Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West-Africa.

BACKGROUND: Although, medicinal plants have been important for women's health historically, the knowledge about such use during pregnancy in developing countries is limited. This is the first quantitative, ethnobotanical study on Malian women's use of and attitudes towards the use of medicinal plants during pregnancy. The aim of the study was to describe Malian women's use of medicinal plants during pregnancy according to indications and to evaluate the potentially safety of such use. The overall aim was to preserve valuable information about medicinal plants for women's reproductive health for the future. METHODS: Data was collected through structured interviews of 209 pregnant women or mothers in three health care centers in Mali. The women were interviewed about their uses of medicinal plants during pregnancy and their attitudes to such use. Nine specific medicinal plants commonly used in Mali and treatment of eleven common ailments in pregnancy were specifically queried about. RESULTS: In total, 79.9 % had used medicinal plants during pregnancy. Only 17 women (8.5 %) had received a recommendation from a traditional practitioner (TP). The most commonly used medicinal plants were Lippia chevalieri (55.5 %), Combretum micranthum (39.7 %), Parkia biglobosa (12.0 %) and Vepris heterophylla (8.1 %). The most common reasons for use were for well-being (37.7 %), symptoms of malaria (37.1 %) and "increased salt-elimination" (to reduce edema) (19.2 %). For treatment of symptoms of malaria and urinary tract infections during pregnancy, the women's choices of medicinal plants agreed with those previously reported from interviews with TPs. Almost 30 % believed that medicinal plants had no adverse effects for the mother. CONCLUSION: This study showed an extensive use and knowledge of medicinal plants during pregnancy in three regions in Mali. However, exclusive use of medicinal plants as treatment of malaria and urinary tract infections during pregnancy may pose a health risk for the mother and her unborn child. A wider collaboration with TPs, with local communities and conventional health workers of the health care centers, on the safe use of medicinal plants, is important to promote safer pregnancies and better health care for pregnant women and their unborn infants in Mali.

[Ginkgo biloba--effect, adverse events and drug interaction]. / Ginkgo biloba--effekt, bivirkninger og interaksjoner.

Ginkgo is probably one of the most widely used medicinal herbs in Europe. In Norway products of ginkgo leaf extract have been approved by the Norwegian Medicines Agency for the following indication: traditionally used to improve blood circulation, for example, cold hands and feet. Elsewhere, ginkgo is used for cognitive impairment and dementia, acute ischaemic stroke, intermittent claudication, tinnitus and age-related macular degeneration. Evidence of the efficacy of ginkgo for these indications has previously been studied by the Cochrane Collaboration. In this update we have repeated all the searches in Medline and EMBASE exactly as described in the five Cochrane Systematic Reviews (last search date: 16.02.2011). We identified two new randomised and placebo-controlled studies on cognitive impairment and dementia (3187 patients) and one study on acute ischaemic stroke (3069 patients). The results of these studies gave no reason to change the conclusions of earlier reviews by the Cochrane Collaboration. There is no convincing evidence that ginkgo is effective for cognitive impairment or dementia, acute ischaemic stroke, intermittent claudication or tinnitus. There is still a lack of conclusive evidence for the effect on age-related macular degeneration. Ginkgo leaf extract appears to be safe to use, with no excess side effects compared with placebo. It can cause some minor side effects such as stomach upset, headache, dizziness, constipation, forceful heartbeat, and allergic skin reactions. There is some concern that ginkgo leaf extract might increase the risk of bruising and bleeding, and interactions with anticoagulants/antiplatelet drugs cannot be ruled out. As a general precaution, it is recommended withdrawing ginkgo two weeks before elective surgery.

Bioactive polyphenols in Ximenia americana and the traditional use among Malian healers.

ETHNOPHARMACOLOGICAL RELEVANCE: Ximenia americana is a medicinal bushy, spiny shrub or small tree used in Mali in West Africa for treatment of various diseases, most common are infectious and inflammatory ailments. AIMS OF THE STUDY: (1) To perform an ethnopharmacological survey on the traditional use of Ximenia americana among healers in Mali. (2) To isolate and identify chemical constituents from the ethanol extract of Ximenia americana leaves and to study their radical scavenging and enzyme inhibitory effects. MATERIALS AND METHODS: In five different districts in Mali, 38 healers were interviewed about their medicinal use of Ximenia americana. An aqueous ethanol extract of the leaves of this tree was prepared and further fractionated with liquid-liquid extraction, VersaFlash and Sephadex LH-20 column chromatography, and preparative HPLC. Isolated compounds were identified by 1D and 2D NMR spectroscopy. Extracts, subfractions and isolated compounds were investigated as DPPH radical scavengers and as inhibitors of xanthine oxidase and 15-lipoxygenase. RESULTS: Major areas of use by Malian healers were against throat infection, amenorrhea and as tonic. Fractionation of the ethanol extract led to the isolation and identification of the cyanogenic glycoside sambunigrin (1), which is previously known from the plant. Additionally, gallic acid (2) and the gallotannins ß-glucogalline (3) and 1,6-digalloyl-ß-glucopyranose (4) were found. The following flavonoids were isolated: quercetin (5), quercitrin (quercetin-3-O-α-rhamnopyranoside) (6), avicularin (quercetin-3-O-α-arabinofuranoside) (7), quercetin-3-O-ß-xylopyranoside (8), quercetin-3-O-(6″-galloyl)-ß-glucopyranoside (9) and kaempferol-3-O-(6″-galloyl)-ß-glucopyranoside (10). The flavonoids were active both as enzyme inhibitors and DPPH radical scavengers. CONCLUSION: Sambunigrin (1) was the main compound in the EtOAc soluble fraction of the alcoholic extract of Ximenia americana leaves. Gallic acid (2), gallotannins (3-4) and flavonoids (5-10) were identified for the first time in the genus Ximenia. The identified compounds may give a rationale for the traditional use of Ximenia americana in Mali. Healers interviewed reported the use against throat infections, amenorrhea, as tonic, for wound healing and against pain.

[Cranberries for prevention of recurrent urinary tract infections]. / Tranebaer til forebygging av residiverende urinveisinfeksjoner.

BACKGROUND: Cranberries have been used for prevention and treatment of urinary tract infections for decades. The berries contain proanthocyanidins that may reduce the susceptibility to infection by preventing bacteria from attaching to uroepithelial cells. Several clinical trials have been published during recent years. This article reviews documentation of cranberries on clinical effect, adverse events, drug interactions and use during pregnancy and lactation. MATERIAL AND METHODS: Clinical effects of cranberries have been assessed based on the Cochrane review from January 2007 and literature on clinical trials retrieved from a systematic search of PubMed and Embase (from 1 January 2007 to 29 October 2008) with the search terms "cranberry", "Vaccinium macrocarpon", "Vaccinium oxycoccus". RESULTS AND INTERPRETATION: Some evidence exists on cranberries' preventive effect on recurrent symptomatic urinary tract infections in women. The evidence is inconclusive for children, men and older people (both men and women). Studies of people with neuropathic bladder are contradictory. Most of the clinical trials published have several flaws and have not used standardised products. More evidence is needed to determine the optimum dosage, method of administration and the minimum length of treatment. Cranberries should not be used during pregnancy and lactation due to lack of safety data. Further, properly designed studies with standardised products and relevant outcomes are needed.

Structures and structure-activity relationships of three mitogenic and complement fixing pectic arabinogalactans from the malian antiulcer plants Cochlospermum tinctorium A. Rich and Vernonia kotschyana Sch. Bip. ex Walp.

Structures of three pectic arabinogalactans, one from Vernonia kotschyana (Vk2a) and two from Cochlospermum tinctorium (Ct50A1 and Ct50A2), and their complement fixation and induction of B cell proliferation in vitro were compared. The polysaccharide Vk2a expressed potent biological activity in both assays compared with Ct50A1 and Ct50A2. Vk2a possessed a very high molecular weight (1150 +/- 20 kDa) compared with Ct50A1 and Ct50A2 which both showed a polydisperse nature with the highest molecular weight polymers in each fraction estimated at approximately 105 kDa (Ct1a) and 640 +/- 100 kDa (Ct2a), respectively. The HMW polymers showed complement fixation in the same range as the native fractions. The arabinogalactan II content was low in Vk2a (2%) compared with that in Ct50A1 (23%) and Ct50A2 (12%). The high molecular weight polymers were subjected to digestion with a beta-d-(1, 3)-galactanase-rich fraction from Driselase, oligomers were isolated by HPAEC, and their finer structures were determined by MALDI- and ES-qoToF-MS, linkage, and monosaccharide composition analyses. Vk2a consists of both a galacturonan core and a rhamnogalacturonan core rich in neutral side chains. The backbones of both Ct-polysaccharides consist mainly of RG-I regions with numerous neutral side chains dominated by galactosyl residues, whereas the homogalacturonan regions seem to be small. Differences in the chain lengths of the 6-linked galacto-oligosaccharides attached to the 3-linked galactan core could not be related to the differences in the potencies of the biological activities observed.

Structure-immunomodulating activity relationships of a pectic arabinogalactan from Vernonia kotschyana Sch. Bip. ex Walp.

Structure and immunological characteristics of the pectic arabinogalactan Vk2a (previously reported as Vk100A2a) from the roots of Vernonia kotschyana Sch. Bip. ex Walp. were investigated after enzymatic digestion of the galacturonan moiety and the side chains of the rhamnogalacturonan structure of Vk2a. endo-alpha-D-(1-->4)-Polygalacturonase digestion released the high molecular weight 'hairy region' (Vk2a-HR) and oligogalacturonides. Vk2a-HR consisted of GalA (4-linked) and Rha (2- or 2,4-linked) in a 1:1 ratio, with 60% of Rha branched at C-4. The Rha located in the rhamnogalacturonan core was branched randomly by Gal units. Vk2a-HR was rich in neutral sugars such as Araf 5- (12.2%) and 3,5-substituted (12.8%) and terminally- (14.1%) linked and Gal 4- (13.0%), 3- (0.9%), 6- (2.2%) and 3,6- (1.1%) substituted. Arabinans with chain lengths up to 11 units were identified. Araf residues were attached to C-3 of alpha-L-(1-->5)-Araf chains and to C-4 of Gal residues. Single Gal units and chains of beta-D-(1-->6)-linked galacto di- to penta-saccharides were attached to a beta-D-(1-->3)-galactan core. All the enzyme resistant fractions expressed potent complement fixation and induction of B-cell mitogenic activity, and the present study indicates that there may be several and possibly structurally different active sites involved in the bioactivity of Vk2a. The bioactive sites may be located both in the more peripheral parts of the molecule but also in the inner core of the 'hairy region' or in larger enzyme-resistant chains.

Structural and immunological studies of a pectin and a pectic arabinogalactan from Vernonia kotschyana Sch. Bip. ex Walp. (Asteraceae).

Two polysaccharides, a pectin (Vk100A2b) and a pectic arabinogalactan (Vk100A2a) with mean Mw 2 x 10(4) and 1.15 x 10(6)Da, respectively, were isolated from the dried powdered roots of Vernonia kotschyana Sch. Bip. ex Walp. by hot water extraction followed by fractionation on DEAE-Sepharose fast flow and Sephacryl S-400 HR. The pectin showed low-complement fixation activity and no influence on proliferation of B or T cells, while the pectic arabinogalactan showed a potent, dose-dependent complement fixation activity and a T cell independent induction of B-cell proliferation. Both polysaccharides induced chemotaxis of human macrophages, T cells and NK cells. exo-alpha-L-arabinofuranosidase and exo-beta-D-galactosidase digestion followed by component sugar and methylation analysis indicated that Vk100A2a consisted of a highly branched rhamnogalacturonan core with approximately 50% of the rhamnose 1,2,4-substituted, side chains rich in terminal-, 1,5-linked and 1,3,5-branched arabinose and terminal-, 1,4-, 1,6-linked and 1,3,6-branched galactose. The enzyme resistant part of Vk100A2a still showed strong complement fixating activity, suggesting that this activity may at least in part be expressed by carbohydrate structures present in the enzyme resistant, inner portion of the polymer.

Medicinal use of Cochlospermum tinctorium in Mali Anti-ulcer-, radical scavenging- and immunomodulating activities of polymers in the aqueous extract of the roots.

Cochlospermum tinctorium A. Rich. (Cochlospermaceae) is a widely used medicinal plant in the West African country, Mali. An ethnopharmacological survey was conducted and 106 traditional practitioners interviewed. The roots were the part of the plant reported to be the most frequently used for medicinal purposes. The main indications were to treat jaundice (41), gastro intestinal diseases or ailments (28), malaria (12), schistosomiasis (10) and dysurea (6). A high-molecular weight water extract (25, 50 and 100 mg/kg, body weight) significantly inhibited HCl/ethanol-induced gastric lesions in mice. The extract showed DPPH-radical scavenging- and immunomodulating activities in vitro. The main components of the extract were identified as polysaccharides (59.3%) and polyphenols (9.3%). The polysaccharides were purified and characterised as highly complex pectic arabinogalactans type II. As parts of the polyphenol compounds gallotannins and ferulic acids were identified. This study shows that the polysaccharides are partly responsible for the bioactivities observed in vitro. Both polysaccharides and polyphenols may be responsible for the anti-ulcer activities observed.

An ethnopharmacological survey of plants used for wound healing in Dogonland, Mali, West Africa.

Traditional medicine, being a significant element in the cultural patrimony, still remains the main recourse for a large majority of people in Dogonland, Mali, for treating various diseases and ailments. This paper reports an ethnopharmacological study in Dogonland with the aim to identify medicinal plants used in the treatment of wounds. Information obtained from traditional healers revealed 73 plant species being used as wound healing remedies, according to the definitions of wounds given by the healers themselves. The plants, belonging to 34 plant families, are used as first aids, in the washing of wounds, extraction of pus, as coagulants, as well as for infected wounds. The most frequently used preparations are decoctions and powdered plant material.

Isolation, partial characterisation and immunomodulating activities of polysaccharides from Vernonia kotschyana Sch. Bip. ex Walp.

The roots from Vernonia kotschyana Sch. Bip. ex Walp. (Baccharoides adoensis var. kotschyana (Sch. Bip. ex Walp.) M.A. Isawumi, G.El-Ghazaly & B. Nordenstam) (Asteraceae) are used in Malian folk medicine for the treatment of gastritis, gastro duodenal ulcers, as an aid to ameliorate digestion and as a wound healing remedy. Since a common feature among these conditions is related to immune responses, immunomodulating activities of fractions isolated from both the 50 degrees C and the 100 degrees C water extracts from Vernonia kotschyana were investigated in this study. The active principles were identified as acidic polysaccharide fractions, containing pectic arabinogalactan type II structures, which showed both complement fixing ability and T-cell independent induction of B-cell proliferation in vitro. Some activity was also observed on macrophages. The present study may provide additional support for the popular use of this plant to improve intestinal health.