Hamamelis virginiana L. Leaf Extracts Inhibit the Growth of Antibiotic-Resistant Gram-Positive and Gram-Negative Bacteria.

Virginian witch hazel (WH; Hamamelis virginiana L.; family: Hamamelidaceae) is a North American plant that is used traditionally to treat a variety of ailments, including bacterial infections. Solvents of varying polarity (water, methanol, ethyl acetate, hexane and chloroform) were used to prepare extracts from this plant. Resuspensions of each extract in an aqueous solution were tested for growth-inhibitory activity against a panel of bacteria (including three antibiotic-resistant strains) using agar disc diffusion and broth microdilution assays. The ethyl acetate, hexane and chloroform extracts were completely ineffective. However, the water and methanolic extracts were good inhibitors of E. coli, ESBL E. coli, S. aureus, MRSA, K. pneumoniae and ESBL K. pneumoniae growth, with the methanolic extract generally displaying substantially greater potency than the other extracts. Combining the active extracts with selected conventional antibiotics potentiated the bacterial growth inhibition of some combinations, whilst other combinations remained non-interactive. No synergistic or antagonistic interactions were observed for any WH extracts/antibiotic combinations. Gas chromatography-mass spectrometry analysis of the extracts identified three molecules of interest that may contribute to the activities observed, including phthalane and two 1,3-dioxolane compounds. Putative modes of action of the active WH extracts and these molecules of interest are discussed herein.

Chemical Composition, Antibacterial Activity, and Antibiotic Potentiation of Boswellia sacra Flueck. Oleoresin Extracts from the Dhofar Region of Oman.

The emergence of MDR bacterial pathogens has directed antibiotic discovery research towards alternative therapies and traditional medicines. Boswellia sacra oleoresin (frankincense) was used to treat bacterial infections in traditional Arabian and Asian healing systems for at least 1000 years. Despite this, B. sacra extracts have not been rigorously tested for inhibitory activity against gastrointestinal pathogens or bacterial triggers of autoimmune diseases. Solvent extracts were prepared from Boswellia sacra oleoresins obtained from three regions near Salalah, Oman. MIC values were quantified against gastrointestinal pathogens and bacterial triggers of selected autoimmune diseases by disc diffusion and broth dilution methods. The antibacterial activity was also evaluated in combination with conventional antibiotics, and the class of interaction was determined by ΣFIC analysis. Isobolograms were used to determine the optimal ratios for synergistic combinations. Toxicity was evaluated by ALA and HDF cell viability bioassays. The phytochemical composition of the volatile components of all extracts was identified by nontargeted GC-MS headspace analysis. All methanolic extracts inhibited the growth of all of the bacteria tested, although the extracts prepared using Najdi oleoresin were generally more potent than the Sahli and Houjari extracts. Combinations of the methanolic B. sacra extracts and conventional antibiotics were significantly more effective in inhibiting the growth of several bacterial pathogens. In total, there were 38 synergistic and 166 additive combinations. Approximately half of the synergistic combinations contained tetracycline. All B. sacra extracts were nontoxic in the ALA and HDF cell viability assays. Nonbiased GC-MS headspace analysis of the methanolic extracts putatively identified a high diversity of monoterpenoids, with particularly high abundances of α-pinene. The antibacterial activity and lack of toxicity of the B. sacra extracts indicate their potential in the treatment and prevention of gastrointestinal and autoimmune diseases. Furthermore, the extracts potentiated the activity of several conventional antibiotics, indicating that they may contain resistance-modifying compounds.

Use of specific combinations of the triphala plant component extracts to potentiate the inhibition of gastrointestinal bacterial growth.

ETHNOPHARMACOLOGICAL RELEVANCE: Triphala is used in Ayurveda to treat a wide variety of diseases, including numerous bacterial infections. Interestingly, the plant components of triphala (Terminalia bellirica, Terminalia chebula and Emblica officinalis) are also good inhibitors of bacterial growth when used individually, yet plant preparations are generally used in combination in traditional medicine. Surprisingly, no previous studies have addressed the reason why the combination is preferred over the individual components to treat bacterial infections. AIM OF THE STUDY: To test and compare the antibacterial efficacy of triphala and its component parts to quantify their relative efficacies. The individual plant components will also be tested as combinations, thereby determining whether combining the individual components potentiates the antibacterial activity of the components used alone. MATERIALS AND METHODS: Triphala and the three individual plant components were extracted using solvents of varying polarity (methanol, water, ethyl acetate) and the antibacterial activity of the aqueous resuspensions was quantified by disc diffusion and broth microdilution MIC assays. Combinations of extracts produced from the individual components were also tested against each bacterial species and the ΣFICs was calculated to determine the class of interaction. Where synergy was detected, isobologram analysis was used to determine the optimal component ratios. The Artemia nauplii bioassay was used to test for toxicity and GC-MS headspace profiling analysis was used to highlight terpenoid components that may contribute to the antibacterial activity of triphala. RESULTS: The aqueous and methanolic triphala, T. bellirica, T. chebula and E. officinalis extracts displayed good inhibitory activity against all bacterial strains, with MICs often in the 250-750 µg/mL range. The methanolic extracts were generally more potent than the aqueous extracts and T. chebula was the most potent of the individual plant components. Combining the extracts of the different plant species resulted in potentiation of the growth inhibitory activity of most combinations compared to that of the individual components. Indeed, with the exception of S. flexneri, all bacterial species were potentiated by at least one combination of methanolic plant extracts, with a substantial proportion of these displaying synergistic interactions. All extracts were found to be either non-toxic, or of low to moderate toxicity in Artemia nauplii assays. CONCLUSION: Whilst the individual plant components of triphala all inhibit the growth of multiple pathogenic bacteria, the activity is potentiated for multiple combinations. Therefore, the traditional usage of the combination of the three plant materials in triphala not only extends the activity profile of the mixture over that of the individual components, but it also substantially potentiates the inhibitory activity towards multiple bacteria, partially explaining the preference of triphala compared to the individual components.

Terminalia ferdinandiana Fruit and Leaf Extracts Inhibit Methicillin-Resistant Staphylococcus aureus Growth.

The development of multiple antibiotic-resistant bacteria has vastly depleted our repertoire of effective antibiotic chemotherapies. The development of multi-ß-lactam-resistant strains are particularly concerning due to our previous reliance on this class of antibiotics because of their initial efficacy and broad-spectrum activity. With increases in extended-spectrum ß-lactam-resistance and an expanded resistance to other classes of antibiotics, there is an urgent need for the development of effective new antibiotic therapies. Terminalia ferdinandiana is an endemic Australian plant known for its high antioxidant and tannin contents. T. ferdinandiana fruit and leaf extracts have strong antibacterial activity against a wide variety of bacterial pathogens. However, T. ferdinandiana extracts have not been tested against ESBL and MRSA antibiotic-resistant pathogens. An objective of this study was to screen T. ferdinandiana fruit and leaf extracts for bacterial growth inhibitory activity by disc diffusion assay against ß-lactam-sensitive and -resistant E. coli strains and against methicillin-sensitive and -resistant S. aureus. The minimum inhibitory concentration (MIC) was quantified by liquid dilution techniques. The fruit methanolic extract, as well as the methanolic, aqueous, and ethyl acetate leaf extracts strongly inhibited the growth of the MRSA, with MICs as low as 223 µg/mL. In contrast, the extracts were ineffective inhibitors of ESBL growth. Metabolomic fingerprint analysis identified a diversity and relative abundance of tannins, flavonoids, and terpenoids, several of which have been reported to inhibit MRSA growth in isolation. All extracts were nontoxic in the Artemia nauplii and HDF toxicity assays, further indicating their potential for medicinal use.

Supporting rural midwifery practice using a mobile health (mHealth) intervention: a qualitative descriptive study.

INTRODUCTION: Hypertensive disorders in pregnancy account for 12% of all maternal deaths globally. The risks of suboptimal outcomes from these disorders might be greater in rural and remote locations. These potential risks might be related to poor intra- and interprofessional communications due to geographic and digital isolation. Studies in low- and middle-income countries suggest that improving communications is essential and that mobile health (m-health) interventions can improve outcomes. However, for such interventions to be successful they must involve midwives in any design and software development. This study explored how an m-health intervention might support midwives in the management of women with pre-eclampsia in Scottish rural and remote locations. METHODS: A qualitative descriptive approach was adopted. Rural and remote practising community midwives (n=18) were recruited to participate in three focus groups. The data were gathered through digital recordings of conversations at these focus groups. Recordings were transcribed and thematically analysed. Themes were agreed by consensus with the research team in an iterative process. RESULTS: Five principal themes were identified: 'working in isolation', 'encountering women with pre-eclampsia in rural and remote settings', 'learning on the move', 'using audio-visual resources' and 'unease with advances in technology'. CONCLUSION: Geographic and digital isolation pose significant challenges to rural midwifery practice in a high income country such as Scotland. Midwives need to be involved in the development of m-health interventions for them to be acceptable and tailored to their needs in a rural and remote context. The study highlights how m-health interventions can support continuous professional development whilst on the move with no internet connectivity. However, pride in current practice and unease with advances in mobile technology are barriers to the adoption of an m-health intervention. M-health interventions could be of value to other specialised healthcare practitioners in these regions, including general practitioners, to manage women with complications in their pregnancies.

Plantago squarrosa Murray extracts inhibit the growth of some bacterial triggers of autoimmune diseases: GC-MS analysis of an inhibitory extract.

Ankylosing spondylitis, multiple sclerosis, rheumatoid arthritis and rheumatic fever are autoimmune inflammatory diseases that may be triggered in genetically susceptible individuals by specific bacterial pathogens. Inhibiting the growth of these bacteria with high antioxidant plant extracts may inhibit the aetiology of these diseases, as well as inhibiting the later phase symptoms. P. squarrosa extracts were analysed for antioxidant activity using a DPPH free radical scavenging assay. Bacterial growth inhibitory activity was evaluated using disc diffusion assays and the activity was quantified by MIC determination. The extracts were screened for toxicity by A. franciscana nauplii assays. The most potent antibacterial extract (ethyl acetate) was analysed by GC-MS headspace profile analysis and compounds were identified with reference to a phytochemical database. All extracts displayed strong DPPH radical scavenging activity. The ethyl acetate extract was particularly potent (IC50 1.4 µg/mL), whilst the other extracts also had significant radical scavenging activity (IC50 values between 11 and 22 µg/mL). Notably, the bacterial growth inhibitory activity of the extracts correlated with their DPPH radical scavenging activity. The ethyl acetate extract, which had the greatest DPPH scavenging activity, generally displayed the most potent bacterial growth inhibitory activity. This extract was particularly potent against P. mirabilis, P. vulgaris and A. baylyi (MIC values of 484, 575 and 880 µg/mL, respectively). It also inhibited P. aeruginosa and S. pyogenes growth, albeit with higher MICs (1600-3700 µg/mL). All other extract-bacteria combinations were either inactive or resulted in mid-low potency inhibition. All extracts were non-toxic in the A. franciscana bioassay (LC50 substantially > 1000 µg/mL). In total, 89 unique mass signals were identified in the P. squarrosa ethyl acetate extract by non-biased GC-MS headspace analysis. A number of compounds which may contribute to the antibacterial activity of this extract have been highlighted.

'Teabacco': Smoking of nicotine-infused tea as an unintended consequence of prison smoking bans.

INTRODUCTION AND AIMS: Following the introduction of smoke-free policies in prisons in several countries, there have been anecdotal reports of prisoners creating cigarettes by mixing nicotine patches or lozenges with tea leaves ('teabacco'). Among a sample of people recently released from smoke-free prisons in Queensland, Australia, the aims of this study were to explore the perceived popularity of teabacco use, motivations for its use and describe the process of creating teabacco to identify potential associated health risks. DESIGN AND METHODS: This study used a mixed-methods design. Eighty-two people recently released from prison in Queensland, Australia completed surveys at parole offices measuring teabacco use while incarcerated. Twenty-one teabacco smokers took part in follow-up, qualitative interviews to explore survey responses in greater depth. RESULTS: The majority of survey participants (57%) reported smoking teabacco while incarcerated, with 37% smoking teabacco frequently (> once per week). Teabacco use was primarily motivated by cigarette cravings. Participants described the perceived inevitability of prisoners finding substitutes for tobacco. Multivariate analyses found that self-rated poor physical health, having been incarcerated five or more times, experiencing cigarette cravings while incarcerated, and use of illicit drugs while incarcerated were positively associated with frequent teabacco use in prison. DISCUSSION AND CONCLUSIONS: Our findings suggest that teabacco use has become common practice in Queensland's smoke-free prisons. Correctional smoking bans are an important public health initiative but should be complemented with demand and harm reduction measures cognisant of the risk environment.

Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review.

PURPOSE: While corticosteroids are relatively inexpensive and commonly used as treatment for a variety of conditions, long-term use is known to be associated with certain toxicities. Prior systematic reviews have revealed an increased risk for costly adverse events (AEs), including bone fracture, infection, and gastrointestinal bleeding. The objective of this study was to conduct a systematic literature review of recent publications on the burden of long-term corticosteroid exposure, specifically, to summarize the AEs and economic impact of long-term corticosteroid use and to reveal data gaps for additional research. METHODS: The Ovid search platform was used to access scientific literature databases. The search strategy targeted the use of corticosteroids and economic outcomes research. Articles were restricted to those published between 2007 and 2016 to cover publications since prior reviews; conference abstracts and articles assessing pediatrics were excluded. Titles and abstracts resulting from inclusion criteria were screened, and reviewers independently extracted relevant information from the relevant full-text articles. FINDINGS: The literature review included 32 articles, with 75% focusing on autoimmune diseases, asthma, or lung diseases. Included articles were 14 database analyses, 6 simulations, 6 clinical trials, 3 systematic literature reviews, 2 patient surveys, and 1 chart review. Commonly-cited AEs associated with long-term corticosteroid exposure included hypertension (prevalence >30%); bone fracture (21%-30%); cataract (1%-3%); nausea, vomiting, and other gastrointestinal conditions (1%-5%); and metabolic issues (eg, weight gain, hyperglycemia, and type 2 diabetes; cases had 4-fold the risk of controls). Association of dose and duration with increased AE risk is not well-quantified. AEs like peptic ulcer and myocardial infarction are particularly costly to payers (1-year cost of $21,825 and $26,472, respectively, in year-2009 USD). The few articles assessing the economic impact of corticosteroid use have found dose-related increases in health care resource utilization and costs, with per-annum incremental costs relative to nonusers ranging from $5700 in low-dose users (<7.5 mg/d) to $29,000 in high-dose users (>15 mg/d). Adherence to treatment guidelines on avoiding AEs (eg, prescribing of oral bisphosphonates, calcium, and vitamin D) remains low. IMPLICATIONS: Although doses of long-term corticosteroids have fallen over the past several decades in response to AEs, dose reduction may not be a sufficient solution. Numerous AEs, some very costly, persist among long-term corticosteroid users, suggesting a need for further research to fill current data gaps, as well as a potential need for alternative treatment options.

Holistic Experiences and Strategies for Conducting Research With Couples.

In this article, we outline methodological considerations for conducting research interviews with couples. We draw from two qualitative men's health studies, both developed to explore social interactions between men and their partners of either sex in relation to their health practices. We utilized a combination of separate interviews and joint couple interviews. From these studies, we offer insight into our experiences of using both types of interview styles, addressing four key areas which span elements across the research project journey: (a) choosing a mode of interview, (b) ethical concerns in couple research,

Caffeine use among active duty US Army soldiers.

Eighty-percent of the US adult population regularly consumes caffeine, but limited information is available on the extent and patterns of use. Caffeine use is a public health issue and its risks and benefits are regularly considered in scientific literature and the lay media. Recently, new caffeine-containing products have been introduced and are widely available on Army bases and are added to rations to maintain cognitive performance. This study surveyed caffeine consumption and demographic characteristics in 990 US Army soldiers. Data were weighted by age, sex, rank, and Special Forces status. Total caffeine intake and intake from specific products were estimated. Logistic regression was used to examine relationships between caffeine use and soldier demographic and lifestyle characteristics. Eighty-two percent of soldiers consumed caffeine at least once a week. Mean daily caffeine consumption was 285 mg/day (347 mg/day among regular caffeine consumers). Male soldiers consumed, on average, 303 mg/day and females 163 mg/day (regular consumers: 365 mg/day for male soldiers, 216 mg/day for female soldiers). Coffee was the main source of caffeine intake. Among young males, energy drinks were the largest source of caffeine intake, but their intake was not greater than older males. Regression analysis indicated an association of higher caffeine intake with male sex, white race, and tobacco use (P<0.01). Most soldiers consume caffeine in levels accepted as safe, but some consume greater quantities than recommended, although definitive information on safe upper limits of caffeine intake is not available. Labels of caffeine-containing products should provide caffeine content so individuals can make informed decisions.

'Straight to the GP; that would be where I would go': an analysis of male frequent attenders' constructions of their decisions to use or not use health-care services in the UK.

An important consideration that needs adding to discussions of patient choice and whether or not men are reluctant to use primary care services is that many frequent attenders are male. The aim of this article is to explore how male frequent attenders construct decisions to use or not use health-care services. This is achieved through secondary analysis of baseline interviews with male frequent attenders from the Self Care in Primary Care study. As this was a complex study, a three-step analytic process was employed to incorporate the involvement of multiple researchers working together over a number of years. First, the interviewer summarised each interview and second, the summaries were read as a group to find themes across them. Subsequently, we returned to the interviews to add detail that would further illustrate or challenge the analysis. Participants talked of 'engaging health and avoiding ill-health', constructing themselves as embodied, health conscious and rational in a similar vein to constructions of feminine interactions with health. While participants talked of 'choosing health services' as if they were drawing upon a range of choices, the dominance of the image of the GP was such that seeing a GP was the only legitimate health choice.

World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries.

Eight World Health Organization (WHO) feeding indicators (FIs) and Demographic and Health Survey data for children <24 months were used to assess the relationship of child feeding with stunting and underweight in 14 poor countries. Also assessed were the correlations of FI with country gross national income (GNI). Prevalence of underweight and stunting increased with age and ≥ 50% of 12-23-month children were stunted. About 66% of babies received solids by sixth to eighth months; 91% were still breastfeeding through months 12-15. Approximately half of the children were fed with complementary foods at the recommended daily frequency, but <25% met food diversity recommendations. GNI was negatively correlated with a breastfeeding index (P < 0.01) but not with other age-appropriate FI. Regression modelling indicated a significant association between early initiation of breastfeeding and a reduction in risk of underweight (P < 0.05), but a higher risk of underweight for continued breastfeeding at 12-15 months (P < 0.001). For infants 6-8 months, consumption of solid foods was associated with significantly lower risk of both stunting and underweight (P < 0.001), as was meeting WHO guidance for minimum acceptable diet, iron-rich foods (IRF) and dietary diversity (P < 0.001); desired feeding frequency was only associated with lower risk of underweight (P < 0.05). Timely solid food introduction, dietary diversity and IRF were associated with reduced probability of underweight and stunting that was further associated with maternal education (P < 0.001). These results identify FI associated with growth and reinforce maternal education as a variable to reduce risk of underweight and stunting in poor countries.

Use of dietary supplements among active-duty US Army soldiers.

BACKGROUND: US Army soldiers engage in strenuous activities and must maintain fitness and body weight to retain their jobs. Anecdotal reports suggest that the use of dietary supplements (DSs) by soldiers may reflect their unique occupational requirements and the complexity of their job and family responsibilities. OBJECTIVE: We assessed the use of DSs by soldiers. DESIGN: We conducted a survey of 990 randomly selected soldiers at 11 army bases globally. Data were weighted by age, sex, rank, and Special Forces status to represent the active-duty army. RESULTS: Overall, 53% of soldiers reported the use of DSs ≥1 time/wk; 23% of soldiers used sports beverages, 6% of soldiers used sports bars or gels, and 3% of soldiers reported the use of meal-replacement beverages. Most commonly used DSs were multivitamins or multiminerals (37.5%), protein and amino acids (18.7%), individual vitamins and minerals (17.9%), combination products (9.1%), and herbal supplements (8.3%). Many soldiers reported the use of performance-enhancement and weight-reduction products, and 22% of soldiers consumed ≥3 different DSs/wk. Logistic regression modeling indicated that older age, educational attainment, higher body mass index, and strength training were associated with DS use (P < 0.05). Reported reasons for DS use were to improve health (64%), provide more energy (31%), increase muscle strength (25%), and enhance performance (17%). Among DS users, mean monthly expenditures on DSs were $38, whereas 23% of soldiers spent >$50/mo. CONCLUSIONS: Soldiers, like civilians, use large amounts of DSs, often in combination. Soldiers use more DSs purported to enhance performance than civilians use when matched for key demographic factors. These differences may reflect the unique occupational demands and stressors of military service.

Hierbas del Ecuador / Grass of Ecuador

Presenta las caracter¡sticas y propiedades medicinales de los principales grupos de las flora ecuatoriana. Expone la ubicaci¢n geográfica de las plantas por regiones y las condiciones climáticas adecuadas para su crecimiento...