melanotic pigmentation of the sclera Pigmented conjunctival lesions Utility of anterior segment optical

peripheral vascular thrombosis Hematological : Polycythemia vera (a rare type of blood cancer) Gastrointestinal : Mild, transient diarrhea Dermatological : Itching

This further inhibits the synthesis of dark pigment melanin called Eumelanin

Pharmacists should ensure important nutritional markers are monitored and corrected if required

256 Conclusion and Future Directions TMAO may drive the cross-talk between inflammatory response and oxidative stress by mediating cell death (including apoptosis, pyroptosis, autophagy, and ferroptosis, etc) and then induce pathological processes such as foam cell activation, massive secretion of cytokines and adhesion molecules, overaccumulation of ROS, enhanced platelet reactivity and abnormal vascular tone regulation