Oral herbal therapies for treating osteoarthritis.

BACKGROUND: Medicinal plant products are used orally for treating osteoarthritis. Although their mechanisms of action have not yet been elucidated in full detail, interactions with common inflammatory mediators provide a rationale for using them to treat osteoarthritic complaints. OBJECTIVES: To update a previous Cochrane review to assess the benefits and harms of oral medicinal plant products in treating osteoarthritis. SEARCH METHODS: We searched electronic databases (CENTRAL, MEDLINE, EMBASE, AMED, CINAHL, ISI Web of Science, World Health Organization Clinical Trials Registry Platform) to 29 August 2013, unrestricted by language, and the reference lists from retrieved trials. SELECTION CRITERIA: Randomised controlled trials of orally consumed herbal interventions compared with placebo or active controls in people with osteoarthritis were included. Herbal interventions included any plant preparation but excluded homeopathy or aromatherapy products, or any preparation of synthetic origin. DATA COLLECTION AND ANALYSIS: Two authors used standard methods for trial selection and data extraction, and assessed the quality of the body of evidence using the GRADE approach for major outcomes (pain, function, radiographic joint changes, quality of life, withdrawals due to adverse events, total adverse events, and serious adverse events). MAIN RESULTS: Forty-nine randomised controlled studies (33 interventions, 5980 participants) were included. Seventeen studies of confirmatory design (sample and effect sizes pre-specified) were mostly at moderate risk of bias. The remaining 32 studies of exploratory design were at higher risk of bias. Due to differing interventions, meta-analyses were restricted to Boswellia serrata (monoherbal) and avocado-soyabean unsaponifiables (ASU) (two herb combination) products.Five studies of three different extracts from Boswellia serrata were included. High-quality evidence from two studies (85 participants) indicated that 90 days treatment with 100 mg of enriched Boswellia serrata extract improved symptoms compared to placebo. Mean pain was 40 points on a 0 to 100 point VAS scale (0 is no pain) with placebo, enriched Boswellia serrata reduced pain by a mean of 17 points (95% confidence interval (CI) 8 to 26); number needed to treat for an additional beneficial outcome (NNTB) 2; the 95% CIs did not exclude a clinically significant reduction of 15 points in pain. Physical function was 33 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) 0 to 100 point subscale (0 is no loss of function) with placebo, enriched Boswellia serrata improved function by 8 points (95% CI 2 to 14); NNTB 4. Assuming a minimal clinically important difference of 10 points, we cannot exclude a clinically important benefit in some people. Moderate-quality evidence (one study, 96 participants) indicated that adverse events were probably reduced with enriched Boswellia serrata (18/48 events versus 30/48 events with placebo; relative risk (RR) 0.60, 95% CI 0.39 to 0.92). Possible benefits of other Boswellia serrata extracts over placebo were confirmed in moderate-quality evidence from two studies (97 participants) of Boswellia serrata (enriched) 100 mg plus non-volatile oil, and low-quality evidence from small single studies of a 999 mg daily dose of Boswellia serrata extract and 250 mg daily dose of enrichedBoswellia serrata. It was uncertain if a 99 mg daily dose of Boswellia serrata offered benefits over valdecoxib due to the very low-quality evidence from a small single study. It was uncertain if there was an increased risk of adverse events or withdrawals with Boswellia serrata extract due to variable reporting of results across studies. The studies reported no serious adverse events. Quality of life and radiographic joint changes were not measured.Six studies examined the ASU product Piasclidine®. Moderate-quality evidence from four studies (651 participants) indicated that ASU 300 mg produced a small and clinically questionable improvement in symptoms, and probably no increased adverse events compared to placebo after three to 12 months treatment. Mean pain with placebo was 40.5 points on a VAS 0 to 100 scale (0 is no pain), ASU 300 mg reduced pain by a mean of 8.5 points (95% CI 1 to 16 points); NNTB 8. ASU 300 mg improved function (standardised mean difference (SMD) -0.42, 95% CI -0.73 to -0.11). Function was estimated as 47 mm (0 to 100 mm scale, where 0 is no loss of function) with placebo, ASU 300 mg improved function by a mean of 7 mm (95% CI 2 to 12 mm); NNTB 5 (3 to 19). There were no differences in adverse events (5 studies, 1050 participants) between ASU (53%) and placebo (51%) (RR 1.04, 95% CI 0.97 to 1.12); withdrawals due to adverse events (1 study, 398 participants) between ASU (17%) and placebo (15%) (RR 1.14, 95% CI 0.73 to 1.80); or serious adverse events (1 study, 398 participants) between ASU (40%) and placebo (33%) (RR 1.22, 95% CI 0.94 to 1.59). Radiographic joint changes, measured as change in joint space width (JSW) in two studies (453 participants) did not differ between ASU 300 mg treatment (-0.53 mm) and placebo (-0.65 mm); mean difference of -0.12 (95% CI -0.43 to 0.19). Moderate-quality evidence from a single study (156 participants) confirmed possible benefits of ASU 600 mg over placebo, with no increased adverse events. Low-quality evidence (1 study, 357 participants) indicated there may be no differences in symptoms or adverse events between ASU 300 mg and chondroitin sulphate. Quality of life was not measured.All other herbal interventions were investigated in single studies, limiting conclusions. No serious side effects related to any plant product were reported. AUTHORS' CONCLUSIONS: Evidence for the proprietary ASU product Piasclidine® in the treatment of osteoarthritis symptoms seems moderate to high for short term use, but studies over a longer term and against an apparently active control are less convincing. Several other medicinal plant products, including extracts of Boswellia serrata, show trends of benefits that warrant further investigation in light of the fact that the risk of adverse events appear low.There is no evidence that Piasclidine® significantly improves joint structure, and limited evidence that it prevents joint space narrowing. Structural changes were not tested for with any other herbal intervention.Further investigations are required to determine optimum daily doses producing clinical benefits without adverse events.

Non-hormonal interventions for hot flushes in women with a history of breast cancer.

BACKGROUND: Hot flushes are common in women with a history of breast cancer. Hormonal therapies are known to reduce these symptoms but are not recommended in women with a history of breast cancer due to their potential adverse effects. The efficacy of non-hormonal therapies is still uncertain. OBJECTIVES: To assess the efficacy of non-hormonal therapies in reducing hot flushes in women with a history of breast cancer. SEARCH STRATEGY: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, CINAHL, PsycINFO (August 2008) and WHO ICTRP Search Portal. We handsearched reference lists of reviews and included articles, reviewed conference proceedings and contacted experts. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing non-hormonal therapies with placebo or no therapy for reducing hot flushes in women with a history of breast cancer. DATA COLLECTION AND ANALYSIS: Two authors independently selected potentially relevant studies, decided upon their inclusion and extracted data on participant characteristics, interventions, outcomes and the risk of bias of included studies. MAIN RESULTS: Sixteen RCTs met our inclusion criteria. We included six studies on selective serotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors, two on clonidine, one on gabapentin, two each on relaxation therapy and homeopathy, and one each on vitamin E, magnetic devices and acupuncture. The risk of bias of most studies was rated as low or moderate. Data on continuous outcomes were presented inconsistently among studies, which precluded the possibility of pooling the results. Three pharmacological treatments (SSRIs and SNRIs, clonidine and gabapentin) reduced the number and severity of hot flushes. One study assessing vitamin E did not show any beneficial effect. One of two studies on relaxation therapy showed a significant benefit. None of the other non-pharmacological therapies had a significant benefit. Side-effects were inconsistently reported. AUTHORS' CONCLUSIONS: Clonidine, SSRIs and SNRIs, gabapentin and relaxation therapy showed a mild to moderate effect on reducing hot flushes in women with a history of breast cancer.

Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials.

BACKGROUND: Women commonly use soy products, herbs, and other complementary and alternative medicine (CAM) therapies for menopausal symptoms. Randomized, controlled trials have evaluated the efficacy and short-term safety of these therapies. PURPOSE: To review randomized, controlled trials of CAM therapies for menopausal symptoms in order to better inform practice and guide future research. DATA SOURCES: Searches of MEDLINE for articles published from January 1966 through March 2002, of the Alternative and Complementary Database (AMED) of the British Library for articles published from January 1985 through December 2000, and of the authors' own extensive files. Search terms were hot flash/flush, menopause, and climacteric, combined with phytoestrogens, alternative medicine, herbal medicine, traditional medicine, Traditional Chinese Medicine (TCM ), Ayurveda, naturopathy, chiropractic, osteopathy, massage, yoga, relaxation therapy, homeopathy, aromatherapy, and therapeutic touch. STUDY SELECTION: 29 randomized, controlled clinical trials of CAM therapies for hot flashes and other menopausal symptoms were identified; of these, 12 dealt with soy or soy extracts, 10 with herbs, and 7 with other CAM therapies. DATA EXTRACTION: Each author extracted information from half of the studies on the number of patients, study design, outcome measures, and results; the other author then checked these results. DATA SYNTHESIS: Soy seems to have modest benefit for hot flashes, but studies are not conclusive. Isoflavone preparations seem to be less effective than soy foods. Black cohosh may be effective for menopausal symptoms, especially hot flashes, but the lack of adequate long-term safety data (mainly on estrogenic stimulation of the breast or endometrium) precludes recommending long-term use. Single clinical trials have found that dong quai, evening primrose oil, a Chinese herb mixture, vitamin E, and acupuncture do not affect hot flashes; two trials have shown that red clover has no benefit for treating hot flashes. CONCLUSIONS: Black cohosh and foods that contain phytoestrogens show promise for the treatment of menopausal symptoms. Clinical trials do not support the use of other herbs or CAM therapies. Long-term safety data on individual isoflavones or isoflavone concentrates are not available.

Calcium intakes in individuals on diets for the management of cows' milk allergy: a case control study.

Three hundred and twenty-three individuals with self-reported food allergy were recruited by media advertisements. Questionnaire information was collected on all respondents. Chocolate (57%), milk (47%), wheat (36%) and food additives (35%) were the most frequently implicated foods. The most frequently reported symptoms were itching (43%), skin rash (43%) and tiredness (43%). Food avoidance was the most common form of food allergy diagnosis (33%) with only 8% of respondents reporting food challenge in food allergy diagnosis. Self-diagnosis was reported by 34% of respondents with 29% and 24% reporting diagnosis by a general practitioner or a homeopath, respectively. Twenty-four per cent of respondents 'always' avoided and a further 57% 'nearly always' avoided the implicated food(s). A group of 38 adults with self-reported 'milk allergy' was selected for further study. Dietary assessments, using the dietary history method, were carried out on this subgroup and on age-, sex- and occupation-matched controls. The results of the dietary assessments revealed that the 'milk allergy' group had significantly higher intakes of fibre, beta-carotene, vitamin C, vitamin E, iron and folic acid (P < 0.05) and significantly lower intakes of calcium (P < 0.002) in comparison to controls. Eighteen per cent of the group used milk alternatives. Thirty-four per cent of the 'milk allergy' group took calcium-containing supplements. Even after calcium supplementation, the mean calcium intake of those who completely avoided milk was unacceptably low (441 mg/d).

Prevalence and predictors of selenium and vitamin E supplementation in a urology population.

OBJECTIVES: Preclinical and epidemiological studies have suggested the use of supplements such as selenium and vitamin E for prostate cancer (PCa) prevention; however, clinical trials have not demonstrated clear benefit in patients. This study aims to investigate the current prevalence and predictors for use of these supplements in men in a urology population. DESIGN, SUBJECTS, AND OUTCOMES MEASURED: Three hundred and twelve (312) men visiting the Princess Margaret Hospital Ambulatory Urology Clinic were enrolled in this University Health Network Research Ethics Board-approved questionnaire-based study investigating supplement use, reasons for use and demographic characteristics. RESULTS: It was observed that 13.5% and 20.8% of the participants are currently using selenium and vitamin E, respectively, while 10.6% and 15.7% previously used selenium and vitamin E, respectively. Both education (percentage of users comparing less than college education versus college or above education: selenium: 14% versus 28%; p=0.008, vitamin E: 26% versus 41%; p=0.013) and health literacy (mean scores±standard error of the mean of users versus nonusers: selenium question 1: 1.4507±0.09576 versus 1.6083±0.07211; p=0.023, selenium question 2: 2.8750±0.04395 versus 2.7106±0.03774; p=0.000, selenium question 3: 1.4583±0.08377 versus 1.7064±0.06278; p=0.025, vitamin E question 1: 2.8036±0.04545 versus 2.7179±0.04097; p=0.010, vitamin E question 2: 1.5446±0.06698 versus 1.7077±0.07241; p=0.006) are predictors of selenium and vitamin E use on univariable analysis. On multivariable analysis education (selenium odds ratio=2.095, 95% confidence interval=1.019-4.305, p=0.044; vitamin E odds ratio=1.855, 95% confidence interval=1.015-3.338, p=0.045) remains a significant predictor of selenium and vitamin E use. Examining the data on use by education, it was found that more men with a higher education attributed their use of selenium to urologist advice (24%), and those with a lower education attributed their use of selenium to naturopath/homeopath advice (28%). CONCLUSIONS: Many men who visit urology clinics use selenium and vitamin E despite the lack of clinical support for chemoprevention. Education and health literacy are important variables in determining the use of these supplements in these men. This information may aid in addressing the needs of the diverse patient population using these supplements for the prevention of PCa.

Effect of noise on microvascular integrity in laboratory rats.

Housing rats in an environment with high personnel activity increases microvascular leakiness to albumin in the mesenteric microcirculation and causes mast cell degranulation. In this study, rats were exposed to daily 15-min episodes of 90-dB SPL noise to determine whether similar effects occurred and whether vitamin E with a-lipoic acid or Traumeel (a homeopathic anti-inflammatory-analgesic) reduced these effects. Groups of rats fed a control diet (1000 IU/kg vitamin E) only, the control diet with Traumeel, or a diet with 10,000 IU/kg vitamin E and 1.65 g/kg lipoic acid were exposed to daily noise for 3 to 5 wk; a fourth group of rats, fed control diet, was housed with no excess noise. The rats were anesthetized, the superior mesenteric artery cannulated, and a portion of the microvasculature perfused for 1 min with fluoroscein isothiocyanate-albumin before fixing for microscopy. All groups exposed to excess noise had significantly more leaks per venule length and greater leak area per venule length than did the quiet group. However, the number and area of leaks in the rats that received Traumeel or vitamin E were significantly smaller than those in rats exposed to noise only. In addition, mast cell degranulation was significantly lower in rats given Traumeel. Thus exposure of rats to excessive noise produces structural damage in the mesenteric microvasculature that is significantly reduced by dietary supplements.

Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know.

BACKGROUND: Widespread use of herbal medications/supplements among the presurgical population may have a negative effect on perioperative patient care. Thus, the authors' goal was to identify the prevalence of such use in a cosmetic surgery patient population compared with use among the general public; to assess physician awareness of proper management of these herbal medications/supplements; and to review the literature to provide rational strategies for managing perioperative patients taking these remedies. METHODS: To assess patient (n = 100) and general public (n = 100) usage rates, open-ended lists of (1) the most common herbal medications/supplements and (2) homeopathic treatments were compiled. Board-certified plastic surgeons (n = 20) were then given the same list of herbs/supplements and surveyed on their awareness of these treatments and perioperative side effects. RESULTS: The usage rate for cosmetic versus public surveys for herbal medicines/supplements was 55 percent versus 24 percent (p < 0.001), with 35 percent versus 8 percent (p < 0.001) engaging in homeopathic practices, respectively. Cosmetic patients' top four herbal/supplements of usage were chondroitin (18 percent), ephedra (18 percent), echinacea (14 percent), and glucosamine (10 percent). The top four used by the general public were echinacea (8 percent), garlic (6 percent), ginseng (4 percent), and ginger (4 percent). The physician survey demonstrated awareness of 54 percent of the listed supplements/herbal medicines, 85 percent of which were not suggested to be discontinued preoperatively, with only ephedra achieving 100 percent physician discontinuation preoperatively. CONCLUSIONS: Herbal medicines and supplements displayed greater prevalence in the cosmetic surgery population than in the population at large. Furthermore, side effects and potential complications warrant addressing these remedies as pharmaceuticals rather than as safe and "natural." Thus, a descriptive "top-10" list with perioperative recommendations was compiled for the plastic surgeon.

[Controversial and so-called alternative therapeutic approaches]. / Umstrittene und sogenannte ausserschulische Therapieansätze.

In spite of intensive research, it has not yet been possible to produce a complete explanation of the aetiology and pathology of rheumatoid arthritis (R.A.). Therapeutic measures are possible in many phases of the pathogenetic concept, and often produce good, modifying results, improving the course of the disease. No causal therapy of R.A. exists--we do not know the aetiology of this disease. Frustration with conventional medicine on the one side, and the predominating spirit of the times on the other--back to biological methods and the old forms of therapy--are the reasons why chronic polyarthritics drift into the sphere of para-medicine. In the judgement of para-medical methods, "risk/benefit relationship", "superfluous and no longer up-to-date", "controversial--absence of scientific evidence", "controversial", and "controversial--not scientifically acceptable" present some of the decision criteria. Treatment with mussel extracts, beta-sitosterins, THX, and substitution with various substances, as well as anthroposophically-oriented high-potency homeopathy, are to be allocated to the "controversial--not scientifically acceptable" category. If one weighs up the "risk/benefit relationship" of cell therapy, this treatment concept also cannot be supported. Moreover, precisely documented scientific results of this form of therapy do not exist. Methods standing on scientifically-hypothetically interesting ground, but which were tested on too small a group and cannot yet be accepted as sufficiently proven, are therapy with Vitamin E, the use of Thymopoietin, in which, for example, dose-finding and mode of application are not yet firmly established, and therapy with enzyme mixtures. Interferon results, initially extolled in the lay press, have not been confirmed in the most recent studies. Thymopoietin treatments, via the laborious road to the correct application (oral, subcutaneous, intramuscular, intravenous as bolus, intravenous--fractionated), show encouraging successes. As tissue-localized immune complexes (which sort?) play a role in the pathogenesis of R.A., but enzyme mixtures, apart from the problems of absorption, only influence circulating immune complexes, and moreover, in many diseases neither the aetiology nor the pathogenesis is connected with the immune complexes, this therapy concept can be regarded neither as causal nor as scientifically guaranteed. In summary: from the start-point that healing is the ideal aim, it has been forgotten that there are many human sufferings which medicine can ease and ameliorate, but not yet cure.(ABSTRACT TRUNCATED AT 400 WORDS)

Niveles de vitaminas antioxidantes de lípidos en escolares con historia familiar de enfermedad arterial coronaria / Antioxidant vitamins of levels in school children with family history of coronary artery disease

Se evaluaron las vitaminas antioxidantes A, E, C y el perfil lipídico, en 50 escolares cuyos padres habían sufrido enfermedad arterial coronaria (EAC) antes de los 55 años (grupo estudio), comparándolos con 46 escolares hijos de padres sanos (grupo control). La concentración sérica de vitaminas A y E fueron determinadas por HPLC y la vitamina C y los lípidos sanguíneos mediante métodos colorimétricos. No se observaron diferencias significativas en los valores absolutos de las vitaminas A, E y C entre ambos grupos. Sin embargo, los valores de vitamina E estandarizada con relación a los lípidos, colesterol total (CT) o CT+ triglicéridos (TG), fueron más bajos (p<-0.05) en el grupo en estudio (vitamina E/CT 3,48±1,52µM/mM y vitamina E/CT+TG 2,82±1,24µM/mM) que el grupo control (vitamina E/CT4,60±2,10µM/mM y vitamina E/CT+TG3,83±1,67 µM/mM). Adicionalmente, los índices de riesgo cardiovascular fueron significativamente más altos (p<-0.05) en el grupo en estudio. Estos resultados indican que los escolares con historia familiar de EAC temprana mostraron deficiencia antioxidante de la vitamina E y alteraciones en el perfil lipídico

Prevençäo da hemorragia periventricular-intraventricular do prematuro: um enfoque farmacológico / Prevention of periventricular and intraventricular haemorrhage of the premature: a pharmacological approach

Apesar dos avanços verificados nos últimos anos em terapia neonatal intensiva, as hemorragias do sistema nervoso central ainda se constituem em expressivas causas morbi-mortalidade para os pequenos prematuros com menos de 35 semanas de idade gestacional e peso de nascimento inferior a 1500g. Sua ocorrência nas primeiras horas de vida pós-natal tem motivado sucessivas pesquisas no sentido de encontrar algum agente que, administrado precocemente, possa preveni-las. Discorre-se nesta revisäo sobre o uso de fenobarbital, brometo de pancurônio, etamsilato, vitamina E, indometacina e teofilina na prevençäo das hemorragias do sistema nervoso central, näo identificando nenhum de eficácia inteiramente comprovada

Prevenção do dano fotooxidativo à pele por tratamento tópico com extrato da raiz de Pothomorphe umbellata L. Miq / Prevention of photo-oxidative damage on the skin by topical treatment with extract of the root of Pothomorphe umbellata L. Miq

Entre as estratégias de fotoproteção encontra-se a inibição da formação e/ou o seqüestro de radicais livres e espécies reativas de oxigênio geradas em conseqüência da exposição à radiação UV, mediante aplicação tópica de antioxidantes. No presente trabalho avaliou-se a permeação cutânea e o efeito da aplicação tópica de um extrato de Pothomorphe umbellata nos efeitos da exposição aguda e crônica à radiação ultravioleta, na pele de camundongos sem pêlo. No estudo de permeação cutânea foram testadas três formulações (gel, gel-creme e creme) contendo o princípio ativo do extrato (4-nerolidilcatecol) isolado...

Prevenção do dano fotooxidativo à pele por tratamento tópico com extrato da raiz de Pothomorphe umbellata L. Miq / Prevention of photo-oxidative damage on the skin by topical treatment with extract of the root of Pothomorphe umbellata L. Miq

Entre as estratégias de fotoproteção encontra-se a inibição da formação e/ou o seqüestro de radicais livres e espécies reativas de oxigênio geradas em conseqüência da exposição à radiação UV, mediante aplicação tópica de antioxidantes. No presente trabalho avaliou-se a permeação cutânea e o efeito da aplicação tópica de um extrato de Pothomorphe umbellata nos efeitos da exposição aguda e crônica à radiação ultravioleta, na pele de camundongos sem pêlo. No estudo de permeação cutânea foram testadas três formulações (gel, gel-creme e creme) contendo o princípio ativo do extrato (4-nerolidilcatecol) isolado...(AU)

Efeito de uma dose aguda de etanol sobre a peroxidação lipídica em ratos: Ação da vitamina E / Acute dose of ethanol's effect on lipid peroxidation in rats: action of the vitamin E

A geração de radicais livres é um passo importante na patogênese da injúria hepática associada a ingestão de etanol. A ingestão do etanol induz a um aumento naperoxidação lipídica por dois mecanismos: uma maior produção de espécies reativas de oxigênio e/ou pela diminuição dos níveis dos antioxidantes endógenos. Este trabalho enfoca a geração de radicais livres em ratos, após a ingestão de uma dose aguda de etanol, e o papel de diferentes níveis de vitamina E na dieta oferecida aos animais. O objetivo do trabalho foi investigar o efeito de dietas com diferentes concentrações de vitamina E (Deficiente, Controle e Suplementada 20 vezes) sobre a peroxidação lipídica plasmática e hepática (medida por SRATB), vitamina E em plasma e fígado e glutationa hepática, em ratos alimentados com as dietas. Os animais receberam uma dose aguda de etanol (5 mg/Kg de peso) ao final do período experimental (4 semanas) e foram sacrificados em cinco períodos distintos: 0, 2, 4, 8 e 24 horas após o etanol...(AU)