Safety Aspects of Herb Interactions: Current Understanding and Future Prospects.

BACKGROUND: The use of herbal medicines is on the rise throughout the world due to their perceived safety profile. However, incidences of herb-drug, herb-herb and herb-food interactions considering safety aspects have opened new arenas for discussion. OBJECTIVE: The current study aims to provide comprehensive insights into the various types of herb interactions, the mechanisms involved, their assessment, and historical developments, keeping herbal safety at the central point of discussion. METHODS: The authors undertook a focused/targeted literature review and collected data from various databases, including Science Direct, Wiley Online Library, Springer, PubMed, and Google Scholar. Conventional literature on herbal remedies, such as those by the WHO and other international or national organizations. RESULTS: The article considered reviewing the regulations, interaction mechanisms, and detection of herb-herb, herb-drug and herb-food interactions in commonly used yet vital plants, including Glycyrrhiza glabra, Mentha piperita, Aloe barbadensis, Zingiber officinale, Gingko biloba, Withania somnifera, etc. The study found that healthcare professionals worry about patients not informing them about their herbal prescriptions (primarily used with conventional treatment), which can cause herb-drug/herb-food/herb-herb interactions. These interactions were caused by altered pharmacodynamic and pharmacokinetic processes, which might be explained using in-vivo, in-vitro, in-silico, pharmacogenomics, and pharmacogenetics. Nutrivigilance may be the greatest method to monitor herb-food interactions, but its adoption is limited worldwide. CONCLUSION: This article can serve as a lead for clinicians, guiding them regarding herb-drug, herb-food, and herb-herb interactions induced by commonly consumed plant species. Patients may also be counseled to avoid conventional drugs, botanicals, and foods with a restricted therapeutic window.

Adverse events of herbal decoction: A systematic review and meta-analysis over past 10 years.

BACKGROUND: Herbal decoctions (HDs) are the oldest and most common herbal medicine formulations. Different HDs exist, and some consumers are concerned that they may become contaminated during manufacturing. Therefore, the need for a safety assessment of HDs has been raised. This study aimed to investigate the adverse events (AEs) associated with HDs by comprehensively analyzing randomized controlled trials (RCTs) using systematic reviews and meta-analyses. METHODS: A systematic search was conducted on PubMed, Embase, and the Cochrane Library for articles published up to November 2022. The included RCTs compared HDs with other treatments published between 2013 and 2022, and the risk of bias was assessed using RevMan 5.4. Meta-analyses of the number of AEs associated with HDs reported in the included RCTs were also performed. RESULTS: The systematic review included 26 RCTs, and the meta-analysis included 17 RCTs that reported AEs. The meta-analysis comparing HDs with active controls showed that both the number of AEs (14 studies; risk ratio (RR)= 0.50 cases, 95 % confidence interval (CI) [0.29, 0.88]; I2 = 42 %) and the number of patients who complained of AEs (seven studies; RR=0.51 patients, 95 % CI [0.28, 0.94]; I2 =9 %) were fewer in the HDs group than in the active control groups. CONCLUSION: This study showed that HDs are safer than other conventional medications based on the results of qualitative and quantitative syntheses of RCTs.

Herbal remedies as a potential cause of hypoadrenalism.

A 37-year-old woman presented with nausea, vomiting and headache. She was found to be profoundly hyponatraemic with a sodium of 121 mmol/L, which deteriorated following a fluid challenge. An initial hyponatraemia screen identified adrenal insufficiency, with cortisol of 48 nmol/L. History confirmed she had been taking the herbal plant, ashwagandha. After 3 days of fluid restriction and steroid replacement, her sodium returned to normal (139 mmol/L). This article reviews the possible harmful effects of over-the-counter herbal remedies and highlights the importance of considering a wide differential diagnosis in patients presenting with non-specific symptoms.

Use of herbal medication in the perioperative period: Potential adverse drug interactions.

Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period.

Consumption and adverse reaction reporting of herbal medicines among people living with HIV at University teaching hospitals in Blantyre, Malawi and Ibadan, Nigeria.

Background: Consumption of herbal medicines among people living with HIV is a common practice in Sub-Saharan Africa. The utilization of herbal medicines was at 17.5% and 67.9% in Malawi and Nigeria, respectively. There is inadequate data on use and adverse reactions (ADRs) reporting of herbal medicines among people living with HIV (PLWHIV). This study was designed to investigate use and ADRs reporting of herbal medicines among PLWHIV at the University Teaching Hospitals in Blantyre, Malawi and Ibadan, Nigeria. Methodology: A cross-sectional study was conducted among PLWHIV attending Antiretroviral Therapy (ART) clinic at Queen Elizabeth Central Hospital, Blantyre, Malawi and University College Hospital, Ibadan, Nigeria. A structured questionnaire was administered to 360 and 370 participants in Blantyre and Ibadan respectively, through face-to-face interviews after obtaining their informed consent. Results: The prevalence of herbal medicines use among PLWHIV in Malawi and Nigeria was at 80.6% and 55.7% (p<0.001), respectively. The most frequently used herbal medicines in Malawi were Aloe vera (14.0%), Moringa oleifera (14.0%), Zingiber officinale (13.0%) and Allium sativum (7.0%). Likewise, in Nigeria, the most commonly used herbal medicines were Zingiber officinale (15.0%), Vernonia amygdalina (14.0%), Moringa oleifera (9.0%), and Allium sativum (11.0%). The major reason for herbal medicines' use in Malawi was ready availability (42.1%) and perception that it boosts immunity (44.6%) in Nigeria. The PLWHIV reported experiencing suspected herbal medicine ADRs in Malawi (3.9%) and in Nigeria (8.0%). Conclusion: A higher percentage of people living with HIV are using herbal medicines in Malawi as well as in Nigeria. In both countries, a few participants reported experiencing suspected ADRs related to herbal medicines.

Principales fitoquímicos con potencial terapéutico en el tratamiento de la retinopatía diabética con fitofármacos / Major Phytochemicals with Therapeutic Potential in the Treatment of Diabetic Retinopathy

La diabetes mellitus tipo 2 representa uno de los principales problemas de salud pública a nivel mundial hoy en día. Entre las principales complicaciones generadas por esta enfermedad se encuentra la retinopatía diabética, la cual puede conducir a pérdida de la visión de manera permanente, por lo que investigaciones sobre tratamientos para esta patología van en aumento. Es por esto que tratamientos en base a químicos obtenidos de plantas medicinales están siendo ampliamente investigados debido a que podrían proveer una alternativa más segura, de menor costo y menor toxicidad que la medicina estándar para el tratamiento de esta patología ocular de alta incidencia mundial. El objetivo de este estudio fue identificar los principales fitoquímicos con potencial para ser usados como tratamiento de la retinopatía diabética. Para lograr este cometido se llevó a cabo una revisión de la literatura publicada entre el enero 2017 y de junio 2021 utilizando las bases de datos WOS, PubMed y Scopus en inglés y español, con el fin de recopilar evidencia científica actualizada sobre el uso y efectos de fitoquímicos en la retinopatía diabética. Diversas familias de fitoquímicos útiles fueron identificadas, entre estas las más comunes fueron las de origen fenólico, aunque menos comunes también se encontraron carotenoides, terpenos y preparaciones constituidas por varias especies de plantas y fitoquímicos. Sus mecanismos de acción también fueron identificados, siendo los más comunes la supresión de la neovascularización mediada por VEGF, la protección y restauración de la barrera hematorretinal, la reducción en la actividad de las especies reactivas del oxígeno y el efecto antiinflamatorio. Dada la evidencia respecto a la utilidad de los fitoquímicos para el tratamiento de la retinopatía diabética, mayores investigaciones deben ser realizadas(AU)

Type 2 diabetes mellitus represents one of the main public health problems worldwide today. Among the main complications generated by this disease is diabetic retinopathy, which can lead to permanent vision loss. For this reason, research on treatments for this pathology is increasing. This is why treatments based on chemicals obtained from medicinal plants are widely investigated as they could provide a safer, less costly and less toxic alternative to standard medicine for the treatment of this eye disease of high incidence worldwide. The aim of this study was to identify the main phytochemicals with potential to be used as treatment for diabetic retinopathy. In order to achieve this purpose, a review of the literature published between January 2017 and June 2021 was conducted using the WOS, PUBMED and Scopus databases in English and Spanish, in order to compile updated scientific evidence on the use and impact of phytochemicals in diabetic retinopathy. Several families of useful phytochemicals were identified. Among these, the most common were those of phenolic origin, although less common were also found carotenoids, terpenes and blends consisting of various plant species and phytochemicals. Their mechanisms of action were also identified, the most common being suppression of vascular endothelial growth factor-mediated neovascularization, protection and restoration of the blood-retinal barrier, reduction in reactive oxygen species activity and anti-inflammatory effect. Given the evidence regarding the usefulness of phytochemicals for the treatment of diabetic retinopathy, further research should be conducted(AU)

Uso de medicamentos y fitofármacos en madres durante periodo de lactancia / Use of medicines and phytopharmaceuticals in mothers during breastfeeding

El único alimento que debe recibir el bebé durante los primeros 6 meses de vida es la leche de su madre. Cualquier sustancia que ella consuma mientras esté lactando tiene repercusiones en su hijo, por lo que la utilización de medicamentos, fitofármacos u otras sustancias debe ser por prescripción facultativa y rigurosamente vigilada. Con el objetivo de caracterizar el uso de medicamentos y fitofármacos en madres durante el periodo de lactancia, se realizó un estudio observacional descriptivo, de corte transversal, en diez consultorios urbanos de Bayamo, provincia Granma, durante el periodo septiembre 2017 a abril 2018. El universo agrupó a las madres lactantes pertenecientes a dichos consultorios, y la muestra la integraron las que aceptaron ser incluidas en la investigación, previo consentimiento informado. Se caracterizaron las madres según las variables siguientes: nivel de escolaridad, medicamentos y fitofármacos consumidos, duración de la lactancia materna exclusiva según consumo de medicamentos y tipo de medicamento que motivó la suspensión de la lactancia materna. Se emplearon métodos teóricos, empíricos y como estadísticos (de la estadística descriptiva, las frecuencias absolutas y relativas). Como resultados relevantes, el 64 por ciento de las madres tenía entre 20 y 34 años y el 54,7 por ciento había vencido el nivel de escolaridad preuniversitario; el 69,3 consumía medicamentos y 41,3 por ciento, fitofármacos, destacando dipirona e ibuprofeno en los primeros y la menta, en los segundos. Se concluyó que los medicamentos más influyentes en la suspensión de la lactancia materna fueron el clorodiazépoxido y la amiodarona(AU)

The only food that the baby should receive during the first 6 months of life is the milk of his mother. Any substance she consumes while breastfeeding has repercussions on her child, so the use of medications, phytopharmaceuticals or other substances must be by prescription and strictly monitored. In order to characterize the use of medicines and phytopharmaceuticals in mothers during the period of breastfeeding, a descriptive, cross-sectional observational study was conducted in ten urban offices in Bayamo, Granma province, during the period September 2017 to April 2018. The universe grouped nursing mothers belonging to these offices, and the sample was made up of those who agreed to be included in the research, with prior informed consent. Mothers were characterized according to the following variables: level of schooling, medications and phytodrugs consumed, duration of exclusive breastfeeding according to medication consumption and type of medication that led to the suspension of breastfeeding. Theoretical, empirical and statistical methods were used (from descriptive statistics, absolute and relative frequencies). As relevant results, 64 percent of the mothers were between 20 and 34 years old and 54.7 percent had overcome the level of pre-university education; 69.3 consumed medications and 41.3 percent, phytopharmaceuticals, highlighting dipyrone and ibuprofen in the former and mint, in the latter. It was concluded that the most influential medications in the suspension of breastfeeding were chlorodiazopoxide and amiodarone(EU)

Genotoxicidade de Helianthus annuus Linné, 1753 (Asteraceae): novas perspectivas e tendências / Genotoxicity of Helianthus annuus Linné, 1753 (Asteraceae): new perspectives and trends

A presente revisão reúne informações acerca dos aspectos genotóxicos de Helianthus annuus Linné (girassol), até o presente momento na literatura. O girassol é uma importante fonte de óleo natural e sua ampla aplicabilidade é atribuível ao variável repertório fitoquímico. A ação preventiva da diurese, diarreia e doenças inflamatórias, além dos efeitos de alívio dos sintomas asmáticos, proteção gástrica, cicatrização, ação anti-inflamatória e antimicrobiana foram reconhecidas quanto às propriedades farmacológicas do girassol. Com um grande potencial fitoquímico, é importante também analisarmos seu potencial tóxico e genotóxico. Vários resultados inconclusivos a respeito da correlação entre a carcinogênese e o óleo de girassol foram observados na literatura. Por outro lado, um número limitado de informações sobre a mutagênese ou antimutagênese do extrato hidroalcoólico e distintas fontes do óleo de sementes de girassol, submetido ou não ao estresse térmico, foi relatado. Esta revisão apresentará os atuais trabalhos envolvendo a ação genotóxica ou anti genotóxica de H. annuus L., colaborando com a implantação de limites ao consumo, potenciais riscos à saúde ou medidas estratégicas quimiopreventivas.(AU)

The present review gathers information about the genotoxic aspects of Helianthus annuus Linné (sunflower), until the present moment in the literature. Sunflower is an important source of natural oil and its wide applicability is attributable to the variable phytochemical repertoire. The preventive action of diuresis, diarrhea and inflammatory diseases, besides the effects of relief of asthmatic symptoms, gastric protection, healing, anti-inflammatory and antimicrobial action were recognized regarding the pharmacological properties of the sunflower. With great phytochemical potential, it is also important to analyze its toxic and genotoxic potential. Several inconclusive results regarding the correlation between carcinogenesis and sunflower oil were observed in the literature. On the other hand, a limited number of information on the mutagenesis or anti-mutagenesis of the hydroalcoholic extract and different sources of sunflower seed oil, whether or not subjected to thermal stress, was reported. This review will present the current works involving the genotoxic or anti genotoxic action of H. annuus L., collaborating with the implementation of consumption limits, potential health risks or strategic chemopreventive measures.(AU)

Aspectos botânicos e clínicos das intoxicações por plantas das Famílias Araceae, Euphorbiaceae e Solanaceae no Estado de Pernambuco / Bothanical and clinical aspectos of intoxications caused by plants of the Araceae, Euphorbiaceae and Solanaceae family in the state of Pernambuco

Trata-se de um estudo investigativo sobre os aspectos botânicos e clínicos das intoxicações humanas provocadas por espécies das famílias Araceae, Euphorbiaceae e Solanaceae. É um estudo transversal, descritivo, com abordagem quantitativa, aprovado pelo Comitê de Ética do Hospital da Restauração. Os dados referentes ao período de 1992 a 2009 foram coletados no Centro de Assistência Toxicológica de Pernambuco (CEATOX). Dos 214 prontuários analisados, 140 tiveram diagnóstico de intoxicação por espécies das famílias Araceae (55%; n=77); Euphorbiaceae (36,43%; n=51) e Solanaceae (8,57%; n=12). A maioria das Araceae foi representada por Dieffenbachia amoena Bull (50%); Euphorbiaceae por Manihot esculenta Crantz (11,42%) e Solanaceae por Brugmansia suaveolens (Willd.) Bercht. & J. Presl. (5,71%), utilizadas como ornamental, alimentícia, medicinal, em brincadeiras infantis e suicídio. Em consequência da ingestão de partes dessas plantas os sintomas apresentados foram: edema (língua, lábio), náusea, diarreia, rubor facial, midríase, alucinações e dores abdominais. O tratamento constou de observação clínica (45,31%) e tratamento sintomático (40,18%). A gravidade das intoxicações foi classificada como aguda moderada em 79,69% dos pacientes.(AU)

This is an investigative study about the clinical and botanical aspects of human poisoning caused by plants of the species Araceae, Euphorbiaceae and Solanaceae. It is a cross-sectional descriptive study with a quantitative approach, approved by the Restoration Hospital Ethics Committee. Data was collected at the Toxicological Assistance Centre of Pernambuco (CEATOX) comprising the period of 1992 to 2009. 214 records were analyzed, 140 had an intoxication diagnostic from the families: Araceae (55%, n = 77); Euphorbiaceae (36,43%; n = 51) and solanaceae (8,57%; n = 12). Aracea was majorly represented by Dieffenbachia Amoena Bull (50%); Euphorbiaceae by Manihot esculenta Crantz (11,42%) and Solanaceae by Brugmansia suaveolens (Willd.) Bercht. & J. Presl. (5, 71%) that were used as ornamental plants, food, medicine, in children's play and suicide attempts. As a result of ingestion of parts of the plant the symptoms were edema (tongue, lips), nausea, diarrhea, facial flushing, mydriasis, hallucinations and abdominal pain. Treatment consisted of clinical observation (45,31%) and symptomatic treatment (40,18%). The severity of the intoxications was classified as 'moderate acute' in 79,69% of patients.(AU)

Aplicación de la Medicina Natural y Tradicional y dificultades para su uso en Estomatología / Uses of Natural and Traditional Medicine and difficulties for its application in dentistry

Introducción: en Cuba con la introducción de la Medicina Natural y Tradicional en Estomatología, se amplía el enfoque terapéutico para las afecciones bucomaxilofaciales. No obstante, en la actualidad se observan dificultades para su aplicación. Objetivos: describir algunos aspectos de la aplicación de la Medicina Natural y Tradicional por estomatólogos del municipio Playa e identificar las dificultades que perciben para su utilización. Métodos: se realizó un estudio descriptivo de corte transversal, de enero a mayo del año 2012, con la aplicación de un cuestionario elaborado al efecto a una muestra de 88 estomatólogos del municipio Playa, La Habana, Cuba. Las variables estudiadas fueron: años de graduado, especialidad, maestría, aplicación de la Medicina Natural y Tradicional en el tratamiento estomatológico, terapias aplicadas con mayor frecuencia, dificultades para su aplicación y recomendaciones para favorecer su utilización. Resultados: en la muestra, el 58,0 por ciento correspondió a profesionales con 1 a 20 años de graduados y el 60,2 por ciento a especialistas en Estomatología General Integral. El 97,7 por ciento refirió hacer uso de la Medicina Natural y Tradicional en el tratamiento estomatológico; la terapia más aplicada resultó ser la Fitoterapia (80,7 por ciento). El 62,5 por ciento refirió como dificultad, falta de conocimiento sobre estas terapias y el 35,2 por ciento recomendó realizar cursos sobre las mismas. Conclusiones: casi la totalidad de los encuestados refirieron aplicar la Medicina Natural y Tradicional en el tratamiento estomatológico. Las principales dificultades referidas para su aplicación fueron la falta de conocimiento sobre estas terapias y no disponer regularmente de los recursos necesarios en la consulta(AU)

Introduction: the incorporation of Natural and Traditional Medicine into dental practice has broadened the scope of therapies for oral and maxillofacial disorders. However, difficulties are still found for its application. Objectives: describe some aspects of the application of Natural and Traditional Medicine by dentists from the municipality of Playa and identify the difficulties perceived for its application. Methods: a descriptive cross-sectional study was conducted from January to May 2012 based on a dedicated questionnaire applied to 88 dentists from the municipality of Playa, Havana, Cuba. The variables studied were years after graduation, specialty, master's degree, application of Natural and Traditional Medicine in dental treatment, therapies most commonly used, difficulties for their application and recommendations to improve their use. Results: from the overall study sample, 58.0 percent were professionals with 1 to 20 years' experience after graduation, whereas 60.2 percent were General Comprehensive Dentistry specialists. 97.7 percent stated they made use of Natural and Traditional Medicine in dental treatment. The therapy most commonly employed was phytotherapy (80.7 percent). 62.5 percent said that insufficient knowledge about these therapies was a difficulty, and 35.2 percent recommended to implement courses about them. Conclusions: almost all surveyed dentists said they included Natural and Traditional Medicine in their dental practice. The main difficulties cited in its application were lack of knowledge about these therapies and non-availability of the resources required in dental consultation offices(AU)

Aplicación de la Medicina Natural y Tradicional y dificultades para su uso en Estomatología / Uses of Natural and Traditional Medicine and difficulties for its application in dentistry

Introducción: en Cuba con la introducción de la Medicina Natural y Tradicional en Estomatología, se amplía el enfoque terapéutico para las afecciones bucomaxilofaciales. No obstante, en la actualidad se observan dificultades para su aplicación. Objetivos: describir algunos aspectos de la aplicación de la Medicina Natural y Tradicional por estomatólogos del municipio Playa e identificar las dificultades que perciben para su utilización. Métodos: se realizó un estudio descriptivo de corte transversal, de enero a mayo del año 2012, con la aplicación de un cuestionario elaborado al efecto a una muestra de 88 estomatólogos del municipio Playa, La Habana, Cuba. Las variables estudiadas fueron: años de graduado, especialidad, maestría, aplicación de la Medicina Natural y Tradicional en el tratamiento estomatológico, terapias aplicadas con mayor frecuencia, dificultades para su aplicación y recomendaciones para favorecer su utilización. Resultados: en la muestra, el 58,0 por ciento correspondió a profesionales con 1 a 20 años de graduados y el 60,2 por ciento a especialistas en Estomatología General Integral. El 97,7 por ciento refirió hacer uso de la Medicina Natural y Tradicional en el tratamiento estomatológico; la terapia más aplicada resultó ser la Fitoterapia (80,7 por ciento). El 62,5 por ciento refirió como dificultad, falta de conocimiento sobre estas terapias y el 35,2 por ciento recomendó realizar cursos sobre las mismas. Conclusiones: casi la totalidad de los encuestados refirieron aplicar la Medicina Natural y Tradicional en el tratamiento estomatológico. Las principales dificultades referidas para su aplicación fueron la falta de conocimiento sobre estas terapias y no disponer regularmente de los recursos necesarios en la consulta(AU)

Introduction: the incorporation of Natural and Traditional Medicine into dental practice has broadened the scope of therapies for oral and maxillofacial disorders. However, difficulties are still found for its application. Objectives: describe some aspects of the application of Natural and Traditional Medicine by dentists from the municipality of Playa and identify the difficulties perceived for its application. Methods: a descriptive cross-sectional study was conducted from January to May 2012 based on a dedicated questionnaire applied to 88 dentists from the municipality of Playa, Havana, Cuba. The variables studied were years after graduation, specialty, master's degree, application of Natural and Traditional Medicine in dental treatment, therapies most commonly used, difficulties for their application and recommendations to improve their use. Results: from the overall study sample, 58.0 percent were professionals with 1 to 20 years' experience after graduation, whereas 60.2 percent were General Comprehensive Dentistry specialists. 97.7 percent stated they made use of Natural and Traditional Medicine in dental treatment. The therapy most commonly employed was phytotherapy (80.7 percent). 62.5 percent said that insufficient knowledge about these therapies was a difficulty, and 35.2 percent recommended to implement courses about them. Conclusions: almost all surveyed dentists said they included Natural and Traditional Medicine in their dental practice. The main difficulties cited in its application were lack of knowledge about these therapies and non-availability of the resources required in dental consultation offices(AU)

Syndrome of inappropriate antidiuretic hormone secretion induced by the phytotherapy Harpagophytum procumbers: case report / Síndrome da secreção inapropriada do hormônio antidiurético induzida pelo fitoterápico Harpagophytum procumbers: relato de caso

Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the inability of antidiuretic hormone (ADH) suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.

Resumo Introdução: A síndrome da secreção inapropriada do hormônio antidiurético (SIADH) consiste na incapacidade de supressão do hormônio antidiurético (ADH), comprometendo os mecanismos de excreção da água e concentração urinária. Possui como manifestações a hiponatremia e seus sintomas, sobretudo neurológicos. Há variadas causas que desencadeiam tal distúrbio, a se destacarem: distúrbios do sistema nervoso central, neoplasias malignas e drogas, dentre outros. Relato de Caso: Paciente feminina, 65 anos, hipertensa, apresentando manifestações clínicas e laboratoriais correspondentes à hiponatremia. O fato ocorreu em duas ocasiões em vigência de medicação fitoterápica para tratamento de osteoartrite. Discussão: A hiponatremia relacionada às drogas pode ser provocada pelo efeito direto do medicamento ou por desencadear SIADH. As manifestações clínicas apresentadas poderiam ter sido atribuídas a um quadro psiquiátrico, o que poderia ter desfecho grave, caso não diagnosticada corretamente. A associação de um fitoterápico à SIADH pôde ser confirmada após novo episódio de hiponatremia relacionado à reintrodução do Harpagophytum procumbers. Nossa revisão da literatura não encontrou este fitoterápico associado à SIADH, até o momento. Conclusão: SIADH pode ser ocasionada por medicamento fitoterápico doravante descrita sua associação na literatura.

Morinda citrifolia: fatos e riscos sobre o uso do noni / Morinda citrifolia: Facts and Risks About the use of noni

Morinda citrifolia L. (Rubiaceae), popularmente conhecida como noni, é amplamente utilizada na Polinésia e no Havaí, para tratamento de diversas patologias, como: dislipidemia, diabetes, câncer, hipertensão, cicatrização, dentre outras. Atualmente, observa-se também o uso exacerbado no Brasil, especialmente na região Nordeste, onde a planta se adaptou bem. Porém, ainda não há certeza da sua eficácia, e muitas pesquisas sobre a ação terapêutica do noni estão em desenvolvimento, embora os resultados sejam bastante controversos. O que torna o noni uma planta diferenciada e que requer atenção especial é seu potencial hepatotóxico. A Agência Nacional de Vigilância Sanitária (ANVISA) fundamenta a sua recomendação de não utilizar o noni, também, com base em relatos de toxicidade em humanos. Este trabalho é uma revisão da literatura, com objetivo de avaliar o potencial terapêutico desta planta de acordo com os estudos já desenvolvidos. Dessa forma, é possível realizar uma análise crítica do uso irracional desta planta e contribuir com a divulgação de possíveis riscos à saúde.(AU)

Morinda citrifolia L. (Rubiaceae), noni, is used in Polynesia and Hawaii in folk medicine against several pathologies. Nowadays it is in process an irrational and dangerous use by Brazilians, especially in Northeastern, since this species is easily cultivated in our climate. The evaluable scientific evidences are not enough to guarantee the noni effectiveness and security. The point is the hepatotoxic potential by noni use. The Brazilian sanitary authorities recommend that the population should not use noni founded on some reported hepatotoxic cases. This paper aims to compile information about chemical, pharmacological and toxicological aspects regarding noni scientific data to contribute to the knowledge about the possible risks to health.(AU)

Hepatotoxicidade relacionada ao uso de suplementos herbais e dietéticos (HDS) / Hepatotoxicity related to the use of herbal dietary supplements (HDS)

Os suplementos herbais e dietéticos (HDS) estão sendo cada vez mais consumidos, principalmente para perda de peso, melhora da estética corporal, prevenção de doenças e retardo dos efeitos do envelhecimento. Existe uma crença popular de que os HDS são seguros, porém, o número de relatos de casos de hepatotoxicidade vem aumentando entre os usuários destes produtos. Dessa forma, o objetivo principal desta revisão bibliográfica foi discorrer sobre a relação entre o uso dos HDS e a hepatotoxicidade, através de análises dos casos clínicos descritos na literatura. Para tal, foi utilizado como metodologia o levantamento de dados de natureza básica, qualitativa e exploratória. Foram localizados um total de 278 documentos referentes ao assunto, destes, 36 atenderam ao objeto de estudo. A característica clínica mais prevalente, nos casos de hepatotoxicidade identificados, foi a lesão hepatocelular, seguida de lesão mista e colestática, assim como a ocorrência de óbitos e pacientes que, por necessidade, foram submetidos a transplante de fígado. Após o levantamento de dados, para a construção desta revisão, foi perceptível a relação entre a hepatotoxicidade e o uso indiscriminado de HDS.(AU)

The herbal dietary supplements (HDS) are being increasingly consumed, mainly for weight loss, improved body aesthetics, disease prevention and delayed effects of aging. There is a popular belief that HDS are safe, however, the number of reports of cases of hepatotoxicity have increased among users of these products. Thus, the main objective of this bibliographic review was to discuss the relationship between the use of HDS and hepatotoxicity, through analyzes of clinical cases described in the literature. For this purpose, a methodology was used to collect basic, qualitative and exploratory data. A total of 278 documents related to the subject were found, of which 36 met the study object. The most prevalent clinical characteristic in the cases of hepatotoxicity identified were hepatocellular lesions, followed by mixed and cholestatic lesions, as well as the occurrence of deaths and patients who needed to undergo liver transplants. After all the data collection performed for the construction of this review, the relationship between hepatotoxicity and the indiscriminate use of HDS was perceptible.(AU)

Fitoterápicos na Rede Pública de Saúde (SUS) no Brasil: Um estudo toxicológico de Mikania glomerata em fetos de ratas Wistar / Herbal Medicines in the Brazilian Public Health System (SUS): A toxicological study of Mikania glomerata in Wistar rat fetuses

Embora seja notável o avanço no uso popular de plantas com finalidade terapêutica, estudos são necessários para demonstrar seus potenciais tóxicos, já que grande parte dos usuários de fitoterápicos os considera inócuos. Durante a gestação, a maioria das alterações no feto é decorrente da exposição da mãe a agentes químicos, podendo ocorrer efeitos abortivos, teratogênicos e citotóxicos. A relevância deste trabalho se deve a escassez de estudos sobre os efeitos tóxicos do extrato de Mikania glomerata, popularmente conhecida como guaco, durante o período gestacional. Foram estudadas ratas Wistar prenhes (normotensas e espontaneamente hipertensas) sob tratamento com extrato seco de M. glomerata (2mL) e avaliada a morfologia do fígado dos fetos. Todos os grupos apresentaram fetos vivos sem alterações macroscópicas, perda pré-implantação e reabsorção fetal normal. Não houve alterações anatômicas nos fígados, apenas presença de monócitos e linfócitos nas veias-centrolobulares. Conclui-se que o extrato, na concentração e formulação estudadas, não apresentou toxicidade aos fetos.(AU)

Although remarkable advances in the use of herbal medicine were observed, studies are needed to demonstrate the toxic potential of their compounds, since most of their users consider them effective and safe. During pregnancy, most of the abnormal changes in the fetus is mainly due to the mother's exposure to chemicals, resulting in abortion or teratogenic and cytotoxic effects to the mother and neonate. The relevance of this research is due to the lack of studies on the toxic effects of Mikania glomerata. popularly known as "guaco" - extract administration during the gestational period. Experimental groups of normotensive and spontaneously hypertensive pregnant Wistar rats were studied. The animals were treated with M. glomerata extract (2 ml) and the morphology of fetal liver was evaluated to evaluate the possible toxic effects of M. glomerata to fetuses. In all groups the live fetuses were without macroscopic changes and the pre-implantation loss or normal fetal reabsorption were physiologically normal (data not shown). There were no anatomical or histological changes in the livers of fetuses studied, which showed centrilobular veins with the presence of monocytes and lymphocytes. The results lead the conclusion that M. glomerata extract, at the tested concentration, did not show toxicity to rats' fetuses.(AU)

A importância da informação do profissional de enfermagem sobre o cuidado no uso das plantas medicinais: uma revisão de literatura / Vocational information about the importance of nursing care in the use of medicinal plants: literature review

Desde a antiguidade a humanidade procura na natureza plantas com poder curativo. O emprego das plantas medicinais/fitoterápicos na recuperação da saúde tem evoluído ao longo dos tempos, desde as formas mais simples (chá) até as de fabricação industrial (fitofármacos). O objetivo do trabalho é advertir sobre o uso correto de plantas medicinais/fitoterápicos, para que os profissionais de enfermagem adquiram um maior conhecimento técnico/científico para orientar os pacientes adequadamente. Foram acessados bancos de dados bibliográficos e bases eletrônicas de dados PubMed e SciElo. Foram observadas inúmeras intoxicações, interações, e demais problemas que o uso incorreto e a automedicação das plantas medicinais/fitoterápicos podem acarretar a saúde. Cuidados em como utilizar plantas que você conhece; nunca coletar plantas medicinais próximas a lixos ou fossas; evitar misturar várias espécies de plantas medicinais; observar as dosagens adequadas é fundamental para o uso correto. A falta de conhecimento e o parco incentivo para estudar as Práticas Alternativas e Complementares, entre os profissionais de enfermagem, fazem com que os mesmos fiquem desprovidos de informações fidedignas para esclarecer as dúvidas dos pacientes sobre o uso correto, desestimulando assim o uso desta terapia alternativa.(AU)

Since ancient times, humanity seeks for the power of plants for healing. The use of medicinal/herbal plants for health care has evolved from the simplest forms (the teas) toward industrial production (the phytopharmaceuticals). Current review is based on bibliographic and electronic data bases of PubMed e Scielo accounting for numerous cases of intoxication, interactions, and other health problems caused by the incorrect use of medicinal plants/phytotherapy, as well as self-medication. The objective of this research is to warn about the correct use of medicinal plants/phytotherapy, so that nursing professionals may assess more technical / scientific knowledge, and appropriately guide their patients. We propose some essential procedures for the correct use of medicinal plants, namely, (1) be careful when using familiar plants; (2) do not collect medicinal plants near waste pits or cesspools; and (3) observe adequate dosages. We could observe that the lack of knowledge on the use of medicinal plants has limited their study among the nursing professionals. Moreover, the lack of encouragement for studying the Integrative and Complementary Practices, among the nursing professionals, has generated a void of reliable information, and has created real inability to answer the patient's questions about the adequate use of medicinal plants, thus discouraging their use as alternative therapy.(AU)

Acute renal failure due to henna stone ingestion as a remedy of diabetes / Fallo renal agudo debido a la ingestión de cálculos de henna en el tratamiento de la diabetes

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Epidemiologia das intoxicações por plantas notificadas pelo Centro de Assistência Toxicológica de Pernambuco (CEATOX-PE) de 1992 a 2009 / Epidemiology of plant poisoning cases reported at the Toxicological Assistance Centre of Pernambuco (CEATOX-PE) between 1992 and 2009

Objetivou-se com este estudo, caracterizar os aspectos epidemiológicos das intoxicações humanas, ocasionadas por plantas no Estado de Pernambuco (PE), através de uma abordagem transversal e descritiva a partir de notificações obtidas no Centro de Assistência Toxicológica deste Estado, no período de 1992 a 2009. Foram analisados 214 prontuários com base nas variáveis: sexo, faixa etária, agente tóxico vegetal, sazonalidade, zona de ocorrência, local do acidente, via de exposição, circunstância, tipo de atendimento, evolução clínica. As intoxicações predominaram no sexo feminino (52,34%), faixa etária de 1 a 4 anos (42,52%), e a maioria ocorreu nos meses de fevereiro, agosto e outubro. A maioria das intoxicações foi na área urbana (74,30%), em acidentes nas residências (72,90%), através de plantas, sendo que 85% por via oral. A família Araceae foi responsável por 35,98% das intoxicações, seguida das famílias Euphorbiaceae 23,83% e Solanaceae com 5,60% dos casos. Os pacientes foram atendidos e a gravidade dos casos, em sua maioria, evoluiu para melhora de saúde, não sendo possível fazer o registro de cura, pelo fato de os mesmos deixarem o hospital sem a devida alta. Espera-se alertar os profissionais de saúde da importância das plantas, como fator de risco de intoxicação, possibilitando o estabelecimento de políticas públicas de prevenção e promoção da saúde.(AU)

The objective of this study was to characterize the epidemiological aspects of human poisoning caused by plants in the State of Pernambuco. This is a cross-sectional descriptive study from notifications obtained in the Toxicological Assistance Centre of Pernambuco (CEATOX), between 1992-2009. 214 records were analyzed using these variables: sex, age group, vegetal toxic agent, seasonality, occurrence zone locations, poisoning site, way of contamination, circumstances of poisoning, type of treatment, and the outcome. Poisoning predominated in females (52.34%) aged 1 to 4 years (42.52%) and the majority occurred in February, August and October. Most poisonings took place in the urban zone (74.30%), caused by home accidents (72.90%) by the oral ingestion of the toxic agent (85%). The family Araceae accounted for (35.98%) of poisonings, followed by Euphorbiaceae families (23.83%) and Solanaceae with (5.60%). Patients were treated and mostly evolved into health improvement, but we lack data regarding cure due to the fact that the patients left the hospital without proper medical release. We hope to alert health professionals of the importance of poisonous plants as a risk factor, enabling the establishment of new public policies for health promotion and prevention for the general public.(AU)