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Hippocratic doctrine of four humors and qualities is implicated to be a pioneer of modern endocrinology because of the concept of dyscrasia. Imbalance in humors causes disease. Unani scholars were aware of endocrinological disorders like endocrinologic syndrome (i.e., association of amenorrhea and galactorrhoea in a non-pregnant woman), castration, contraceptives techniques, infertility, obesity, diabetes etc., and also their mode of remedy, albeit with a phenomenological approach. Their understanding of the symptoms and signs related to endocrinologic syndromes, which were explained in detail in the recent account of the endocrine system, is presented here with historical chronology. The survey was carried out from the literature of the Unani system of medicine, and the same was analyzed from the observations reported in various indexed journals and reputed books. The paper details the account of endocrinologic syndrome from the Greek era to the end of the medieval ages. Highlights – Description of the endocrinal disorders is mentioned in Unani Medicine for centuries, albeit with a different name for the disease category. – According to Unani Medicine, this disease arises due to abnormal quality and quantity of humour. – Renowned Unani scholars like Hippocrates (370–460 BC), Aristotle (384–322 BC), Aretaeos of Kappadokia (81–96 AD), Galen (130–200 AD), Zakaria Razi (865–925 AD), Majusi (930–994 AD), Ibn-e-Sina (980–1037 AD), Albucasis (1013–1106 AD) and Ismail Jorjani (1042–1137 AD) also treated such ailments through Unani medicine (plant, mineral and animal origin drugs). – Majusi performed surgery of Goiter and mentioned in his treatise and recommended the method of surgery. – Albucasis performed the first successful thyroidectomy under opium ( Papaver somniferum L.) sedation and simple ligatures and hot cautery in the name of ‘elephantiasis’ of the throat (goiter). – The principles of treatment in Unani medicine may provide a guide for better management of endocrinal disorders (e.g., hypothyroidism, hyperthyroidism, diabetes etc.). – The treatment in Unani medicine for various diseases/syndromes/signs, which are now likely associated with hormone dysfunction, can open up the new field of Unani therapeutics for these diseases for the exploration of better treatment options.

Objectives Fibromyalgia, a painful musculoskeletal disorder is associated with sleep disturbances as well as autonomic dysfunction. Pathophysiology of fibromyalgia is yet not clear and neuroanatomical proximity of sleep and autonomic centre prompts probable involvement of the two impacting the quality of life of fibromyalgia patients. Present study was done with the objective to explore the extent of sleep disturbances and/or autonomic dysfunction in fibromyalgia and asses their impact on quality of life of fibromyalgia patients. Method and materials Thirty consecutive fibromyalgia patients (diagnosed by ACR 2010) from out-patient department and 30 age-gender matched controls were enrolled after the ethical clearance. All participants were evaluated for: (1) sleep using Pittsburgh sleep quality index and medical outcomes study sleep scale-12 Revised, (2) Quality of life by 36 item short-form health survey-36v2TM and revised fibromyalgia impact questionnaire (only patients). Autonomic functions of patients were evaluated by standard cardiovascular autonomic function tests by Ewing’s battery and heart rate variability (5-min) measurement. Results Fibromyalgia patients had increased sleep disturbances compared to controls (39.46 ± 11, 59.61 ± 2.31; p=0.0001) and very poor sleep quality (13.63 ± 4.15, 3.03 ± 1.56; p=0.0001) as well as quality of life (p=0.0001) which further deteriorated with increasing severity of fibromyalgia. Twelve patients had autonomic dysfunction but it was neither associated with sleep disturbances nor with quality of life. Conclusions Mild to moderate grade fibromyalgia patients have significant sleep disturbance, poor sleep quality which remarkably impacts their quality of life. Autonomic dysfunction is not an early feature of disease. The study suggests that full spectrum of sleep disturbances and sleep quality should be explored in fibromyalgia syndrome (FMS) patients.

Objectives Several epidemiological data indicate that chronic hyperglycemia is associated with behavioral changes such as anxiety and depressive symptoms. Date seeds, one of the most potent products with potential antioxidant activities and possess many benefits against hyperglycemia and its complication. The aim of the current study was to explore the potential effect of date seeds extract on biochemical and behavioral changes (anxiety and depression) in streptozotocin (STZ)-diabetic rats. Methods Rats were divided into four groups as follows: normal control, diabetic control, diabetic treated with the lyophilized aqueous extract of the date seed (2,000 mg/kg) (LAE-DS) and diabetics treated with insulin (4 UI/day). Experimental diabetes was induced by a single intraperitoneal injection of STZ (60 mg/kg). After 24 days treatment period, anxiety and depressive behaviors were evaluated using four behavioral tests. After sacrifice, blood samples were collected to evaluate lipid parameters. In addition, rat organs (kidney, liver and brain) were dissected out in order to estimate lipid peroxidation levels as oxidative stress marker. Results Oral administration of the lyophilized aqueous extract of date seeds and insulin injection for 30 days significantly decreased blood glucose levels in STZ-diabetic rats and protected them against undesirable changes in lipid parameters, including cholesterol, triglycerides, LDL cholesterol, VLDL cholesterol and atherosclerosis index. Compared to untreated diabetic rat, a significant decrease in lipid peroxidation levels in kidney, liver and brain (Hippocampus and prefrontal cortex) were observed after treatment with insulin or LAE-DS in diabetic rats. Furthermore, insulin and LAE-DS administration prevented anxiety-related behaviors in STZ-diabetic rats. Conclusions Therefore, it would be possible to combine this extract with insulin and use it as an antioxidant supplement for type 1 diabetic patients.

Objectives Pain associated with various underlying pathologies is a major cause of morbidity and diminished life quality in diabetic patients. Effective control of pain requires the use of analgesics with the best efficacy and with minimal side effects. Therefore, our aim in this study was to investigate the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on pain in diabetic rats. Methods In this study, we investigated the analgesic effects of drugs belonging to three different classes of NSAIDs in a rat model of diabetes. Four diabetic groups received normal saline, diclofenac, piroxicam and ketorolac, respectively, and four non-diabetic groups received normal saline, diclofenac, piroxicam and ketorolac. Type 1 diabetes was induced in rats by a single injection of streptozotocin (60 mg/kg bw). Formalin (50 µL of 2.5%) nociception assay was used to examine the effect of treatment with diclofenac, piroxicam and ketorolac on acute and chronic pain in healthy and diabetic rats. Results Piroxicam showed significant analgesic effects both in the acute phase of pain (5–10 min after injection of formalin into the left hind paw), and in the chronic phase (20–60 min after formalin injection) in healthy as well as diabetic rats. Diclofenac and ketorolac also reduced pain scores in healthy rats. However, these two drugs failed to diminish pain in diabetic rats. Conclusion Our data point for better efficacy of piroxicam in controlling pain in diabetes.

Objectives Pre-pregnancy obesity is a serious epidemics concern that negatively affects the neurodevelopmental of the offspring. Elateriospermum tapos (E. tapos) commonly used to enhance weight loss in obesity treatment. This study was aimed to investigate the influence of E. tapos supplement in obese maternal prior pregnancy on the offspring’s bodyweight, lipid metabolism and memory function. Methods Thirty female Sprague Dawley rats were used. Six rats were assigned to the normal diet group (DND). The remaining rats were fed with a high-fat and cafeteria diet (HFCD) to generate obesity for 5 weeks. Obese rats were further divided into four groups: Negative Control (DNC; HFCD), Positive Control (DPC; Orlistat 200 mg/kg), treatment 1 (DTX1; E. tapos seed 200 mg/kg) and treatment 2 (DTX2, E. tapos shell 200 mg/kg) were given daily, for 6 weeks prior to mating. At weaning, offspring of both genders were designated into six groups according to their dam’s group (n=6/group). All groups were fed with a cafeteria diet except for the control group. Memory tasks for object and place recognition were conducted on offspring at eighth weeks of age. The offspring were cull at the 12th week of age for their blood sample. Results Both offspring genders from DTX2 significantly reduce bodyweight, calorie intake and triglyceride level. In memory tasks, offspring from DTX2 showed a significant increase in exploration rate in place test as compared to offspring from the DNC group. Conclusions This study highlights E. tapos shell as an anti-obesity agent and protecting memory deficit in obese dam’s offspring.

Objectives The study has been commenced to discover the potential of Phlorizin (dual SGLT inhibitor) in streptozotocin induced dementia of Alzheimer’s disease (AD) type. Material and methods Injection of Streptozotocin (STZ) was given via i.c.v. route (3 mg/kg) to induce dementia of Alzheimer’s type. In these animals learning and memory was evaluated using Morris water maze (MWM) test. Glutathione (GSH) and thiobarbituric acid reactive species (TBARS) level was quantified to evaluate the oxidative stress; cholinergic activity of brain was estimated in term of acetylcholinesterase (AChE) activity; and the levels of myeloperoxidase (MPO) were measured as inflammation marker. Results The mice model had decreased performance in MWM, representing impairment of cognitive functions. Biochemical evaluation showed rise in TBARS level, MPO and AChE activity, and fall in GSH level. The histopathological study revealed severe infiltration of neutrophils. In the study, Phlorizin/Donepezil (serving as positive control) treatment mitigate streptozotocin induced cognitive decline, histopathological changes and biochemical alterations. Conclusions The results suggest that Phlorizin decreased cognitive function via its anticholinesterase, antioxidative, antiinflammatory effects and probably through SGLT inhibitory action. It can be conferred that SGLTs can be an encouraging target for the treatment of dementia of AD.

Objectives Acetaminophen (paracetamol) and alcohol are widely consumed as analgesic/antipyretic and recreational agent, respectively. High doses of both agents induce liver and male reproductive toxicities. This study investigated the toxicological outcome of concurrent administration of paracetamol and ethanol in the liver and testis in mice. Methods Animals were gavaged paracetamol (250 mg/kg), ethanol (3 g/kg) or paracetamol + ethanol for 2 d. Some groups were sacrificed 12 h after the last dose, while others were sacrificed 21 d posttreatment for reversibility study. Control group received carboxymethylcellulose sodium (0.2%). Serum levels of liver biochemical indices and epididymal sperm were analysed. Histopathological analysis of the liver and testis were also performed. Results Alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin in serum were elevated (p<0.001); whereas albumin and total protein were reduced (p<0.001) in paracetamol or ethanol groups compared to control. In the combination group, only mild elevation of ALT (p<0.05) was observed. Additionally, hepatocyte necrosis occurred in the livers of paracetamol and ethanol groups, while only mild inflammatory changes were seen in the combination group. All liver indices were normal in reversibility study animals. Furthermore, sperm count, motility, viability and morphology did not change in all treated animals, except that sperm count was decreased (p<0.05) in paracetamol group. Testis histology of all animal groups were normal. Conclusions The results demonstrated that simultaneous treatment with acute paracetamol and ethanol doses will possibly minimize hepatotoxicity and reduction of epididymal sperm reserve by the individual agents, and the toxicities are reversible.

Objectives Vestibular nerve stimulation using the portable battery-operated vestibular nerve stimulator is a sophisticated method noninvasive, safe, and easy to operate. It was hypothesized that vestibular nerve stimulation is effective in the management of type 2 diabetes. Hence, the present study was undertaken to determine the effectiveness of vestibular nerve stimulation using portable battery-operated vestibular nerve stimulator in the management of diabetes. Methods The present study was a double-blind randomized controlled trial with 1:1 split between the control and experimental groups. A total of 30 participants with type 2 diabetes were part of the study after obtaining the written informed consent. After recording the baseline values, the vestibular nerve stimulation was administered to the participants in the intervention group for 90 days. Sham stimulation was administered to the control group for 90 days. Outcome measures were recorded after 30 days and after 90 days of the intervention in both the groups. Results There was significant decrease in the total body weight, fasting, postprandial blood glucose, glycosylated hemoglobin levels, leptin, very low density lipoproteins levels followed by the intervention. There was significant improvement in both spatial and verbal memory scores. Depression and stress scores and systolic blood pressure decreased and remained in normal limits. Conclusions The study results have proven multimodal action of vestibular stimulation. It not only acts on regulation of the glucose metabolism but also can regulate the autonomic activity and improve cognition and relieve stress. This is the interesting finding of our study, which needs detailed further research to support implementation of vestibular nerve stimulation as an adjunctive therapy in the management of diabetes.

Objectives Roxithromycin, a macrolide antibiotic, has been shown to ameliorate acetic acid induced colitis in rats by suppressing inflammation and oxidative stress. The aim of this study was to evaluate the effect of roxithromycin on small intestinal transit and cholinergic responsiveness of the colonic smooth muscles of colitic rats. Methods Colitis was induced in rats by acetic acid and the small intestinal transit was determined by measuring the distance traversed by charcoal meal from the gastro-duodenal junction in 1 h. The test drug roxithromycin, reference drug mesalazine and anti-inflammatory drug diclofenac were administered orally before inducing colitis and their effect on intestinal transit was compared with colitic control group. The effect on cholinergic responsiveness of colonic smooth muscles was evaluated in vitro by plotting a dose-response curve using different concentrations of acetylcholine. The concentration producing 50% of maximal response (EC 50 ) was calculated for all the treatment groups. Results The small intestinal transit was enhanced in colitic rats as compared to normal rats (86.00 ± 1.36 vs. 57.00 ± 1.34 cm; p<0.001). Like mesalazine, roxithromycin normalized intestinal transit while diclofenac was ineffective. The results of in vitro experiment show that colitis increased cholinergic responsiveness of the colonic smooth muscles that was not affected by roxithromycin and mesalazine while diclofenac significantly decreased it. Conclusions This study shows that like mesalazine, roxithromycin affords protection in colitis mainly by normalizing propulsive movement of the small intestine than by affecting cholinergic responsiveness of the colonic smooth muscles.

Objectives Several cultivars of Allium cepa L. have been studied for anti-inflammatory and analgesic activities but there is inadequate information on such biological activities of the concentrated extracts of the Nigerian grown red cultivar A. cepa bulb. Methods The anti-inflammatory models used in this study were Carrageenan-induced paw oedema and formalin-induced paw lick in rats, while acetic acid-induced abdominal writhing, hot plate reaction, hot water tail flick tests in mice were the analgesic models. Results At 30 min post-induction (pi), the inhibition of paw oedema (62.50%) by 200 mg/kg of methanol extract of red cultivar A. cepa bulb (MERCACB) was significantly (p<0.001) higher than that of indomethacin (15.63%) at 10 mg/kg. The paw oedema inhibition at 60 min pi by MERCACB (76.92%) was significantly higher than that of indomethacin (41.03%). At the early phase of formalin paw-lick test, the pain reaction time (PRT) of rat treated with MERCACB (400 mg/kg) was significantly lower than that of indomethacin and the control groups. The hotplate test revealed that PRT of mice treated with 800 mg/kg of MERCACB were significantly (p<0.01) longer in comparism to indomethacin and control groups. The PRT of mice subjected to thermal pain due to hot water and treated with 800 mg/kg of MERCACB was significantly (p<0.05) longer than that of the control group. Conclusions These findings indicate that MERCACB possesses potent anti-inflammatory and analgesic properties which confirm the traditional use of the plant for the treatment of inflammatory diseases and may be useful as a future therapeutic agent.

Objectives Ulcerative colitis (UC) is a non-specific intestinal inflammatory disease. Several studies demonstrated that inflammation and oxidative stress play significant role in the pathogenesis of this disease. This study aimed to determine the protective effect and possible mechanism by which stevia affects the course of experimentally induced colitis. Methods Male rats were received stevia 20, 40, 80 mg/kg/day before induction of colitis by intra-rectal administration of 2 mL of 4% acetic acid, AA. Macroscopic and histopathological examination of the colon were done. Colonic content of catalase (CAT), superoxide dismutase (SOD), reduced glutathione (GSH), myeloperoxidase (MPO) and thiobarbituric acid reactive substances (TBARS) activities and serum levels of interleukin (IL)1- β and tumor necrosis factor (TNF)-α were assessed. Real time-PCR (RT-PCR) was done to determine the expression of NF-κB, Nrf2 and PPARγ genes. Spontaneous contraction and effects of increasing concentrations of acetylcholine and stevia have been studied on the isolated colonic segments. Results Stevia ameliorated colitis not only histopathologically but also it decreased the level of TNF-α, IL-1β, TBARS, MPO and the expression of NF-κB which were significantly increased in the AA group. The concentration of GSH, SOD, CAT and expression of Nrf2 and PPARγ were significantly increased with stevia. Moreover, stevia showed a relaxant effect on the colonic contractility which was increased in AA group. These all effects of stevia were more prominent with its highest dose. Conclusion Our results explored that, stevia acts protectively against UC by its anti-inflammatory and antioxidant properties which mediated by up-regulation of Nrf2 and PPARγ with downregulation of NF-κB. We suggest that stevia has the potential for treatment of chronic inflammatory diseases, such as UC.

Objectives Matrix metalloproteinase-13 (MMP-13) has been reported to be involved in different biological processes such as degradation of extracellular matrix proteins, activating or degrading some significant regulatory proteins, wound healing, tissue remodeling, cartilage degradation, bone development, bone mineralization, ossification, cell migration, and tumor cell invasion. Further, MMP-13 participates in many oral diseases such as tooth decay, gingivitis, and degradation of enamel and tissue around the implant. In addition, inhibition of MMP-13 has shown therapeutic properties for Alzheimer’s disease (AD). We performed molecular docking to assess the binding affinity of 29 flavonoid compounds with the MMP-13. Additionally, pharmacokinetic and toxicity characteristics of the top-ranked flavonoids were studied. The current study also intended to identify the most important amino acids involved in the inhibition of MMP-13 based on topological feature (degree) in the ligand-amino acid network for MMP-13. Methods Molecular docking and network analysis were studied using AutoDock and Cytoscape software, respectively. Pharmacokinetic and toxicity characteristics of compounds were predicted using bioinformatics web tools. Results The results revealed that nine of the studied flavonoids had considerable estimated free energy of binding and inhibition constant: Rutin, nicotiflorin, orientin, vitexin, apigenin-7-glucoside, quercitrin, isoquercitrin, quercitrin-3-rhamnoside, and vicenin-2. Proline-242 was found to be the most important amino acid inhibiting the enzyme. Conclusions The results of the current study may be helpful in the prevention and therapeutic procedures of many disorders such as cancer, tooth caries, and AD. Nevertheless, validation tests are required in the future.

Objectives Snakebite envenoming is an important public health problem that threatens the lives of healthy individuals especially in many tropical countries like Nigeria. Antivenins, the only efficient approach for snakebite envenoming, are limited in their efficacy in the neutralization of local tissue damage. Snake venom phospholipase A 2 (PLA 2 ), protease, hyaluronidase and l -amino acid oxidase (LAAO) are the major hydrolytic enzymes involve in local tissue damage. Therefore, this study evaluates the inhibitory effect of kolaviron (KV) against Naja n. nigricollis (NNN) snake venom hydrolytic enzymes involved in local tissue damage. Methods Kolaviron was evaluated for its ability to inhibit the hydrolytic enzyme activities of NNN venom phospholipase A 2 (PLA 2 ), protease, hyaluronidase and l -amino acid oxidase (LAAO). Present study also deals with the neutralization of NNN venom enzyme(s) induced complications such as myotoxic, edemic, hemolytic and procoagulant effects. Results Kolaviron inhibited the PLA 2 , protease, hyaluronidase and LAAO enzyme activities of NNN venom in a dose-dependent manner. Furthermore, myotoxic, edemic, hemolytic and procoagulant effects induced by NNN venom enzyme were neutralized significantly (p<0.05) when different doses of KV were pre-incubated with venom before assays. Conclusions These findings clearly present kolaviron as a potent inhibitor against NNN venom hydrolytic enzymes involved in local tissue damage and may act by either forming an inhibitor-enzyme complex that restricts the substrate availability to the enzyme or direct binding to the enzyme active site that affects the enzyme activity thereby mitigating venom-induced toxicity.

Objectives The liver is one of the primary biorepositories of cadmium (Cd) and it has been implicated in the pathogenesis of hepatic diseases. Quassia amara stem bark has been reputed to have strong antimalarial, antimicrobial, antiulcerative and amoebicidal properties. This study aims to determine the effects of Q. amara on Cd-induced hepatotoxicity and lipid profile in male Wistar rats. Methods The animals were divided into three groups of five animals each. Group 1 served as control while group 2 received Cd (5 mg/kg) for 4 weeks. Prior to Cd treatment, group 3 was treated with Q. amara extract (200 mg/kg) for 2 weeks and received the Q. amara and Cd simultaneously for 4 weeks. Results Cadmium caused significant increase in serum total cholesterol and low-density lipoprotein (LDL) as well as increased hepatic malondialdehyde (MDA) when compared with the control group. On the other hand, Cd caused a decrease in serum high-density lipoprotein (HDL) and hepatic superoxide dismutase (SOD) when compared with control. However, treatment with Q. amara prevented Cd-induced changes in the lipid profile, augmented Cd-induced decline in SOD and also ameliorated the Cd-induced increase in MDA. Catalase level was however comparable across the groups. Conclusions Q. amara ameliorated the Cd-induced damage to liver by preventing dyslipidemia and oxidative damage in the hepatic tissue.

Objectives Tithonia diversifolia (Asteraceae) is used in Cameroonian traditional medicine for the treatment of several diseases amongst which are hepatic disorders. Anti-inflammatory, analgesic and anti-diabetic properties have been reported but, there is no scientific information on its hepato-protective effects. The aim of this study was to evaluate the curative effects of the Tithonia diversifolia ( T. diversifolia ) leaves aqueous extract on ethanol induced-hepatotoxicity in rats. Methods Ethanol 40° (4 g/kg) was administered daily by intragastric gavage for 21 days, and then the extract was administered concomitantly with ethanol for two more weeks. Some biochemical serum and tissue parameters were evaluated. Histopathologic analysis of the liver was carried out. Results The ingestion of ethanol induced a significant reduction of body weight and a significant increase in some markers of hepatic function (Alanine Amino-transferase, Aspartate Amino-transferase, alkaline phosphatase, gamma glutamyl-transferase, total bilirubin and albumin). These alterations were accompanied by a significant increase in the levels of serum triglycerides (p<0.001). Intoxicated animals were also characterized by a significant decrease of reduced glutathione and nitrites concentrations, catalase and superoxide dismutase activities as well as an increase of malondialdehyde levels. The histopathological examination showed vascular congestion, disorganized parenchyma, liver inflammation and dilation of sinusoid. The extract at the doses of 60 and 120 mg/kg reversed ethanol-induced adverse effects. Conclusion Our study found that, the aqueous extract of T. diversifolia leaves has hepato-protective activity against ethanol-induced liver damages due partly to its antioxidant effect. This result justifies its empirical use for the treatment of liver problems.

Objectives Glucocorticoid-induced osteoporosis (dexamethasone) is a primary cause of secondary osteoporosis by the decreasing formation and increasing resorption activities. Previously, the in vitro study showed that 70% ethanol and aqueous extract of deer antler have increased alkaline phosphatase in osteoblast cell that known as marker of bone formation. The mind of this study is to analyze the effect of deer antlers in increasing the bone trabecular density of osteoporosis-induced male mice. Methods This study used a post-test control group design. A total of 54 healthy male mice were randomly divided to nine groups, i.e., healthy control, osteoporotic, positive control, 70% ethanol (4, 8, and 12 mg/kg BW), and aqueous extracts (4, 8, and 12 mg/kg BW) of deer antler groups. All of the interventions were given 1 mL of test sample for 4 weeks orally. The bone densities were determined using histomorphometry by Image J and Adobe Photoshop. The statistical data were performed using SPSS 23 and statistical significance was set at p<0.05. Results The results showed that alendronate group, 70% ethanol, and aqueous extract groups increased bone density and calcium levels in serum (p<0.05) compared to osteoporotic group in dose dependent manner. It indicated that 70% ethanol and aqueous extract of deer antler stimulating bone turnover and aqueous extract showed the highest. Conclusions Dexamethasone induction for 4 weeks caused osteoporotic mice and the administration of 70% ethanol and aqueous extracts of deer antler from East Kalimantan increased trabecular bone density and calcium levels in dose dependent manner.

Objectives Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported. Case presentation We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI. Conclusions In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.