Subchorionic Hemorrhage in the Second and Third Trimesters of Pregnancy: A Review.

Importance: Subchorionic hemorrhage (SCH) in the second and third trimesters of pregnancy can be associated with maternal morbidity and fetal morbidity/mortality. Management of SCH in the second or third trimesters can be complicated, especially in the setting of a large SCH that requires hospitalization and blood transfusion. Objective: The aim of this review is to describe SCH in second and third trimesters, risk factors, diagnosis, maternal and fetal outcomes, and management of this uncommon pregnancy complication. Evidence Acquisition: A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. Results: There were 123 abstracts and/or articles reviewed, with 48 articles being the basis of review. The only known risk factors for SCH are maternal factor deficiency and anticoagulation therapy. The diagnosis is usually made by ultrasound imaging. Subchorionic hemorrhage in second and third trimesters has been associated with several adverse fetal outcomes including preterm birth, preterm prelabor rupture of membranes, fetal growth restriction, fetal demise, and neonatal pulmonary morbidity. There is no proven treatment for SCH, although there are several investigational therapies reported. Conclusions: Subchorionic hemorrhage can be complex and difficult to manage in the second and third trimesters. There are no recommendations or guidelines for management; however, serial growth ultrasounds, umbilical artery Doppler studies, and antenatal fetal testing should be considered particularly if the SCH is large or treatment requires a maternal blood transfusion. Relevance: Subchorionic hemorrhage in the second and third trimester is associated with poor fetal outcomes and maternal morbidity, especially if the SCH is significant.

Relative popularity level of medicinal plants in Talagang, Punjab Province, Pakistan

ABSTRACT This is the first ethnobotanical exploration with the aim to document the traditional medicinal usage of plants with the therapeutic values in Tehsil Talagang of Punjab province, Pakistan. The study shows the dependence of local people on medicinal plants in their daily life and provides practical evidence regarding the traditional usage of medicinal plants in health care practices. A total of 196 respondents including residents of the study area with gender representation and traditional healers were interviewed by using visual appraisal approach and rapid rural appraisal methods along semi-structured interviews and open-ended questionnaire. The data was quantitatively analyzed by using quantitative indices like use value, the relative frequency of citation, informant consensus factor, fidelity level and relative importance. A comparison with 25 published ethnobotanical and pharmacological studies was carried out to authenticate the ethnomedicinal relevance of the data recorded. The ethnomedicinal practices of 101 medicinal plants belonging to 36 families were reported. The results indicated that the dominant family was Brassicaceae (nine species). Herbs (57%) were the most dominant life form and leaves (29%) were the frequently used plant part with 45 reports. Mentha arvensis was found as highly cited plant species by respondents. The highest informant consensus factor value (0.65) was found for gastrointestinal disease category. There are 25 plant species having 100% fidelity level value. Use value and relative frequency of citation ranges from 0.04 to 0.16 and 0.15 to 0.36, respectively. The majority of the plant species were found to have strong pharmacological evidence. The current study will provide the basis for the preservation of ethnomedicinal heritage, knowledge and practices as well as for the further scientific investigations regarding the development of new herbal drugs.

A Randomized Controlled Trial of an Outpatient Protocol for Transitioning Children from Tube to Oral Feeding: No Need for Amitriptyline.

OBJECTIVE: To assess the role of amitriptyline in the effectiveness of an outpatient protocol for weaning medically complicated children from tube to oral feeding. STUDY DESIGN: Twenty-one children seen in multidisciplinary outpatient feeding teams across 4 sites were recruited to a randomized placebo-controlled trial of a 6-month outpatient treatment protocol with behavioral, oral-motor, nutrition, and medication components. RESULTS: All of the children who completed the 6-month program (73%) were weaned to receive only oral feeding, regardless of group assignment. The transition from tube to oral feeding resulted in decreases in body mass index percentile and pain, some improvements in quality of life, and no statistically significant changes in cost. CONCLUSIONS: Amitriptyline is not a key component of this otherwise effective outpatient, interdisciplinary protocol for weaning children from tube to oral feeding. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01206478.

Medicinal plants used in the traditional management of diabetes and its sequelae in Central America: A review.

ETHNOPHARMACOLOGICAL RELEVANCE: Globally 387 million people currently have diabetes and it is projected that this condition will be the 7th leading cause of death worldwide by 2030. As of 2012, its total prevalence in Central America (8.5%) was greater than the prevalence in most Latin American countries and the population of this region widely use herbal medicine. The aim of this study is to review the medicinal plants used to treat diabetes and its sequelae in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. MATERIALS AND METHODS: We conducted a literature review and extracted from primary sources the plant use reports in traditional remedies that matched one of the following disease categories: diabetes mellitus, kidney disease, urinary problems, skin diseases and infections, cardiovascular disease, sexual dysfunctions, visual loss, and nerve damage. Use reports were entered in a database and data were analysed in terms of the highest number of use reports for diabetes management and for the different sequelae. We also examined the scientific evidence that might support the local uses of the most reported species. RESULTS: Out of 535 identified species used to manage diabetes and its sequelae, 104 species are used to manage diabetes and we found in vitro and in vivo preclinical experimental evidence of hypoglycaemic effect for 16 of the 20 species reported by at least two sources. However, only seven of these species are reported in more than 3 studies: Momordica charantia L., Neurolaena lobata (L.) R. Br. ex Cass., Tecoma stans (L.) Juss. ex Kunth, Persea americana Mill., Psidium guajava L., Anacardium occidentale L. and Hamelia patens Jacq. Several of the species that are used to manage diabetes in Central America are also used to treat conditions that may arise as its consequence such as kidney disease, urinary problems and skin conditions. CONCLUSION: This review provides an overview of the medicinal plants used to manage diabetes and its sequelae in Central America and of the current scientific knowledge that might explain their traditional use. In Central America a large number of medicinal plants are used to treat this condition and its sequelae, although relatively few species are widely used across the region. For the species used to manage diabetes, there is variation in the availability and quality of pharmacological, chemical and clinical studies to explain traditional use.

Approaches for controlling illicit tobacco trade--nine countries and the European Union.

An estimated 11.6% of the world cigarette market is illicit, representing more than 650 billion cigarettes a year and $40.5 billion in lost revenue. Illicit tobacco trade refers to any practice related to distributing, selling, or buying tobacco products that is prohibited by law, including tax evasion (sale of tobacco products without payment of applicable taxes), counterfeiting, disguising the origin of products, and smuggling. Illicit trade undermines tobacco prevention and control initiatives by increasing the accessibility and affordability of tobacco products, and reduces government tax revenue streams. The World Health Organization (WHO) Protocol to Eliminate Illicit Trade in Tobacco Products, signed by 54 countries, provides tools for addressing illicit trade through a package of regulatory and governing principles. As of May 2015, only eight countries had ratified or acceded to the illicit trade protocol, with an additional 32 needed for it to become international law (i.e., legally binding). Data from multiple international sources were analyzed to evaluate the 10 most commonly used approaches for addressing illicit trade and to summarize differences in implementation across select countries and the European Union (EU). Although the WHO illicit trade protocol defines shared global standards for addressing illicit trade, countries are guided by their own legal and enforcement frameworks, leading to a diversity of approaches employed across countries. Continued adoption of the methods outlined in the WHO illicit trade protocol might improve the global capacity to reduce illicit trade in tobacco products.

Questionnaire surveys: methodological and epistemological problems for field-based ethnopharmacologists.

The classical scientific approach is empirical. One of the favoured means of gathering quantitative data in the health and social sciences, including ethnopharmacology and medical ethnobotany, is by use of questionnaires. However, while there are numerous published articles discussing the importance of questionnaire content, the fact that questionnaires themselves may be inappropriate in a number of cultural contexts, even where literacy is not a factor, is usually ignored. In this paper, the authors will address the main issues posed by the use of questionnaire surveys, using case studies based on their own personal experiences as ethnopharmacologists 'in the field'. The pros and cons of qualitative and quantitative research and the use of alternative means to elicit quantitative data will be discussed.