Background: Diabetes associated with multiple metabolic problems in the body, including bone mineralization remodeling, osteoporosis and increase risk of fracture. Quercetin is natural flavonoids and according to animal studies; it has potent antioxidant, antidiabetic and protective effect against bone loss due to various causes. Objectives: explore effect of quercetin as nutritional supplement administrated orally on some bone mineralization bio-markers such as calcium, vitamin D and osteocalcin in Iraqi diabetic patients. Methods: interventional double-blind placebo randomized controlled study in which 40 patients with type 2 diabetes mellitus (age range 40-45) assigned randomly (using simple randomization) in either control (n=20) or study (n=20) group. Study group received Quercetin oral supplement as 500mg capsule once daily for three months. Venous blood was used for measuring Serum calcium, 25(OH) vitamin D and osteocalcin at base line and after 3 months. Results: After 3 months treatment with Quercetin; levels of Osteocalcin (28.1±7.6), serum calcium (9.2±1.8) and 25(OH) vitamin D (26.6±8.7) were significantly (p<0.05) higher than pretreatment values of osteocalcin (24.0±8.6); serum calcium (7.0±2.2) and 25(OH) vitamin D (20.6±7.7) and control values of serum calcium (6.8±2.0) and 25(OH) vitamin D (20.8±7.4), but not Osteocalcin (25.2±9.0). There was also significant correlation between use of quercetin; elevation of serum calcium and osteocalcin (r= 0.454; p= 0.032), indicating modulation in bone mineralization. Conclusions: Quercetin's use in diabetic patients may elevate Serum level of Calcium; 25(OH) vitamin D and may modulate bone mineralization represented by elevation of osteocalcin.

Taurine is sulfur containing semi-essential amino acid that has important roles in many biological processes, but its effect on glucose homeostasis, weight, growth and bone mineralization weren’t well defined. Objectives: the evaluation of oral Taurine effects has used for 3 months on bone mineralization biomarker, glycemic control and body weight in type ll diabetic patients. Methods: the interventional double-blind placebo-controlled study in which 80 patients with type 2 diabetes mellitus (age range 45-55) assigned in either control (n=40), or study group the (n=40) group. The last group has received a 1000mg capsule of Taurine once a day for three months. Parameters measured were serum calcium, 25(OH) vitamin D and osteocalcin, NTX-1 HbA1C% with fasting blood glucose before and after 3 months. Results: taurine led to significant (p<0.05) rise in osteocalcin, significant lowering in body weight, BMI and there were no significant changes in serum calcium, NTX-1, Vitamin D, HbA1C and fasting blood glucose, all as compared with the control value. Conclusions: the 3 months of oral Taurine are used in type II diabetic patients may modulate bone mineralization represented by elevation of osteocalcin and reduction of body weight, but has no significant effect on glycemic control and did not reduce HbA1C%.

Background: Quercetin is a food supplement with multiple biological activities including antihypertensive, vasodilator effects, antiobesity, antihypercholesterolemic, antiatherosclerotic and other activities, it is available in wide range of dietary supplement and daily food intake, after oral ingestion, quercetin is metabolized by intestinal enzymes and absorbed by the duodenum, then be transported to the liver where is transformed into its glucuronidated, methylated and sulfo-substituted metabolites.Aim of Study: Boosting the bioavailability of Quercetin by enzyme inhibitor effect of ketoconazoleMethod: 10 apparently healthy adult, male (5) and female (5) were grouped A and B, with a 1-week wash-period, Group A received Quercetin 1000 mg, group B received Quercetin 1000 mg and Ketoconazole 400 mg, and 15 blood samples are collected on the following timing 0, 0.5 - 12.5 by 1 hour interval and other by hour 24 for HPLC Assay.Results: Concurrent ketoconazole administration with Quercetin significantly improves the mean plasma concentration under the curve from zero time to infinity (AUC0–∞) by 176% (403.41 ± 62.28 vs. 228.51 ± 28.67 μg.h/mL; P <0.0001) and prolonged time to complete elimination (44.66 ± 9.17 vs. 12.93 ± 1.4 hr.; P <0.0000) compared with Quercetin alone.Conclusion: Bioavailability of Quercetin will be increased by its administration together with ketoconazole, due to enzyme inhibiting effect of ketoconazole which delay elimination and increase the AUC of Quercetin.

Background: For years, specialists have been interested on the verge of documentation of adverse drug reactions because of its great importance. The countries of the Middle East have also kept pace with this mission and developed in the past years. Like any other project, this documentation process is accompanied by several problems that will negatively affect the objectives set in this area. Objective: The aim of the current study is to know the main barriers regarding the process of adverse drug reactions in the Middle East area. Patients and methods: In October 2022, a manual search of the literary databases PubMed and Google Scholar has done. The 102 articles were manually screened. Studies that have been published between 2012 and 2022 were eligible. Results: From the 102 publications that underwent manual screening, 26 research articles from 12 different countries qualified for inclusion in the study. Lack of enthusiasm, a professional atmosphere for the conduct of pharmacovigilance, a general lack of knowledge and awareness concerning pharmacovigilance and not enough time for reporting are the main barriers for adverse drug reactions. Conclusion:According to the results, the lack of knowledge or awareness of pharmacovigilance practices and the absence of mechanisms that assist recording in terms of enough time, motivation, or the environment as a whole are the two most significant causes of underreporting.

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