CLINICAL SIGNIFICANCE OF CHANGES IN QUALITY OF LIFE INDICATORS AS A METHOD FOR ASSESSING THE EFFECTIVENESS OF ENT HERBAL REMEDIES.

Ear, nose, and throat (ENT) diseases cause major disruption in patients' daily lives. Self-medication with conventional and herbal drugs are common in ENT patients. Recent studies reported that the ENT patients' self-medication with conventional medication ranged from 79.1-83.0%. It is also reported that the rate of herbal drug utilization among ENT patients ranges from 2-63% in different nations. The research aims to evaluate the effectiveness of "Herbanoma" as a Phyto preparation for ENT diseases according to the prognostic clinical significance of changes in quality-of-life parameters. The study employed the stratified sampling technique to randomly select participants. Five secondary schools of Yerevan were chosen through random selection, followed by the selection of 236 observation units from the selected schools. For the treatment and prevention of diseases of the upper respiratory tract, we used the herbal inhalation mixture "Herbaroma" as an ingredient. The composition of these drops is approved by the Intellectual Property Agency of the Republic of Armenia. SF-36 questionnaire was used to assess the quality of life of adolescents aged 15-17 years who had ENT diseases. The change of the parameters of QL in the experimental group had the greatest clinical significance for the components RP, RE, SF, and Mental Health - MH. The effectiveness of the preventive program was also evaluated according to the main groups of ENT diseases. The clinical significance of the effectiveness of the program for chronic diseases of the nasal cavities was significantly high for almost all components of the quality of life, in particular: Physical health - PH, Mental Health - MH. The program had great effectiveness for this group of ENT diseases. The clinical significance of the effectiveness of prevention programs for chronic inflammatory diseases of the throat was significantly high for the following components of the quality of life: RP, GH, PH, MH. The program has been highly effective for this group of ENT diseases. The clinical significance of the effectiveness of the prevention of chronic inflammatory diseases of the ear was generally assessed as weak. It had reliable average clinical significance for SF, RE, and MH components. Among school-aged children with ENT pathology, the use of the "Herbaroma" drug for prophylactic purposes leads to an improvement in quality-of-life parameters. According to the results of the research, the "Herbaroma" drug had an anti-inflammatory, antiseptic effect, contributed to the reduction of the incidence of acute respiratory viral infections, and the prevention of complications. The use of the relatively safe and effective "Herbaroma" preparation in school conditions should be included in the comprehensive program of preventive measures.

Systematic assessment of the influence of quality of studies on mistletoe in cancer care on the results of a meta-analysis on overall survival.

PURPOSE: Mistletoe treatment in cancer patients is controversial, and a Cochrane review concluded that due to heterogeneity, performing a meta-analysis was not suitable. However, several systematic reviews included meta-analyses in favor of mistletoe. The aim of this work was to assess the influence of the methodological quality of controlled studies on the results of a meta-analysis regarding overall survival. METHODS: Between April and August 2022, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL and Web of Science were systematically searched. In addition, reference lists of previously published meta-analyses were checked for relevant publications. A random effects meta-analysis with clustering was performed. The risk of bias within the studies was assessed using ROB 2.0 and ROBINS-I. RESULTS: The search identified 4685 hits, and 28 publications reporting on 28 298 patients were included in the quantitative analysis. Overall, the analysis led to a significant result in favor of mistletoe therapy (overall HR = 0.61 with 95% CI [0.53;0.7]). According to our subgroup analysis of randomized studies, studies of higher quality (lower risk of bias) did not lead to a significant result in favor of mistletoe therapy (HR = 0.78; CI = [0.30; 2.00]). CONCLUSIONS: In the case of mistletoe therapy, the results of the meta-analysis strongly depended on the methodological quality of the included studies. Calculating meta-analyses that include low-quality studies may lead to severe misinterpretation of the data.

Ethnobotanical assessment of antidiabetic medicinal plants in District Karak, Pakistan.

BACKGROUND: Diabetes is a leading health disorder and is responsible for high mortality rates across the globe. Multiple treatment protocols are being applied to overcome this morbidity and mortality including plant-based traditional medicines. This study was designed to investigate the ethnomedicinal status of plant species used to treat diabetes in District Karak, Pakistan. MATERIALS AND METHODS: A semi-structured survey was created to collect data about traditionally used medicinal plants for diabetes and other ailments. The convenience sampling method was applied for the selection of informants. The collected data was evaluated through quantitative tools like frequency of citation (FC), relative frequency of citation (RFC), informant consensus factor (FIC), fidelity level (FL), and use value (UV). RESULTS: A total of 346 local informants were selected for this research. Out of them, 135 participants were men and 211 participants were women. Overall 38 plant species belonging to 29 plant families were used to treat diabetes. The most dominant plant family was Oleaceae having 11 species. Powder form (19%) was the most recommended mode of preparation for plant-based ethnomedicines. Leaves (68%) were the most frequently used parts followed by fruit (47%). The highest RFC was recorded for Apteranthes tuberculata (0.147). The maximum FL was reported for Apteranthes tuberculata (94.4) and Zygophyllum indicum (94.11) for diabetes, skin, and wounds. Similarly, the highest UV of (1) each was found for Brassica rapa, Melia azedarach, and Calotropis procera. Based on documented data, the reported ailments were grouped into 7 categories. The ICF values range between 0.89 (diabetes) to 0.33 (Cardiovascular disorders). CONCLUSION: The study includes a variety of antidiabetic medicinal plants, which are used by the locals in various herbal preparations. The species Apteranthes tuberculata has been reported to be the most frequently used medicinal plant against diabetes. Therefore, it is recommended that such plants be further investigated in-vitro and in-vivo to determine their anti-diabetic effects.

Ethnobotanical uses, phytochemistry and bioactivities of Cymbopogon plants: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Cymbopogon (Poaceae) plants have been used for various purposes by many indigenous peoples in all continents. In particular, almost all species in the genus have traditionally been used as folk medicine to treat ailments. Traditional application records indicated that Cymbopogon might be used extensively to treat cold, dizziness, headache, loss of appetite, abdominal pain, rheumatism, diarrhea, whole grass for cold, sore throat, tracheitis and others. AIMS OF THE REVIEW: Despite several research confirmed that Cymbopogon includes a range of active components, no review has been undertaken to consolidate information on its traditional uses, phytochemistry, pharmacology, and/or quality control. Thus this article aims to update a comprehensive review about the traditional uses, phytochemistry, pharmacology, cultivation techniques, economic benefits, trade, threats, and future conservation implications of Cymbopogon species. It may provide informative data for future development and further investigation of this important plant group. MATERIALS AND METHODS: Traditional medicinal books and ethnomedicinal publications related to Cymbopogon from 1992 to 2023 were collated to investigate its ethnobotanical, phytochemical and pharmacological information. The online databases including Google Scholar, SciFinder, Web of Science, Scopus, Springer Link, PubMed, Wiley, China National Knowledge Infrastructure (CNKI), Baidu Scholar, and WanFang Database were screened. RESULTS: Cymbopogon (Gramineae or Poaceae) plants have been grown worldwide. Traditional Chinese medicine and other medicinal systems believes that Cymbopogon has the effect of relieve a cough, analgesia, treating dizziness, traumatic injury and can relieve abdominal pain. A total of 153 compounds, including flavonoids, terpenoids, fatty acid and other compounds were isolated or identified from Cymbopogon species by phytochemical studies. The extracts or compounds from Cymbopogon have exhibited numerous biological activities such as antibacterial, antiinflammatory, antiviral, antineoplastic, antiarrhythmic, antidiabetic and other activities. The rich contents of citronellal, citronellol and geraniol found in Cymbopogon also provide significant nutritional benefits. CONCLUSION: Based on their traditional uses, phytochemicals, and pharmacological activities, Cymbopogon plants are potential medicinal and edible resources with diverse pharmacological effects. Due to various advantages of this group, they possess huge application potential in food and pharmaceutical industries, and animal husbandry. Among them, citronella is very important in terms of economic development. Further comprehensive research to evaluate the medicinal properties of Cymbopogon species will be necessary for future development.

The sustainable use of diverse plants accustomed by different ethnic groups in Sibi District, Balochistan, Pakistan.

The present study was conducted to analyze the utilization of medicinal plants (traditional as well as cultivated) and there recipes accustomed by different ethnic groups of Sibi District (SD), Balochistan, Pakistan. The study was carried out between 2018 and 2021 by using semi-structured and open-ended questionnaire.. The randomly selected methods applied for this study were mainly based on household surveys walk through and interview with indigenous communityage 40 to 80, a total of 75 plants, belonging to 63 genera and distributed among 33 plant families were recorded. The dominant Plant families were the Fabaceae (12%) of all studied taxa, followed by the Amaranthaceae (7%), Asteraceae (6%), Cucurbitaceae, Solanaceae, Poaceae (4% each), Rhamnaceae and Zygophyllaceae (3%). Thirty traditional Food Recipes (TFR) and Traditional Medicinal Recipes (TMR) were novel being first time reported from SD., which are utilized by the local communities in their daily routine. These ethnic TFR and TMR have a tremendous role in preservation and sustainable use of traditional food habits and culture. It was also documented that along with cultivated, the wild edible and medicinal plant preparations play a significant role in in the economic potential and primary health care system of the local communities. The study recommends the specific measures, such as small industries, improved export means, tourism and educational activities, to protect the traditional knowledge and biocultural heritage of the region before its erosion.

[Outcome indicators in clinical trials on traditional Chinese medicine treatment of microvascular angina].

This study reviewed the current status of the use of outcome indicators in randomized controlled trial(RCT) on traditional Chinese medicine(TCM) treatment of microvascular angina(MVA) and analyzed the existing problems and possible solutions, aiming to provide a basis for the design of high-quality RCT and the establishment of core outcome sets for MVA. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, and 2 clinical trial registries were searched for the RCT on TCM treatment of MVA according to pre-defined criteria. The Cochrane's risk of bias assessment tool was used to evaluate the methodological quality of the included RCT and the use of outcome indicators was summarized. A total of 69 RCTs were included, from which 100 outcome indicators were extracted, with the frequency of 430. The extracted outcome indicators belonged to 8 domains: response rate, symptoms and signs, physical and chemical examinations, TCM efficacy, safety, quality of life, economic evaluation, and long-term prognosis. The indicators of physical and chemical examinations were the most(70 indicators with the frequency of 211), followed by those of response rate(7 indicators with the frequency of 73) and symptoms and signs(7 indicators with the frequency of 54). The outcome indicators with higher frequency were adverse reactions, angina attack frequency, clinical efficacy, endothelin-1, total duration of treadmill exercise, and hypersensitive C-reactive protein. The RCT on TCM treatment of MVA had the following problems: irregular reporting of adverse reactions, diverse indicators with low frequency, lack of attention to the application of endpoint indicators, insufficient use of TCM differentiation and efficacy indicators, non-standard evaluation criteria and failure to reflect the basic characteristics of TCM. A unified MVA syndrome differentiation standard should be established, on the basis of which an MVA treatment efficacy evaluation system and core outcome indicator set that highlights the characteristics of TCM with patient-reported outcomes as the starting point should be established to improve the clinical research and research value.

Linking traditional medicine to modern phytotherapy: Chemical characterization and assessment of antioxidant and anticholinesterase effects in vitro of a natural Persian remedy for dementia.

Several natural remedies are used in the Traditional Persian Medicine (TPM) to prevent dementia, but their efficacy is debated. In this work, an improved "Safoof-e-Nesyan" formulation described in the "Qarabadin-e-Azam" pharmacopoeia was developed, and its chemical composition and antioxidant and anti-cholinesterase properties were assessed. The formulation contains a mixture (FM) of Cinnamomum cassia (CC), C. verum (CV), Pistacia lentiscus (PL), Rheum palmatum (RP), Syzygium aromaticum (SA), and Zingiber officinalis (ZO) powdered plants. Its total phenolic content is 110.45 mg GAE/g, while the total flavonoid content is 6.28 mg RE/g. 66 secondary metabolites (mainly tannins, flavonoids, anthraquinones, and gingerols) were identified by UPLC-QToF-MS analysis. FM exerts antioxidant effects by scavenging radicals, and by reducing and chelating metals such as Mb, Cu and Fe. The anticholinesterase activity of one gram of the FM equals that of 3.60 mg of the reference drug galantamine, on both acetyl- and butyryl-cholinesterase. Correlations between specific compounds and bioactivities were highlighted by multivariate analysis of data: lyoniresinol 9'-glucoside strongly correlates with antiradical activities on DPPH and ABTS and reducing activity on Cu, and with anti-AChE effects. Most of the identified flavonoids and the ellagic acid derivatives positively correlate with the reducing activity on Fe and Mb, and with anti-BChE effects. Finally, a tablet formulation of the FM was developed, and its physical properties were preliminarily assessed. Overall, our results indicate that the FM may be a useful natural remedy for dementia, although further safety and efficacy assessments in vivo are required.

Patient' and social aspects related to complementary mistletoe therapy in patients with breast cancer: A systematic review commissioned by the German agency for Health Technology Assessment.

PURPOSE: To mitigate side effects of conventional cancer care and improve quality of life, many patients with breast cancer in German-speaking countries opt for mistletoe therapy in addition to standard treatment. To understand the value for users, we evaluated the domain "Patient and Social aspects" in a health technology assessment on complementary mistletoe therapy in patients with breast cancer. METHODS: A systematic review was conducted according to PRISMA guidelines. Fifteen electronic databases and the internet were searched. Qualitative studies were analyzed using qualitative content analysis; quantitative studies were systematically summarized in evidence tables. RESULTS: Seventeen studies out of 1203 screened publications with 4765 patients and 869 healthcare professionals were included in the review. The median proportion of patients using mistletoe therapy was 26.7% (range: 7.3-46.3%). Predictors for use were younger age and higher educational level. Main reasons for patients' use of mistletoe therapy were to leave nothing untried and to be actively involved in the treatment process. Reasons against use were related to a lack of knowledge or uncertainty regarding effectiveness and safety. Physicians mainly aimed to support the patient's physical condition as main reason for use and a lack of resources and knowledge as main reason against use. CONCLUSION: Mistletoe therapy was commonly used in the treatment of breast cancer despite a lack of scientific knowledge among patients and physicians. Transparent communication on motivation for use and its potential effect enables realistic expectations. Relatively small samples of mistletoe therapy users limit the representativeness and validity of our results.

A Pragmatic Historical Assessment Tool: A New Systematic Framework for the Collation and Evaluation of Documented Empirical Effectiveness and Safety of Traditional Plant Medicines in the European Materia Medica.

INTRODUCTION: Traditional plant medicines (TPMs) are plant-derived therapeutic products prepared and applied according to longstanding medical customs. Around the world they are widely used in primary and preventative health care. The World Health Organization (WHO) calls in its Traditional Medicine Strategy 2014-2023 for Member States to provide a regulatory framework so that the formal contribution of traditional therapeutics can be advanced in national systems of health care. Evidence of effectiveness and safety is paramount for the regulatory integration of TPMs; however, a presumed lack of such "evidence" is one obstacle for full integration. The consequential health policy question is how to systematically evaluate therapeutic claims relating to herbal remedies when the extant evidence is predominantly based on historical and contemporary clinical usage, i.e., is empiricist in nature. This paper introduces a new method along with several illustrative examples. METHOD: Our research design employs a longitudinal, comparative textual analysis of standard textbooks of the professional European medical literature from the early modern period (1588/1664) onwards to today. It then triangulated these intergenerationally documented clinical observations on two exemplars (Arnica and St. John's Wort) with corresponding listings in multiple qualitative and quantitative sources. A Pragmatic Historical Assessment (PHA) tool was developed and tested as a method to systematically collate the large amount of pharmacological data recorded in these judiciously selected sources. The evidential validity of longstanding professional clinical knowledge could thus be compared with therapeutic indications approved in official and authoritative sources (pharmacopoeias, monographs) and with those supported by contemporary scientific research (randomised-controlled trials [RCTs], experimental research). RESULTS: There was high congruency between therapeutic indications that are based on repeated empirical observations from professional patient care (empirical evidence), those approved in pharmacopoeias and monographs, and modern scientific evidence based on RCTs. The extensive herbal triangulation confirmed parallel records of all main therapeutic indications of the exemplars across all qualitative and quantitative sources over the past 400 years. CONCLUSIONS: Historical clinical medical textbooks and contemporary phytotherapeutic equivalents are the key repository of repeatedly evaluated therapeutic plant knowledge. The professional clinical literature proved to be a reliable and verifiable body of empirical evidence that harmonised with contemporary scientific assessments. The newly developed PHA tool provides a coding framework for the systematic collation and evaluation of empirical data on the effectiveness and safety of TPMs. It is suggested as a feasible and efficient tool to extend evidence typologies that substantiate therapeutic claims for TPMs as part of an evidence-based regulatory framework that formally integrates these medically and culturally important therapeutics.Traditionelle pflanzliche Arzneimittel sind aus Pflanzen gewonnene Heilmittel, die gemäß langjähriger medizinischer Praxis zubereitet und angewendet werden. Weltweit sind sie in der primären und präventiven Gesundheitsversorgung weit verbreitet. Die Weltgesundheitsorganisation (WHO) ruft in ihrer Traditional Medicine Strategy 2014­2023 die Mitgliedstaaten dazu auf, regulatorische Rahmenbedingungen zu schaffen, welche den formellen Beitrag traditioneller Therapeutika in den nationalen Gesundheitssystemen fördern. Der Nachweis von Wirksamkeit und Sicherheit ist von zentraler Bedeutung für die regulatorische Integration traditioneller pflanzlicher Arzneimittel, doch das angebliche Fehlen solcher "Nachweise" ist eine der Hürden für die vollständige Integration. Daraus ergibt sich die gesundheitspolitische Frage, wie man therapeutische Anwendungsgebiete pflanzlicher Heilmittel systematisch evaluieren kann, wenn die vorliegende Evidenz überwiegend auf deren historischer und aktueller klinischen Verwendung beruht, also empirischer Natur ist. In dieser Arbeit wird eine neue Methode mitsamt veranschaulichenden Beispielen vorgestellt.Unser Forschungsansatz beruhte auf einer longitudinalen, vergleichenden Textanalyse von Standard-Lehrwerken der europäischen medizinischen Fachliteratur ausgehend von der frühen Neuzeit (1588/1664) bis heute. Die über Generationen dokumentierten klinischen Beobachtungen wurden anhand von zwei Beispielen (Arnika and Johanniskraut) mit den diesbezüglichen Angaben in unterschiedlichen qualitativen und quantitativen Quellen trianguliert. Ein Pragmatisch­Historisches Auswertungstool (PHA) wurde als Methode entwickelt und getestet, um die großen Mengen der in diesen kritisch ausgewählten Quellen enthaltenen pharmakologischen Daten systematisch zu erfassen. Die Evidenzvalidität des langjährigen klinischen Fachwissens konnte so mit den therapeutischen Anwendungsgebieten verglichen werden, die in offiziellen und autoritativen Quellen (Pharmakopöen, Monografien) zugelassen sind, sowie mit denjenigen, die durch zeitgenössische wissenschaftliche Forschung gestützt werden (randomisierte kontrollierte Studien [RCTs], experimentelle Forschung).Es bestand ein hohes Maß an Kongruenz zwischen den therapeutischen Anwendungsgebieten, welche auf wiederholte empirische Beobachtung aus der professionellen Patientenversorgung beruhen (empirische Evidenz), den zugelassenen Indikationen in Pharmakopöen und Monographien sowie der aktuellen wissenschaftlichen Evidenz basierend auf klinischen Studien. Die umfassende pflanzenbezogene Triangulation bestätigte parallele Aufzeichnungen aller wesentlichen Anwendungsgebiete der untersuchten Beispiele in allen qualitativen und quantitativen Quellen über die letzten 400 Jahre hinweg.Historische Lehrbücher für klinische Medizin und zeitgenössische phytotherapeutische Äquivalente sind die wichtigsten Quellen von wiederholt evaluiertem therapeutischem Wissen zu Heilpflanzen. Die klinische Fachliteratur erwies sich als zuverlässiger und verifizierbarer Korpus empirischer Evidenz, der mit aktuellen wissenschaftlichen Untersuchungen übereinstimmte. Das neu entwickelte PHA-Verfahren bietet ein Kodierungs­Instrument für das systematische Erfassen und Auswerten empirischer Daten zur Wirksamkeit und Sicherheit von traditionellen pflanzlichen Arzneimitteln. Das PHA­Verfahren wird als praktikables und effizientes Instrument zur Erweiterung der Evidenz­Typologien empfohlen, indem es therapeutische Indikationen für traditionelle pflanzliche Arzneimittel untermauern kann, so dass diese medizinisch und kulturell wichtigen Therapeutika in einen evidenz-basierten regulatorischen Rahmen integriert werden können.

Ethnobotanical study on herbal tea drinks in Guangxi, China.

BACKGROUND: Herbal tea drinks, different from classical Camellia beverages, are a wide variety of herbal drinks consumed for therapeutic purposes or health promotion. Herbal tea is widely consumed in Guangxi. However, the documentation on the plants for herbal tea and their related health benefits is still limited. METHODS: An ethnobotanical survey was conducted in 52 villages and 21 traditional markets in Guangxi from 2016 to 2021. Semi-structured interviews, key informant interviews, and structured questionnaires were applied to obtain ethnobotanical information of herbal tea, in which 463 informants had participated. Relative frequency of citation (RFC) and cultural food significance index (CFSI) were used to evaluate the most culturally significant herbal tea plants, and informant consensus factor (ICF) was applied to assess the agreement among informants. RESULTS: This study recorded 155 herbal tea species belonging to 49 families. The most commonly used parts included leaf (27.61%), whole plant (22.09%), branch and leaf (19.02%), and flower (13.50%). The most frequent preparation method of herbal tea was decoction. Herbal tea was very popular in Guangxi, attributing to its therapeutic value, special odor, and good taste. There are 41 health benefits classified into eight categories. Among them, clearing heat was the most medicinal effects. Local people had high consistency in tonic, removing cold and cough, improving blood circulation, and clearing heat away. Based on CFSI values of each species, the most culturally significant herbal tea species were Siraitia grosvenorii (Swingle) C. Jeffrey ex A. M. Lu & Zhi Y. Zhang, Plantago asiatica L., Gynostemma pentaphyllum (Thunb.) Makino, Zingiber officinale Roscoe, Pholidota chinensis Lindl., and Morus alba L. CONCLUSION: Herbal tea is a valuable heritage that carries the local people's traditional knowledge, like health care and religious belief. The recorded herbal tea species in this study possess tremendous potential for local economic development in the future. Further research on efficacy evaluation and product development of herbal tea species is necessary.

Swertia chirayita: A comprehensive review on traditional uses, phytochemistry, quality assessment and pharmacology.

ETHNOPHARMACOLOGICAL RELEVANCE: Swertia chirayita (Roxb.) H. Karst. is a traditionally used, well-recognized medicinal plant of the family Gentianaceae with significant therapeutic potential. It has been traditionally used to cure various ailments such as fever, vomiting, jaundice, digestive disorders, heart diseases, diabetes, malaria, scorpion bite, and skin diseases. AIM OF REVIEW: The present review emphasized the traditional uses, phytochemistry, pharmacology, toxicology, chemical profiling, and structural identification of isolated compounds by analytical and spectroscopic techniques. This review demonstrates the possibility of advanced ethnopharmacological research. MATERIALS AND METHODS: The literature on S. chirayita was obtained from bibliographic databases like Web of Science, PubMed, Science-Direct, American Chemical Society (ACS), Google Scholar, and SciFinder. The compiled review is covered up until March 2022. RESULTS: Approximately, 123 specialized metabolites including xanthones, seco-iridoids, terpenoids, alkaloids, and flavonoids have been isolated and characterized from S. chirayita. The extract and isolated compounds exhibited a wide spectrum of pharmacological effects such as anti-inflammatory, antioxidant, antitumor, hepatoprotective, antiviral, antimalarial, and antibacterial offering scientific evidence for traditional claims of this medicinal plant. In addition, various analytical methods using HPTLC, UPLC, HPLC, LC-MS, and GC-MS have also been documented to determine the phytochemicals of S. chirayita. CONCLUSION: The current article provides information on traditional usage, phytochemistry, chemical profiling, structure elucidation, pharmacological efficacy, toxicity, and future prospects of S. chirayita. This plant has long been traditionally used in a variety of ways by indigenous people. Numerous phytoconstituents and several pharmacological activities have been reported in S. chirayita. However, there are still some scientific gaps such as identification of bioactive compounds, structure-activity relationship and mechanistic action of isolated bioactive compounds, development of effective analytical methods for comprehensive quality control, and safety profiles that need to be addressed.

Inclusão de plantas medicinais para ampliar a adesão ao tratamento de pacientes diabéticos na estratégia de saúde da família 24 de dezembro, no município de Várzea Grande / Inclusion of medicinal plants to increase adherence to treatment diabetic patients in the family health strategy December 24, at municipality of Várzea Grande

O Diabetes Mellitus (DM) tem se tornado um desafio crescente em termos de saúde pública. É uma condição metabólica multifacetada que afeta indivíduos de todas as faixas etárias. O DM é caracterizado por hiperglicemia, seja por falha na produção de insulina pelo pâncreas ou por defeito em sua ação. Este desequilíbrio metabólico pode levar a complicações crônicas e disfunções de múltiplos órgãos. Neste cenário complexo, as plantas medicinais emergem como uma alternativa terapêutica relevante no tratamento do DM, ganhando destaque devido à sua acessibilidade, custo relativamente baixo e potencial significativo na promoção da cura, na regulação dos níveis de glicose no sangue e no controle da doença. Portanto, elas representam uma abordagem promissora para melhorar a qualidade de vida das pessoas afetadas pelo DM. O emprego da fitoterapia à Atenção Primária contribui para resgatar conhecimentos populares e culturais, contribuindo para aumentar o vínculo entre os pacientes e a equipe de saúde. O objetivo deste trabalho foi aumentar a adesão de pacientes diabéticos ao tratamento, a partir da introdução de plantas medicinais, sendo elas Bauhinia forficata (Pata-de-vaca) e a Baccharis trimera (Carqueja), a fim de se ter um melhor controle do DM tipo 2, na Estratégia de Saúde da Família 24 de Dezembro, no município de Várzea Grande. O presente trabalho teve momentos de capacitação com a equipe da unidade de saúde, e momentos de roda de conversa e troca de saberes com a população. Os pacientes diabéticos receberam orientações em consultas médicas e de enfermagem além de abordagem a respeito da fitoterapia na pré-consulta

Fitoterápicos e plantas medicinais na prática dos profissionais de saúde em Unidades de Estratégia Saúde da Família / Phytotherapies and medicinal plants in the practice of health professionals in Family Health Strategy units

Introdução: o uso da fitoterapia como alternativa terapêutica, tem aumentado, no entanto ainda existem lacunas no conhecimento sobre o tema, o que impede a completa adesão da prática por parte dos profissionais de saúde. Objetivos: este trabalho teve como objetivoverificar o conhecimento sobre a prática da fitoterapia por profissionais de saúde em unidades de Estratégia Saúde da Família (ESF). Metodologia: foi realizado umestudo quantitativo, transversal, com aplicação de questionário contendo perguntas sobre a fitoterapia. Além disso, foi também desenvolvida uma análise descritiva, com frequência relativa e absoluta e análise de correlação através do teste de qui-quadrado de Pearson, utilizando teste de regressão binomial e multinominal. Resultados: participaram da pesquisa, 156 profissionais de saúde, distribuídos em 20 ESF do município de Rondonópolis-MT, sendo 24 enfermeiros, 8 médicos, 7 odontólogos, 4 farmacêuticos, 6 psicólogos, 10 técnicos em enfermagem, 88 agentes comunitários de saúde, 7 técnicos em saúde bucal, 1 técnico de farmácia e 1 educador físico. Destaca-se que 58% não souberam explicar a diferença entre fitoterápicos e plantas medicinais, 52% não sabiam realizar orientações nem citar o nome de medicamentos proveniente das plantas (53%), 88% não fizeram curso ou disciplina na área. No entanto, 86% tem interesse em se qualificar no assunto. Dentre os profissionais prescritores, 72,1% afirmaram prescrever raramente ou não prescrever a fitoterapia em sua prática profissional. Conclusão: evidenciam-se falhas no conhecimento sobre a fitoterapia e a necessidade de capacitação aos profissionais que atuam nas ESF, de forma a se sentirem seguros para prescrever e orientar quanto aos riscos e benefícios do uso das plantas como alternativa terapêutica.

Introduction: the use of phytotherapy as a therapeutic alternativehas increased, however there are still gaps in knowledge on the subject, what stopping the full adherence to the practice by health professionals. Objectives: this work aimed to verify the knowledge about the practice of herbal medicine by health professionals in Family Health Strategy Units (FHS). Method: A quantitative study was carried out, cross-sectional study, with the application of a questionnaire containing questions about herbal medicine. In addition, a descriptive analysis was also carried out, using relative and absolute frequency and correlation analysis through Pearson's chi-square test, using binomial and multinomial regression test. Results: 156 health professionals participated in the research, distributed in 20 FHS in the city of Rondonópolis-MT, 24 nurses, 8 doctors, 7 dentists, 4 pharmacists, 6 psychologists, 10 nursing technicians, 88 community health agents, 7 technicians in oral health, 1 pharmacy technician and 1 physical educator. It is noteworthy that 58% could not explain the difference between herbal medicines and medicinal plants, 52% did not know how to provide guidance or mention the name of medicines derived from plants (53%), 88% did not take a course or discipline in the area. However, 86% are interested in qualifying in the subject. Among the prescribing professionals, 72.1% stated that they rarely or didn ́t prescribe phytotherapy in their professional practice. Conclusion: there is evidence of gaps in knowledge about herbal medicine and the need for training professionals working in the FHS, in order to feel safe to prescribe and guide about the risks and benefits of using plants as a therapeutic alternative.

Medicinal waterbirds in the traditional healthcare system: an assessment of biodiversity-cultural linkages in Eastern Khyber Pakhtunkhwa, Pakistan.

BACKGROUND: Eastern Khyber Pakhtunkhwa is home to a vast range of medicinal and edible waterbird species due to its diverse geographical environment. Waterbird species have been used for various ailments and cultural practices since ancient times, while ethno-pharmacological applications and cultural uses of waterbird species in this area have seldom been documented. This study is the first ethnomedicinal and cultural assessment of waterbird species, and the first compilation and listing of all known data on these species in Eastern Khyber Pakhtunkhwa, Pakistan. METHODS: Interviews and questionnaires were used to collect data from native respondents (N = 100). To analyze the data, principal component analysis (PCA), relative frequency of citation (RFC), fidelity level (FL%), relative popularity level (RPL), rank order priority, and similarity index were used. RESULTS: In total, 64 waterbird species were utilized in cultural practices, of which 40 species are used to cure different infectious and chronic diseases such as cold, cough, flu, fever, respiratory disorders, asthma, TB, gastric ulcers, kidney stones, male impotency, obesity, paralysis, piles, cancer, arthritis, body pain, and weakness. PCA showed significant differences in the use of waterbird species among the local inhabitants of the study area, separated along the axis-2 (p < 0.05). The FL% of waterbird species varied from 12 to 100%. 100% FL was analyzed for four waterbird species, i.e., Charadrius mongolus (cold), Gallicrex cinerea (asthma), Anas platyrhynchos (cancer), and Esacus recurvirostris (body weakness). In this study, Mallard (Anas platyrhynchos) was the most popular species used in the healthcare system of Eastern Khyber Pakhtunkhwa, with high RFC (4.06), FL% (100), and RPL (1.0) values. CONCLUSION: We concluded that waterbird species are more used for medicine and food purposes in the study area. However, in vitro/in vivo assessment of biochemical activities of waterbird species with a maximum FL% might be significant to produce novel drugs. Recent research shows important ethno-ornithological information about native people and their links with waterbird species, which might be helpful for the sustainable use of waterbird diversity in the research area.

Quality assessment of African herbal medicine: A systematic review and the way forward.

BACKGROUND: In Africa, herbalism supplements allopathic medicine's efforts to ensure Universal Health Coverage attainment. This review was conducted to identify and to summarise current literature on methodological approaches used for quality control of herbal medicines in Africa, to evaluate the gaps associated with existing strategies within context of best practices, and make recommendations for future improvements. METHODS: A systematic search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were screened and assessed for eligibility. RESULTS: 118 articles were included into the study. There was a high preference for impurity profiling tests (77%) indicating the prioritization for tests that guarantee safety despite the limited analytical resources available. Other classes of tests reported included identification tests (29%), physicochemical tests (18%), and content assays (12%). Although standard methods exist in preparing samples for impurity tests, different techniques were observed in different studies, and this could lead to differences in analytical outcomes. Content assays focused on single marker assessments, which may be inadequate to comprehensively assess the quality of products. CONCLUSION: This review provides knowledge of existing strengths and challenges for herbal medicine quality assessments in Africa. For future it is recommended to implement more studies on contaminants (e.g. mycotoxins) and pharmaceutical adulterants. The use of chemometrics to develop analytical methods should be promoted. Also, stakeholders in the medicine quality industry in Africa need to effectively collaborate to establish a well co-ordinated and harmonized system to provide a sustainable framework for the GACP and GMP guided production and quality assurance of herbal medicines.

Ethnobotany of medicinal plants used by the Yao people in Gongcheng County, Guangxi, China.

BACKGROUND: Gongcheng Yao Autonomous County (Gongcheng) is typical for the Yao people in northeastern Guangxi, southern China. The Yao people have a long history of using medicinal plants. In this study, we used ethnobotanical methods to collect traditional knowledge regarding herbal medicines in Gongcheng. Our study provides fundamental data for developing and applying local ethnic medicines and their protection. METHODS: Ethnobotanical data were collected from 103 villages in nine townships from 2014 to 2018 in Gongcheng. A total of 352 informants (279 male and 73 female) were interviewed through semi-structured interviews, key informant interviews, and guided field walks. All the informants were local inhabitants aged between 28 and 101 years of age, of which 40 key informants were selected based on the recommendations of knowledgeable elders and local medical institutions. The informant consensus factor (ICF) was used to evaluate the degree and importance of differences in medicinal plant species and calculated the relative frequencies of citation (RFC) for the recorded medicinal plants. RESULTS: Data from 352 local healers were collected for the study. The Guanyin and Sanjiang townships had the highest distribution of per capita healers (Pch), while the Gongcheng, Lianhua, and Ping'an townships were relatively lower. Of the 352 local healers, more than half were older than 60 years of age and therefore faced the problem of suitable successors and potential loss of traditional medicinal knowledge. There are 12 types of diseases treated by local healers in the study area, and most of the types had a high ICF value. The highest ICF (0.80) was reported for digestive system disease, followed by urinary system disease (0.78) and nervous system disease (0.77). Traumatic injury and orthopedics, digestive system, and rheumatic disease are the most common ailments. The RFC value calculated in 33 medicinal plant species (with an FC of more than 5) ranged from 0.024 to 0.056. The higher RFC values included Kadsura longipedunculata, Schefflera heptaphylla, Plantago asiatica, etc. The most commonly used medicinal method was decoction; plasters, creams, and some form of moxibustion and cupping skills were locally practiced, but only rarely. The local healers used 306 medicinal plant species (116 families and 255 genera). Herbal plants were most commonly used among these, with whole plants and roots being favored. CONCLUSION: The Yao people are highly skilled at using medicinal plants to treat various diseases in Gongcheng. Their treatment methods are varied, convenient, and efficient. Due to the impact of urbanization and economic development, knowledge of traditional medicine is under threat, with declining numbers of local healers and a lack of suitable successors. In order to protect and inherit Yao's traditional medicinal knowledge, it is necessary to educate young healers and to protect biodiversity.

Hepatotoxicity and Mutagenicity assessment during chronic in vivo exposure to aqueous extracts from Peperomia pellucida.

Studies on herbal medicine have exposed some toxic effects on humans. Peperomia pellucida (L.) HBK (P. pellucida) is one of the herbal medicines recommended as an alternative to synthetic medicine for diseases. Studies exist on the pharmacological activities of P. pellucida extracts, but studies on the potential hepatotoxic and mutagenic effects of subchronic administration of P. pellucida aqueous extracts, which is very important knowledge when we venture into alternative medicine, are lacking. In this study, two concentrations (60 mg/kg and 30 mg/kg) of P. pellucida aqueous extracts - decoction and freeze-dried extracts -were administered in vivo to BALB/c mice for nine (9) weeks. Significant differences were observed between the 60 mg/kg freeze-dried extract and the control in terms of mice weight and micronucleus frequency at 7-8 weeks of treatment. Also, no significant differences were found between groups in serum transaminases levels. Generally, there is no sufficient evidence to show that subchronic exposure to P. pellucida aqueous extracts is hepatotoxic though 60 mg/kg concentration may be mutagenic. This study suggests that although the herbal medicine is safe for prolonged consumption, users are advised to take precautions and moderations of its use due to the possibility of potential mutagenic effects.

Food and medicinal uses of Annona senegalensis Pers.: a country-wide assessment of traditional theoretical knowledge and actual uses in Benin, West Africa.

BACKGROUND: The growing interest for more natural products in food and health industries has led to increasing research on traditional knowledge related to plants. While theoretical knowledge (TK) on the uses of a species informs on the wide spectrum of potential uses of that species, actual uses (AU) highlight their potential being actually used. Distinguishing between the two is important when reporting ethnobotanical studies. However, studies often equated AU and TK, sometimes misleading conclusions, and decision-making. This study assessed TK, AU, and difference between TK and AU of Annona senegalensis and how each is related to factors such as age, sex, sociolinguistic group, and main activity in Benin republic. METHODS: Data were collected through semi-structured individual interviews (n = 755) and analyzed using among others, relative frequency of citation (RFC), and use-value (UV). RESULTS: A total of 168 theoretical uses were recorded but only 92 were "actually" practiced, of which four were food and 88 medicinal uses. TK and AU were positively correlated. As expected, TK was also significantly higher than AU, indicating that some potential uses of the species are still not valued. Sociolinguistic group and main activity, not age and sex, were the main factors influencing TK, AU, and difference between TK and AU. The highest TK was found with Bariba sociolinguistic group and the highest AU with Otamari. Fruits (100%) and flowers (10%) were the most used organs for food, while leaves (40%) and roots (7%) were mostly used for medicinal purposes. The most common food uses were consumption of the ripe fruits (100%), and food seasoning with flowers (10%). The most cited diseases were malaria (28%) and intestinal worms (8%). CONCLUSIONS: The study illustrated the importance of differentiating between TK and AU. It documented  the wide range of the uses of A. senegalensis, while highlighting its most common uses, and the need to better valorize and sustainably manage the species.

Factors Influencing Demand for Medical Cannabis Use among Cancer Patients in the North of Thailand.

OBJECTIVE: Cancer treatments often cause side effects. Cannabis is a plant that has been studied and used to treat and relieve side effects from modern medicine. Medical cannabis (MC) was legalized in Thailand in 2019 with limited research on demand for its use. Therefore, this study aimed to identify factors associated with demand for MC use among cancer patients in the North of Thailand. METHODS: This analytical cross-sectional study administered a multistage random sampling to recruit 1,284 cancer patients in northern Thailand to response a self-administered structured questionnaire. Generalized Linear Mixed Model (GLMM) was used to identify the determinants of demand for MC use among the population, presented adjusted odds ratios (adj.OR), 95% confidence intervals (95% CI), and p-values. RESULT: Nearly half of the respondents reported demand to use MC (44.0%). The factors that were significantly associated with demand to use MC included had high levels of health literacy about MC (adj.OR = 5.70; 95% CI: 4.08 to 7.96), higher levels of social support (adj.OR =5.50; 95% CI: 3.60 to 8.39), positive attitudes toward MC use (adj.OR = 2.56; 95% CI: 1.83 to 3.56), aged less than 30 (adj.OR =1.89; 95% CI: 1.21 to 2.93), diagnosis with cancerfor more than 12 months ago (adj.OR =1.73; 95% CI: 1.19 to 2.52) when controlling effect of other covariates. CONCLUSION: We found substantial demand for MC use among cancer patients. Health literacy,social support, attitudes about MC, age, and duration of having cancer were significantly associated with demand for MC use. Therefore, improving health literacy and social support, especially among older cancer patients, could help increasing demand for MC as a complementary medicine to treat cancers.

Medicinal Plants for the Treatment of Mental Diseases in Pregnancy: An In Vitro Safety Assessment.

Pregnancy is a critical period for medical care, during which the well-being of woman and fetus must be considered. This is particularly relevant in managing non-psychotic mental disorders since treatment with central nervous system-active drugs and untreated NMDs may have negative effects. Some well-known herbal preparations (phytopharmaceuticals), including St. John's wort, California poppy, valerian, lavender, and hops, possess antidepressant, sedative, anxiolytic, or antidepressant properties and could be used to treat mental diseases such as depression, restlessness, and anxiety in pregnancy. Our goal was to assess their safety in vitro, focusing on cytotoxicity, induction of apoptosis, genotoxicity, and effects on metabolic properties and differentiation in cells widely used as a placental cell model (BeWo b30 placenta choriocarcinoma cells). The lavender essential oil was inconspicuous in all experiments and showed no detrimental effects. At low-to-high concentrations, no extract markedly affected the chosen safety parameters. At an artificially high concentration of 100 µg/mL, extracts from St. John's wort, California poppy, valerian, and hops had minimal cytotoxic effects. None of the extracts resulted in genotoxic effects or altered glucose consumption or lactate production, nor did they induce or inhibit BeWo b30 cell differentiation. This study suggests that all tested preparations from St. John's wort, California poppy, valerian, lavender, and hops, in concentrations up to 30 µg/mL, do not possess any cytotoxic or genotoxic potential and do not compromise placental cell viability, metabolic activity, and differentiation. Empirical and clinical studies during pregnancy are needed to support these in vitro data.