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A Review of Moisturizing Additives for Atopic Dermatitis. COSMETICS 2022. [DOI: 10.3390/cosmetics9040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Atopic dermatitis, the most common form of eczema, is a chronic, relapsing inflammatory skin condition that occurs with dry skin, persistent itching, and scaly lesions. This debilitating condition significantly compromises the patient’s quality of life due to the intractable itching and other associated factors such as disfigurement, sleeping disturbances, and social stigmatization from the visible lesions. The treatment mainstay of atopic dermatitis involves applying topical glucocorticosteroids and calcineurin inhibitors, combined with regular use of moisturizers. However, conventional treatments possess a certain degree of adverse effects, which raised concerns among the patients resulting in non-adherence to treatment. Hence, the modern use of moisturizers to improve barrier repair and function is of great value. One of the approaches includes incorporating bioactive ingredients with clinically proven therapeutic benefits into dermocosmetics emollient. The current evidence suggests that these dermocosmetics emollients aid in the improvement of the skin barrier and alleviate inflammation, pruritus and xerosis. We carried out a critical and comprehensive narrative review of the literature. Studies and trials focusing on moisturizers that include phytochemicals, natural moisturizing factors, essential fatty acids, endocannabinoids, and antioxidants were identified by searching electronic databases (PubMed and MEDLINE). We introduce the current knowledge on the roles of moisturizers in alleviating symptoms of atopic dermatitis. We then further summarize the science and rationale of the active ingredients in dermocosmetics and medical device emollients for treating atopic dermatitis. Finally, we highlight the limitations of the current evidence and future perspectives of cosmeceutical research on atopic dermatitis.
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Mahmoudzadeh E, Nazemiyeh H, Hamedeyazdan S. Anti-inflammatory Properties of the Genus Symphytum L.: A Review. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e123949. [PMID: 36060906 PMCID: PMC9420230 DOI: 10.5812/ijpr.123949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/17/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
: The Symphytum genus has been mainly used in traditional medicine, containing its anti-inflammatory activity. Symphytum spp.’s active components, such as allantoin, polyphenols, flavonoids, and alkaloids, can act on several intentions in the signaling pathway, constrain pro-inflammatory enzymes, reducing the construction of inflammatory chemokine’s and cytokines, and decreasing oxidative stress, which afterward suppresses inflammation procedures. Preclinical and clinical trials have reported the prevailing anti-inflammatory effect of several Symphytum species. This review presents an overview of the anti-inflammatory activities of different products and bioactive constituents in this genus. The papers with the English language were gathered from 2000 to 2021. This review may provide a scientific base for establishing innovative and alternative techniques for isolating a single individual from this genus to attenuate inflammatory disorders. The Symphytum genus is waiting for researchers to develop safe and effective anti-inflammatory agents for additional investigation of other different mechanisms of action.
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Affiliation(s)
- Elaheh Mahmoudzadeh
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Pharmacognosy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Nazemiyeh
- Department of Pharmacognosy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Pharmaceutical Nanotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanaz Hamedeyazdan
- Department of Pharmacognosy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Department of Pharmacognosy, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
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Zengin G, Sinan KI, Ak G, Angeloni S, Maggi F, Caprioli G, Kaplan A, Çakılcıoğlu U, Akan H, Jugreet S, Mahomoodally MF. Preliminary investigation on chemical composition and bioactivity of differently obtained extracts from Symphytum aintabicum Hub.- Mor. &Wickens. BIOCHEM SYST ECOL 2021. [DOI: 10.1016/j.bse.2020.104203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Conservative Treatment for Acute Ankle Sprain: A Systematic Review. J Clin Med 2020; 9:jcm9103128. [PMID: 32992655 PMCID: PMC7599579 DOI: 10.3390/jcm9103128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
The aim was to identify conservative treatments available for acute ankle sprain and to evaluate their effectiveness with respect to pain relief and short-term recovery of functional capacity. A systematic review of the relevant literature was conducted via a data search of the PROSPERO, PubMed, Scopus, CINAHL, PyscINFO and SPORTDiscus databases, from inception until December 2019, focusing on randomised control trial studies. Two of the authors independently assessed the quality of each study located and extracted the relevant data. The quality of each paper was assessed using the Cochrane risk of bias tool included in RevMan 5. In all, 20 studies met the inclusion criteria. In terms of absence of bias, only nine papers were classed as “high quality”. Studies (75%) were of low quality in terms of the blinding of participants and personnel and uncertainty in blinding of outcome assessment and all presented one or more other forms of bias. Despite the generally low quality of the studies considered, it can be concluded that conservative treatment for acute ankle sprain normally achieves pain relief and rapidly improved functionality. Research based on higher-quality study designs and procedures would enable more definitive conclusions to be drawn.
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Salehi B, Sharopov F, Boyunegmez Tumer T, Ozleyen A, Rodríguez-Pérez C, Ezzat SM, Azzini E, Hosseinabadi T, Butnariu M, Sarac I, Bostan C, Acharya K, Sen S, Nur Kasapoglu K, Daşkaya-Dikmen C, Özçelik B, Baghalpour N, Sharifi-Rad J, Valere Tsouh Fokou P, Cho WC, Martins N. Symphytum Species: A Comprehensive Review on Chemical Composition, Food Applications and Phytopharmacology. Molecules 2019; 24:2272. [PMID: 31216776 PMCID: PMC6631335 DOI: 10.3390/molecules24122272,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 06/28/2023] Open
Abstract
Symphytum species belongs to the Boraginaceae family and have been used for centuries for bone breakages, sprains and rheumatism, liver problems, gastritis, ulcers, skin problems, joint pain and contusions, wounds, gout, hematomas and thrombophlebitis. Considering the innumerable potentialities of the Symphytum species and their widespread use in the world, it is extremely important to provide data compiling the available literature to identify the areas of intense research and the main gaps in order to design future studies. The present review aims at summarizing the main data on the therapeutic indications of the Symphytum species based on the current evidence, also emphasizing data on both the efficacy and adverse effects. The present review was carried out by consulting PubMed (Medline), Web of Science, Embase, Scopus, Cochrane Database, Science Direct and Google Scholar (as a search engine) databases to retrieve the most updated articles on this topic. All articles were carefully analyzed by the authors to assess their strengths and weaknesses, and to select the most useful ones for the purpose of review, prioritizing articles published from 1956 to 2018. The pharmacological effects of the Symphytum species are attributed to several chemical compounds, among them allantoin, phenolic compounds, glycopeptides, polysaccharides and some toxic pyrrolizidine alkaloids. Not less important to highlight are the risks associated with its use. In fact, there is increasing consumption of over-the-counter drugs, which when associated with conventional drugs can cause serious and even fatal adverse events. Although clinical trials sustain the folk topical application of Symphytum species in musculoskeletal and blunt injuries, with minor adverse effects, its antimicrobial potency was still poorly investigated. Further studies are needed to assess the antimicrobial spectrum of Symphytum species and to characterize the active molecules both in vitro and in vivo.
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Affiliation(s)
- Bahare Salehi
- Student Research Committee, School of Medicine, Bam University of Medical Sciences, Bam 44340847, Iran.
| | - Farukh Sharopov
- Department of Pharmaceutical Technology, Avicenna Tajik State Medical University, Rudaki 139, Dushanbe 734003, Tajikistan.
| | - Tugba Boyunegmez Tumer
- Department of Molecular Biology and Genetics, Faculty of Arts and Science, Canakkale Onsekiz Mart University, Canakkale 17020, Turkey.
| | - Adem Ozleyen
- Graduate Program of Biomolecular Sciences, Institute of Natural and Applied Sciences, Canakkale Onsekiz Mart University, Canakkale 17020, Turkey.
| | - Celia Rodríguez-Pérez
- Department of Nutrition and Food Science, University of Granada, Campus of Cartuja, E-18071 Granada, Spain.
- Institute of Nutrition and Food Technology (INYTA) 'José Mataix', Biomedical Research Centre, University of Granada, Avenida del Conocimiento s/n, E-18071 Granada, Spain.
| | - Shahira M Ezzat
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Kasr El-Ainy Street, Cairo 11562, Egypt.
- Department of Pharmacognosy, Faculty of Pharmacy, October University for Modern Science and Arts (MSA), 6th October City 12566, Egypt.
| | - Elena Azzini
- Centre for Research on Food and Nutrition, Council for Agricultural Research and Economics, Rome 546-00178 , Italy.
| | - Tahereh Hosseinabadi
- Department of Pharmacognosy and Biotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 11369, Iran.
| | - Monica Butnariu
- Banat's University of Agricultural Sciences and Veterinary Medicine "King Michael I of Romania" from Timisoara, 300645 Calea Aradului 119, Timis, Romania.
| | - Ioan Sarac
- Banat's University of Agricultural Sciences and Veterinary Medicine "King Michael I of Romania" from Timisoara, 300645 Calea Aradului 119, Timis, Romania.
| | - Cristian Bostan
- Banat's University of Agricultural Sciences and Veterinary Medicine "King Michael I of Romania" from Timisoara, 300645 Calea Aradului 119, Timis, Romania.
| | - Krishnendu Acharya
- Molecular and Applied Mycology and Plant Pathology Laboratory, Department of Botany, University of Calcutta, Kolkata 700019, India.
| | - Surjit Sen
- Molecular and Applied Mycology and Plant Pathology Laboratory, Department of Botany, University of Calcutta, Kolkata 700019, India.
- Department of Botany, Fakir Chand College, Diamond Harbour, West Bengal 743331, India.
| | - Kadriye Nur Kasapoglu
- Istanbul Technical University, Chemical and Metallurgical Engineering Faculty, Food Engineering Department, Ayazağa Campus, Maslak 34469, Istanbul, Turkey.
| | - Ceren Daşkaya-Dikmen
- Istanbul Technical University, Chemical and Metallurgical Engineering Faculty, Food Engineering Department, Ayazağa Campus, Maslak 34469, Istanbul, Turkey.
- Istanbul Gedik University, Department of Gastronomy and Culinary Arts, 34876 Kartal, Istanbul, Turkey.
| | - Beraat Özçelik
- Istanbul Technical University, Chemical and Metallurgical Engineering Faculty, Food Engineering Department, Ayazağa Campus, Maslak 34469, Istanbul, Turkey.
- Bioactive Research & Innovation Food Manufac. Indust. Trade Ltd., Katar Street, Teknokent ARI-3, B110, Sarıyer 34467, Istanbul, Turkey.
| | - Navid Baghalpour
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran 11369, Iran.
| | - Javad Sharifi-Rad
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol 61615-585, Iran.
| | - Patrick Valere Tsouh Fokou
- Antimicrobial and Biocontrol Agents Unit, Department of Biochemistry, Faculty of Science, University of Yaounde 1, Ngoa Ekelle, Annex Fac. Sci, Yaounde 812, Cameroon.
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, China.
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
- Institute for Research and Innovation in Health (i3S), University of Porto, 4200-135 Porto, Portugal.
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Salehi B, Sharopov F, Boyunegmez Tumer T, Ozleyen A, Rodríguez-Pérez C, Ezzat SM, Azzini E, Hosseinabadi T, Butnariu M, Sarac I, Bostan C, Acharya K, Sen S, Nur Kasapoglu K, Daşkaya-Dikmen C, Özçelik B, Baghalpour N, Sharifi-Rad J, Valere Tsouh Fokou P, Cho WC, Martins N. Symphytum Species: A Comprehensive Review on Chemical Composition, Food Applications and Phytopharmacology. Molecules 2019; 24:E2272. [PMID: 31216776 PMCID: PMC6631335 DOI: 10.3390/molecules24122272] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 12/20/2022] Open
Abstract
Symphytum species belongs to the Boraginaceae family and have been used for centuries for bone breakages, sprains and rheumatism, liver problems, gastritis, ulcers, skin problems, joint pain and contusions, wounds, gout, hematomas and thrombophlebitis. Considering the innumerable potentialities of the Symphytum species and their widespread use in the world, it is extremely important to provide data compiling the available literature to identify the areas of intense research and the main gaps in order to design future studies. The present review aims at summarizing the main data on the therapeutic indications of the Symphytum species based on the current evidence, also emphasizing data on both the efficacy and adverse effects. The present review was carried out by consulting PubMed (Medline), Web of Science, Embase, Scopus, Cochrane Database, Science Direct and Google Scholar (as a search engine) databases to retrieve the most updated articles on this topic. All articles were carefully analyzed by the authors to assess their strengths and weaknesses, and to select the most useful ones for the purpose of review, prioritizing articles published from 1956 to 2018. The pharmacological effects of the Symphytum species are attributed to several chemical compounds, among them allantoin, phenolic compounds, glycopeptides, polysaccharides and some toxic pyrrolizidine alkaloids. Not less important to highlight are the risks associated with its use. In fact, there is increasing consumption of over-the-counter drugs, which when associated with conventional drugs can cause serious and even fatal adverse events. Although clinical trials sustain the folk topical application of Symphytum species in musculoskeletal and blunt injuries, with minor adverse effects, its antimicrobial potency was still poorly investigated. Further studies are needed to assess the antimicrobial spectrum of Symphytum species and to characterize the active molecules both in vitro and in vivo.
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Affiliation(s)
- Bahare Salehi
- Student Research Committee, School of Medicine, Bam University of Medical Sciences, Bam 44340847, Iran.
| | - Farukh Sharopov
- Department of Pharmaceutical Technology, Avicenna Tajik State Medical University, Rudaki 139, Dushanbe 734003, Tajikistan.
| | - Tugba Boyunegmez Tumer
- Department of Molecular Biology and Genetics, Faculty of Arts and Science, Canakkale Onsekiz Mart University, Canakkale 17020, Turkey.
| | - Adem Ozleyen
- Graduate Program of Biomolecular Sciences, Institute of Natural and Applied Sciences, Canakkale Onsekiz Mart University, Canakkale 17020, Turkey.
| | - Celia Rodríguez-Pérez
- Department of Nutrition and Food Science, University of Granada, Campus of Cartuja, E-18071 Granada, Spain.
- Institute of Nutrition and Food Technology (INYTA) 'José Mataix', Biomedical Research Centre, University of Granada, Avenida del Conocimiento s/n, E-18071 Granada, Spain.
| | - Shahira M Ezzat
- Pharmacognosy Department, Faculty of Pharmacy, Cairo University, Kasr El-Ainy Street, Cairo 11562, Egypt.
- Department of Pharmacognosy, Faculty of Pharmacy, October University for Modern Science and Arts (MSA), 6th October City 12566, Egypt.
| | - Elena Azzini
- Centre for Research on Food and Nutrition, Council for Agricultural Research and Economics, Rome 546-00178 , Italy.
| | - Tahereh Hosseinabadi
- Department of Pharmacognosy and Biotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 11369, Iran.
| | - Monica Butnariu
- Banat's University of Agricultural Sciences and Veterinary Medicine "King Michael I of Romania" from Timisoara, 300645 Calea Aradului 119, Timis, Romania.
| | - Ioan Sarac
- Banat's University of Agricultural Sciences and Veterinary Medicine "King Michael I of Romania" from Timisoara, 300645 Calea Aradului 119, Timis, Romania.
| | - Cristian Bostan
- Banat's University of Agricultural Sciences and Veterinary Medicine "King Michael I of Romania" from Timisoara, 300645 Calea Aradului 119, Timis, Romania.
| | - Krishnendu Acharya
- Molecular and Applied Mycology and Plant Pathology Laboratory, Department of Botany, University of Calcutta, Kolkata 700019, India.
| | - Surjit Sen
- Molecular and Applied Mycology and Plant Pathology Laboratory, Department of Botany, University of Calcutta, Kolkata 700019, India.
- Department of Botany, Fakir Chand College, Diamond Harbour, West Bengal 743331, India.
| | - Kadriye Nur Kasapoglu
- Istanbul Technical University, Chemical and Metallurgical Engineering Faculty, Food Engineering Department, Ayazağa Campus, Maslak 34469, Istanbul, Turkey.
| | - Ceren Daşkaya-Dikmen
- Istanbul Technical University, Chemical and Metallurgical Engineering Faculty, Food Engineering Department, Ayazağa Campus, Maslak 34469, Istanbul, Turkey.
- Istanbul Gedik University, Department of Gastronomy and Culinary Arts, 34876 Kartal, Istanbul, Turkey.
| | - Beraat Özçelik
- Istanbul Technical University, Chemical and Metallurgical Engineering Faculty, Food Engineering Department, Ayazağa Campus, Maslak 34469, Istanbul, Turkey.
- Bioactive Research & Innovation Food Manufac. Indust. Trade Ltd., Katar Street, Teknokent ARI-3, B110, Sarıyer 34467, Istanbul, Turkey.
| | - Navid Baghalpour
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran 11369, Iran.
| | - Javad Sharifi-Rad
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol 61615-585, Iran.
| | - Patrick Valere Tsouh Fokou
- Antimicrobial and Biocontrol Agents Unit, Department of Biochemistry, Faculty of Science, University of Yaounde 1, Ngoa Ekelle, Annex Fac. Sci, Yaounde 812, Cameroon.
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, China.
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
- Institute for Research and Innovation in Health (i3S), University of Porto, 4200-135 Porto, Portugal.
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Kucera A, Barna M, Holcova S, Horacek O, Hladiková M, Ottillinger B. Tolerability and effectiveness of an antitrauma cream with comfrey herb extract in pediatric use with application on intact and on broken skin. Int J Pediatr Adolesc Med 2019; 5:135-141. [PMID: 30805549 PMCID: PMC6363250 DOI: 10.1016/j.ijpam.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 11/16/2022]
Abstract
Objective The safety of comfrey herbal cream application to broken skin is still a matter of regulatory debate. It was therefore examined in children with intact and with broken skin treated for blunt traumas and sports injuries, with the aim of collecting data for pharmacovigilance and clinical safety assessments. Methods A total of 712 children (386 children with intact skin and 326 children with abrasions and superficial wounds) were openly treated for up to 2 weeks with 1-5 applications daily of comfrey herb cream after presenting for blunt traumas and sports accidents. The incidence rate of adverse events was calculated, next to a global assessment of treatment effects. Results No adverse events occurred in the group of children with intact skin, and one intolerability reaction (burning and reddening) was observed after application to broken skin. The overall incidence rate of intolerability reactions per patient was calculated as 0.14% (95% CI 0.00-0.78%) and that of systemic adverse effects as 0.00% (95% CI 0.00-0.42%). Accordingly, the probability of the occurrence of local reactions and systemic adverse events is well below, which is one in 100 treated patients. The global assessment of effects corresponded to previously published experience. Conclusion These studies confirm an excellent benefit-to-risk ratio for the application of comfrey herb cream in the treatment of blunt traumas and sports injuries in children with intact and with broken skin.
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Affiliation(s)
- Alexander Kucera
- 2nd Medical Faculty of the Charles University, V Úvalu 84, 15006 Prague 5, Czech Republic
| | - Milos Barna
- Ordination for Rehabilitation, Marakova 3/263, 16000 Prague 6, Czech Republic
| | - Simona Holcova
- Outpatient Department of Dermatovenerology, Jugoslávská 13, CZ-61300 Brno 2, Czech Republic
| | - Ondrej Horacek
- 2nd Medical Faculty of the Charles University, V Úvalu 84, 15006 Prague 5, Czech Republic
| | - Marie Hladiková
- Department of Medical Informatics, 2nd Faculty of Medicine, Charles University of Prague, V Úvalu 84, CZ-15006 Prague 5, Czech Republic
| | - Bertram Ottillinger
- Ottillinger Life Sciences, Foehrenstrasse 12, D-85649, Brunnthal-Hofolding, Germany
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Freitas AL, Santos CA, Souza CA, Nunes MA, Antoniolli ÂR, da Silva WB, da Silva FA. The use of medicinal plants in venous ulcers: a systematic review with meta-analysis. Int Wound J 2017; 14:1019-1024. [PMID: 28488305 DOI: 10.1111/iwj.12751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/04/2017] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to systematically review the use of medicinal plants for the treatment of varicose ulcers. The databases used in the search were: Medline/Pubmed, Scopus, Cinhal, Lilacs and Web of Science. The selection process was divided into two phases: the reading of titles and abstracts and the full reading of selected articles. The item description was compared with the checklist of the Consolidated Standards of Reporting Trials. The initial search produced 3505 articles and seven were selected for inclusion in the systematic review. Of the included studies, 7 (100%) evaluated the reduction of the ulcer area, 4 (57·14%) evaluated reepithelisation, 2 (28·57%) evaluated bacterial flora and 1 (14·28%) evaluated the oxygen pressure and percutaneous carbon dioxide. The level of evidence rating indicated that five studies (71·42%) were rated at level 2 and two (28·57%) were rated at level 3. The quality assessment was performed using the Jadad scale, which is prevalent in the literature. The quality score of the Jadad questionnaire ranges from 0 to 5; here, the studies analysed had an average of 2·5. A meta-analysis was performed on two studies that analysed the effects of Mimosa tenuiflora hydrogel in the treatment of venous ulcer and included 42 patients with a mean age of 60·5 years and a mean duration of treatment of 10·5 weeks. Heterogeneity was assessed using I2 ; we obtained a high value of 84%. We concluded that, despite the efficacy of the incorporation of Ageratina pichinchensis into the gel, the hydrogel that incorporated M. tenuiflora appeared to be a promising candidate for the management of venous ulcers.
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Affiliation(s)
- Anderson L Freitas
- Departament of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Carla A Santos
- Departament of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Carlos As Souza
- Departament of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
| | - Marco Ap Nunes
- Departament of Medicine, Federal University of Sergipe, São Cristóvão, Brazil
| | - Ângelo R Antoniolli
- Departament of Pharmacy, Federal University of Sergipe, São Cristóvão, Brazil
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Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med 2016; 51:113-125. [PMID: 28053200 DOI: 10.1136/bjsports-2016-096178] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. OBJECTIVE To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. DESIGN Overview of intervention systematic reviews. PARTICIPANTS Individuals with acute ankle sprain/CAI. MAIN OUTCOME MEASUREMENTS The primary outcomes were injury/reinjury incidence and function. RESULTS 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. CONCLUSIONS For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.
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Affiliation(s)
- Cailbhe Doherty
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Dublin, Ireland
| | - Chris Bleakley
- Sport and Exercise Sciences Research Institute, Ulster Sports Academy, University of Ulster, Newtownabbey, UK
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Bigdeli Shamloo MB, Nasiri M, Dabirian A, Bakhtiyari A, Mojab F, Alavi Majd H. The Effects of Topical Sesame (Sesamum indicum) Oil on Pain Severity and Amount of Received Non-Steroid Anti-Inflammatory Drugs in Patients With Upper or Lower Extremities Trauma. Anesth Pain Med 2015; 5:e25085. [PMID: 26161326 PMCID: PMC4493737 DOI: 10.5812/aapm.25085v2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 11/27/2014] [Accepted: 01/07/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Most patients with trauma experience different levels of pain. Due to side effects as well as economic burden of drugs used for pain relief after trauma commonly, it is important to use low-cost methods independently or combined with drugs to alleviate pain. Objectives: Therefore, this study aimed to investigate the effects of topical sesame oil on pain severity and frequency of received NSAIDs of patients with trauma. Patients and Methods: This randomized clinical trial study was conducted on 150 patients with upper or lower extremities trauma in Dezful Ganjavian Hospital, Ahvaz, Iran, in 2014. Data was collected by a researcher-made questionnaire and Visual Analogue Scale (VAS). Patients were divided into two groups of control (n = 75) and intervention (n = 75) randomly. In the intervention group, patients applied topical sesame oil beside the routine cares, while in the control group patients just received routine cares. Severity of pain and frequency of received NSAIDs was assessed in the first, third, seventh and tenth days after the intervention in the both groups. Data was analyzed by SPSS19 software using descriptive and analytic (Chi-square and independent sample t-test) statistical methods. Results: Based on student sample t-test, there was a significant difference between intervention and control groups regarding the pain severity in the first (P = 0.06), third (P = 0.001), seventh (P = 0.001) and tenth (P = 0.001) days after the intervention. Besides, the frequency of received NSAIDs in the intervention group and the control group showed significant difference in four days after the intervention (for four days P = 0.001). Conclusions: Topical application of sesame oil could reduce pain severity and frequency of received NSAIDs in patients with upper or lower extremities trauma. Therefore, it is recommended to use this oil in complementary medicine for pain relief due to low cost, easy usage and lack of adverse effects.
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Affiliation(s)
| | - Morteza Nasiri
- Department of Nursing, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding author: Morteza Nasiri, Department of Nursing, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Tel: + 98-9171745485, Fax: +98-7726223012, E-mail:
| | - Aazam Dabirian
- Department of Pharmacognosy, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Bakhtiyari
- Department of Emergency Medicine, Medicine School, Dezful University of Medical Sciences, Dezful, Iran
| | - Faraz Mojab
- Pharmacy School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Epidemiology and Statistic, Health School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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[Efficacy and safety of symphytum herb extract cream in the treatment of pressure ulcers]. Z Gerontol Geriatr 2014; 47:228-35. [PMID: 24048776 DOI: 10.1007/s00391-013-0522-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In an open, prospective use study, 161 patients with 198 decubitus ulcers (pressure ulcers, ITT population) in stages II and III were treated with the topical preparation symphytum herb extract cream. The bandages with the cream were changed every 2-3 days. The primary parameters evaluated were the area of the sore and the depth of the wound (planimetrically in mm). In all, 151 patients with a total of 184 pressure sores (PP population) were included and received treatment over a period of 4 weeks in order to evaluate the treatment results. Complete healing of the pressure sores within 4 weeks was observed in 85.9 % (PP population)/79.8 % (ITT population) of the treated ulcers. Over a treatment duration of 25-30 days, a 89.2 % reduction of the total decubitus area was observed. The same result was found for the depth of the pressure ulcer with a reduction of 88 %. The overall treatment success was from both the perspective of the physician and the patient considered successful in 90.4 % (5-point scale) of cases and 87.9% (100 mm VAS, PP population). Two cases of local irritation were observed after 25/30 days (1.2 % of the patients with exposure), thus showing very good skin compatibility. The efficacy of symphytum herb extract cream is surprisingly good in the treatment of pressure ulcers.
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Frost R, O'Meara S, MacPherson H. The external use of comfrey: A practitioner survey. Complement Ther Clin Pract 2014; 20:347-55. [DOI: 10.1016/j.ctcp.2014.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
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13
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Efficacy of a massage roller combined with cooling lotion in the prevention of calf muscle cramps. PHLEBOLOGIE 2014. [DOI: 10.12687/phleb2167-2-2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungIn dieser offenen Anwendungsbeobachtung wurde an 208 Patienten über 4 Wochen geprüft, ob die Kombination des Massagerollers mit der Waden Massage Pflegelotion die Anzahl der Waden- und Fußkrämpfe senken kann. Zur Prophylaxe wurden täglich über mindestens 5 Minuten die betroffenen Muskeln ausgehend von der Großzehe in Rich-tung der Leiste mit dem Massageroller mit mäßig bis mittelstarkem Druck ausgerollt. Bei 151 Patienten zeigte sich eine deutliche Besserung, indem die Frequenz der Wadenkrämpfe um mehr als die Hälfte abnahm bzw. keine Wadenkrämpfe mehr auftraten. Auch die Krampflänge nahm durch Anwendung des Massagerollers bei einem aktuellen Wadenkrampf ab. Die Häufigkeit und Stärke wurde in einem Fragebogen dokumentiert. Schwangere, jüngere Patienten, solche mit Venenerkrankungen und Männer in jedem sowie Frauen im mittleren Alter profitierten von der Anwendung des Massagerollers am besten.
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Frost R, MacPherson H, O’Meara S. A critical scoping review of external uses of comfrey (Symphytum spp.). Complement Ther Med 2013; 21:724-45. [DOI: 10.1016/j.ctim.2013.09.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/25/2013] [Accepted: 09/29/2013] [Indexed: 12/23/2022] Open
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Kaminski TW, Hertel J, Amendola N, Docherty CL, Dolan MG, Hopkins JT, Nussbaum E, Poppy W, Richie D. National Athletic Trainers' Association position statement: conservative management and prevention of ankle sprains in athletes. J Athl Train 2013; 48:528-45. [PMID: 23855363 PMCID: PMC3718356 DOI: 10.4085/1062-6050-48.4.02] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present recommendations for athletic trainers and other allied health care professionals in the conservative management and prevention of ankle sprains in athletes. BACKGROUND Because ankle sprains are a common and often disabling injury in athletes, athletic trainers and other sports health care professionals must be able to implement the most current and evidence-supported treatment strategies to ensure safe and rapid return to play. Equally important is initiating preventive measures to mitigate both first-time sprains and the chance of reinjury. Therefore, considerations for appropriate preventive measures (including taping and bracing), initial assessment, both short- and long-term management strategies, return-to-play guidelines, and recommendations for syndesmotic ankle sprains and chronic ankle instability are presented. RECOMMENDATIONS The recommendations included in this position statement are intended to provide athletic trainers and other sports health care professionals with guidelines and criteria to deliver the best health care possible for the prevention and management of ankle sprains. An endorsement as to best practice is made whenever evidence supporting the recommendation is available.
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Affiliation(s)
- Thomas W Kaminski
- National Athletic Trainers’ Association, Communications Department, 2952 Stemmons Freeway, Dallas, TX 75247, USA
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Mazzocchi A, Montanaro F. Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery. HOMEOPATHY 2013; 101:211-6. [PMID: 23089216 DOI: 10.1016/j.homp.2012.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 03/31/2012] [Accepted: 07/24/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the effect of Symphytum 5CH on the postoperative pain and swelling after placement of a titanium dental implant. MATERIAL AND METHODS Data on pain and swelling following pure titanium implants were reviewed. Patients were treated postoperatively with ketoprofen only or ketoprofen and Symphytum 5CH, according to the treating dentist's usual practice. Demographics and baseline characteristics were recorded and compared. Pain and swelling were compared between the two treatment groups using the Wilcoxon rank sum test and ordinal logistic regression, estimating odds ratios and confidence intervals. RESULTS 100 implants in 57 patients (28 males, 29 females) were treated with ketoprofen alone; 100 implants in 60 patients (14 males, 46 females) with ketoprofen and Symphytum. The group treated with ketoprofen and Symphytum appeared to have a better response in terms of both pain and swelling. Ordinal logistic regression: pain 0.23, 95% CI 0.13-0.41; swelling 0.24, 95% CI 0.13-0.44. Correction for demographics and implant characteristics greatly widened the confidence intervals so that the results were no longer statistically significant (pain: OR = 0.15, 95% CI 0.07-34.56; swelling OR = 0.18, 95% CI 0.07-46.78). CONCLUSIONS Adding Symphytum 5CH to conventional analgesia may reduce pain and swelling after minor dental implant surgery. No firm conclusion can be drawn since the results are confounded by baseline differences, principally gender. Further, randomized, studies should be conducted.
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Staiger C. Comfrey: a clinical overview. Phytother Res 2012; 26:1441-8. [PMID: 22359388 PMCID: PMC3491633 DOI: 10.1002/ptr.4612] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 09/05/2011] [Accepted: 12/14/2011] [Indexed: 11/09/2022]
Abstract
Comfrey has a centuries-old tradition as a medicinal plant. Today, multiple randomized controlled trials have demonstrated the efficacy and safety of comfrey preparations for the topical treatment of pain, inflammation and swelling of muscles and joints in degenerative arthritis, acute myalgia in the back, sprains, contusions and strains after sports injuries and accidents, also in children aged 3 or 4 and over. This paper provides information on clinical trials and non-interventional studies published on comfrey to date and further literature, substantiating the fact that topical comfrey preparations are a valuable therapy option for the treatment of painful muscle and joint complaints.
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Arnica/Hydroxyethyl salicylate combination spray for ankle distortion: a four-arm randomised double-blind study. PAIN RESEARCH AND TREATMENT 2011; 2011:365625. [PMID: 22110924 PMCID: PMC3195812 DOI: 10.1155/2011/365625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 01/17/2011] [Indexed: 11/17/2022]
Abstract
570 patients with acute ankle joint distortion were randomized to four treatment groups: a combination spray of arnica tincture and hydroxyethyl salicylate (HES; group A, n = 228), arnica (B, n = 57), HES (C, n = 228), and placebo (D, n = 57). The medication was applied 4-5 times daily for 10 days. Efficacy was assessed on day 3-4 by evaluating pain on motion on a visual analogue scale (VAS).
Pain improvement in group A was significantly superior over groups B–D (t-test with unadjusted baseline values, P < 4 × 10−7 and ANCOVA after adjustment, P < 5 × 10−11) and approximately corresponded to the cumulative effect of the single constituents (12.1, 7.5, and 18.7 mm VAS for A versus B, A versus C, and A versus D; 95% CI 8.0–16.2, 4.7–10.4, and 14.8–22.5 mm). The combination is justified by the additive effects of the single active constituents.
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Moseley AM, Herbert R, Maher CG, Sherrington C, Elkins MR. PEDro scale can only rate what papers report. ACTA ACUST UNITED AC 2009; 54:288. [PMID: 19025514 DOI: 10.1016/s0004-9514(08)70017-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. ACTA ACUST UNITED AC 2008; 54:7-20. [PMID: 18298355 DOI: 10.1016/s0004-9514(08)70061-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
QUESTIONS Which intervention(s) best augment early mobilisation and external support after an acute ankle sprain? What is the most appropriate method of preventing re-injury? DESIGN A systematic review of randomised controlled trials published from 1993 to April 2005. PARTICIPANTS People with an acute ankle sprain. INTERVENTION Any pharmacological, physiotherapeutic, complementary or electrotherapeutic intervention added to controlled mobilisation with external support. Immobilisation, surgical intervention, and use of external ankle supports in isolation were excluded. OUTCOMES Pain, function, swelling, re-injury, and global improvement; assessed at short, intermediate, and long-term follow-up. RESULTS 23 trials were included with a mean PEDro score of 6/10. There was strong evidence that non-steroidal anti-inflammatory drugs can reduce pain and improve short-term ankle function. There was moderate evidence that neuromuscular training decreases functional instability and minimises re-injury; and that comfrey root ointment decreases pain and improves function. There was also moderate evidence that manual therapy techniques improve ankle dorsiflexion. There was no evidence to support the use of electrophysical agents or hyperbaric oxygen therapy. Very few long-term follow-ups were undertaken, and few studies focused on preventing long-term morbidity. CONCLUSIONS Non-steroidal anti-inflammatory drugs, comfrey root ointment, and manual therapy can significantly improve short-term symptoms after ankle sprain, and neuromuscular training may prevent re-injury. More high quality studies are needed to develop evidence-based guidelines on ankle rehabilitation beyond the acute phases of injury management.
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Barna M, Kucera A, Hladícova M, Kucera M. [Wound healing effects of a Symphytum herb extract cream (Symphytum x uplandicum NYMAN: ): results of a randomized, controlled double-blind study]. Wien Med Wochenschr 2008; 157:569-74. [PMID: 18157595 DOI: 10.1007/s10354-007-0474-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 07/19/2007] [Indexed: 11/29/2022]
Abstract
METHOD Wound healing effects of a topically applied preparation (Traumaplant) containing a concentrate (10 % active ingredient) from the aerial parts of medicinal comfrey (Symphytum x uplandicum NYMAN: ) were examined in a randomized clinical double-blind study including 278 patients with fresh abrasions (verum: n = 137), among them 64 patients of up to 20 years of age (verum n = 29, reference product n = 35). An otherwise identical low-dose preparation (1 % active ingredient; n = 141) was used as a reference. RESULTS After 2-3 days of application of the study medication a highly significantly and clinically relevantly faster initial reduction of wound size of 49 + or - 19 % versus 29 + or - 13 % per day in favour of verum (p < 5x10(-21)) was found. From linear regression time to complete healing was determined to be 2.97 days faster with verum than with reference (4.08 vs. 7.05 days, p = 7.4 x 10(-45) in the t-Test comparison of regression lines). The physicians rated efficacy as good to very good in 93.4 % of cases, as compared to 61.7 % in the group treated with the reference product (p = 2 x 10(-11)). On a scale of 0-100 verum was rated with 84.4 + or - 10.1 points by the patients themselves. The reference product was rated with 65.5 + or - 24.8 points (p = 6.1 x 10(-18)). In subgroup analyses no significant influence of abrasion area, gender and age on healing effects was found, albeit a tendency towards better effects with increasing age was observed. No adverse effects or problems with drug tolerability occurred. Specifically, cutaneous reactions were observed in none of the patients throughout the 10 day observation phase. CONCLUSIONS Symphytum herb extract can be attributed distinct wound healing effects, effects that can explicitly be used in paediatry.
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Affiliation(s)
- Milos Barna
- Abteilung für Sportmedizin und Rehabilitation, 2. Medizinische Fakultät der Karls-Universität Prag, Prag, Tschechishe Republik
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Kucera M, Barna M. Was the PEDro rating accurate? THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2008; 54:288. [PMID: 19025515 DOI: 10.1016/s0004-9514(08)70016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Bleakley CM. PEDro scores were based on information in the paper. THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY 2008; 54:289. [PMID: 19025516 DOI: 10.1016/s0004-9514(08)70018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Predel HG, Giannetti B, Koll R, Bulitta M, Staiger C. Efficacy of a comfrey root extract ointment in comparison to a diclofenac gel in the treatment of ankle distortions: results of an observer-blind, randomized, multicenter study. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2005; 12:707-14. [PMID: 16323288 DOI: 10.1016/j.phymed.2005.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In the treatment of minor blunt injuries several topical drugs are known to have anti-inflammatory and analgesic properties. They represent, however, two fundamentally different major pharmacological therapy approaches: the "chemical-synthetical" and the "phytotherapeutical" approach. The main objective of this trial (CODEC_2004) was to compare the efficacy and tolerability of an ointment of Comfrey extract (Extr. Rad. Symphyti) with that of a Diclofenac gel in the treatment of acute unilateral ankle sprain (distortion). In a single-blind, controlled, randomized, parallel-group, multicenter and confirmatory clinical trial outpatients with acute unilateral ankle sprains (n=164, mean age 29.0 years, 47.6% female) received either a 6 cm long ointment layer of Kytta-Salbe f (Comfrey extract) (n=82) or of Diclofenac gel containing 1.16 g of diclofenac diethylamine salt (n=82) for 7 +/- 1 days, four times a day. Primary variable was the area-under-the-curve (AUC) of the pain reaction to pressure on the injured area measured by a calibrated caliper (tonometer). Secondary variables were the circumference of the joint (swelling; figure-of-eight method), the individual spontaneous pain sensation at rest and at movement according to a Visual Analogue Scale (VAS), the judgment of impaired movements of the injured joint by the method of "neutral-zero", consumption of rescue medication (paracetamol), as well as the global efficacy evaluation and the global assessment of tolerability (both by physician and patient, 4 ranks). In this study the primary variable was also to be validated prospectively. It was confirmatorily shown that Comfrey extract is non-inferior to diclofenac. The 95% confidence interval for the AUC (Comfrey extract minus Diclofenac gel) was 19.01-103.09h*N/cm2 and was completely above the margin of non-inferiority. Moreover, the results of the primary and secondary variables indicate that Comfrey extract may be superior to Diclofenac gel.
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Affiliation(s)
- H G Predel
- Merck Selbstmedikation GmbH, Roesslerstr. 96, D-64293 Darmstadt, Germany
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