Ethnobotanical survey of medicinal plants used by various ethnic tribes of Mizoram, India.

Mizoram has a diverse range of ethnic and cultural groups, including the Lushai, Mara, Lai, Bawm, Hmar, Chakma, and Bru. Through practice and experience in their protracted battles with disease and the harsh natural environment, they have amassed rich folk medicine knowledge. The preservation of indigenous knowledge, identification of bioactive compounds, and the eventual discovery of novel medicinal plant species all depend on the documentation of the traditional uses of medicinal plants. Therefore, the present study was designed to document the ethnomedicinal knowledge related to the usage of medicinal plants in Mizoram, India. An ethnobotanical study of medicinal plants was carried out in 17 villages of 5 districts in Mizoram between September 2022 and January 2023. A total of 128 informants (77 males and 51 females) were interviewed. Information was gathered through field observations, group discussions, and semistructured interviews. The data were presented using descriptive statistics. To assess the importance of medicinal plant species, quantitative indices such as the informant consensus factor (ICF), fidelity level (FL), use value (UV), and cultural index (CI) was used. In our ethnobotanical investigation, 102 medicinal plant species from 95 genera and 58 families were recorded and documented. The majority of them (90 species) were obtained from wild habitats. The majority of the documented species were trees (48), followed by herbs (23 species) and shrubs (21 species). The most common method of preparation was decoction (67 species). Diabetes had the highest ICF value (0.81), followed by cancer, liver problems, and hypertension (0.8). The fidelity level (FL) of indigenous communities in the study area was evaluated to determine the dependability and consistency of herbal drug use. Indigenous knowledge and the variety of medicinal plant species that are used are of great values. The therapeutic applications of documented plants provide fundamental information for additional studies centered on pharmacological investigations and the preservation of the most significant species.

Knowledge and practices of traditional management of child malnutrition and associated pathologies in Benin.

BACKGROUND: Child malnutrition is a major public health challenge, affecting millions of children worldwide, with alarming proportions of children under five in Benin. The complexity of managing this condition is increased by its potential association with opportunistic pathologies. An interesting approach arises from the use of medicinal plants, to address child malnutrition and its associated pathologies. This study aimed to document the knowledge and practices of Beninese mothers and traditional practitioners with regard to the use of medicinal plants to treat child malnutrition and associated diseases. METHODS: A total of 844 Beninese mothers and 201 traditional healers were surveyed between March 2022 and August 2023 in the communes of Karimama, Bopa and Za-Kpota in Benin. The respondents' knowledge of child malnutrition and associated pathologies was explored. The ethnobotanical data collected from the subjects concerned the medicinal recipes used to treat child malnutrition, the medicinal plants that make them up and the methods of use. These data were analyzed using ethnobotanical indices such as the Informant Consensus Factor, the frequency of citation of medicinal recipes types and medicinal plants, and the contribution of plants to medicinal recipes. RESULTS: All respondents cited a total of 82 plant species used to treat child malnutrition and associated diseases. These plants were grouped into 37 botanical families, the most common of which were Fabaceae, Malvaceae and Annonaceae. The leaves were the most commonly used part of the plant species identified. The mothers shared 122 medicinal recipes, ranging from recipes based on a single plant to more complex compositions involving five plants. The most notable plants were Moringa oleifera Lam, Phyllanthus amarus Schumach & Thonn, Senna siamea (Lam.) H.S.Irwin & Barneby, Carica papaya L. and Ocimum gratissimum L. Traditional healers provided 52 plants in 71 recipes, with Moringa oleifera featuring prominently in both single-plant and multiplant formulations. CONCLUSION: This study made it possible to constitute a rich base of medicinal recipes used against malnutrition and associated pathologies, with the preponderant involvement of certain plant species. It is therefore necessary to deepen research on these different identified species in order to scientifically assess their potential.

Effect of Salvia hispanica (Chia seeds) and Foeniculum vulgare (Fennel seeds) against weight-loss and lipid profile in obese human subjects.

Increased levels of bad cholesterol in the body result in increasing blood pressure and weight gain. The rate of mortality in people, especially who are obese, is increasing due to absence of organic sources of fiber in their diets. Chia and fennel seeds are rich sources of fiber. The objective of this study was to evaluate the combined effect of Salvia hispanica (Chia seeds) and Foeniculum vulgare (Fennel seeds) against weight-loss and lipid profile in obese human subjects. The research was conducted on obese people aged 25 to 40 years at the Jinnah Hospital Lahore. The study design was randomized control trial (RCT). The sample size was calculated and was divided in-to two groups. With the duration of study being 3 months, pre-testing of all the participants was done. Group 1 was control group, given placebo treatment and Group 2 was an intervention group and given chia and fennel seeds. Post-testing was done and data were analyzed. Results showed that chia and fennel seeds have significant effect (p <0.05) on BMI and lipid profile hence, both are beneficial for lowering body weight and improving LDL, HDL, serum triglycerides and total cholesterol levels.

Study of medicinal plants used in ethnoveterinary medical system in riverine areas of Punjab, Pakistan.

BACKGROUND: The use of medicinal plants to treat various veterinary illnesses has been practiced for millennia in many civilizations. Punjab is home to a diverse ethnic community, the majority of whom work in dairy farming, agriculture, and allied professions and have indigenous practices of treating animal illnesses using native flora. This study was designed to (1) document and preserve information about the applications of medicinal plant species in ethnoveterinary remedies among inhabitants of Punjab, Pakistan, and (2) identify popular plants for disease treatment by quantitative analysis of the obtained data and to assess the pharmacological relevance of these species. METHODS: To collect data from informants (N = 279), questionnaires and semi-structured interviews were used. The ethnoveterinary data were analyzed using principal component analysis, relative frequency citation, fidelity level, relative popularity level, and rank order priority. RESULTS: A total of 114 plant species utilized in the ethnoveterinary medicinal system were found, which were divided into 56 families and used to treat 16 different illnesses. The Poaceae family, with 16 species, was the most common in the region. The most commonly employed growth form in herbal preparation was herb (49%). The most used part in ethnoveterinary remedies was leaves (35%), while powder was the most commonly used way for preparing ethnoveterinary remedies (51 applications). According to principal component analysis, the most typically used species in the research region were grasses. Five grasses (Arundo donax, Desmostachya bipinnata, Eleusine indica, Hordeum vulgare, and Pennisetum glaucum) showed a 100% FL value when used to treat diuretics, helminthiasis, digestive problems, fever, cough, worm infestation, indigestion, galactagogue, oral infections, and genital prolapse. The maximum value of disease cured level (DCL%) was recorded at 87.6% for endo- and ecto-parasitic ailments in the study area. CONCLUSION: This study demonstrates that medicinal plants play an important part in satisfying farmers' animal healthcare demands, making it a feasible practice. The study also provides a wealth of knowledge regarding ethnoveterinary methods for further planning and application, providing an option for farmers who cannot afford allopathic therapy.

[Homemade herbal remedies - tradition with practical relevance]. / Pflanzliche bäuerliche Hausmittel ­ Tradition mit Praxisrelevanz.

OBJECTIVE: The preparation of homemade herbal remedies has always been practiced by animal keepers and is still employed in farm animals today. In order to document this practice, an ethnoveterinary study was conducted in Bavaria in 2018-2021. MATERIAL AND METHOD: The farmers were interviewed on site and the reported recipes were documented in detail and, where possible, also carried out during the interviews. The plant parts used were weighed using a laboratory balance in order to be able to calculate a daily dose per animal or the concentration in the end product for as many of these traditional use reports (UR) as possible. RESULTS: A total of 716 recipes for 884 UR were named in the 77 interviews by the participating farmers. Two thirds (69%) of the formulations mentioned consisted of one or more medicinal plants and 31% dealt with other natural home remedies (honey, vinegar, etc.). Overall, the farmers surveyed preferred the use of single plants in their formulations. Most UR were for cattle (77% of all reports). These traditional remedies are most often used in Bavarian stables for the treatment and prophylaxis of gastrointestinal diseases and metabolic disorders. Furthermore, there was a high correspondence of the medicinal plants used with described UR from two historical reference books. The study participants used their homemade herbal remedies with a high degree of satisfaction and thereby act within the scope of their own responsibility as farmers. CONCLUSION AND CLINICAL RELEVANCE: This traditional knowledge of herbal preparations containing active ingredients, which has been passed on for generations, may also be a good starting point for a phytotherapeutic supplement in the treatment of farm animals in veterinary practice. Pharmaceutical and feed law framework conditions must be adhered to.

Usefulness of Opuntia spp. on the Management of Obesity and Its Metabolic Co-Morbidities.

The plants of the Opuntia genus mainly grow in arid and semi-arid climates. Although the highest variety of wild species is found in Mexico, Opuntia spp. is widely distributed throughout the world. Extracts of these cacti have been described as important sources of bioactive substances that can have beneficial properties for the prevention and treatment of certain metabolic disorders. The objective of this review is to summarise the presently available knowledge regarding Opuntia ficus-indica (nopal or prickly pear), and some other species (O. streptacantha and O. robusta) on obesity and several metabolic complications. Current data show that Opuntia ficus-indica products used in preclinical studies have a significant capacity to prevent, at least partially, obesity and certain derived co-morbidities. On this subject, the potential beneficial effects of Opuntia are related to a reduction in oxidative stress and inflammation markers. Nevertheless, clinical studies have evidenced that the effects are highly contingent upon the experimental design. Moreover, the bioactive compound composition of nopal extracts has not been reported. As a result, there is a lack of information to elucidate the mechanisms of action responsible for the observed effects. Accordingly, further studies are needed to demonstrate whether Opuntia products can represent an effective tool to prevent and/or manage body weight and some metabolic disorders.

Effects of Withania somnifera Extract in Chronically Stressed Adults: A Randomized Controlled Trial.

BACKGROUND: Stress is a known causative factor in modulating cognitive health, which overall well-being and quality of life are dependent on. Long-term stress has been shown to disrupt the balance of the hypothalamic-pituitary-adrenal (HPA) axis. Adaptogens, such as Withania somnifera (ashwagandha), are commonly used in Ayurvedic medicine for stress relief and ameliorating HPA-axis dysfunction. The aim of this study was to support the role of a root and leaf water-extracted ashwagandha extract (WS) in stress reduction by confirming the lowest clinically validated dose for stress management (125 mg/day) in a dose-dependent clinical study in adults with self-reported high stress. METHODS: An 8-week, randomized, double-blinded, placebo-controlled study to compare the effects of three different WS extract doses (125, 250 and 500 mg) was performed. A total of 131 adults were enrolled, and 98 were included in the final analysis. Attenuation of chronic stress was measured using the 14-item Perceived Stress Scale (PSS) and biochemical-related stress parameters. RESULTS: We have shown that aqueous WS extract (roots and leaves) safely reduces mild to moderate chronic stress at doses of 125 mg, 250 mg, and 500 mg/day for 8 weeks. CONCLUSIONS: Our findings demonstrate the stress-reduction capabilities of this well-characterized aqueous extract of WS (root and leaf) at the low dose of 125 mg/day, in a dose-dependent manner, via the modulation of the HPA axis. TRIAL REGISTRATION: This study was registered with the Clinical Trials Registry-India (CTRI) with the registration number: CTRI/2019/11/022100.

Characterizations of White Mulberry, Sea-Buckthorn, Garlic, Lily of the Valley, Motherwort, and Hawthorn as Potential Candidates for Managing Cardiovascular Disease-In Vitro and Ex Vivo Animal Studies.

Cardiovascular diseases are a broadly understood concept focusing on vascular and heart dysfunction. Lack of physical exercise, type 2 diabetes, obesity, hypertension, dyslipidemia, thromboembolism, and kidney and lung diseases all contribute to the development of heart and blood vessel dysfunction. Although effective and important, traditional treatment with diuretics, statins, beta blockers, calcium inhibitors, ACE inhibitors, and anti-platelet drugs remains a second-line treatment after dietary interventions and lifestyle changes. Scientists worldwide are still looking for an herbal product that would be effective and free from side effects, either taken together with or before the standard pharmacological intervention. Such herbal-originated medication therapy may include Morus alba L. (white mulberry), Elaeagnus rhamnoides (L.) A. Nelson (sea-buckthorn), Allium sativum L. (garlic), Convallaria majalis L. (lily of the valley), Leonurus cardiaca L. (motherwort), and Crataegus spp. (hawthorn). Valuable herbal raw materials include leaves, fruits, seeds, and even thorns. This short review focuses on six herbs that can constitute an interesting and potential therapeutic option in the management of cardiovascular disorders.

Traditional Uses, Phytochemistry, and Pharmacological Activities of Vernonia cinerea (L.) Less.: An Updated Review.

Vernonia cinerea (L.) Less. is a perennial herbaceous plant found mainly in tropical areas, particularly in Southeast Asia, South America, and India. Various parts of V. cinerea have traditionally been used in folk medicine to treat several diseases, such as malaria, fever, and liver diseases. V. cinerea has so far yielded about 92 secondary metabolites. The majority of these are sesquiterpene lactones, but triterpenes, flavonoids, steroids, phenolics, and other compounds are present as well. V. cinerea crude extracts reportedly exhibit anti-inflammatory, antiprotozoal, antidiabetic, anticancer, antimicrobial, antioxidant, and renoprotective activities. This study aims to provide the latest up-to-date information on the botanical characterization, distribution, traditional uses, phytochemistry, and pharmacological activity of V. cinerea. Information on V. cinerea was thoroughly reviewed. The literature published between 1950 and 2024 was compiled through online bibliographic databases, including SciFinder, Web of Science, Google Scholar, PubMed, ScienceDirect, Springer Link, Wiley, and the MDPI online library. The keywords used for the literature search included Vernonia cinerea (L.) Less. and the synonyms Cyanthillium cinereum (L.) H.Rob., Conyza cinerea L., and various others.

Comparison between intrauterine application of an antibiotic and an herbal product to treat clinical endometritis in dairy cattle - A randomized multicentre field study.

Uterine diseases are main indications for antibiotic use in dairy cows. To test a non-antibiotic treatment option, we compared the effect of an intrauterine cephapirin (Metricure®; cefapirin benzathin 500 mg per dosis; CEPH) with an intrauterine applied herbal product (25 ml of EucaComp® PlantaVet containing alcoholic extracts of Calendula officinalis L., Mellissa officinalis L., Origanum majorana L. and Eucalyptus globulus Labill. (EUC)) on the clinical cure of endometritis. Examinations of 816 cows between 21 and 35 days after calving were performed and cases of clinical endometritis (n = 169) were included. Diagnosis based on a scoring system for vaginal discharge. Study animals were randomly assigned to one of two treatment groups and treated immediately. After excluding animals with incomplete datasets, 136 cows (EUC: n = 61; CEPH: n = 75) remained for the final analysis. In total, 64% (EUC: 61%, CEPH: 67%) of analysed endometritis cases were considered as clinically cured 14 ± 2 days after the first treatment, 15% stayed uncured after the application of a maximum of two consecutive treatments, leading to an overall clinical cure rate of 85% (EUC: 82%, CEPH: 88%). No statistically difference in clinical cure rates could be observed between both treatment groups nor 14 ± 2 days after the first treatment (p = 0.956) neither regarding the overall cure rate (p = 0.923). In conclusion, the clinical cure of dairy cows' endometritis after the intrauterine application of the herbal product was non-inferior to the intrauterine application of the antibiotic cephapirin. These results could contribute to reduce the antimicrobial use in the daily veterinary routine treatment of endometritis.

Comparative evaluation of the efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine mouthwashes in the treatment of gingival inflammation: A randomized controlled trial.

BACKGROUND: Chemical plaque control with mouthwashes as an adjunct to mechanical plaque control with a toothbrush and dental floss has been considered an effective method for controlling gingivitis. The anti-inflammatory effects of chemical plaque control benefit the oral tissues by reducing inflammation and bleeding. OBJECTIVES: The aim of the present study was to evaluate and compare the clinical efficacy of probiotic, Aloe vera, povidine-iodine, and chlorhexidine (CHX) mouthwashes in treating gingivitis patients by assessing changes in their clinical parameters. MATERIAL AND METHODS: This prospective study was conducted on 40 patients from our outpatient department, divided into 4 groups of 10 patients each: probiotic mouthwash group (group 1); herbal (Aloe vera) mouthwash group (group 2); povidone-iodine mouthwash group (group 3); and CHX mouthwash group (group 4). All participants were provided with the same type of manual toothbrush, the Pepsodent® toothpaste and a respective mouthwash for twice-daily use until the end of a 28-day observation period. Clinical parameters, such as the marginal plaque index (MPI) and bleeding on interdental brushing (BOIB), were recorded at baseline, and on the 14th and 28th day of the study period. RESULTS: All groups showed a significant decrease in the MPI and BOIB scores. The results were similar in patients who used a probiotic mouthwash and those who used a CHX mouthwash. A comparable change in the mean scores was observed among the herbal and povidone-iodine groups from baseline to day 28. CONCLUSIONS: In the treatment of chronic gingivitis patients,a probiotic mouthwash was nearly as effective as CHX in reducing the plaque and bleeding scores. It showed better results in all clinical parameters than herbal and povidone-iodine mouthwashes. Using a mouthwash along with routine tooth brushing can help in treating gingivitis and slow the progression of the periodontal disease.

Phytotherapy of Vulvovaginal Candidiasis: A Narrative Review.

Vulvovaginal candidiasis (VVC) is a real gynecological problem among women of reproductive age from 15 to 49. A recent analysis showed that 75% of women will have an occurrence at least once per year, while 5% are observed to have recurrent vaginal mycosis-these patients may become unwell four or more times a year. This pathology is caused in 85-90% of cases by fungi of the Candida albicans species. It represents an intractable medical problem for female patients due to pain and pruritus. Due to the observation of an increasing number of strains resistant to standard preparations and an increase in the recurrence of this pathology when using local or oral preferential therapy, such as fluconazole, an analysis was launched to develop alternative methods of treating VVC using herbs such as dill, turmeric, and berberine. An in-depth analysis of databases that include scientific articles from recent years made it possible to draw satisfactory conclusions supporting the validity of herbal therapy for the pathology in question. Although phytotherapy has not yet been approved by the Food and Drug Administration, it appears to be a promising therapeutic solution for strains that are resistant to existing treatments. There is research currently undergoing aimed at comparing classical pharmacotherapy and herbal therapy in the treatment of vaginal candidiasis for the purpose of increasing medical competence and knowledge for the care of the health and long-term comfort of gynecological patients.

Traditional lore on the healing effects of therapeutic plants used by the local communities around Simien Mountains National Park, northwestern Ethiopia.

BACKGROUND: Simien Mountain National Park is a world heritage site with spectacular landscapes and rich in floral diversity. Exploring the plethora of conventional wisdom regarding therapeutic flora for sustainable use and drug development is a timely endeavor. Thus, the present study was aimed at investigating therapeutic plant uses and conservation practices by the local communities dwelling in the vicinity of the Park. METHODS: Eighty randomly selected general informants and 20 purposefully selected key informants were used to collect the traditional lore from 10 purposefully selected kebeles that border the Park. Data were collected using face-to-face interviews, guided field walks, group discussions and market surveys. Descriptive statistics were used to analyze the basic information collected from the informants. An independent sample t test was computed to compare the knowledge variations among different informant groups. Clustering and ranking techniques were employed to validate traditional wisdom of informants. RESULTS: Significant differences in traditional wisdom (P < 0.05) were observed only between general and key informants. Hundred thirteen therapeutic plant species belonging to 56 families were recorded. Asteraceae was the most species-rich family (10%). The majority of therapeutic species were collected from the wild (77%). Herbs and roots were the most preferred habit (47%) and plant parts (37%) for remedy preparation, respectively. Pounding was the most common preparation method (50.1%). The most frequently practiced route of administration was the oral route (48.1%). The highest Informant Consensus Factor (ICF) value (84%) was recorded for respiratory and febrile illnesses. Rumex nepalensis was the most preferred for the treatment of wounds, and Olea europaea subsp cuspidata was the first-ranked multipurpose plant. CONCLUSION: The Park is rich in therapeutic species serving as a refuge for many endemic and endangered species associated with the local community rich medicinal traditional lore. Erosion of therapeutic plants, verbal transfer of the traditional wisdom and young generation negligence in acquiring traditional lore led to the deterioration of the long tradition of using therapeutic plants for health care. Endangered multipurpose therapeutic plants like Echinops kebericho should get conservation priority. Therapeutic plants with the highest ICF and fidelity level could be candidates for drug development.

[Phytoprophylaxis of complications after extracorporeal lithotrips].

AIM: To evaluate the efficiency of the drug phytolysin (capsules) in the prevention of complications after extracorporeal lithotripsy. MATERIALS AND METHODS: A total of 15 patients diagnosed with urolithiasis and chronic pyelonephritis in the latent phase were treated. The predominant localization of radiopaque stones no larger than 20 mm in size was the collecting system. The piezoelectric lithotripsy (1-2 sessions) was performed, followed by the administration of the herbal drug Phytolysin in the dosage form of a capsule. The follow-up was carried out after 14- and 30-days using laboratory, ultrasound and x-ray methods. RESULTS: In the postoperative period, there were no cases of the pyelonephritis, which may result from a short-term disturbance of the upper urinary tract urodynamics due to the passage of stone fragments. The antibacterial, antispasmodic, diuretic and anti-inflammatory effects of Phytolysin ensured positive changes in laboratory and bacteriological tests, contributed to the prevention of postoperative complications after extracorporeal lithotripsy (renal colic, pyelonephritis), and contributed to maintaining renal blood flow within normal limits and significantly reduced the time to stone-free status. CONCLUSIONS: Our results justify the feasibility of using phytolysin in capsules in patients with urolithiasis after extracorporeal lithotripsy. The dosage form in capsules eliminates the undesirable effects associated with the specific smell and taste, that patients noted when using phytolysin in the form of a paste.

[Restorative capability of traditional Chinese medicine in autoimmune diseases of nervous system: a literature review]. / Vosstanovitel'nyi potentsial traditsionnoi kitaiskoi meditsiny pri autoimmunnykh zabolevaniyakh nervnoi sistemy: obzor literatury.

Autoimmune diseases of the nervous system are characterized by the formation of pronounced neurological deficiency and often lead to disability. Complementary medicine as an adjuvant or preventive therapy of various diseases, including autoimmune ones, is increasingly attracting the attention of doctors and researchers. Traditional Chinese medicine (TCM) has a complex of treatment methods, including acupuncture, phytotherapy, nutrition, physical exercises and other methods that are often used in common with the recognized approaches of the official medical science. The article describes the TCM methods application in autoimmune diseases of nervous system, presents the practical experience of using acupuncture, phytotherapy, diet, physical exercises. It was concluded that TCM is important and frequently underestimated health care resource, especially in prevention and treatment of autoimmune diseases of nervous system.

Dryopteris crassirhizoma Nakai.: A review of its botany, traditional use, phytochemistry, pharmacological activity, toxicology and pharmacokinetics.

ETHNOPHARMACOLOGICAL RELEVANCE: The Dryopteris crassirhizoma Nakai., a commonly used herb, is known as "Guan Zhong" in China, "Oshida" in Japan and "Gwanjung" in Korea. It has long been used for parasitic infestation, hemorrhages and epidemic influenza. AIM OF THE REVIEW: The present paper aims to provide an up-to-date review at the advancements of the investigations on the traditional use, phytochemistry, pharmacological activity, toxicology and pharmacokinetics of D. crassirhizoma. Besides, possible trends, therapeutic potentials, and perspectives for future research of this plant are also briefly discussed. MATERIALS AND METHODS: Relevant information on traditional use, phytochemistry, pharmacological activity, toxicology and pharmacokinetics of D. crassirhizoma was collected through published materials and electronic databases, including the Chinese Pharmacopoeia, Flora of China, Web of Science, PubMed, Baidu Scholar, Google Scholar, and China National Knowledge Infrastructure. 109 papers included in the article and we determined that no major information was missing after many checks. All authors participated in the review process for this article and all research paper are from authoritative published materials and electronic databases. RESULTS: 130 chemical components, among which phloroglucinols are the predominant groups, have been isolated and identified from D. crassirhizoma. D. crassirhizoma with its bioactive compounds is possessed of extensive biological activities, including anti-parasite, anti-microbial, anti-viral, anti-cancer, anti-inflammatory, anti-oxidant, anti-diabetic, bone protective, immunomodulatory, anti-platelet and anti-hyperuricemia activity. Besides, D. crassirhizoma has special toxicology and pharmacokinetics characterization. CONCLUSIONS: D. crassirhizoma is a traditional Chinese medicine having a long history of application. This review mainly summarized the different chemical components extract from D. crassirhizoma and various reported pharmacological effects. Besides, the toxicology and pharmacokinetics of D. crassirhizoma also be analysed in this review. However, the chemical components of D. crassirhizoma are understudied and require further research to expand its medicinal potential, and it is urgent to design a new extraction scheme, so that the active ingredients can be obtained at a lower cost.

Systematic assessment of the influence of quality of studies on mistletoe in cancer care on the results of a meta-analysis on overall survival.

PURPOSE: Mistletoe treatment in cancer patients is controversial, and a Cochrane review concluded that due to heterogeneity, performing a meta-analysis was not suitable. However, several systematic reviews included meta-analyses in favor of mistletoe. The aim of this work was to assess the influence of the methodological quality of controlled studies on the results of a meta-analysis regarding overall survival. METHODS: Between April and August 2022, Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL and Web of Science were systematically searched. In addition, reference lists of previously published meta-analyses were checked for relevant publications. A random effects meta-analysis with clustering was performed. The risk of bias within the studies was assessed using ROB 2.0 and ROBINS-I. RESULTS: The search identified 4685 hits, and 28 publications reporting on 28 298 patients were included in the quantitative analysis. Overall, the analysis led to a significant result in favor of mistletoe therapy (overall HR = 0.61 with 95% CI [0.53;0.7]). According to our subgroup analysis of randomized studies, studies of higher quality (lower risk of bias) did not lead to a significant result in favor of mistletoe therapy (HR = 0.78; CI = [0.30; 2.00]). CONCLUSIONS: In the case of mistletoe therapy, the results of the meta-analysis strongly depended on the methodological quality of the included studies. Calculating meta-analyses that include low-quality studies may lead to severe misinterpretation of the data.