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Background: Sarcopenia, characterized by muscle mass decline due to aging or other causes, is exacerbated by decreased estrogen levels after menopause in women. Isoflavones, a class of flavonoids acting on estrogen receptors, may have beneficial effects on metabolic disorders. We examined these effects in ovariectomized mice fed a high-fat, high-sucrose diet (HFHSD)., Methods: At 7 weeks old, female C57BL6/J mice (18-20 g, n = 12) underwent bilateral ovariectomy (OVX), and were then fed a high-fat, high-sucrose diet starting at 8 weeks of age. Half of the mice received isoflavone water (0.1%). Metabolic analyses, including glucose and insulin tolerance tests, were conducted. Muscle analysis involved grip strength assays, next-generation sequencing, quantitative RT-PCR, and western blotting of skeletal muscle after euthanizing the mice at 14 weeks old. Additionally, 16S rRNA gene sequence analysis of the gut microbiota was performed., Results: The results demonstrated that isoflavone administration did not affect body weight, glucose tolerance, or lipid metabolism. In contrast, isoflavone-treated mice had higher grip strength. Gene expression analysis of the soleus muscle revealed decreased Trim63 expression, and western blotting showed inactivation of muscle-specific RING finger protein 1 in isoflavone-treated mice. Gut microbiota analysis indicated higher Bacteroidetes and lower Firmicutes abundance in the isoflavone group, along with increased microbiota diversity. Gene sets related to TNF-α signaling via NF-κB and unfolded protein response were negatively associated with isoflavones., Conclusions: Isoflavone intake alters gut microbiota and increases muscle strength, suggesting a potential role in improving sarcopenia in menopausal women., Competing Interests: Nakajima, H. received individual compensation from Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., and Nippon Boehringer Ingelheim Co., Ltd. Nakanishi, N. received individual compensation from Kowa Pharmaceutical Co., Ltd., Novo Nordisk Pharma Ltd., Nippon Boehringer Ingelheim Co., Ltd., and TERUMO CORPORATION. Hamaguchi, M. received grants from AstraZeneca K.K., Ono Pharma Co., Ltd., and Kowa Pharmaceutical Co., Ltd.; and also received individual compensation from AstraZeneca K.K., Ono Pharma Co., Ltd., Eli Lilly Japan K.K., Sumitomo Dainippon Pharma Co., Ltd., Daiichi Sankyo Co., Ltd., Mitsubishi Tanabe Pharma Corp., Sanofi K.K., and Kowa Pharmaceutical Co., Ltd. outside of the submitted work. Fukui, M. received grants from Ono Pharma Co., Ltd., Oishi Kenko Inc., Yamada Bee Farm, Nippon Boehringer Ingelheim Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Sanofi K.K., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., MSD K.K., Kyowa Kirin Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Kowa Pharmaceutical Co., Ltd., Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Eli Lilly Japan K.K., Taisho Pharmaceutical Co., Ltd., Terumo Corp., Teijin Pharma Ltd., Nippon Chemiphar Co., Ltd., Abbott Japan Co., Ltd., and Johnson & Johnson K.K. Medical Co., TERUMO CORPORATION, and also received individual compensation from Nippon Boehringer Ingelheim Co., Ltd., Kissei Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corp., Daiichi Sankyo Co., Ltd., Sanofi K.K., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., MSD K.K., Kyowa Kirin Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Kowa Pharmaceutical Co., Ltd., Novo Nordisk Pharma Ltd., Ono Pharma Co., Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Eli Lilly Japan K.K., Taisho Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., AstraZeneca K.K., Mochida Pharmaceutical Co., Ltd., Abbott Japan Co., Ltd., Teijin Pharma Ltd., Arkray Inc., Medtronic Japan Co., Ltd., and Nipro Corp., TERUMO CORPORATION, outside of the submitted work. Sasano, R. was employed by the company AiSTI SCIENCE Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: Sarcopenic obesity, which is associated with a poorer prognosis than that of sarcopenia alone, may be positively affected by soy isoflavones, known inhibitors of muscle atrophy. Herein, we hypothesize that these compounds may prevent sarcopenic obesity by upregulating the gut metabolites with anti-inflammatory effects., Methods: To explore the effects of soy isoflavones on sarcopenic obesity and its mechanisms, we employed both in vivo and in vitro experiments. Mice were fed a high-fat, high-sucrose diet with or without soy isoflavone supplementation. Additionally, the mouse C2C12 myotube cells were treated with palmitic acid and daidzein in vitro., Results: The isoflavone considerably reduced muscle atrophy and the expression of the muscle atrophy genes in the treated group compared to the control group ( Fbxo32 , p = 0.0012; Trim63 , p < 0.0001; Foxo1 , p < 0.0001; Tnfa , p = 0.1343). Elevated levels of daidzein were found in the muscles and feces of the experimental group compared to the control group (feces, p = 0.0122; muscle, p = 0.0020). The real-time PCR results demonstrated that the daidzein decreased the expression of the palmitate-induced inflammation and muscle atrophy genes in the C2C12 myotube cells ( Tnfa , p = 0.0201; Il6 , p = 0.0008; Fbxo32 , p < 0.0001; Hdac4 , p = 0.0002; Trim63 , p = 0.0114; Foxo1 , p < 0.0001). Additionally, it reduced the palmitate-induced protein expression related to the muscle atrophy in the C2C12 myotube cells ( Foxo1 , p = 0.0078; MuRF1, p = 0.0119)., Conclusions: The daidzein suppressed inflammatory cytokine- and muscle atrophy-related gene expression in the C2C12 myotubes, thereby inhibiting muscle atrophy.

Context: Branched-chain amino acids (BCAA) are substrates for protein synthesis. Although their intake may contribute to an increase in skeletal muscle mass, elevated serum BCAA levels have been reported to be associated with insulin resistance, potentially resulting in decreased skeletal muscle mass., Objective: This study aimed to explore the association between elevated serum BCAA levels and longitudinal skeletal muscle loss., Design and Setting: A cohort analysis was conducted, in which serum amino acids were analyzed in healthy individuals who underwent a medical health checkup at Kameoka Municipal Hospital (HOZUGAWA study), Japan., Patients: Seventy-one participants (37 men and 34 women) underwent follow-up checkups after the baseline visit. The follow-up duration was 1.2 ± .4 years., Main Outcome Measures: The relationship between fasting baseline serum BCAA levels and lifestyle factors, body composition, blood test results, dietary history, and changes in skeletal muscle mass was evaluated., Results: In both men and women, serum BCAA levels were positively correlated with body weight, body mass index, skeletal muscle mass index (SMI), and serum triglycerides but inversely correlated with serum high-density lipoprotein cholesterol. In men, fasting serum BCAA levels were inversely associated with the rate of change in SMI (adjusted β = -.529, P = .006), and elevated BCAA levels were independently associated with a longitudinal decrease in skeletal muscle mass (odds ratio: 1.740; 95% confidence interval: 1.023-2.960 per 50 nmol/mL serum BCAAs increase)., Conclusion: Increased circulating BCAAs could be an indicator of skeletal muscle loss in men., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

This study investigated the effects of miso, a traditional fermented soybean food in Japan, on muscle mass atrophy. Eight week old male C57BL/6J mice were fed high fat/high sucrose diet with or without miso for 12 weeks. A miso diet increased soleus muscle weights ( p <0.05) and reduced intraperitoneal glucose tolerance and insulin tolerance ( p <0.05). The miso diet downregulated the Tnfα and Ccl2 expression, related to inflammation, and Trim63 and Fbxo32 expression, related to muscle atrophy, in the soleus muscle ( p <0.05). The miso diet increased short-chain fatty acids levels, including acetic, propanoic, and butanoic acids, in the feces, serum, and soleus muscle ( p <0.05). According to the LEfSe analysis, the miso diet increased family Prevotellaceae, family Christensenellaceae, family Dehalobacterium, family Desulfitibacter; family Deferribacteraceae, order Deferribacterales, class Deferribacteres; and family Gemmatimonadaceae, order Gemmatimonadetes, and class Gemmatimonadales, whereas the miso diet decreased family Microbacteriaceae, order Micrococcales, class Actinobacteria, and family Lactobacillaceae. Miso suppressed high fat/high sucrose diet induced impaired glucose tolerance, low muscle strength, and muscle atrophy by improving dysbiosis and increasing short-chain fatty acids production and provides new insights into the preventive effects of fermented foods on sarcopenia., Competing Interests: YH has received personal fees from Sanofi K.K., Mitsubishi Tanabe Pharma Co., Daiichi Sankyo Co., Ltd., and Novo Nordisk Pharma Ltd., outside the submitted work. TS has received personal fees from MSD K.K., Astellas Pharma Inc., Ono Pharma Co., Ltd., Kissei Pharma Co., Ltd., Mitsubishi Tanabe Pharma Co., Kowa Pharma Co., Ltd., Taisho Toyama Pharma Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Takeda Pharma Co., Ltd., Sanofi K.K., Novo Nordisk Pharma Ltd., and Eli Lilly Japan K.K., outside the submitted work. EU has received grants from the Japanese Study Group for Physiology and Management of Blood Pressure (Grant number: 4024). Donated Fund Laboratory of Diabetes therapeutics is an endowment department, supported with an unrestricted grant from Ono Pharmaceutical Co., Ltd., and received personal fees from MSD K.K., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Kowa Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., AstraZeneca plc, Novo Nordisk Pharma Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Company Ltd., Daiichi Sankyo Co., Ltd., and Sumitomo Dainippon Pharma Co., Ltd., outside the submitted work. MH has received grants from Mitsubishi Tanabe Pharma Co., Sumitomo Dainippon Pharma Co., Ltd., Asahi Kasei Pharma, Sanofi K.K., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., Daiichi Sankyo Co., Ltd., Eli Lilly Japan K.K., Novo Nordisk Pharma Ltd., Nippon Boehringer Ingelheim Co., Ltd., and Kyowa Kirin Co., Ltd., outside the submitted work. MF has received grants from Taisho Pharma Co., Ltd., Ono Pharma Co., Ltd., Daiichi Sankyo Co., Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Astellas Pharma Inc., Kissei Pharma Co., Ltd., Sanofi K.K., MSD K.K., Takeda Pharma Co., Ltd., Teijin Pharma Ltd., Eli Lilly Japan K.K., Novo Nordisk Pharma Ltd., Sumitomo Dainippon Pharma Co., Ltd., Abbott Japan Co., Ltd., Mitsubishi Tanabe Pharma Co., Kyowa Hakko Kirin Co., Ltd., Johnson & Johnson K.K. Medical Co., Terumo Co., Nippon Chemiphar Co., Ltd., and Kowa Pharmaceutical Co., Ltd.; and received personal fees from Taisho Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma Co., AstraZeneca plc, Nippon Boehringer Ingelheim Co., Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Astellas Pharma Inc., Kissei Pharma Co., Ltd., Daiichi Sankyo Co., Ltd., Bayer Yakuhin, Ltd., Kyowa Kirin Co., Ltd., Kowa Pharma Co., Ltd., Novo Nordisk Pharma Ltd., Medtronic Japan Co., Ltd., Ono Pharma Co., Ltd., Mochida Pharma Co., Ltd., Takeda Pharma Co., Ltd., Abbott Japan Co., Ltd., Arkley Inc., MSD K.K., Teijin Pharma Ltd., Sanofi K.K., and Nipro Co., outside the submitted work., (Copyright © 2024 JCBN.)

This study compares and clarifies the changes in intestinal flora resulting from the continuous consumption of two types of matcha. Healthy adults will consume two types of matcha tea for four weeks, and differences in the intestinal microflora before and after drinking will be compared. Gut microbiota will be identified using next-generation sequencing. Phylogenetic classification of the enterobacteria will be performed based on sequence similarities. The relative proportions of the classified enterobacteria to the total nucleotide sequences will be compared between the samples obtained from the two groups consuming different matcha. The continuous consumption of matcha may improve dysbiosis and prevent atherosclerosis. The effects may vary according to the type of matcha used. Trial registration: The study was registered with university hospital medical information network (UMIN) (UMIN000040303), and all participants gave their written informed consent. Registered 1 November 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr&#95;view.cgi?recptno=R000045982., (Copyright © 2022 JCBN.)

The BMDs of the lumbar spine, whole femur, and femoral neck and TBS were measured. Change in BMD or TBS was defined as the BMD or TBS at follow-up, performed 1 year after baseline, minus baseline BMD or TBS. Results: This retrospective cohort study included 93 patients, of whom 52 received no medication, 26 received bisphosphonates, and 15 received weekly teriparatide. BMD of the lumbar spine increased in all three groups. There was no change in BMD of the whole femur and femoral neck in the no medication and bisphosphonates groups, whereas the BMD of the whole femur (from 0.73 (0.15) to 0.74 (0.15) g/cm 2 , p = 0.011) and femoral neck (from 0.59 (0.16) to 0.60 (0.16) g/cm 2 , p = 0.011) in the teriparatide group increased. The change in BMD of the femoral neck (no medication; -0.002 (0.034) g/cm 2 , bisphosphonates; -0.0001 (0.024) g/cm 2 , and teriparatide; 0.017 (0.022) g/cm 2 , p = 0.091) or TBS (no medication; -0.007 (0.051), bisphosphonates; -0.058 (0.258), and teriparatide; 0.021 (0.044), p = 0.191) in the teriparatide group tended to be higher than that in the other groups, although there was no statistically significant difference. Conclusions: Teriparatide increased the BMD of the femoral neck and TBS in osteoporosis patients with type 2 diabetes mellitus, compared to bisphosphonates and no medication.

Aim/introduction: As the association between a fasting glucose concentration of 90-99 mg/dL and the onset of type 2 diabetes is still controversial, we aimed to assess it in 37,148 Japanese individuals with a normal plasma glucose concentration., Materials and Methods: This long-term retrospective cohort study included individuals having a medical checkup at Panasonic Corporation from 2008 to 2018. In total, 1,028 participants developed type 2 diabetes., Results: Cox regression analyses revealed that the risk for the onset of diabetes increased by 9.0% per 1 mg/dL increase in fasting plasma glucose concentration in subjects with the concentration ranging from 90 to 99 mg/dL. Compared with individuals with a fasting glucose concentration of ≤89 mg/dL, the adjusted hazard ratios for developing diabetes were 1.53 (95% CI; 1.22-1.91), 1.76 (95% CI; 1.41-2.18), 1.89 (95% CI; 1.52-2.35), 3.17 (95% CI; 2.61-3.84), and 3.41 (95% CI; 2.79-4.15) at fasting plasma glucose concentrations of 90-91, 92-93, 94-95, 96-97, and 98-99 mg/dL, respectively. In populations with obesity, the adjusted hazards ratios for developing diabetes were 1.56 (95% CI; 1.15-2.09), 1.82 (95% CI; 1.37-2.40), 2.05 (95% CI; 1.55-2.69), 3.53 (95% CI; 2.79-4.46), and 3.28 (95% CI; 2.53-4.22) at fasting plasma glucose concentrations of 90-91, 92-93, 94-95, 96-97, and 98-99 mg/dL, respectively., Conclusions: This study demonstrates that the risk of type 2 diabetes among subjects having a fasting plasma glucose concentration of 90-99 mg/dL, is progressively higher with an increasing level of fasting plasma glucose concentration in a Japanese people., (© 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Aim: We aimed to develop an application to calculate mean amplitude of glycaemic excursions (MAGE) automatically and to evaluate its accuracy., Materials and Methods: We named the application intermittently scanned continuous glucose monitoring (isCGM) calculator KAMOGAWA (Kyoto Auto MAGE Of Glucose cAlcutator With isCGM Application). The isCGM data from 20 patients, 10 with and 10 without diabetes, were used to compare manually calculated MAGE values with those calculated using KAMOGAWA. The rate of agreement for the MAGE values was calculated., Results: Comparing the MAGE values calculated manually with those calculated using KAMOGAWA, the total mean rate of agreement was 81.6%. Nonmatching values were checked and it was found that the inconsistencies were all attributable to errors in manual calculations. After correcting errors in the manual calculation, the MAGE values matched to one decimal place for all data in the manual and KAMOGAWA calculations., Conclusions: KAMOGAWA can help diabetologists use MAGE in clinical practice, which could contribute to improving glycaemic control in patients who use isCGM., (© 2021 John Wiley & Sons Ltd.)

Background: To investigate the acute effects of coronavirus disease (COVID-19) on lifestyle and metabolic parameters in patients with type 1 diabetes (T1D)., Methods: This retrospective cohort study included 34 patients who were admitted to our hospital from April 16 to May 1, 2020. Data on stress levels, sleep duration, exercise, total diet, snacks, and prepared food intake were obtained from the questionnaires. Changes in the values of hemoglobin A1c (HbA1c) and body weight from 3 months before the administration of the questionnaire to the time the study questionnaire was administered (pandemic year), and those from 15 months before to 12 months before the administration of the questionnaire (pre-pandemic year) were evaluated., Results: Increased stress levels and decreased exercise volumes were observed in approximately 60% and 50% of participants during the COVID-19 pandemic, respectively. Decreased sleep duration was associated with changes in the body weight for 3 months during pandemic year ( r  = - 0.40, p  = 0.043). Furthermore, compared with changes in HbA1c for 3 months during pre-pandemic year, changes in HbA1c during the pandemic year were worse (0.12% [0.33] % during pandemic year vs. - 0.09 [0.39] % during pre-pandemic year, p  = 0.027)., Conclusions: Many patients experienced stress and exercised less due to the COVID-19 pandemic. Glycemic control in patients with T1D was worse than that in the previous year. Since the pandemic is currently ongoing, more attention should be paid to stress and lifestyle factor management in patients with T1D., Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-021-00507-4., Competing Interests: Disclosure of potential conflicts of interestMichiaki Fukui received honoraria from Sanofi K.K., Novo Nordisk Pharma Ltd., Mitsubishi Tanabe Pharma Corporation., MSD K.K., Takeda Pharmaceutical Company Limited, ONO PHARMACEUTICAL CO., LTD., Taisho Pharmaceutical Co., Ltd.,　Nippon Boehringer Ingelheim Co. Ltd., AstraZeneca K.K., SANWA KAGAKU KENKYUSHO CO., LTD., Eli Lilly Japan K.K., and KOWA PHARMACEUTICAL COMPANY LTD. and subsidies or received donations from Nippon Boehringer Ingelheim Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, DAIICHI SANKYO COMPANY, LIMITED, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Takeda Pharmaceutical Company Limited, Sanofi K.K., Novo Nordisk Pharma Ltd., MSD K.K., Eli Lilly Japan K.K., SANWA KAGAKU KENKYUSHO CO., LTD., and Abbott Japan LLC. and received endowed departments by commercial entities from ONO PHARMACEUTICAL CO., LTD. The other authors have nothing to disclose., (© The Japan Diabetes Society 2021.)

Background : The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m 2 ) was calculated as appendicular muscle mass (kg) divided by height squared (m 2 ). Change in SMI (kg/m 2 /year) was calculated as (follow-up SMI-baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m 2 before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m 2 after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (-0.117 (0.240) vs. 0.005 (0.289) kg/m 2 /year, p = 0.049). This decrease was observed in men (-0.159 (0.257) vs. 0.031 (0.325) kg/m 2 /year, p = 0.038), patients with poor glycemic control (-0.170 (0.264) vs. 0.031 (0.285) kg/m 2 /year, p = 0.042), and those with a long diabetes duration (-0.153 (0.229) vs. 0.082 (0.291) kg/m 2 , p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.

To investigate the acute effects of the coronavirus disease 2019 (COVID-19) on the lifestyle and metabolic parameters in patients with type 2 diabetes mellites. This cross-sectional and retrospective cohort study induced 203 patients who completed a questionnaire regarding stress levels and lifestyles. Data regarding stress levels, sleep time, exercise, and total diet, snack, and prepared food intake were obtained from the questionnaires. The changes in the body weight or HbA1c levels were determined by comparing the values at the time the questionnaire was administered to those noted 3 months ago. Increased levels of stress and decreased exercise levels were reported in approximately 40% and >50%. During the COVID-19 pandemic. There was a negative correlation between stress and exercise (r = -0.285, p < 0.001) and a positive correlation between stress and prepared food intake (r = 0.193, p = 0.009). Decreased exercise levels (r = -0.33, p < 0.001) and increased snack consumption (r = 0.24, p = 0.002) were associated with increased body weight. Furthermore, increased total diet intake (r = 0.16, p = 0.031) was associated with increased HbA1c levels. These relationships remained significant for patients aged <65 years and patients who did not engage in regular exercise. Many patients experienced stress and lifestyle changes due to the COVID-19 pandemic, and these changes were associated with increased body weight and HbA1c levels.

BACKGROUND Electrolyte imbalance is frequent in many situations, but severe hyperchloremia is markedly rare in the absence of renal impairment. We report a patient with preserved renal function who exhibited severe hyperchloremia and negative anion gap. CASE REPORT A 70-year-old female with preserved renal function presented with fatigue and impaired consciousness. Venous blood gas analysis was notable for a chloride level of 137 mEq/L and anion gap of -18.2 mEq/L. Careful history taking revealed that she had taken bromide-containing over-the-counter painkillers. Her symptoms and laboratory tests gradually improved after intravenous hydration and painkiller withdrawal. The serum level of bromide ions on admission was later found to be 4-times higher than that considered toxic. CONCLUSIONS It is important to recognize that hyperchloremia with a negative anion gap strongly suggests bromide intoxication, and that bromide intoxication can develop even in patients with preserved renal function. Careful history taking is essential to the diagnosis because some over-the-counter drugs that are widely available and a few prescription drugs contain bromides.