity. The paper concludes with suggestions for future research opportunities.