Predictors of medicinal cannabis users' willingness to utilise a new prescription Medicinal Cannabis Scheme in New Zealand.

AIM: To investigate medicinal cannabis users' intentions to transition to the new prescription Medicinal Cannabis Scheme (MCS) in New Zealand. METHOD: An online survey of 3,634 past-year medicinal cannabis users completed prior to implementation of the MCS in New Zealand in April 2020. Logistic regression models were fitted to identify predictors of intended future engagement with the MCS. RESULTS: Seventy-eight percent of respondents were aware of the new MCS and 66% intended to use it. Higher income (OR=1.57), younger age (OR=1.02) and smoking cannabis (v. vaping (OR=2.0) or oral ingestion in edible form (OR=2.22)) predicted intention to engage with the MCS. Conversely, Maori (OR=0.63) and those who grew their own cannabis (OR=0.52) were less likely to intend to engage with the new prescription MCS. CONCLUSION: The lower intended engagement with the MCS by Maori, lower income groups and those who home-grow cannabis may reflect their perceptions of the MCS as restrictive and expensive.

[Pain management in cancer patients in a Tunisian hospital]. / La gestion de la douleur chez les patients atteints du cancer dans un hôpital tunisien.

Pain is a common symptom in cancer patients. It is subjective and difficult to communicate. It continues to be outsourced and often overlooked despite the existence of multiple recommendations. The objective of this study is to describe pain management in cancer patients in a Tunisian hospital. This is a prospective study, conducted over one month at the maternity centre of Monastir by an intern in pharmacy using a questionnaire. Of 128 patients assessed, 50 were algic. Twenty-six percent of algic patients were not treated. The neuropathic component of pain was present in 30 % of cases but under treatment. Relief opioids were prescribed in 43 % of cases to relieve pain. Paracetamol was prescribed in 26 % of cases. Ten percent of patients use paracetamol self-medication. Sixteen percent of patients have tried non-pharmacological means, of which 62 % consume plants. To optimise the management of pain at our centre, the available analgesic sheets have been developed, validated by the medical staff and disseminated in the departments of carcinology and oncohematology. Therapeutic education sessions were also scheduled to warn patients about the risks of self-medication and misuse of medicinal plants. Pain management is complex. It requires respect for international recommendations, but especially for the efforts made by all stakeholders.

Attitudes towards and use of cannabis in New Zealand patients with inflammatory bowel disease: an exploratory study.

AIMS: We aimed to assess the use of and attitudes towards cannabis use (medicinal and recreational) by people with IBD in New Zealand. METHODS: People with IBD were invited to complete an anonymous online questionnaire. Participants were recruited via postal mail using a hospital database of patients with IBD (developed by the Gas-troenterology Department at Dunedin Public Hospital) and via online recruitment (advertised on the Crohn's and Colitis New Zealand website, Facebook page and e-mail list). Inclusion criteria were ages 18+ and self-reported confirmed IBD diagnosis. RESULTS: In total, 378 participants completed the questionnaire, with 334 eligible responses. Partici-pants were predominantly New Zealand European (84%) and female (71%). Sixty-one percent of re-spondents had CD and 34% UC. Overall, 51% of respondents reported having ever used cannabis. Of those, 63% reported use as recreational and 31% for reduction of IBD symptoms. Users were more likely to be younger (on average by 6.4 years), with on-going symptoms, unemployed or self-employed and current or ex-smokers. There were no differences by disease status or severity. Symp-toms most reported as improved by cannabis use were abdominal pain/cramping, nausea/vomiting and loss of appetite. Fifty-four percent of participants reported that if cannabis were legal, they would request it for medicinal use to help manage their symptoms. CONCLUSIONS: Overall, our research aligns with previous observational research that reports im-provements in symptoms of IBD with cannabis use. Studies of a higher evidence level (eg, RCTs) would be needed to guide prescribing. In the meantime, this research provides useful background to clini-cians about patients' views and experiences.

Contemporary use of phytotherapy in patients with lower urinary tract symptoms due to benign prostatic hyperplasia: results from the EVOLUTION European registry.

BACKGROUND: To use the European Association of Urology Research Foundation (EAURF) registry data to determine the proportion of contemporary Lower Urinary Tract Symptoms associated with Benign Prostatic Enlargement (LUTS/BPE) patients prescribed phytotherapy, and to determine their subjective quality of life and clinical progression responses. METHODS: This was a prospective multicenter multinational observational registry study, conducted over 2 years. Men ≥ 50 years seeking LUTS/BPE were divided at baseline into two cohorts, presently/recently untreated patients (PUP) commencing pharmacotherapy at baseline and presently/recently treated patients (c-PTP) continuing previously received pharmacotherapy, with 24-month follow-up (FU). RESULTS: Overall, 2175 patients were enrolled with 1838 analyzed. Of the PUP cohort (n = 575), 92 (16%) received phytotherapy and 65 (71%, n = 65/92) completed 24-month FU, with France prescribing 34% (n = 30/89) the highest proportion of phytotherapy among all LUTS/BPE medications. In the c-PTP group (n = 1263), only 69 (5%) patients were using phytotherapy, falling to n = 35/69 (51%) at 24-month FU (highest in France 20% (n = 43/210)). Though defined disease progression occurred in ≤ 20%, with only 1% proceeding to surgical intervention, in both groups, clinically meaningful improvement was lower and symptom persistence was higher in PUP but similar in the treated (c-PTP) patients on phytotherapy compared to the other LUTS/BPE medication. CONCLUSION: Low heterogeneous prescribing rates for phytotherapy were reported in both PUP and c-PTP cohorts over the 24-month FU. Although phytotherapy led to subjective improvements, healthcare practitioners should prescribe them with caution until higher quality evidence and guideline recommendations supporting its use are available.

Anticancer agents and phytotherapy: Interactions that are often unrecognized.

Phytotherapy is the main complementary medicine for which patients afflicted with cancer have recourse but the associated consumption of phytotherapy products gives rise to a risk of interaction with anticancer agents. The aim of this prospective study was to measure the prevalence of the consumption of phytotherapy products as well as their interactions with anticancer agents in a cohort of patients from January 2018 to August 2019. Patients hospitalized in the conventional hematology unit and outpatients who had their prescriptions for oral anticancer agents filled at the hospital pharmacy were questioned about consumption of phytotherapy products by pharmacy externs trained in pharmaceutical interviews. Among the 110 hospitalized patients who answered the questionnaire, 40% (n = 44) used phytotherapy and 5 of them continued to consume it during the cycles of injectable chemotherapy. As a result, 10 interactions were found between the plants and the anticancer agents (prevalence of 27%). Among the 59 outpatients, 17% (n = 10) consumed phytotherapy. Eight interactions were identified (prevalence of 80%). The potential consequences were an increase or a decrease in the concentration of the anticancer agents and an increase in the risk of bleeding, hepatoxicity, and hypokalemia. The consumption of phytotherapy was unknown by a health professional for 44% of hospitalized patients and 60% of the outpatients. The risk of interactions between plants and anticancer agents is not negligible and professionals should be cognizant of this in their daily practice. The availability of tools for training and detection of interactions is indispensable for managing patients undergoing onco-hematology treatments.

Concomitant botanical medicine use among patients participating in commercial prostate cancer trials.

OBJECTIVES: Patients with cancer frequently use botanical medications. The concomitant use of such medications by patients on commercial trials has not been well-described, despite the importance of these trials for evaluating the safety and efficacy of new agents. We sought to describe the use of botanical medications taken by patients with prostate cancer enrolled on global commercial trials. DESIGN: Retrospective study. SETTING: Regulatory repository of commercial clinical trial data. INTERVENTIONS: Anti-cancer therapy. MAIN OUTCOME MEASURES: Botanical and medication use data were pooled across six international commercial randomized trials for metastatic prostate cancer with detailed information on medication and indications. Botanical products were considered to have potential for drug interaction if they led to a change in drug exposure in human trials. Potential for interaction was ascertained by PubMed review. Descriptive statistics were used for analysis. RESULTS: Of 7318 enrolled patients, 700 (10 %) reported botanical use at any time and 653 (9%) reported use of botanical products while on trial. Nearly half of botanical product types were not classified by plant (43 %). The highest proportion of botanical use was among patients in Asian countries (32 %), followed by patients in North America (13 %). Eighty-six different types of botanical products were used; of these, nineteen had a patient-reported anti-cancer indication. CONCLUSIONS: Botanical medicine use among patients with prostate cancer in commercial trials is moderate, although it varies by region. Practitioners should be aware of the use of botanical interventions in a clinical trial context.

Cannabis Use in Hospitalized Patients with Chronic Pain.

INTRODUCTION: To date, no study has reported the prevalence of cannabis use in chronic pain patients. The aim of this study is to investigate the trends in cannabis use among chronic pain in-patients from 2011 to 2015 in the USA. METHODS: Patients were identified from the National Inpatient Sample (NIS) database using the International Classification of Diseases, Ninth and Tenth Revision, diagnosis codes for chronic pain and cannabis use. Annual estimates and trends were determined for cannabis use, patient characteristics, cannabis use among subgroups of chronic pain conditions, cost, length of stay, and associated discharge diagnosis. RESULTS: Between 2011 to 2015, a total of 247,949 chronic pain patients were cannabis users, increasing from 33,189 to 72,115 (P < 0.001). There were upward trends of cannabis use in females (38.7-40.7%; P = 0.03), Medicare insured patients (32.7-40.4%; P < 0.01), patients with lowest annual household income (36.1-40.9%; P = 0.02), patients aged 45-64 years (45.9-49.2%; P < 0.001), and patients with tobacco use disorder (63.8-72.4%; P < 0.0001). Concurrently, cannabis use decreased among patients with opioid use disorder (23.8-19.9%; P < 0.001). Cannabis use increased from 2011 to 2015 in patients with chronic regional pain syndrome, trauma, spondylosis, and failed back surgery syndrome. Adjusted total hospitalization cost increased from $31,271 ($1333) in 2011 to $38,684 ($946) in 2015 (P < 0.001). CONCLUSIONS: Cannabis use increased substantially from 2011 to 2015, while the rates of cannabis use in opioid users down-trended simultaneously. Disparities in cannabis use among subgroups should be explored further.

Exploring medicinal use of cannabis in a time of policy change in New Zealand.

AIMS: To explore patterns of medicinal cannabis use prior to implementation of the new Medicinal Cannabis Scheme (MCS) in New Zealand. METHODS: An anonymous online convenience survey of 3,634 last-year medicinal users of cannabis promoted via Facebook™ from May to August 2019. RESULTS: Fifty percent of the sample were female, 18% were Maori and the median age was 38 years. The medical conditions for which cannabis was most often used were pain (81%), sleep (66%) and mental health conditions (64%). Respondents perceived cannabis to be an effective therapy and reported reducing use of other pharmaceutical medicines. Fifty-two percent reported side effects from cannabis use, including increased appetite (29%), drowsiness (12%), eye irritation (11%), dependency (10%), memory impairment (10%) and lack of energy (9%). Smoking was the dominant route of administration. Nearly half (47%) had discussed their use of cannabis with a medical professional in the previous year, while 14% had requested a prescription and 5% accessed a prescribed cannabis-based product (mostly oral CBD). CONCLUSION: Respondents self-medicated with cannabis to treat a wide range of health complaints. Only half discussed medicinal cannabis use with their medical professional, and a minority requested a prescription and used a prescribed cannabis-based product.

Use of complementary and alternative medicine in cancer: A Tunisian single-center experience.

INTRODUCTION: We aimed to explore the use of complementary and alternative medicine (CAM) and to identify their side effects, when used in cancer patients. We also assessed the communication of the patients and families with the oncologist about this issue. METHODS: A cross-sectional survey of 120 adult patients treated for cancer in our medical oncology department between January and April 2019, using an anonymous questionnaire to assess complementary and alternative medicine use. RESULTS: One hundred twenty patients participated in the survey, among them 102 used CAM (85%). A majority of users were female patients (n=72, 70.6%), and mean age was 52.4 years±11.6. Patients had breast cancer in 48% of cases. Wild herbs were the most commonly used alternative therapy (67.7%), particularly Ephedra foeminea (Alanda) in 52% of cases. Patients' families incited them to use CAM in 64.7% of cases. Internet and social network (Facebook) were the major sources of information on CAM (79.4%), followed by family and friends (72.5%). Fourteen patients (13.7%) reported nausea and vomiting secondary to CAM use. We reported disruption of liver function in 9.8% of cases, and renal failure in 1.96%, with fatal issue in one patient using Ephedra. Nineteen patients (18.6%) informed their oncologist about the alternative therapy they received. CONCLUSION: The oncologist has to explore the use of alternative therapies with their patients. Communication about CAM should be a part of cancer care. It may protect patients from some dangerous side effects and improve efficacy of conventional therapy.

The prevalence and predictors of using herbal medicines among Iranian cancer patients.

BACKGROUND: and Purpose: Using of herbal medicines is common for cancer treatment. The aim of this study was to determine the prevalence, reasons, and predicting factors for the use of herbal medicines by Iranian cancer patients. MATERIALS AND METHODS: We conducted this cross-sectional study on 315 cancer patients through face-to-face interview in Kerman, Southeast of Iran, 2017. RESULTS: In total, 267 (84.1%) patients used at least one herbal medicine during chemotherapy courses, while only 42 (16.1%) patients discussed the use of herbal medicines with physicians. Living in urban regions (OR, 2.56; 95% CI, 1.30-5.05; P<0.0001) and the experience of constipation and diarrhea (OR, 2.11; 95% CI, 1.09-4.05; P = 0.02) were determined as some predicting factors for the use of herbal medicines. CONCLUSION: Our findings indicate that as herbal medicines are common among cancer patients and their use is often overlooked, physicians should pay particular attention to herbal medicines during chemotherapy.

In vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs / Uso in vitro e in vivo do óleo essencial de Melaleuca (Melaleuca alternifolia) em otites bacterianas e por leveduras

Otitis externa is a common complaint in dogs. Bacteria and yeasts are commonly involved and may perpetuate inflammatory reactions inside the ear canal. Otoscopy, cytological examination of secretion and microbiological culture embody forms of diagnosis. Cytology also has great use in accessing treatment evolution. Therapy usually consists of cleaning ear canals and subsequent use of antibiotics or antifungal products. As some of them may cause hypersensitivity and even ototoxicity, searching for new pharmacological bases is currently necessary and justifies this study, which aimed to evaluate in vitro and in vivo efficacy of tea tree essential oil for bacterial and yeast ear infections in dogs. Twenty-eight dogs from a particular shelter in Cuiabá (Mato Grosso, Brazil), presenting clinical signs of otitis externa, were enrolled in this clinical trial. In all of them, clinical and cytological evaluations, as well as culture and susceptibility testing of the affected ears were carried out. From each dog, one ear was treated with 5% tea tree essential oil lotion and the other with standard otic formulation, according to the type of infection (bacterial, yeast or both). In vitro susceptibility testings of all ear cultures, to the same drugs used in treatment, were also carried out. Culture results showed 62.5% bacterial and fungal infection, 33.9% bacterial infection and 3.6% fungal infection, from the 56 ear samples collected. The most common microorganisms isolated were Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis and Malassezia pachydermatis. Gram-positive bacteria were susceptible to gentamycin in 60.5% and resistant in 16.3% of the samples. Five percent tea tree essential oil formulation produced a 5mm clear zone of inhibition around the disks in one of the 63 samples evaluated. Pure (100%) tea tree essential oil formulation produced a 10mm clear zone of inhibition around the disks in four of the 63 samples evaluated, a 9mm zone in three samples, an 8mm zone in 16 samples, a 7mm zone in seven samples, a 6mm zone in two samples and there was no clear zone in 31 samples. Inhibition zones were produced by strains of Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis and Enterobacter sp. tea tree essential oil ear solution significantly induced remission of clinical signs both in bacterial and yeast ear infections. It also reduced as much Malassezia pachydermatis ear infection as the nystatin solution used in this study, while gentamycin solution showed better antibacterial effect. More studies should be conducted to evaluate in vitro diffusion properties of tea tree essential oil. Good antimicrobial spectrum and the absence of adverse reactions confirm the importance of developing a tea tree formulation as an alternative therapy for ear infections in dogs.(AU)

Otite externa é queixa frequente em cães. Bactérias e leveduras estão comumente envolvidas e podem perpetuar as reações inflamatórias dentro do canal auditivo. Dentre as formas de diagnóstico, encontram-se a otoscopia, o exame citológico da secreção e a cultura microbiológica. Citologia também tem grande utilidade no acesso à evolução do tratamento. A terapia consiste de limpeza dos canais auditivos e posterior utilização de antibióticos ou produtos antifúngicos. Como alguns antimicrobianos utilizados no tratamento podem causar hipersensibilidade e até mesmo ototoxicidade, a busca por novas bases farmacológicas justifica a existência deste estudo, que teve como objetivo avaliar in vitro e in vivo a eficiência do óleo de Melaleuca alternifolia em otites bacterianas e fúngicas de cães. Vinte e oito cães, de um abrigo particular, apresentando sinais clínicos de otite externa, foram incluídos neste estudo clínico. Todos passaram por avaliação clínica, citologia e cultura de material das orelhas afetadas. De cada animal, uma orelha foi tratada com óleo de Melaleuca 5% e a outra com formulação ótica padrão, de acordo com a afecção (bacteriana, fúngica ou mista). As culturas também foram submetidas a testes de susceptibilidade in vitro aos mesmos agentes utilizados no tratamento in vivo. Os resultados da cultura mostraram 62,5% de infecção mista (bacteriana e fúngica), 33,9% de infecção bacteriana e 3,6%, de infecção fúngica a partir das 56 orelhas. Os micro-organismos mais isolados foram Staphylococcus intermedius, Staphylococcus aureus, Proteus mirabilis e Malassezia pachydermatis. As bactérias GRAM-positivas foram sensíveis à gentamicina em 60,5% e resistentes em 16,3% das amostras. A formulação com 5% de óleo essencial de Melaleuca produziu uma zona de inibição de 5mm em torno dos discos em uma das 63 amostras avaliadas. A formulação pura (100%) do mesmo produto produziu uma zona de 10mm de inibição em quatro das 63 amostras analisadas, uma zona de 9 mm em três amostras, uma zona de 8mm em 16 amostras, uma zona de 7mm em sete amostras, uma zona de 6mm em duas amostras e não havia nenhuma zona clara em 31 amostras. Zonas de inibição foram produzidas por estirpes de Staphylococcus intermedius, Staphylococcus hyicus, Corynebacterium sp., Proteus mirabilis e Enterobacter sp. Clinicamente, a formulação com o óleo essencial de melaleuca induziu significativamente uma melhora nas manifestações, tanto nas otites bacterianas quanto nas causadas por leveduras, sendo estatisticamente semelhante ao tratamento com nistatina (nas otites por levedura), mas menos eficaz que a solução de gentamicina nas otites bacterianas. Mais estudos devem ser realizados para avaliar as propriedades de difusão in vitro do óleo essencial de melaleuca. O bom espectro antimicrobiano, a boa resposta clínica e a ausência de reações adversas confirmam a possibilidade de desenvolvimento de formulação ótica com o óleo essencial de melaleuca, como uma alternativa para a terapia de infecções do ouvido em cães.(AU)

[The interpretation and integration of traditional Chinese phytotherapy into Western-type medicine with the possession of knowledge of the human genome]. / A hagyományos kínai fitoterápia értelmezése és beillesztése a nyugati típusú orvoslásba az emberi genom ismeretének birtokában.

The terminology of traditional Chinese medicine (TCM) is hardly interpretable in the context of human genome, therefore the human genome program attracted attention towards the Western practice of medicine in China. In the last two decades, several important steps could be observed in China in relation to the approach of traditional Chinese and Western medicine. The Chinese government supports the realization of information databases for research in order to clarify the molecular biology level to detect associations between gene expression signal transduction pathways and protein-protein interactions, and the effects of bioactive components of Chinese drugs and their effectiveness. The values of TCM are becoming more and more important for Western medicine as well, because molecular biological therapies did not redeem themselves, e.g., in tumor therapy. Orv Hetil. 2018; 159(18): 696-702.

Trends in and correlates of medical marijuana use among adults in the United States.

BACKGROUND: Trends in and correlates of medical marijuana use are important to inform ongoing clinical, research, policy, and programmatic efforts. This study assessed trends in and correlates of medical marijuana use among U.S. adults. METHODS: We analyzed data from approximately 147,200 U.S. civilians aged 18 or older who participated in the 2013-2015 National Surveys on Drug Use and Health. Descriptive analyses, multivariable logistic regressions, and zero-truncated native binomial regressions were applied. RESULTS: Among U.S. adults, the prevalence of medical marijuana use increased from 1.2% in 2013 to 1.6% in 2015 (p = 0.0007). After adjusting for covariates, adults residing in medical marijuana states (states with legalized medical marijuana use) were 1.3 times more likely to use marijuana medically in 2015 than in 2013 (adjusted odds ratio (AOR) = 1.3, 95% confidence interval (CI) = 1.03-1.61), and adults in nonmedical marijuana states were 1.4 times more likely to report medical marijuana use in 2015 than in 2013 (AOR = 1.4, 95% CI = 1.05-1.90). Among adults who used marijuana exclusively for medical purposes in the past 12 months, trends in 12-month cannabis use disorders, daily or near daily use, and the number of days of marijuana use remained unchanged during 2013-2015. We identified how correlates of medical marijuana use among adults in medical marijuana states differed from their counterparts in nonmedical marijuana states. CONCLUSIONS: Adults were more likely to use marijuana medically in 2015 than in 2013 in both medical and nonmedical marijuana states. Clinicians need to learn about and address evolving patterns of medical marijuana use in patients.

Medicinal plants profile used by the 3rd District population of Maceió-AL / Perfil de plantas medicinais utilizadas pela população do 3º Distrito Sanitário de Maceió-AL

Abstract Herein the use of medicinal plants by the population of the 3rd Sanitary District of Maceió-AL city is reported. Transversal description was conducted from February 2013 to January 2014, with a sample of 116 individuals of both Gender Genders aged over 18 years. The ethnobotanical information interviews ethnobotanical information were obtained through semi - structured questionnaire featuring the use of medicinal plants and social and economical data. Descriptive statistics was applied for quantitative variables as mean and standard deviation and proportions for qualitative variables in the frequency table format. The results showed that 85.34% of the interviewees used plants for medicinal purposes. As the majority of these were (73.28%) females in the age group between 30-60 years of old. Among a total of 45 identified plant species, the highest use frequency were for Boldus Peumus (bilberry), Melissa officinalis (lemon balm), and Mentha piperita (mint). The most widely used plant foliage part was (53.53%) prepared as an infusion (55.5%). The use of medicinal plants in Maceió cityis widespread, highlighting the importance of ethnobotanical knowledge for the study of medicinal plants.

Resumo O presente estudo teve como objetivo analisar o perfil de utilização de plantas medicinais dos indivíduos residentes no 3º Distrito Sanitário do município de Maceió, Alagoas. Trata-se de um estudo observacional, descritivo de caráter transversal que foi realizado no período de fevereiro de 2013 a janeiro de 2014, com amostra de 116 indivíduos, maiores de 18 anos de ambos os gêneros. As informações etnobotânicas foram obtidas através de entrevistas semi-estruturadas realizadas por meio de questionário semiestruturado para traçar o perfil de utilização de plantas medicinais e dados socioeconômicos e demográficos dos entrevistados. A estatística descritiva foi aplicada para as variáveis quantitativas na forma de média e desvio padrão e proporções para variáveis qualitativas no formato de tabelas de frequência. Os resultados evidenciaram que 85,34% dos entrevistados utilizavam plantas para finalidades medicinais. Sendo a maioria destes, (73,28%) do Gênero feminino estando na faixa etária de 30 a 60 anos de idade. De um total de 45 espécies vegetais identificadas, as de maior frequência de utilização foram o Peumus boldus (boldo), a Melissa officinalis (erva-cidreira) e a Menta piperita (hortelã). A parte mais utilizada das plantas foi às folhas (53,53%) sendo ainda esta preparada sob forma de infusão (55,5%). A utilização de plantas medicinais no município de Maceió, Alagoas é bastante difundida, reforçando a importância de estudos etnobotânicos a fim de trabalhar com o resgate do conhecimento popular aliado a literatura científica.

Brazilian panorama about the registration and use of herbal medicines / Panorama brasileño en cuanto al registro y el uso de las hierbas medicinales

It was evaluated the Brazilian panorama regarding the registration and use of phytotherapics. A descriptive study about herbal medicines was carried out using the Pubmed and Portal Capes databases, and online data from the National Health Surveillance Agency (ANVISA). Of the 114-plant species described in the list of Brazilian Common Denomination (CBD), 67 have at least one formulation registered by ANVISA, with emphasis on Ginkgo biloba L. Fifteen different pharmaceutical forms were observed, the most common being tablets. There are 22 different indications, laxative was the most cited. Publications in the field of herbal medicine have increased significantly in the last 2 decades.

Se evaluó el panorama brasileño sobre el registro y uso de fitoterápicos. Se realizó un estudio descriptivo de las hierbas medicinales utilizando las bases de datos Pubmed y Portal Capes, así como datos en línea de la Agencia Nacional de Vigilancia Sanitaria (ANVISA). De las 114 especies de plantas descritas en la lista de Denominación Común Brasileña (CBD), 67 tienen al menos una formulación registrada por ANVISA, con énfasis en Ginkgo biloba L. Se observaron 15 formas farmacéuticas diferentes, siendo las más comunes las tabletas. Hay 22 indicaciones diferentes, laxante fue el más citado. Las publicaciones en el campo de la medicina herbal han aumentado significativamente en las últimas 2 décadas.

HERBAL PRODUCT USE BY THE CANCER PATIENTS IN BOTH THE PRE AND POST SURGERY PERIODS AND DURING CHEMOTHERAPY.

BACKGROUND: The aim of this study was to evaluate of the use of herbal products in patients in both pre- and post- surgery periods and during chemotherapy, and to determine the factors behind it. MATERIALS AND METHODS: This study was conducted as a descriptive study with 281 patients in 4 centers. The data of the study were collected by using a survey form prepared by the researcher, depending on literature and interview with the participants face-to-face. RESULTS: While the average age of the patients involved in the study is 49.1±12.8, 51.6% of them were females, 34.6% graduate of elementary school, and 34.5% were housewives. While the prevelance of the use of herbal product prior to surgical treatment is 38.9%, it was observed that this rate increased to 54.1% during chemotherapy. It was observed that the most frequently used product was garlic prior to surgical treatment (19.2%), that it was urtica dioica (13.8%) during chemotherapy. Before the surgical treatment, 94.3% of the patients, and during chemotherapy treatment, 81.7% of the patients, stated that the use of herbal product had not been questioned by the physician or nurse. CONCLUSION: Analysis of the results indicates that health professionals need to obtain information regarding the use of herbal products by cancer patients during both pre- and post- surgery periods, as well as during chemotherapy. Patients should be provided with information and guidance about the advantages and disadvantages of using herbal products.

Disponibilidade de medicamentos fitoterápicos e plantas medicinais nas unidades de atenção básica do Estado de São Paulo: resultados do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) / Availability of herbal medicines and medicinal plants in the primary health facilities of the state of São Paulo, Southeast Brazil: results from the National Program for Access and Quality Improvement in Primary Care

Resumo Este estudo objetiva descrever a utilização e a disponibilidade de medicamentos fitoterápicos e plantas medicinais nas unidades de atenção básica do estado de São Paulo, a partir dos resultados do primeiro Ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). O PMAQ utiliza um desenho transversal e multicêntrico, de abrangência nacional, sendo utilizados no presente estudo os dados de 4.249 unidades de saúde, distribuídas entre os 645 municípios do estado de São Paulo. Dentre este total de unidades, em 467 (11%) foi constatada a disponibilidade de medicamentos fitoterápicos e/ou plantas medicinais. Dentre os 645 municípios paulistas, em 104 (16,1%) havia ao menos uma unidade de saúde que disponibilizava estes fármacos. Observou-se que a disponibilidade da fitoterapia é maior em municípios mais populosos e com melhores condições sociais e econômicas. Além disso, foi constatado que medicamento fitoterápico industrializado tem sido mais utilizado do que a droga vegetal ou medicamento fitoterápico manipulado.

Abstract This study aims to describe the availability of herbal medicines and medicinal plants in the primary care facilities in the state of São Paulo, Southeast Brazil, from the results of the first cycle of the National Program for Access and Quality Improvement in Primary Care (PMAQ). The PMAQ uses a national cross-sectional multicenter design, with data from 4,249 health facilities distributed among 645 municipalities of the state of São Paulo. Of these facilities, 467 (11%) had herbal medicines and/or medicinal plants. Among the 645 municipalities, 104 (16.1%) had at least one health facility that provided these drugs. We observed that the availability of herbal medicines is greater in larger cities with better social and economic conditions. Furthermore, we found that use of industrialized herbal medicines prevailed over that of vegetal drugs or compounded herbal medicines.

Prescription frequency and patterns of Chinese herbal medicine for liver cancer patients in Taiwan: a cross-sectional analysis of the National Health Insurance Research Database.

BACKGROUND: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Chinese herbal medicine (CHM) is frequently provided to HCC patients. The aim of this study was to understand the prescription frequency and patterns of CHM for HCC patients by analyzing the claims data from the National Health Insurance (NHI) in Taiwan. METHODS: We identified 73918 newly diagnosed HCC subjects from the database of Registry for Catastrophic Illness during 2002 to 2009 and to analyze the frequency and pattern of corresponding CHM prescriptions for HCC patients. RESULTS: There were a total of 685,079 single Chinese herbal prescriptions and 553,952 Chinese herbal formula prescriptions used for 17,373 HCC subjects before 2 years of HCC diagnosis. Among the 13,093 HCC subjects who used CHMs after HCC diagnosis, there were 462,786 single Chinese herbal prescriptions and 300,153 Chinese herbal formula prescriptions were counted. By adjusting with person-year and ratio of standardized incidence rate, the top ten prescribed single herbal drugs and Chinese herbal formulas for HCC patients were described in our study. Among them, we concluded that, Oldenlandia diffusa (Chinese herbal name: Bai-Hua-She-She-Cao), Radix et Rhizoma Rhei (Da Huang) and the herbal preparation of Xiao-Chai-Hu-Tang and Gan-Lu-Yin, were the most obviously increased and important CHMs been used for HCC patients. CONCLUSION: We established an accurate and validated method for the actual frequency and patterns of CHM use in treating HCC in Taiwan. We propose that these breakthrough findings may have important implications for HCC therapy, clinical trials and modernization of CHM.

Safety of herbal medicine use during chemotherapy in patients with ovarian cancer: a "bedside-to-bench" approach.

In this study, we explored herbal supplements used by patients during chemotherapy and test for herb-drug interactions and response of cancer cells to treatment. Patients with gynecological cancer referred to a complementary and integrative medicine (CIM) service were asked about their use of herbal medicine during chemotherapy. The leading five clinically relevant herbs selected for cytotoxicity analysis included the following: wheatgrass (Triticum aestivum), European mistletoe (Viscum album), ginger (Zingiber officinale), Ephedra (Ephedra campylopoda), and Oriental mistletoe (Viscum cruciatum). Cytotoxicity was examined using XTT assays in cisplatin-sensitive and resistant ovarian cancer cell lines (A2780, A2780CisR), and non-cancer kidney cells (HEK-293). The effect of the selected herbs on carboplatin and paclitaxel cytotoxicity was tested as well. Pro-apoptotic effects were tested using Poly(ADP-ribose) polymerase (PARP) cleavage. Of 98 patients referred to the CIM service, 42 (42.9%) reported using/intending to use herbal products during chemotherapy. European mistletoe and ginger exhibited significant anti-cancer activity in cisplatin-sensitive and resistant ovarian cells. Wheatgrass and ephedra reduced cytotoxicity of carboplatin on cisplatin-sensitive ovarian cancer cells, while ginger, European and Oriental mistletoe increased chemosensitivity in both cancer cell lines. Wheatgrass, European mistletoe, and ginger increased sensitivity to cisplatin-resistant cells treated with carboplatin and paclitaxel. No effect was observed with the addition of any of the herbs on non-cancerous embryonic kidney cells (HEK-293). Herbal medicine use by patients with ovarian cancer may influence anti-cancer activity of chemotherapy. Integrative physicians can provide "bedside-to-bench" guidance on the safety of these products.

Reports on in vivo and in vitro contribution of medicinal plants to improve the female reproductive function / Relatos sobre a contribuição in vivo e in vitro de plantas medicinais na melhora da função reprodutiva feminina

Medicinal plants are known as a prolific source of secondary metabolites which have important function both in vivo and in vitro during the ovarian folliculogenesis and steroidogenesis in many animal species. Some secondary metabolites can act as antioxidants generally through their ability to scavenge reactive oxygen species (ROS) or can regulate ovarian hormonal production. In general, these properties are responsible for the medicinal functions to treat woman infertility disorder. Some plants are constituted of biological actives substances which have been used to treat reproductive dysfunction. However, until recently, little was known about the implication of plants and/or their secondary metabolites on in vitro folliculogenesis and steroidogenesis. With the development of the technology, there is an increase implication of those substances in assisted reproductive technology (ART). The present review highlights some medicinal plants used in the treatment of woman disorders related to infertility. In addition, it provides an in vivo and in vitro overview of herbs and their active compounds with claims for improvement of ovarian activity thus showing their implication in female reproductive health care.(AU)

Sabe-se que as plantas medicinais são uma fonte abundante de metabólitos secundários que têm função importante tanto in vivo quanto in vitro durante a foliculogênese e a esteroidogênese ovarianas em muitas espécies animais. Alguns metabólitos secundários podem atuar como antioxidantes, geralmente através de sua capacidade de eliminar espécies reativas de oxigênio (ROS) ou podem regular a produção hormonal ovariana. Em geral, essas propriedades são responsáveis pelas funções medicinais usadas para tratar distúrbios da infertilidade feminina. Algumas plantas contêm substâncias biológicas ativas que têm sido utilizadas para tratar a disfunção reprodutiva. No entanto, até recentemente, pouco se sabia sobre o efeito das plantas e/ou seus metabólitos secundários na foliculogênese e na esteroidogênese in vitro. Com o desenvolvimento da tecnologia, há uma implicação crescente dessas substâncias na tecnologia de reprodução assistida (TRA). A presente revisão destaca algumas plantas medicinais utilizadas no tratamento de distúrbios femininos relacionados à infertilidade. Além disso, fornece uma visão in vivo e in vitro de ervas e seus compostos ativos com alegações de melhora da atividade ovariana, mostrando assim seu envolvimento nos cuidados de saúde reprodutiva feminina.(AU)