Quantitative analysis of aconitine in body fluids in a case of aconitine poisoning.

Aconitine belongs to the Aconitum alkaloids and is a natural toxic substance. Aconitine has been used as a traditional medicine in East Asian culture. Today, aconitine is still in use with or without a prescription, in the Republic of Korea. Here we present a case report of accidental death due to acute aconitine poisoning. An 81-year-old woman ingested liquid that had been heat extracted from the root of the Aconitum plant; she presented to the emergency room 1 h after ingestion. Her electrocardiogram showed irregular ventricular arrhythmias including ventricular tachycardia; she progressed to cardiac arrest. Cardiopulmonary resuscitation and anti-arrhythmic drugs were administered, but the patient did not survive. An autopsy was performed 2 days postmortem. Toxicological analysis was performed, and aconitine was detected by liquid chromatography tandem mass spectrometry. The antemortem blood concentration of aconitine was 39.1 ng/ml and the concentrations of aconitine in the postmortem cardiac blood, peripheral blood, cerebrospinal fluid (CSF), pericardial fluid, and urine were 21.1 ng/ml, 28.6 ng/ml, 6.8 ng/ml, 24.1 ng/ml, and 67.4 ng/ml, respectively. This is the first forensic case report of an aconitine poisoning death in the Republic of Korea with quantitative measurement of aconitine in the antemortem blood and various postmortem body fluids. To the best of our knowledge, this is the first report of the detection of aconitine in the CSF. These data about the distribution of aconitine in the antemortem blood and various postmortem body fluids is helpful for future aconitine poisoning death cases.

Hospital-acquired fever in oriental medical hospitals.

BACKGROUND: Traditional Oriental medicine is used in many Asian countries and involves herbal medicines, acupuncture, moxibustion, and cupping. We investigated the incidence and causes of hospital-acquired fever (HAF) and the characteristics of febrile inpatients in Oriental medical hospitals (OMHs). METHODS: Patients hospitalized in two OMHs of a university medical institute in Seoul, Korea, were retrospectively reviewed from 2006 to 2013. Adult patients with HAF were enrolled. RESULTS: There were 560 cases of HAF (5.0%). Infection, non-infection, and unknown cause were noted in 331 cases (59.1%), 109 cases (19.5%), and 120 cases (21.4%) of HAF, respectively. Respiratory tract infection was the most common cause (51.2%) of infectious fever, followed by urinary tract infection. Drug fever due to herbal medicine was the most common cause of non-infectious fever (53.1%), followed by procedure-related fever caused by oriental medical procedures. The infection group had higher white blood cell count (WBC) (10,400/mm3 vs. 7000/mm3, p < 0.001) and more frequent history of antibiotic therapy (29.6% vs. 15.1%, p < 0.001). Multivariate analysis showed that older age (odds ratio (OR) 1.67, 95% confidence interval (C.I.) 1.08-2.56, p = 0.020), history of antibiotic therapy (OR 3.17, C.I. 1.85-5.41, p < 0.001), and WBC > 10,000/mm3 (OR 2.22, C.I. 1.85-3.32, p < 0.001) were associated with infection. CONCLUSIONS: Compared to previous studies on HAF in Western medicine, the incidence of HAF in OMHs was not high. However, Oriental medical treatment does play some role in HAF. Fever in patients with history of antibiotic therapy, or high WBC was more likely of infectious origin.

The Comparative Double-Blind Clinical Study in Antihelmintic Efficacy Between Thai Traditional Herbal Formulae and Mebendazole.

This study was carried out in Mahasarakham Primary Healthcare Centre, Mahasarakham province in the area of Northeastern of Thailand. The experiment was randomized controlled trial in the clinical study to examine the efficacy of Thai Traditional Herbal Formula (TTHF) in the treatment of antihelmintic activity of mixed worm infections in human. The 2 experimental groups consisted of 10 patients, and 5 patients for control group with inclusion and exclusion criteria, who were screened by the selection of mixed worm infection symptom samples. The investigation and extraction of worm eggs per gram (EPG) of patient feces method were performed with Ether-Formalin Sedimentation test. The percentage of reduction of EPG of patient feces were collected, counted, and confirmed by parasitologist, and the clinical efficacy was investigated by the physician and the pharmacist. The percent EPG data were collected before and after the treatment with TTHF and with mebendazole. The result showed that TTHF had higher efficacy in antihelmintic activity than mebendazole and placebo, which had the percent reduction of EPG of feces as 93.69 in TTHF and percent reduction of EPG of feces as 87.50 in mebendazole. The suggestion of this study should increase the number of samples of worm-infected patients, which the samples can be identified with the specific helminths genus and species to obtain the efficacy by the treatment using TTHF and mebendazole comparatively.

Signal detection for Thai traditional medicine: examination of national pharmacovigilance data using reporting odds ratio and reported population attributable risk.

Herbal containing medicine consumption has increased while the awareness of adverse drug reaction (ADR) was less than conventional medicine. Early detection of unexpected numbers of ADRs from herbal medicines' reports which are abnormal from the whole database needs quantification. Disproportionality analysis has been performed for signal detection by using reporting odds ratio (ROR) as measurement. The impact of having medicine as exposures in each ADR should be measured by using reported population attributable risks (RPAR). This study aimed to quantify the contribution of Thai traditional medicine (TTM) to ADR reports and to assess the association between TTMs and serious adverse drug reactions. Data were retrieved from the adverse drug reaction surveillance database, Thai-Food and Drug Administration from 2002 to 2013. Crude and adjusted RORs for each drug-ADR pair and RPARs were computed. TTM contributed only 0.001% of all serious ADRs reported. Out of 4208 TTM-ADR pairs were examined, three had the statistically significant RORs, namely Andrographis paniculata and anaphylactic shock (ROR 2.32, 95% CI 1.03, 5.21); green traditional medicine and Stevens-Johnson syndrome (ROR 13.04, 95% CI 5.4-31.51) and Derris scandens Benth and angioedema (ROR 2.71, 95% CI 1.05-6.95). Their RPARs ranged from 0.05% to 0.16%. We conclude that TTMs need more intensive surveillance.

Efficacy and Safety of East Asian Herbal Medicine for Brain Metastases in Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis Protocol to Identify Specific Herbs.

INTRODUCTION: Brain metastasis (BM) is a significant risk factor for survival and prognosis in non-small cell lung cancer (NSCLC). While surgical resection and radiotherapy are the primary treatment modalities, the overall prognosis in NSCLC patients with BM remains poor, and all therapies lead to adverse events. East Asian herbal medicine (EAHM) has broad prospects as an adjuvant treatment, but its efficacy and safety remain controversial. We propose to conduct a systematic review and meta-analysis to summarize the clinical efficacy and safety of EAHM for the treatment of NSCLC with BMs and to identify specific herbs that can improve the prognosis. METHODS: The PubMed, EMBASE, CENTRAL, Web of Science, CBM, CNKI, Wanfang, VIP, Evidence Reports on Kampo Treatment, ICHUSHI, and Oriental Medicine Advanced Searching Integrated System databases will be searched from their inception to October 2022. Randomized controlled trials will be included. Two authors will evaluate the eligibility and quality of the included trials. The methodological quality will be assessed using the RoB 2 tool, and Stata 16 will be used for data synthesis. Publication bias will be assessed using funnel plots and Egger tests. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system will evaluate the quality of the synthesized evidence. Further sensitivity analyses will be performed to determine the efficacies of specific herbs in EAHM. DISCUSSION: Given there are currently no systematic reviews and meta-analyses of the efficacy of EAHM as a treatment for NSCLC with BMs, a compilation and analysis of the available high-quality clinical research evidence are essential. The results will help establish guidelines for the application of specific herbs as a complementary alternative therapy for BMs in NSCLC. The findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022300527.

Current status of Oriental medicine in treating Korean allergy patients.

PURPOSE: To evaluate the prevalence, compliance, pattern of use, and economic cost of OM in Korean allergy patients. METHODS: A total of 647 allergy patients were enrolled from 10 general hospitals, and were surveyed by the questionnaire. It consisted of 12 items and regarded the prescription rates, reasons for referring, their opinions for the efficacy of OM, and economic costs. RESULTS: A total of 259 (40.5%) patients had used OM, and 35.5% of these patients experienced two or more kinds of these practices. A patients' income or education level did not affect the prescription rates of OM. Of the patients that used OM, 34.6% of them were satisfied with the effect of OM treatment, and 40.9% of them were inclined to continue with their OM treatments. The most frequent reasons for choosing OM were the patient's belief that OM can predispose 'allergic constitution to normal' (30.2%), worries about the possible adverse reactions of the long-term administration of the proven drugs (20.2%), and the safety of OM (15.6%). However, 18.9% of these patients experienced perceived adverse events to their OM treatment such as skin rashes, gastrointestinal discomfort, and hepatitis. The patients that have used OM spent on average $915 US dollars annually for OM treatment. CONCLUSIONS: Many Korean allergy patients are cliental to OM. Some patients experienced a satisfactory treatment effect from OM, however, others had no treatment effect, even adverse event. Therefore, it is important to educate people to use OM appropriately to make harmony with modern medicine.

Phototoxicity of oriental medicinal plants: measurement and possible applications.

Phototoxicity can be either harmful and induce adverse skin reactions or beneficial and be used therapeutically as in psoralen and UV-A or photodynamic therapy. Hundreds of medicinal plants are widely used in Asia and Western countries in oriental medicine, yet the phototoxicity of oriental medicinal plants is an understudied area. In this contribution, the authors discuss some methods used to measure the phototoxicity of plants and give an overview of the results of their previous and ongoing studies into the phototoxicity of medicinal plants. The authors argue that because they found that more than a quarter of oriental medicinal plants can be phototoxic, such research is helpful for dermatologists and that active phototoxic components extracted from oriental medicinal plants may be used therapeutically.

Adverse events from pharmacopuncture treatment in Korea: A protocol for systematic review and meta analysis.

BACKGROUND: Pharmacopuncture is a combination of acupuncture and herbal medicine, which involves the injection of herbal extracts into acupuncture points (acupoints). Pharmacopuncture has become one of the major therapeutic tools used in Korea; however, safety is one of the major concerns associated with it. We aim to systematically review clinical studies on the adverse events of pharmacopuncture in Korea. METHODS: To collect data on the incidence and characteristics of adverse events (AEs) and to evaluate pharmacopuncture safety, 2 or more researchers will conduct a comprehensive search of pertinent English and Korean databases using the keywords "pharmacopuncture" and "adverse events." Regardless of the participants' conditions or treatment types, we will include clinical studies on the AEs of pharmacopuncture. Studies that were not conducted in Korea, and acupoint injections containing Western medications, vitamins, or autologous serum will be excluded from this study. The severity of AEs will be classified using the common terminology criteria for adverse events, and the causality between pharmacopuncture and AEs will be assessed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality scale. The quality of identifying and reporting the AEs will be assessed using the McHarm scale. The risk of selection bias will be assessed using the Cochrane risk of bias and the risk of bias for non-randomized studies tools. Studies will be assessed for heterogeneity utilizing Higgins's I2 statistics, and the risk of publication bias will be assessed and expressed in the form of a contour-enhanced funnel plot. RESULTS AND CONCLUSION: Comprehensive investigation of all types of clinical studies in Korea will provide clearer evidence of the safety of pharmacopuncture. The results of this study will be useful for traditional medical doctors and patients who use such treatments and interventions.Systematic Review Registration: Open Science Foundation (osf.io/umhyz).

Toxic Animal-Based Medicinal Materials Can Be Effective in Treating Endometriosis: A Scoping Review.

Animal toxins and venoms have recently been developed as cancer treatments possessing tumor cell growth-inhibitory, antiangiogenesis, and proapoptotic effects. Endometriosis is a common benign gynecological disorder in reproductive-age women, and no definite treatment for this disorder is without severe side effects. As endometriosis and malignant tumors share similar characteristics (progressive, invasive, estrogen-dependent growth, and recurrence), animal toxins and venoms are thought to be effective against endometriosis. The objective of this study was to outline studies using toxic animal-based medicinal materials (TMM) as endometriosis treatment and to explore its clinical applicability. Preclinical and clinical studies using TMM were searched for in four databases from inception to October 2020. A total of 20 studies of TMM on endometriosis were included. In eight clinical studies, herbal medicines containing TMM were effective in relieving symptoms of endometriosis, with no side effects. In twelve experimental studies, the main therapeutic mechanisms of TMM against endometriosis were proapoptotic, antiangiogenesis, estrogen level-reducing, and possible anti-inflammatory effects. TMM are thus considered promising sources for the development of an effective treatment method for endometriosis. Further studies are needed to clarify the therapeutic mechanism of TMM against endometriosis and to provide sufficient grounds for clinical application.

Efectos de la terapia con ventosas en pacientes con dolor lumbar / Effects of cupping therapy in patients with low back pain

Introducción: El dolor lumbar es uno de los síntomas referidos con mayor frecuencia en la consulta médica, siendo un factor limitante en las actividades de la vida diaria y la actividad laboral. Las nuevas terapias, como el tratamiento con ventosas, parece aportar resultados prometedores al manejo del dolor lumbar. Objetivo: Evaluar la evidencia científica acerca de los efectos de la aplicación de terapia con ventosas en pacientes con dolor lumbar. Material y Métodos: Se realizó una búsqueda bibliográfica en PubMed, Medline, Cinhal, Scopus, Web of Science, PEDro y Cochrane con los términos “Cupping Therapy” y “Low Back Pain” y la palabra clave “Cupping Therapy”. Resultados: Se incluyeron 10 artículos que usaban la terapia con ventosas para el tratamiento de la lumbalgia, centrándose en las escalas de dolor y discapacidad y obteniendo resultados significativos beneficiosos. Conclusión: La terapia con ventosas parece disminuir el dolor y la discapacidad en pacientes con lumbalgia. (AU)

Introduction: Low back pain is one of the most frequently referred symptoms in medical consultation, being a limiting factor in activities of daily living and work activity. New therapies, such as cupping, seem to bring promising results in the management of low back pain. Objective: To evaluate the scientific evidence on the effects of the application of cupping therapy in patients with low back pain. Material and Methods: A literature search was carried out in PubMed, Medline, Cinhal, Scopus, Web of Science, PEDro and Cochrane with the terms “Cupping Therapy” and “Low Back Pain” and the keyword “Cupping Therapy”. Results: 10 articles using cupping therapy for the treatment of low back pain were included, focusing on pain and disability scales and obtaining significant beneficial results. Conclusion: Cupping therapy appears to reduce pain and disability in patients with low back pain. (AU)

Herbal medicine Yukgunja-tang for functional dyspepsia protocol for a systematic review of randomized controlled trials.

BACKGROUND: Functional dyspepsia (FD) is a common functional gastrointestinal disorder characterized by recurrent dyspeptic symptoms. Yukgunja-tang (YGT) is a traditional herbal formula that has been used for treating FD. This systematic review protocol aims to provide a guideline for investigating the efficacy and safety of YGT in the treatment of FD. METHODS: The following databases will be searched from their inception until July 2018: Medline (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Complementary Medicine Database (AMED), KoreaMed, National Digital Science Library (NDSL), Korean Medical Database (KMbase), Oriental Medicine Advanced Searching Integrated System (OASIS), Korean Studies information Service System (KISS), China National Knowledge Infrastructure Database (CNKI), and Citation Information by Nii (CiNii). Randomized controlled trials (RCTs) that used YGT or modified YGT for treating FD will be included. The control groups in these RCTs will include placebo, no-treatment waiting, and conventional western medicine groups. Trials testing YGT as an adjunct to western medicine for synergistic effect will also be included. The main outcome will be the total clinical efficacy rate. Data extraction and risk of bias assessment will be performed by two independent assessors. RevMan V.5.3 will be used for data analysis. RESULTS: This study will provide a high-quality synthesis of current evidence of YGT for FD from several aspects including dyspepsia-related symptoms, quality of life and adverse events. CONCLUSION: The conclusion of our systematic review will provide evidence to judge whether YGT is an effective intervention for patient with FD. ETHICS AND DISSEMINATION: The protocol does not need ethics approval because identifying information of the participants will not be revealed. The systematic review will be published in a peer-reviewed journal and disseminated electronically and in print. TRIAL REGISTRATION NUMBER: PROSPERO CRD42018090139.

History conflict and non-formulary medicine: a threat for anaesthesiologist in low and middle-income countries.

The practice of complementary and non-formulary medicine has gained tremendous popularity due to their claimed beneficial effects in cardiac, respiratory and chronic diseases, as also other disorders. The most threatening aspect related to these practices pertains to the non-disclosure of its use by patients at the time of their preoperative assessment in elective or emergency setting. We report a case of profound, long-lasting unexplained hypotension during and after anaesthesia in a patient presented for emergency vocal cord surgery (cordectomy). He was taking complementary medicine for last 2 years. Serum cortisol level was sent postoperatively in intensive care unit that was found extremely low.

Survey of disease awareness, treatment behavior and treatment satisfaction in patients with atopic dermatitis in Korea: A multicenter study.

In Korea, there is a high dependency on oriental medicine and folk remedies (Korean J Asthma Allergy Clin Immunol, 25, 2005, 110). In addition, inaccurate information available through the Internet is increasing (Korean J Dermatol, 44, 2006, 137). So, there is always a possibility that patients may have difficulty obtaining accurate information about atopic dermatitis (AD). The aim was to determine the awareness, treatment behavior and treatment satisfaction of patients with AD and their caregivers. In October 2017, patients diagnosed with AD at nine hospitals were enrolled in this study. A questionnaire was completed by each patient. A total of 371 subjects were surveyed. In response to the question asking about knowledge of AD, the correct answer rate was 55.4%. Bathing using soap, body scrub and moisturizer showed favorable outcomes. A total of 54.9% patients responded that they were reluctant to use steroid ointment. When asked about their previous treatment, 39.6% reported using oriental medicine and 26.5% had tried folk remedies. The hospital treatment satisfaction score was 6.6. Patients usually applied their knowledge in their daily lives. However, there was a lot of inaccurate knowledge. Therefore, it is important for patients to understand the characteristics of this disease and obtain correct information.

Integrative medicine for managing the symptoms of lupus nephritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Integrative medicine is claimed to improve symptoms of lupus nephritis. No systematic reviews have been performed for the application of integrative medicine for lupus nephritis on patients with systemic lupus erythematosus (SLE). Thus, this review will aim to evaluate the current evidence on the efficacy of integrative medicine for the management of lupus nephritis in patients with SLE. METHODS AND ANALYSES: The following electronic databases will be searched for studies published from their dates of inception February 2018: Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as 6 Korean medical databases (Korea Med, the Oriental Medicine Advanced Search Integrated System [OASIS], DBpia, the Korean Medical Database [KM base], the Research Information Service System [RISS], and the Korean Studies Information Services System [KISS]), and 1 Chinese medical database (the China National Knowledge Infrastructure [CNKI]). Study selection, data extraction, and assessment will be performed independently by 2 researchers. The risk of bias (ROB) will be assessed using the Cochrane ROB tool. DISSEMINATION: This systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. TRIAL REGISTRATION NUMBER: PROSPERO 2018 CRD42018085205.

Natural occurrence of genotoxic and carcinogenic alkenylbenzenes in Indonesian jamu and evaluation of consumer risks.

The consumer risks of jamu, Indonesian traditional herbal medicines, was assessed focussing on the presence of alkenylbenzene containing botanical ingredients. Twenty-three out of 25 samples contained alkenylbenzenes at levels ranging from 3.8 to 440 µg/kg, with methyleugenol being the most frequently encountered alkenylbenzene. The estimated daily intake (EDI) resulting from jamu consumption was estimated to amount to 0.2-171 µg/kg bw/day for individual alkenylbenzenes, to 0.9-203 µg/kg bw/day when adding up all alkenylbenzenes detected, and to 0.9-551 µg/kg bw/day when expressed in methyleugenol equivalents using interim relative potency (REP) factors. The margin of exposure (MOE) values obtained were generally <10,000 indicating a priority for risk management when assuming daily consumption during a lifetime. Using Haber's rule it was estimated that two weeks consumption of these jamu only once would not raise a concern (MOE >10,000). However, when considering use for two weeks every year during a lifetime, 5 samples still raise a concern. It is concluded that the consumption of alkenylbenzene containing jamu can be of concern especially when consumed on a daily basis for longer periods of time on a regular basis.