Efficacy and safety of "Yahom" as a traditional Thai herbal therapy: A systematic review.

ETHNOPHARMACOLOGICAL RELEVANCE: Yahom is a traditional Thai medicine used to treat syncope and abdominal discomfort. AIM OF THE STUDY: This study aimed to systematically review all available evidence which purports to support these claims. MATERIAL AND METHODS: The systematic review accorded with the Cochrane Collaboration framework and PRISMA reporting. Databases including MEDLINE, Excerpta Medica Database (EMBASE), Cochrane library database, and Google Scholar were searched by keywords, Yahom and Ya-hom. Pharmacological and toxicity data from non-animal and animal studies were included. RESULTS: Twenty-four articles: 2 on in vitro cell lines or bacteria, 3 in vitro cell-free, 5 in vitro animal, 13 in vivo and 1 human mainly reported (A) Cardiovascular effects (i) transient hypotension (0.2-0.8g/kg, intravenous injection (i.v.)), increased cerebral blood flow (2g/kg, single oral) and vascular dilatation/relaxation (ii) elevated blood pressure (BP) (0.2-0.8g/kg, i.v. or 2-4g/kg oral) and vasocontraction. Single Yahom doses (3g) given to healthy volunteers had no effect on cutaneous blood flow, ECG or systolic BP although marginally increased diastolic BP was claimed. (B) Yahom (2-4g/kg) completely inhibited gastric acid secretion evoked by gastric secretagogues. (C) Toxicity: Chronic oral doses of selected Yahoms to rodents (0.001-1g/kg) supports its status as generally regarded as safe. CONCLUSIONS: Most studies supported declared objectives relating to perceived Yahom actions, but lacked background demonstrating clinical efficacy, and mechanistic data that would validate conclusions. Our study suggests that research into traditional medicinal herbs needs underpinning by appropriate clinical interventions and pharmacovigilance, thereby optimising efficacy and minimizing toxicity by combining traditional wisdom and modern testing.

Intervention to promote patients' adherence to antimalarial medication: a systematic review.

Non-adherence as a major contributor to poor treatment outcomes. This study aimed to explore the effectiveness of existing interventions promoting adherence to antimalarial drugs by systematic review. The following databases were used to identify potential articles: MEDLINE, EMBASE, the Cochrane CENTRAL, and CINAHL (through March 2013). From 1,813 potential papers identified, 16 studies met the selection criteria comprising 9,247 patients. Interventions were classified as packaging aids, visual media, combined visual media and verbal information, community education, medication supervision, and convenient regimen. These interventions were shown to increase adherence to antimalarial drugs (median relative risk = 1.4, interquartile range 1.2-2.0). Although a most effective intervention did not emerge, community education and visual media/verbal information combinations may well have most potential to improve adherence to antimalarial medication. These interventions should be implemented in combination to optimize their beneficial effects. The current understanding on improved adherence would facilitate to contain outbreaks of malaria cost effectively.

Opportunistic screening and health promotion for type 2 diabetes: an expanding public health role for the community pharmacist.

BACKGROUND: Early detection to identify people at risk of diabetes is an important approach to prevent or delay type 2 diabetes. This study aimed to implement the Diabetes Prevention Program in community pharmacy using a diabetes risk prediction tool. METHODS: The program was conducted in seven pharmacies in Bangkok, Thailand. Participants were the pharmacy's clients aged ≥ 35 years without the history of diabetes. A validated risk prediction tool was used to assess individuals' diabetes risk. Educational information was offered to all participants. Those with a high risk score (≥ 9 out of 17) were offered a self-check of fasting capillary blood glucose (CBG). A referral was made for those with CBG ≥ 126 mg/dl. RESULTS: During a 3-month service, 397 individuals participated in the program. Nearly half of the participants (49.4%) were at a high risk of diabetes (risk score: ≥ 9). Ninety five (48.5%) of these high risk individuals undertook fasting CBG. Elevated fasting CBG (≥ 126 mg/dl) was found in 12 persons (12.7%). Overall, two patients with diabetes were identified during the provision of the program. CONCLUSIONS: The Diabetes Prevention Program in community pharmacies uncovered half of the clients who were at risk of diabetes and provided an opportunity for participants to learn more about the prevention of diabetes.

Hypoglycemic effect of bitter melon compared with metformin in newly diagnosed type 2 diabetes patients.

ETHNOPHARMACOLOGICAL RELEVANCE: Bitter melon (Momordica charantia L.) has been widely used as an traditional medicine treatment for diabetic patients in Asia. In vitro and animal studies suggested its hypoglycemic activity, but limited human studies are available to support its use. AIM OF STUDY: This study was conducted to assess the efficacy and safety of three doses of bitter melon compared with metformin. MATERIALS AND METHODS: This is a 4-week, multicenter, randomized, double-blind, active-control trial. Patients were randomized into 4 groups to receive bitter melon 500 mg/day, 1,000 mg/day, and 2,000 mg/day or metformin 1,000 mg/day. All patients were followed for 4 weeks. RESULTS: There was a significant decline in fructosamine at week 4 of the metformin group (-16.8; 95% CI, -31.2, -2.4 µmol/L) and the bitter melon 2,000 mg/day group (-10.2; 95% CI, -19.1, -1.3 µmol/L). Bitter melon 500 and 1,000 mg/day did not significantly decrease fructosamine levels (-3.5; 95% CI -11.7, 4.6 and -10.3; 95% CI -22.7, 2.2 µmol/L, respectively). CONCLUSIONS: Bitter melon had a modest hypoglycemic effect and significantly reduced fructosamine levels from baseline among patients with type 2 diabetes who received 2,000 mg/day. However, the hypoglycemic effect of bitter melon was less than metformin 1,000 mg/day.