The prevalence and predictors of herb-drug interactions among Iranian cancer patients during chemotherapy courses.

BACKGROUND: The concurrent usage of herbal medicines with conventional therapies is an important concern in cancer treatment which can lead to unexpected consequences like herb-drug interactions. This study aimed to determine the prevalence of potential herb-drug interactions and to predict factors associated with herb-drug interactions for cancer patients. METHODS: This cross-sectional study was conducted among a convenience sample of 315 cancer patients referring to the oncology clinics of Kerman city in 2018. Data were collected via comprehensive face-to-face interviews and medical chart reviews. A drug interaction checker was used to determine herb-drug interactions. The information of patients was compared based on herb-drug interactions using bivariable logistic regression models, and predictors were determined by the multivariable logistic regression model. All analyses were performed by Stata software version 16. RESULTS: Of 262 patients (83.2% of the patients) who used herbal medicines, 209 patients [79.8% (95% Confidence Intervals (CI): 75.2 - 85.1)] had potential herb-drug interactions. Chamomile was the most popular herbal medicine (n = 163, 78.0%), and minor and moderate herb-drug interactions were caused by green tea (n = 34, 16.3%) and peppermint (n = 78, 37.5%). The number of chemotherapeutic agents (OR: 1.92, 95% CI: 1.43-2.58; P-value < 0.0001) and the experienced of pain during chemotherapy courses (OR = 2.22, 95%CI:1.00-4.94; P-value = 0.04) were some of the predictors of herb-drug interactions among cancer patients. CONCLUSION: Herbal medicine use during chemotherapy was found prevalent among cancer patients; of them, the experience of potential herb-drug interactions was highly frequent. Oncologists and clinical pharmacologists are recommended to take into account challenges associated with herb-drug interactions in their routine practices, particularly during chemotherapy among these patients.

Phytosomes as Innovative Delivery Systems for Phytochemicals: A Comprehensive Review of Literature.

Nowadays, medicinal herbs and their phytochemicals have emerged as a great therapeutic option for many disorders. However, poor bioavailability and selectivity might limit their clinical application. Therefore, bioavailability is considered a notable challenge to improve bio-efficacy in transporting dietary phytochemicals. Different methods have been proposed for generating effective carrier systems to enhance the bioavailability of phytochemicals. Among them, nano-vesicles have been introduced as promising candidates for the delivery of insoluble phytochemicals. Due to the easy preparation of the bilayer vesicles and their adaptability, they have been widely used and approved by the scientific literature. The first part of the review is focused on introducing phytosome technology as well as its applications, with emphasis on principles of formulations and characterization. The second part provides a wide overview of biological activities of commercial and non-commercial phytosomes, divided by systems and related pathologies. These results confirm the greater effectiveness of phytosomes, both in terms of biological activity or reduced dosage, highlighting curcumin and silymarin as the most formulated compounds. Finally, we describe the promising clinical and experimental findings regarding the applications of phytosomes. The conclusion of this study encourages the researchers to transfer their knowledge from laboratories to market, for a further development of these products.

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.

Proliferation and In Vitro Wound Healing Effects of the Microniosomes Containing Narcissus tazetta L. Bulb Extract on Primary Human Fibroblasts (HDFs).

PURPOSE: In Traditional Persian Medicine (TPM), different natural treatments have been suggested for skin damages such as Narcissus tazetta L. bulb application. New drug delivery systems such as niosomes have shown considerable increase transdermal drug delivery through stratum corneum, the main barrier against substances transport into skin. The aim of this study is preparation of niosomal formulations from N. tazetta bulb extract and evaluation of its in vitro wound healing effect. MATERIALS AND METHODS: Non-ionic surfactant vesicles (NSVs or niosomes) were prepared by film hydration method from percolated extract of N. tazetta bulb. A number of 12 niosomal formulations (F1-F12) were prepared using different proportions of Span 60/Tween 60/cholesterol and 80% methanol-dissolved/aqueous PEN (percolation extract of N. tazetta) (30 and 50 mg/ml). Their morphology, particle size, physical and chemical stability and encapsulation efficiency was studied. In vitro wound healing effect of various concentrations of the best PEN niosomal formulation (F9) was evaluated in comparison to PEN on human dermal fibroblasts (HDFs). RESULTS: Increasing the aqueous/methanolic PEN concentration from 3 to 5% resulted size reduction of NSVs with statistically significant difference (p < 0.05). F9 showed the most physicochemical stability and was chosen for in vitro wound healing effect. This formulation exhibited significantly effects (p < 0.05) on cell proliferation in HDF cells at 1.562 and 3.125 µg/ml compared with the untreated cells using neutral red assay. CONCLUSION: Formulation of PEN in niosome carrier significantly decreased the gap width on human dermal fibroblasts. Graphical abstract Schematic processes of proliferation effect of narcisus tazetta bulb on fibroblast cells.

Pharmacological safety evaluation of a traditional herbal medicine "Zereshk-e-Saghir" and assessment of its hepatoprotective effects on carbon tetrachloride induced hepatic damage in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: "Zereshk-e-Saghir" (ZES), one of the traditional herbal medicines in old manuscripts of Persian hakims, has been used for the treatment of liver disorders. This current study is aimed to evaluate ZES effects on animal model to investigate its safety and hepatoprotective activity. MATERIALS AND METHODS: ZES was prepared according to a traditional method by blending aqueous extracts of Berberis vulgaris L., with fine particles of other plants including Rosa damascene Mill, Cichorium intybus L., Cucumis sativus L., Portulaca oleracea L., Rheum palmatum L., and Nardostachys jatamansi DC.. The lethality of ZES was determined in male NMRI mice. Acute organ toxicity of ZES (750 and 1500mg/kg for 15 days, orally) was evaluated by measuring the cell blood count, liver marker enzymes, creatinine, antioxidant status and histopathological examinations in rats. CCl4-induced liver toxicity was used to examine the hepatoprotective effects of the preparation. The rats were pretreated with 250, 500, 750 and 1500mg/kg ZES by gavage for 15 days. At day 16, the rats were intraperitoneally injected 1ml/kg CCl4 in olive oil. Forty-eight hours after CCl4 injection, the animals were sacrificed and their liver samples and blood were collected for determination of alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase (ALT, AST, and ALP), histopathological examinations and antioxidant status. RESULTS: Treatment of the mice with a single dose of ZES up to 2g/kg did not cause mortality. Treatment of the rats with doses of 750 and 1500mg/kg for 15 days showed no significant hematotoxicity and hepatotoxicity. Treatment of the rats with ZES reduced the increased serum levels of ALT, AST, and ALP induced by CCl4 at the doses of 250, 500, and 750mg/kg. This was almost confirmed by histopathological examinations. Pretreatment with ZES also decreased lipid peroxidation and maintained the levels of glutathione and total antioxidant capacity. CONCLUSIONS: The present in vivo study revealed that the long term usage of ZES was safe for organs in laboratory animals. Meanwhile, prescribing the traditionally-recommended dose of ZES can be probably used against the liver injuries induced by xenobiotics. Further studies in other models of liver injuries are recommended for finding the exact hepatoprotective mechanism of ZES.

Effect of Boswellia papyrifera on cognitive impairment in multiple sclerosis.

BACKGROUND: Cognitive impairment is one of the most crucial disorders among multiple sclerosis (MS) patients. Since MS is an inflammatory disease and Boswellia papyrifera has anti-inflammatory effects, the influence of B. papyrifera on cognitive impairment in MS patients has been investigated in the present study. METHODS: In this clinical trial, 80 MS patients who referred to the clinic of Shafa Hospital, Kerman, Iran were selected. Having completed a written consent form, patients with relapsing remitting MS, with no occurrence of a new attack throughout 1 month before the study, with no pregnancy or breastfeeding entered the study. The patients were randomly divided into two groups; then Brief International Cognitive Assessment for MS (BICAMS) test was carried out. One group received B. papyrifera (capsule 300 mg, twice a day) while the other group received placebo with the same dose for 2 months. After 2 months of treatment, BICAMS was redone and changes were analyzed. The significant change value on the before-after BICAMS points were considered to be 8, 13, and 7 points for the symbol digit modality test (SDMT), the California verbal learning test (CVLT), and the brief visual-spatial memory test revised (BVMT-R), respectively. RESULTS: The patients' mean age was 36.58 8.50 years. The mean duration of disease was 7.41 4.13 years. About 84.2% (n = 64) of the patients was female. In the BVMT-R, 13 patients (34.2%), who had already taken B. papyrifera, were shown to have significant improvement compared to the placebo group with no improvement (P < 0. 001). About 12 and 8 patients in the treatment and placebo groups in the SDMT, respectively (P = 0.200) and 17 and 12 patients in the treatment and placebo groups in the CVLT, respectively (P = 0.170) had significant change values. CONCLUSION: B. papyrifera showed significant improvement in visuospatial memory, but had no effect on verbal memory and information processing speed.

Effect of topical anesthesia on pain during infiltration injection and success of anesthesia for maxillary central incisors.

INTRODUCTION: This study was performed to investigate the effect of topical anesthesia on pain during needle penetration and infiltration injection as well as the effect of pain during injection on success rate of anesthesia in maxillary central incisors. METHODS: In a crossover double-blind study, 25 volunteers randomly received either topical anesthesia or placebo before infiltration injection with prilocaine for their maxillary central incisors in 2 separate appointments. The pain after needle penetration and during injection was separately recorded. An electric pulp tester was used to evaluate the success of the anesthetic injection. Data were analyzed by McNemar, Wilcoxon, and χ(2) tests. RESULTS: Overall for 50 injections, 72% of the teeth had successful anesthesia. No significant difference was found between placebo and topical anesthetic groups for the pain of needle penetration as well as pain during injection (P > .05). The volunteers who reported moderate-to-severe pain during injection showed no significant difference in the success rate of anesthesia compared with those with no or mild pain during injections (P > .05). CONCLUSIONS: Use of topical anesthesia had no significant effect on pain during either needle penetration or injection. Pain during injection had no significant effect on the success of anesthesia.