Herbal infusions used for induced abortion

"I wasn't sure it would work. I was just trying": an ethnographic study on the choice of abortion methods among young women in Kilifi County, Kenya, and Atlantique Department, Benin

BACKGROUND

Despite the increased availability of safe abortion methods in sub-Saharan Africa, women and girls continue to use unsafe abortion methods and procedures to terminate their unwanted pregnancies, resulting in severe complications, lifelong disabilities, and death. Barriers to safe abortion methods include restrictive laws, low awareness of safe abortion methods, poverty, and sociocultural and health system barriers. Nonetheless, there is a paucity of data on the decision-making around and use of abortion methods. This paper aims to provide answers to the following questions: Which abortion methods do women and girls use and why? Who and what influences their decisions? What can we learn from their decision-making process to enhance the uptake of safe abortion methods? We focus our in-depth analysis on the rationale behind the choice of abortion methods used by women and girls in Kilifi County in Kenya and Atlantique Department in Benin.

METHODS

We draw on data collected as part of an ethnographic study conducted between January and August 2021 on lived experiences, social determinants, and pathways to abortion. Data were collected using repeated in-depth interviews with 95 girls and women who had a recent abortion experience. Data from the interviews were supplemented using information from key informant interviews, focus group discussions, and participant observation. Data analysis was conducted through an inductive process.

RESULTS

Our findings reveal that women and girls use various methods to procure abortions, including herbs, high doses of pharmaceutical drugs, homemade concoctions, medical abortion drugs, and surgical abortion methods. Procedures may involve singular or multiple attempts, and sometimes, mixing several methods to achieve the goal of pregnancy termination. The use of various abortion methods is mainly driven by the pursuit of social safety (preservation of secrecy and social relationships, avoidance of shame and stigmatization) instead of medical safety (which implies technical safety and quality).

CONCLUSION

Our findings reaffirm the need for comprehensive access to, and availability of, abortion-related information and services, especially safe abortion and post-abortion care services that emphasize both medical and social safety.

Toxicities of herbal abortifacients

BACKGROUND

In the post-Roe era, barriers to facility-based abortions may lead to an increased incidence of self-managed abortions. While misoprostol-based medication abortions have significant literature supporting its safety profile, there is a knowledge deficit within the medical community regarding the toxicities of commonly used herbal abortifacients.

METHODS

This is a narrative review, based on a MEDLINE and HOLLIS database search, of self-managed abortion methods with herbal abortifacients and their associated toxicities.

RESULTS

Common herbal abortifacients with significant morbidity and mortality implications include pennyroyal, blue cohosh, rue, and quinine. Other commonly reported abortifacients considered to be less toxic also are discussed in brief. Special considerations for hepatic, cardiac, renal, and hematologic toxicities are important in patients with significant exposures to these herbal substances.

CONCLUSION

There is an anticipated increase in the utility of herbal xenobiotics for self-managed abortions with post-Roe restrictions to standard mifepristone-misoprostol protocols. Frontline providers should be aware of the associated toxicities and have special considerations when treating a poisoned patient in this population.

The Role of Dietary Polyphenols in Pregnancy and Pregnancy-Related Disorders

Polyphenols are a group of phytochemicals with extensive biological functions and health-promoting potential. These compounds are present in most foods of plant origin and their increased widespread availability through the intake of nutritional supplements, fortified foods, and beverages, has also led to increased exposure throughout gestation. In this narrative review, we focus on the role of polyphenols in both healthy and pathological pregnancy. General information related to their classification and function is followed by an overview of their known effects in early-pregnancy events, including the current insights into molecular mechanisms involved. Further, we provide an overview of their involvement in some of the most common pregnancy-associated pathological conditions, such as preeclampsia and gestational diabetes mellitus. Additionally, we also discuss the estimated possible risk of polyphenol consumption on pregnancy outcomes. The consumption of dietary polyphenols during pregnancy needs particular attention considering the possible effects of polyphenols on the mechanisms involved in maternal adaptation and fetal development. Further studies are strongly needed to unravel the in vivo effects of polyphenol metabolites during pregnancy, as well as their role on advanced maternal age, prenatal nutrition, and metabolic risk of the offspring.

Assessment of Genetic Diversity among Wild Ruta chalepensis L. from the North of Jordan

Ruta chalepensis, known as Fringed Rue, is a small shrub of the Rutaceae family. To date, there is no record of its natural distribution across Jordan, a country located in the eastern part of the Mediterranean basin, and there are no previous studies on its genetic diversity in the region. Therefore, this study was conducted to assess the genetic diversity of R. chalepensis in the northern parts of Jordan using morphological trait and amplified fragment length polymorphism (AFLP) analyses. For the morphological traits, the analysis of variance indicated that there were significant differences between the identified populations. The Shannon diversity indices showed relatively high values, indicating the existence of a high variability among the identified populations. The principal component analysis explained 82% of the variation between the collected plants, and a clear separation of the collected individuals from the Jarash-A, Jarash-B and Ajloun-B populations from the rest of the populations was observed. The heatmap clustering was in general agreement with the results of the principal component analysis, with the plant height, rachis length and plant width considered as the discriminative traits. The AFLP analysis using eight different primer combinations generated 59 polymorphic bands, with an average polymorphism information content value of 0.32. The phylogenetic analysis identified three main clusters, with the first cluster including 65% of the individuals collected from the Jarash and Ajloun provinces, with a clear separation of the Jarash-B population. The AMOVA revealed that the genetic variation between the populations contributed 30% of the total genetic variation, while the variation within the populations explained 70%. In conclusion, morphological traits and molecular markers were used successfully to assess the genetic diversity among wild R. chalepensis from the north of Jordan, and such data can be used for future conservation plans and utilization purposes.

Therapeutic potential of medicinal plants for the management of renal stones: A review

Kidney stone disease is the third most common urological ailment worldwide, people. The mechanism of stone formation includes: urine supersaturation, aggregation, retention, nucleation, and growth of crystals in the cells of the renal tubular epithelium. Kidney stones may cause extreme pain and blockage of urine flow. They are usually treated with conventional drugs and shock wave (ESWL) as well as a variety of medications that may cause several adverse effects. The remaining stone fragments and the risk of infection following ESWL are major challenges in the treatment of kidney stones. Recently, despite the emergence of modern drugs, medicinal plants have been recognized and utilized in many nations clinically due to their safety profile, efficiency, cultural acceptance, and fewer side effects than approved drugs. Medicinal plants are used in different cultures as a reliable source of natural remedies. The aim of this review is to provide comprehensive information about traditionally used plants as well as their scientifically proven pharmacological activities, their primary chemical ingredients, and potential mechanisms of action, such as analgesic, astringent, demulcent, diuretic activity, antioxidant activity, inhibition of the inflammatory process, nucleation inhibition, crystallization inhibition, inhibition of crystal aggregation, reducing , reducing stone size, and reducing urine supersaturation.

Mentha pulegium L. (Pennyroyal, Lamiaceae) Extracts Impose Abortion or Fetal-Mediated Toxicity in Pregnant Rats; Evidenced by the Modulation of Pregnancy Hormones, MiR-520, MiR-146a, TIMP-1 and MMP-9 Protein Expressions, Inflammatory State, Certain Related Signaling Pathways, and Metabolite Profiling via UPLC-ESI-TOF-MS

Pregnant women usually turn to natural products to relieve pregnancy-related ailments which might pose health risks. Mentha pulegium L. (MP, Lamiaceae) is a common insect repellent, and the present work validates its abortifacient capacity, targeting morphological anomalies, biological, and behavioral consequences, compared to misoprostol. The study also includes untargeted metabolite profiling of MP extract and fractions thereof viz. methylene chloride (MecH), ethyl acetate (EtOAc), butanol (But), and the remaining liquor (Rem. Aq.) by UPLC-ESI-MS-TOF, to unravel the constituents provoking abortion. Administration of MP extract/fractions, for three days starting from day 15th of gestation, affected fetal development by disrupting the uterine and placental tissues, or even caused pregnancy termination. These effects also entailed biochemical changes where they decreased progesterone and increased estradiol serum levels, modulated placental gene expressions of both MiR-(146a and 520), decreased uterine MMP-9, and up-regulated TIMP-1 protein expression, and empathized inflammatory responses (TNF-α, IL-1β). In addition, these alterations affected the brain's GFAP, BDNF, and 5-HT content and some of the behavioral parameters escorted by the open field test. All these incidences were also perceived in the misoprostol-treated group. A total of 128 metabolites were identified in the alcoholic extract of MP, including hydroxycinnamates, flavonoid conjugates, quinones, iridoids, and terpenes. MP extract was successful in terminating the pregnancy with minimal behavioral abnormalities and low toxicity margins.

Misuse, consequences and phototoxic skin-related effects of Rutaceae: a comprehensive literature review

Ruta is a common plant growing in Italy and in the Mediterranean area. It has been used in popular tradition with different aims, ranging from therapeutic to esoteric purposes. However, the plant is still used as a common remedy in some of present-day rural and urban communities and it can be found in gardens all over Europe. Ruta's photosensitizing effect has been described in the literature and seems to be mediated by furanocoumarins. We collected data from the 18 case-reports for a total of 32 patients that we included in our analysis, assessing demographic variables, clinical findings, diagnosis, time of onset of lesions, time of resolution and therapy. The main aim of this work was to outline the clinical presentation, therapeutic management and demography of phytophototoxic reactions from contact with Ruta in order to suggest the correct diagnostic approach and disease recognition, as well as its possible prevention.

Maternal Reproductive Toxicity of Some Essential Oils and Their Constituents

Even though several plants can improve the female reproductive function, the use of herbs, herbal preparations, or essential oils during pregnancy is questionable. This review is focused on the effects of some essential oils and their constituents on the female reproductive system during pregnancy and on the development of the fetus. The major concerns include causing abortion, reproductive hormone modulation, maternal toxicity, teratogenicity, and embryo-fetotoxicity. This work summarizes the important studies on the reproductive effects of essential oil constituents anethole, apiole, citral, camphor, thymoquinone, trans-sabinyl acetate, methyl salicylate, thujone, pulegone, β-elemene, β-eudesmol, and costus lactone, among others.

Genus Ruta: A natural source of high value products with biological and pharmacological properties

ETHNOPHARMACOLOGICAL RELEVANCE

Ruta genus is constituted by ten species, of which the most commonly described are R. chalepensis and R. graveolens. Ruta plants are perennial shrubs belonging to the family Rutaceae, which are traditionally used in folk medicine, since ancient times mostly for the treatment of various ailments of the womb.

AIM OF THE STUDY

To provide a review of the different uses of Ruta species in traditional medicine, as well as, on their multifactorial biological and pharmacological properties.

MATERIAL AND METHODS

A search of the literature on genus Ruta and Ruta species was performed using various scientific databases and search engines and the information of articles were reviewed and compiled.

RESULTS

Different parts of the plants belonging to Ruta genus are used in folk medicine to treat a wide range of different diseases. The principal use of these is in gynaecological field, but the treatment of pain, fever, nausea, inflammation, infections, nervous disorders, among others, are also described. These plants have been used to fertility regulation, as anti-fertility agent, to control menstrual flux and bleedings, as abortifacient and as contraceptive. The phytochemical composition of these plants consists mainly in essential oil (EO), but phenolic compounds were also reported, like coumarins and flavonoids, as well as alkaloids. Ruta species products like extracts and EOs have shown broad pharmacological activities, such as antimicrobial and antifungal activities, as well as, antiviral and antiparasitic. Moreover, Ruta plants products present antioxidant, neuroprotective, anti-inflammatory, anti-cancer and anti-diabetic activities and demonstrated contraceptive and abortifacient effects. These plants were also tested to be used for non-therapeutic approaches, as bio-insecticides in the control of different insect pests showing to be able to reduce infestation.

CONCLUSIONS

Ruta species could be a potential source of natural products with biological activities. Ruta extracts, essential oils and isolated compounds have shown a diverse potential for use in the treatment of different diseases, as well as, for pests control, contributing to the valorisation of these plants. Nonetheless, this review indicates that more studies are needed to demonstrate the full potential of Ruta species, and to further explore the toxicology and safety of these plants.

Evaluation of Abortifacient Effect of Rumex nepalensis Spreng Among Pregnant Swiss Albino Rats: Laboratory-Based Study

Background

Rumex nepalensis Spreng (Amharic: Yewsha Tult) belongs to the Polygonaceae (buckwheat) family. In Ethiopia, the plant is traditionally used for the treatment of stomach ache, tonsillitis, ascariasis, uterine bleeding, etc. An ethnobotanical study from Mizan–Tepi University also reported the use of the plant by “Shekicho” people as an abortifacient. As a result, this study aimed at the assessment of the outcome of hydro-ethanolic leaves extract of R. nepalensis on Swiss albino pregnant rats and confirm its abortifacient activity.

Methods

The hydro-alcoholic leaves extract of Rumex nepalensis Spreng was evaluated for its abortifacient activity in Swiss albino rats. The mature female rats were mated overnight to male rats in mating cages. Two different dosage regimens (300 mg/kg, 600 mg/kg) of the extract were administered. Laparotomy was performed on the rats to assess the uterus and ovary, the viable, non-viable, adsorbing sites, and corpora lutea. Differences between the experimental and control groups were compared using one-way analysis of variance (ANOVA), followed by Dunnett’s T-test to determine their level of significance.

Results and Discussion

This study revealed that Rumex nepalensis Spreng had anti-implantation and abortifacient activities at both 300 and 600 mg/kg doses, which was statistically significant as compared with the controls. It was relatively safe up to the dose of 5000 mg/kg, where no mortality and organ toxicity were manifested. Phytochemicals identified were alkaloids, flavonoids, saponins, tannins, steroids, and anthraquinones.

Conclusion

In general, our study showed that R. nepalensis had a significant abortifacient activity that testifies its traditional dibs. Therefore, the use of this plant should be avoided in pregnant women to minimize unintended abortion and further studies are needed to know its mechanism of activity and to identify the phytochemicals corresponding to this activity. Checking its efficacy on other species is also needed.

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Self-managed abortion: A systematic scoping review

Self-managed abortion, when a person performs their own abortion without clinical supervision, is a model of abortion care used across a range of settings. To provide a comprehensive synthesis of the available literature on self-managed abortion, we conducted a systematic search for peer-reviewed research in April 2019 in PubMed, Embase, Web of Science, Popline, PsycINFO, Google Scholar, Scielo, and Redalyc. We included studies that had a research question focused on self-managed abortion; and were published in English or Spanish. The combined search returned 7167 studies; after screening, 99 studies were included in the analysis. Included studies reported on methods, procurement, characteristics of those who self-managed, effectiveness, safety, reasons for self-managed abortion, and emotional and physical experiences. Numerous abortion methods were reported, most frequently abortion with pills and herbs. Studies reporting on self-managed medication abortion reported high-levels of effectiveness. We identify gaps in the research, and make recommendations to address those gaps.

Essential Oils as a Feed Additives: Pharmacokinetics and Potential Toxicity in Monogastric Animals

Essential oils (EOs) are now a hot topic in finding modern substitutes for antibiotics. Many studies have shown positive results and confirmed their high antibacterial activity both in vitro and in vivo. Deservedly, there is an attempt to use EOs as a substitute for antibiotics, which are currently limited by legislation in animal breeding. Given the potential of EOs, studies on their fate in the body need to be summarized. The content of EO's active substances varies depending on growing conditions and consequently on processing and storage. Their content also changes dynamically during the passage through the gastrointestinal tract and their effective concentration can be noticeably diluted at their place of action (small intestine and colon). Based on the solubility of the individual EO's active substances, they are eliminated from the body at different rates. Despite a strong antimicrobial effect, some oils can be toxic to the body and cause damage to the liver, kidneys, or gastrointestinal tissues. Reproductive toxicity has been reported for Origanum vulgare and Mentha arvensis. Several publications also address the effect on the genome. It has been observed that EOs can show both genoprotective effects (Syzygium aromaticum) and genotoxicity, as is the case of Cinnamomum camphor. This review shows that although oils are mainly studied as promising antimicrobials, it is also important to assess animal safety.

Discovery of nano-piperolactam A: A nonsteroidal contraceptive lead acting through down-regulation of interleukins

Elevated serum interleukins (IL-6, IL-1β) over baseline concentration help in blastocyst adhesion to the uterine endometrium in the early phase of pregnancy. A nano PLA (Piperolactam A)-HPBCD (2-hydroxy-propyl-β-cyclodextrin) inclusion complex was developed as an interleukin down-regulator that exhibited 100% anti-implantation activity in rodents at a dose as low as 2.5-5.0 mg/kg. On metabolomics study, among major glyco-lipo-protein metabolites, only serum low-density lipoprotein (LDL) or very low-density lipoprotein (VLDL) levels revealed alteration by the formulation. Administration of PLA-HPBCD did not cause changes in serum estrogen and progesterone levels. However, IL-6 and IL-1β failed to increase post PLA-HPBCD administration; hence, it is assumed to be the mode of the drug's abortifacient action. In addition, absence of signs of either acute or chronic toxicity suggests the formulation was considerably non-toxic. Therefore, the nano-PLA conjugate promises as a non-steroidal contraceptive lead apart from ormeloxifene, the only non-steroidal anti-fertility agent currently available globally.

Action of the hydroethanolic extract of the flowers of Acmella oleracea (L.) R.K. Jansen on the reproductive performance of Wistar females rats: A popular female aphrodisiac from the Amazon

ETHNOPHARMACOLOGICAL RELEVANCE

The species Acmella oleracea (L.) R.K. Jansen (Asteraceae), popularly known as jambú, is marketed in fairs as a female aphrodisiac and has several pharmacological activities already confirmed, among them the sexual stimulant action. The objective of this study was to evaluate the effects of the oral administration of the hydroethanolic extract of A. oleracea flowers (EHAo) on wistar rats during the pre-mating, mating, and pre-implantation period.

MATERIAL AND METHODS

During the treatment period, measurements of feed intake, water intake, weight, estrous cycle, behavior, reproductive parameters, biochemical parameters, hematological parameters, and histopathology of ovaries were performed daily.

RESULTS

In the gas chromatography analysis - mass spectrometry characterization, the compound (2E, 6Z, 8E) -N-isobutyldeca-2,6,8-trienamide (spilanthol) was detected as the majority compound at the 84% concentration. In the conditions of this study, EHAo did not cause maternal toxicity. However, in the estrous cycle, the frequency of the Proestrous (P) and Estrous (E) phase was significantly increased with the doses of 88.91 and 444.57mg/kg of the EHAo in relation to the control. On the other hand, the metaestrous (M) and diestrous (D) phases showed a significant reduction in their frequency in the groups treated with EHAo. Water intake increased significantly (p < 0.01), as well as the triglyceride levels, the total cholesterol and fractions (p < 0.05), and the percentage of neutrophils (p < 0.05).

CONCLUSION

It is concluded, therefore, that the treatment with EHAo, which is one of the forms popularly used, is safe in the concentrations and time of treatment studied as it is able to influence the estrous cycle without altering folliculogenesis and fertility.

Self-medication practice in pregnant women from central Mexico

Self-medication during pregnancy represents a serious threat for mother and child health. The objective of this study was to evaluate the prevalence and the factors associated with self-medication among Mexican women living in the central region of Mexico. This is a descriptive interview-study of 1798 pregnant women or women who were pregnant no more than 3 years ago, when the interview was carried out. Data analysis was carried out with chi-square analysis and odds ratio. The prevalence of self-medication (allopathic drugs, medicinal plants, and other products, including vitamins, food supplements, among others) was 21.9%. The factors associated (p < 0.05) with self-medication were: higher education (college and postgraduate), smoking, and consumption of alcohol. Smoking was the strongest factor (OR: 2.536; 1.46–4.42) associated to self-medication during pregnancy, followed by consumption of alcohol (OR: 2.06; 1.38–3.08), and higher education (OR: 1.607; 1.18–2.19). Medicinal plant consumption was associated with nausea, constipation, migraine, and cold (p < 0.05), whereas he self-medication of allopathy was associated with gastritis and migraine (p < 0.05). Self-medication was influenced mainly by a relative or friend, who recommended the use of herbal medicine/allopathic medication. Two of the most common medicinal plants (arnica and ruda) here informed are reported to induce abortion or toxicity during pregnancy. The findings showed that self-medication (medicinal plants and allopathic medication) is a common practice among pregnant women from central Mexico. Adequate counselling of pregnant women by healthcare professionals about the potential risks of self-medication with herbal medicine and allopathic drugs during pregnancy is strongly warranted.

Hepatotoxicity of Herbal Supplements Mediated by Modulation of Cytochrome P450

Herbal supplements are a significant source of drug-drug interactions (DDIs), herb-drug interactions, and hepatotoxicity. Cytochrome P450 (CYP450) enzymes metabolize a large number of FDA-approved pharmaceuticals and herbal supplements. This metabolism of pharmaceuticals and supplements can be augmented by concomitant use of either pharmaceuticals or supplements. The xenobiotic receptors constitutive androstane receptor (CAR) and the pregnane X receptor (PXR) can respond to xenobiotics by increasing the expression of a large number of genes that are involved in the metabolism of xenobiotics, including CYP450s. Conversely, but not exclusively, many xenobiotics can inhibit the activity of CYP450s. Induction of the expression or inhibition of the activity of CYP450s can result in DDIs and toxicity. Currently, the United States (US) Food and Drug Administration does not require the investigation of the interactions of herbal supplements and CYP450s. This review provides a summary of herbal supplements that inhibit CYP450s, induce the expression of CYP450s, and/or whose toxicity is mediated by CYP450s.

Alkaloid profiling of herbal drugs using high resolution mass spectrometry

Herbal infusions are consumed worldwide thanks to their "natural" beneficial effects, also due to the presence of alkaloids, although these compounds can have poisonous effects. A method combining online solid-phase purification with high resolution mass spectrometry was used to define the alkaloid profiles of 117 herbs and 7 commercial blends. Forty-one alkaloids were quantified in reference to analytical standards, while the presence of a further 116 was confirmed based on accurate mass, retention time, and fragmentation profile. The targeted study showed that 52% of herbs and 42% of commercial blends contained at least one alkaloid. Pyrrolizidines were the most commonly present (26% of samples), with concentrations generally ranging from the quantification limit to roughly 100 μg kg^-1 . Moreover, a homemade infusion was studied, finding on average 45% and 6% lower extraction for pyrrolizidine and steroidal alkaloids, respectively. Nevertheless, the migration of pyrrolizidines was confirmed. The study confirmed the frequent presence, natural or accidental, of alkaloids in commercial infusion herbs, highlighting the urgent need for routine and accurate controls.

Reverse ethnopharmacology and drug discovery

ETHNOPHARMACOLOGICAL RELEVANCE

Ethnopharmacological investigations of traditional medicines have made significant contributions to plant-derived drugs, as well as the advancement of pharmacology. Drug discovery from medicinal flora is more complex than generally acknowledged because plants are applied for different therapeutic indications within and across cultures. Therefore we propose the concept of "reverse ethnopharmacology" and compare biomedical uses of plant taxa with their ethnomedicinal and popular uses and test the effect of these on the probability of finding biomedical and specifically anticancer drugs.

MATERIALS AND METHODS

For this analysis we use data on taxonomy and medical indications of plant derived biomedical drugs, clinical trial, and preclinical trial drug candidates published by Zhu et al. (2011) and compare their therapeutic indications with their ethnomedicinal and popular uses as reported in the NAPRALERT^® database. Specifically, we test for increase or decrease of the probability of finding anticancer drugs based on ethnomedicinal and popular reports with Bayesian logistic regression analyses.

RESULTS

Anticancer therapy resulted as the most frequent biomedicinal indication of the therapeutics derived from the 225 drug producing higher plant taxa and showed an association with ethnomedicinal and popular uses in women's medicine, which was also the most important popular use-category. Popular remedies for dysmenorrhoea, and uses as emmenagogues, abortifacients and contraceptives showed a positive effect on the probability of finding anticancer drugs. Another positive effect on the probability of discovering anticancer therapeutics was estimated for popular herbal drugs associated with the therapy of viral and bacterial infections, while the highest effect was found for popular remedies used to treat cancer symptoms. However, this latter effect seems to be influenced by the feedback loop and divulgence of biomedical knowledge on the popular level.

CONCLUSION

We introduce the concept of reverse ethnopharmacology and show that it is possible to estimate the probability of finding biomedical drugs based on ethnomedicinal uses. The detected associations confirm the classical ethnopharmacological approach where a popular remedy for disease category X results in a biomedical drug for disease category X but does also point out the existence of cross-over relationships where popular remedies for disease category X result in biomedical therapeutics for disease category Y (Zhu et al., 2011).

Sexual violence-related pregnancies in eastern Democratic Republic of Congo: a qualitative analysis of access to pregnancy termination services

BACKGROUND

Sexual violence has been prevalent throughout the armed conflict in eastern Democratic Republic of Congo (DRC). Research on sexual violence-related pregnancies (SVRPs) and pregnancy termination in eastern DRC, a context with high prevalence of sexual violence, high maternal mortality, and restrictive abortion laws, is scant but crucial to improving the overall health of women in the DRC. Understanding women's perceptions and experiences related to an SVRP, and in particular to pregnancy termination in this context, is critical for developing effective, targeted programming.

METHODS

Respondent-driven sampling (RDS) was used to recruit two subgroups of women reporting SVRPs, 1) women raising a child from an SVRP (parenting group) and 2) women who had terminated an SVRP (termination group), in Bukavu, DRC in 2012. Semi-structured qualitative interviews on pregnancy history and outcomes were conducted with a systematically selected sub-group of women recruited through RDS methodology. Interview responses were translated, transcribed and uploaded to the qualitative data analysis software Dedoose. Thematic content analysis, complemented by the constant comparative technique from grounded theory, was subsequently used as the analytic approach for data analysis.

RESULTS

Fifty-five qualitative interviews (38 parenting group and 17 termination group) were completed. The majority of women in the termination group reported using traditional herbs to terminate the SVRP, which they often obtained on their own or through family, friends and traditional healers; whereas women in the parenting group reported ongoing pregnancies after attempting pregnancy termination with herbal medications. Three women in the termination group reported accessing services in a health center. Almost half of the women in the parenting group cited fear of death from termination as a reason for continuing the pregnancy. Other women in the parenting group contemplated pregnancy termination, but did not know where to access services. Potential legal ramifications and religious beliefs also influenced access to services.

CONCLUSIONS

Women in this study had limited access to evidence-based safe abortion care and faced potential consequences from unsafe abortion, including increased morbidity and mortality. Increased access to reproductive health services, particularly safe, evidence-based abortion services, is paramount for women with SVRPs in eastern DRC and other conflict-affected regions.

DNA Protection against Oxidative Damage Using the Hydroalcoholic Extract of Garcinia mangostana and Alpha-Mangostin

Garcinia mangostana, popularly known as “mangosteen fruit,” originates from Southeast Asia and came to Brazil about 80 years ago where it mainly grows in the states of Pará and Bahia. Although mangosteen or its extracts have been used for ages in Asian folk medicine, data on its potential genotoxicity is missing. We, therefore, evaluated genotoxicity/mutagenicity of hydroethanolic mangosteen extract [HEGM, 10 to 640 μg/mL] in established test assays (Comet assay, micronucleus test, and Salmonella/microsome test). In the Comet assay, HEGM-exposed human leukocytes showed no DNA damage. No significant HEGM-induced mutation in TA98 and TA100 strains of Salmonella typhimurium (with or without metabolic activation) was observed and HEGM-exposed human lymphocytes had no increase of micronuclei. However, HEGM suggested exposure concentration-dependent antigenotoxic potential in leukocytes and antioxidant potential in the yeast Saccharomyces cerevisiae. HEGM preloading effectively protected against H₂O₂-induced DNA damage in leukocytes (Comet assay). Preloading of yeast with HEGM for up to 4 h significantly protected the cells from lethality of chronic H₂O₂-exposure, as expressed in better survival. Absence of genotoxicity and demonstration of an antigenotoxic and antioxidant potential suggest that HEGM or some substances contained in it may hold promise for pharmaceutical or nutraceutical application.

Unsafe abortion in rural Tanzania - the use of traditional medicine from a patient and a provider perspective

BACKGROUND

The circumstances under which women obtain unsafe abortion vary and depend on the traditional methods known and the type of providers present. In rural Tanzania women often resort to traditional providers who use plant species as abortion remedies. Little is known about how these plants are used and their potential effect.

METHODS

Data were obtained among women admitted with incomplete abortion at Kagera Regional Hospital during the period January - June, 2006. The women underwent an empathetic interview to determine if they had experienced an unsafe abortion prior to their admission. In all 125/187 women revealed having had an unsafe abortion. The women identified as having had an unsafe abortion underwent a questionnaire interview where information about abortion provider and abortion method used was obtained through open-ended questions. To get more detailed information about the traditional methods used to induce abortion, in-depths interviews and focus group discussions were performed among traditional providers and nurses. Finally, the plant specimen's effectiveness as abortion remedies was assessed through pharmacological analyses.

RESULTS

Among women admitted with incomplete abortions, 67% had had an unsafe abortion. Almost half of the women who had experienced an unsafe abortion had resorted to traditional providers and plant species were in these cases often used as abortion remedies. In all 21 plant species were identified as potential abortion remedies and analysed, 16 of the species were found to have a uterine contractive effect; they significantly increased the force of contraction, increased the frequency of contractions or did both.

CONCLUSION

Unsafe abortion is common in rural Tanzania where many women use plant species to terminate an unwanted pregnancy. The plants have a remarkable strong uterine contractive effect. To further understand the consequences of unsafe abortion there is a need for further analyses of the plants' potential toxicity and mutagenicity.

Medicinal plants used for menstrual disorders in Latin America, the Caribbean, sub-Saharan Africa, South and Southeast Asia and their uterine properties: a review

ETHNOPHARMACOLOGICAL RELEVANCE

Menstrual disorders are generally not perceived as major health concerns by global health organizations, despite being disruptive to women׳s daily activities, particularly when access to sanitary facilities or analgesics is limited. Improving menstrual health requires access to safe and effective medication, but many women in Latin America, Africa or Asia prefer traditional medicine above modern remedies (such as contraceptives), as they can cause physical symptoms associated with fertility loss. Many medicinal plants are used for menstrual disorders, but few have been examined for their pharmacological activities related to traditional uses. Plants that have a smooth muscle-relaxant effect could ease menstrual cramps, but there are indications that dysmenorrhea in low-income countries is commonly treated with emmenagogues. This review aims to assess the most salient plants used to treat menstrual morbidity in Latin America and the Caribbean, sub-Saharan Africa, South and Southeast Asia, their uterine properties and adverse effects. To test whether plants used for painful menstruation could have uterine contracting properties, we recorded whether these species were also used to ease birth, induce menstruation, abortion or expel the afterbirth, as these suggest spasmogenic activities.

MATERIALS AND METHODS

We reviewed the literature documenting traditional plant use in the study area for dysmenorrhea, regulating or inducing menstruation, uterine cleansing, uterine fibroids, expelling the placenta and lochia and for easing childbirth. Thirty genera (59 species) used in at least two continents or frequently throughout one continent, where shortlisted from the 90 most salient plant species emerging from our literature review. Using Medline, we searched for pharmacological properties and/or mechanisms of action relevant to their traditional uses of the shortlisted species. We searched VigiBase™, the WHO global individual case safety report database, on reported adverse drug reactions associated with these species.

RESULTS

More than 2000 plant species are used for menstrual disorders in the study area. The most salient uses are to treat painful menstruation, induce or regulate menses, and induce abortion. Around half (29) of the 59 most salient species have been tested for their pharmacological effects, of which 48% act as uterine spasmolytics and 31% as uterine spasmogenics. Several frequently used species contain toxic constituents, which may put women and their unborn children at serious risk. VigiBase(TM) listed adverse drug reactions for 18 of these species, but few reports came from the study area.

CONCLUSIONS

Research into the risks and benefits of medicinal plants for menstrual complaints should be given a higher priority in reproductive health programs that respect traditional knowledge and practices. Increased data collection is needed on adverse drug reactions among women using herbal medicines for reproductive health, especially in countries with limited reproductive health facilities.

The globalization of traditional medicine in northern peru: from shamanism to molecules

Northern Peru represents the center of the Andean "health axis," with roots going back to traditional practices of Cupisnique culture (1000 BC). For more than a decade of research, semistructured interviews were conducted with healers, collectors, and sellers of medicinal plants. In addition, bioassays were carried out to evaluate the efficacy and toxicity of plants found. Most of the 510 species encountered were native to Peru (83%). Fifty percent of the plants used in colonial times have disappeared from the pharmacopoeia. Market vendors specialized either on common and exotic plants, plants for common ailments, and plants only used by healers or on plants with magical purposes. Over 974 preparations with up to 29 different ingredients were used to treat 164 health conditions. Almost 65% of the medicinal plants were applied in these mixtures. Antibacterial activity was confirmed in most plants used for infections. Twenty-four percent of the aqueous extracts and 76% of the ethanolic extracts showed toxicity. Traditional preparation methods take this into account when choosing the appropriate solvent for the preparation of a remedy. The increasing demand for medicinal species did not increase the cultivation of medicinal plants. Most species are wild collected, causing doubts about the sustainability of trade.

Knowledge and use of and opportunities for emergency contraception in Northern Haiti

OBJECTIVE

To evaluate the knowledge and experience of, and desire for, emergency contraception (EC) in postpartum women in Haiti, and to determine the knowledge and practices of EC providers.

METHODS

As part of a larger postpartum family planning study, 6 focus groups were conducted with postpartum women (n=33), 3 were conducted with providers (n=22), and a questionnaire was given to postpartum women (n=250).

RESULTS

Of the 249 women who completed the survey, 145 (58.2%) were aware of the concept of EC as an emergency measure in the postcoital period. Of these, 130 (89.7%) had knowledge of traditional methods only. Twenty-eight (11.2%) women had used some form of EC in the past, but only 2 (0.8%) reported ever using a modern form of EC. Providers reported that EC was offered to women only in cases of sexual assault. Their impression was that there was no demand for EC.

CONCLUSION

Awareness and use of EC is low in the context of high unmet need. The results demonstrate a need for improved education and provision of modern effective EC as part of the constellation of family planning choices.

Medicinal plants with teratogenic potential: current considerations

The aim of this study was to present the implications of the use of herbs during pregnancy, pointing out those that should be avoided during this condition because of their abortifacient and/or teratogenic potential. We carried out searches in the databases ScienceDirect, Scielo and Google Scholar, adopting as criteria for inclusion: book chapters and/or complete articles (with abstract), available in English, Portuguese or Spanish, published from 1996 to in 2011. After a pre-selection of 83 articles, 49 bibliographies were used in the manufacturing end of the article, where 25 were from the Scielo database, 18 from ScienceDirect and 6 from Google Scholar. From the articles studied, we identified the four most commonly used plants as emmenagogue/abortifacient agents by patients of the Department of Prenatal SUS: senne, arruda, boldo and buchinha-do-norte or cabacinha. Thus, we conclude that people often adhere to the maxim "if it's natural, it does no harm" in their rational use of natural products, without the right guidance, believing that these products are safe to use. This usage is even more worrisome among the elderly, pregnant women and children. Regarding the safety of these products, some information and reliable data are scarce or contradictory.

Medicinal plants used in Northern Peru for reproductive problems and female health

Infections of the reproductive tract, complications after childbirth, and reproductive problems continue to be a major health challenge worldwide. An impressive number of plant species is traditionally used to remedy such afflictions, and some have been investigated for their efficacy with positive results. A total of 105 plant species belonging to 91 genera and 62 families were documented and identified as herbal remedies for reproductive problems in Northern Peru. Most species used were Asteraceae (9.52%), followed by Lamiaceae and Fabaceae (8.57% and 6.67%). The most important families are clearly represented very similarly to their overall importance in the local pharmacopoeia. The majority of herbal preparations for reproductive afflictions were prepared from the leaves of plants (22.72%), the whole plant (21.97%), and stems (21.21%), while other plant parts were used less frequently. More than 60% of the cases fresh plant material was used to prepare remedies. Over 70% of the remedies were applied orally, while the remaining ones were applied topically. Many remedies were prepared as mixtures of multiple ingredients. Little scientific evidence exists to prove the efficacy of the species employed as reproductive disorder remedies in Northern Peru. Only 34% of the plants found or their congeners have been studied at all for their medicinal properties. The information gained on frequently used traditional remedies might give some leads for future targets for further analysis in order to develop new drugs.

Assessment of drug use among pregnant women in Addis Ababa, Ethiopia

PURPOSE

To assess the drug use among antenatal care (ANC) attendant pregnant women in Addis Ababa.

METHODS

Institution-based cross sectional study was conducted reviewing the antenatal care follow up cards and interviewing pregnant women using semi-structured questionnaire.

RESULTS

A total of 1268 women were included in the study; of which 71.3% of them were prescribed at least one drug during pregnancy. Twelve point four per cent of the pregnant women who reported illness in the 2 weeks prior to the date of the interview, self-medicated themselves with either over the counter or prescription drugs or traditional herbs. The majority of the drugs prescribed were iron and vitamins followed by anti-infectives. Nearly 4% of the pregnant women were prescribed with drugs from category D or X of the US-FDA risk classification.

CONCLUSION

A considerable proportion of pregnant women were exposed to drugs, including those with potential harm to the fetus. Furthermore, pregnant women self-medicated themselves with modern medications or traditional herbs. Health care providers should thus weigh the therapeutic benefits of the drug to the mother against its potential risk to the developing fetus before prescribing. In addition it is essential to routinely inquire about the woman's self-medication practice and provide the appropriate advice to the pregnant women.

Dietary supplements and herbal medicine toxicities-when to anticipate them and how to manage them

BACKGROUND

Dietary supplements and herbal medicines are gaining popularity in many developed countries.

AIMS

Although most can be used without any problem, serious toxicities do occur.

METHODS

Problems can be anticipated when they are used for non-traditional indications, at excessive dose, for prolonged duration, or by patients who are also on multiple modern pharmaceuticals. Problems should also be anticipated when these products claim to be able to relieve symptoms rapidly or when herbs with pronounced pharmacological effects or toxic components are used.

RESULTS

Resuscitation, symptomatic and supportive care are the most important aspects of management of toxicities from these products.

CONCLUSION

This article reviews when problems with these products can be anticipated and outlines a practical approach to management.

Spasmolytic effect of Petroselinum crispum (Parsley) on rat's ileum at different calcium chloride concentrations

Traditional herbal medicines such as Petroselinum crispum (Parsley) have been used for treatment of intestinal disorders in Iran. To date no pharmacological evidence for their effectiveness has been reported. The aim of this study was to examine the relaxant effect of hydroalcoholic extract of Petroselinum crispum on isolated adult male Wistar rat's ileum contraction by KCl 60 (mM). The extract was prepared from parsley seed with 80% ethanol. A portion of ileum was removed and placed in an organ bath containing Tyrode solution (37 degrees C, pH = 7.4) bubbled with air. From a resting tension of 1 g, isotonic Transducer and Harvard Universal Oscillograph were used for recording contraction of ileum after administration of 60 mM KCl. Various concentration of extract were added to the bath. This experiment showed that, the extract in a dose-dependent manner decreased the induced-KCl ileums contraction (n = 7, p < 0.001). Also adding extract before influence of KCl, cause reduced effect of KCl (n = 7, p < 0.001). In addition, the Tyrode solution without CaCl2 and high concentration of K+, various concentration of extract significantly (n = 7, p < 0.001) decreased the CaCl2-induced contraction. Therefore, it seems that the relaxation effect of extract alcoholic parsley seed on the contraction of ileum is performed by blocking of voltage-gated calcium channels.

Ruta Graveolensintoxication

We describe a case of unintentional poisoning from Ruta Graveolens, a medicinal herb that is used for heart protection in Taiwan. A 78-year-old woman developed bradycardia, acute renal failure with hyperkalemia, and coagulopathy after three days of consuming a decoction made from Ruta Graveolens for the treatment of palpitations and heart protection. She was treated with hemodialysis in the emergency department for hyperkalemia. Her bradycardia and hypotension improved gradually three days later. Ruta use might cause multi-organ toxicity. We believe this case report helps in the recognition of the systemic toxicity of Ruta Graveolens.

Isoflavones in the Rutaceae family: twenty selected representatives of the genera Citrus, Fortunella, Poncirus, Ruta and Severinia

Enzyme-linked immunosorbent assays in combination with semi-preparative high-performance liquid chromatography (HPLC) and analytical HPLC with mass spectroscopy in the selective ion monitoring mode were used for the determination of selected isoflavones, daidzein, genistein, biochanin A and their homologues, in 20 representatives of the Rutaceae family. Species belonging to five genera were studied, namely Citrus, Fortunella, Poncirus, Ruta and Severinia. The enzyme immunoassays used were based on polyclonal antibodies raised against isoflavonoid conjugates with bovine serum albumin (BSA), namely biochanin A-7-BSA, daidzein-7-BSA, daidzein-4'-BSA, genistein-7-BSA and genistein-4'-BSA. Aglycones as well as glycosides were detected, and methoxyisoflavones appeared to be more abundant than hydoxyisoflavones. The content of individual isoflavonoids ranged from 0 to 2.6 mg/kg (dry weight); the sum of all measured substances reached up to 5.9 mg.

Platelet Aggregation Inhibitors from Aerial Parts of Ruta Chalepensis Grown in Jordan

From the aerial parts of Ruta chalepensis L., grown in Jordan, two furanocoumarins (bergapten and chalepensin), one flavonoid glycoside (rutin) as well as several minor compounds have been isolated. The structural elucidation of these compounds was established based on spectral data (UV, IR, MS, 1 H-NMR and 13 C-NMR). In Jordan, R. chalepensis is recommended for the treatment of rheumatism, mental disorders and menstrual problems. Fresh and dried leaves are used as flavoring agent in food and beverages. Antiplatelet activities of the crude methanolic and ethylacetate extracts in addition to the three isolated major compounds were measured by the aggrometric method according to Beretz and Casenave. Optical aggregometer connected to dual channel recorder was used for measuring aggregation. Both, ethylacetate and methanol extracts inhibited ADP- induced platelet aggregation (ADP-IA) of human blood. However, only ethylacetate extract was able to induce 50% inhibition of collagen-induced platelet aggregation (Co-IA) platelet rich plasma. Bergapten was more active against ADP-IA compared to chalepensin while the latter was more active against Co-IA compared to bergapten.

Ethnomedicines used in Trinidad and Tobago for reproductive problems

BACKGROUND

Throughout history women have tried to control or enhance their fertility using herbal remedies, with various levels of societal support. Caribbean folk medicine has been influenced by European folk medicine, either through the early Spanish and French settlers or through the continuous immigration of Spanish-speaking peoples from Venezuela. Some folk uses are ancient and were documented by Galen and Pliny the Elder.

METHODS

Thirty respondents, ten of whom were male were interviewed from September 1996 to September 2000. The respondents were obtained by snowball sampling, and were found in thirteen different sites, 12 in Trinidad (Paramin, Talparo, Sangre Grande, Mayaro, Carapichaima, Kernahan, Newlands, Todd's Road, Arima, Guayaguayare, Santa Cruz, Port of Spain and Siparia) and one in Tobago (Mason Hall). Snowball sampling was used because there was no other means of identifying respondents and to cover the entire islands. The validation of the remedies was conducted with a non-experimental method.

RESULTS

Plants are used for specific problems of both genders. Clusea rosea, Urena sinuata and Catharanthus roseus are used for unspecified male problems. Richeria grandis and Parinari campestris are used for erectile dysfunction. Ageratum conyzoides, Scoparia dulcis, Cucurbita pepo, Cucurbita maxima, Gomphrena globosa and Justicia pectoralis are used for prostate problems. The following plants are used for childbirth and infertility: Mimosa pudica, Ruta graveolens, Abelmoschus moschatus, Chamaesyce hirta, Cola nitida, Ambrosia cumanenesis, Pilea microphylla, Eryngium foetidum, Aristolochia rugosa, Aristolochia trilobata, Coleus aromaticus, Laportea aestuans and Vetiveria zizanioides. The following plants are used for menstrual pain and unspecified female complaints: Achyranthes indica, Artemisia absinthium, Brownea latifolia, Eleutherine bulbosa, Hibiscus rosa-sinensis, Eupatorium macrophyllum, Justicia secunda, Parthenium hysterophorus, Wedelia trilobata, Abelmoschus moschatus, Capraria biflora, Cordia curassavica, Croton gossypifolius, Entada polystachya, Leonotis nepetaefolia, Eryngium foetidum, Aristolochia rugosa, Aristolochia trilobata and Ambrosia cumanenesis.

CONCLUSION

Native Caribbean plants have been less studied that those from Africa, India and Europe. Chamaesyce hirta has scientific support but as a diuretic. Other plants with level 3 validity for reproductive issues are: Achyranthes indica, Coleus aromaticus, Hibiscus rosa-sinesis, Parthenium hysterophorus and Ruta graveolens. The non-experimental validation method can be used to advise the public on which plants are safe, effective and useful, and which are not; pending clinical trials. This is especially important since so few clinical trials are conducted on Caribbean plants.

Abortifacient effect of Prangos ferulacia on pregnant rats

PURPOSE

Prangos ferulacea grows in southern Iran and used in Iranian herbal medicine for gastrointestinal disorders, but it seems it has an abortifacient effect on pregnant women. To verify its potential as an abortifacient agent, we administered the leaves of this plant to pregnant rats.

MATERIAL AND METHODS

Hydroalcoholic and aqueous extract of the leaves was administered orally at different doses to 60 rats on the first 18 days of pregnancy. Group 1 (G1) was considered as control group and was given only water. Groups 2-5 (G2-G5) received 25, 50, 100 mg/g per day and Groups 6-8 (G6-G8) received 300, 500 and 1000 mg/g per day, respectively. On Day 18 of pregnancy, they were killed and laparotomized. The uterine horns of each group were opened to see whether they contained any live and degenerated/dead fetuses. We used Student's t-test to analyze the data (p < or = .05 was considered significant).

RESULTS

Of the total 504 fetuses in the studied groups, 13 fetuses (2.57%) were aborted. The abortion rate in the control group was 2 (1.94%) of 103 fetuses; the abortion rate was higher in the treated groups but not statistically significant. There was no relationship between the dose and type of extract and abortion rate in all studied groups.

CONCLUSION

This study shows that the aqueous or hydroalcoholic extract of P. ferulacea is ineffective on the rate of abortion of pregnant rats. Future studies should be performed with higher doses to test the efficacy of this agent on other animals.

Effect of Ruta graveolens L. on pregnant mice

Ruta graveolens L. is used in many countries, including Brazil, as an abortifacient. To determine its effect on pregnancy, the lyophilized hydroalcoholic extract of its aerial parts was administered orally at a dose of 1000 mg/kg per day to mice between the first and third day of pregnancy (DOP), between the fourth and sixth DOP or between the seventh and ninth DOP. The extract did not cause preimplantation embryonic loss or reabsorptions. Fetal death was found. Estrogenic activity was not exhibited by the extract.

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

The purpose of this paper is to explore the possibility that adverse reactions and drug interactions arising from the use of homeopathic and herbal medicines could lead to confusion when adverse reactions to conventional medicines are reported. An extensive literature review was conducted on the occurrence of adverse reactions and drug interactions following the use of homeopathic or herbal remedies, and the potential for these to confound adverse event reporting to conventional medicines considered. The survey demonstrates the potential for herbal remedies and homeopathic products, to produce adverse drug reactions or drug interactions, and shows the scope for potential for confusion with those arising from conventional medicines. There is a need for greater awareness that adverse reactions apparently due to a conventional medicine, might in reality be due to a herbal medicine or a drug interaction between a herbal medicine and a conventional drug, particularly when a health professional is unaware of the extent of a patient's self-medication with alternative therapies.

Ruta graveolens aqueous extract retards mouse preimplantation embryo development

This work was undertaken to examine possible embryotoxicity of Ruta graveolens (rue), a plant used by indigenous communities for the purposes of therapeutic and fertility regulation. Superovulated mice were mated and isolated after copulation. They were given aqueous extract of R. graveolens (5, 10, and 20% w/v) or plain water (control) orally for 4 days. Ninety-eight hours post-human chorionic gonadotrophin (hCG), embryos were flushed from oviducts and uterine horns to assess their state of development and extent of embryo transport. Ingestion of rue at 10 and 20% resulted in a high proportion of abnormal embryos (36.7 and 63.6%, respectively, P<0.05). Cell number was diminished (P<0.01) and embryo transport was slightly delayed in the highest dose group. These findings demonstrate that oral administration of R. graveolens extract can interfere with preimplantation development and embryo transport.

Herbals and asthma: usage patterns among a border population

BACKGROUND

The use of herbal products (HP) is rising in the US. Higher rates of HP use have been documented in the US/Mexico border population, as well as increasing concerns about herbal-related adverse events.

OBJECTIVE

To evaluate the prevalence of HP use in adult asthmatic patients requiring hospitalization and the frequency of HP documentation in medical records.

METHODS

We conducted a retrospective chart review of admissions for asthma to determine the frequency of HP documentation. Additionally, during a 12-month period, a bilingual interviewer conducted prospective, semistructured interviews with patients with asthma exacerbations to record data on HPs used specifically for the treatment of asthma.

RESULTS

A total of 67 cases were chart-reviewed retrospectively; 60 patients were interviewed prospectively. We found no documentation of HP use by chart review, while prospective interviews showed that 42% of patients reported using HPs for the treatment of asthma. The most common HPs used were oregano 28%, chamomile 20%, garlic 16%, eucalyptus 12%, and lime 12%. Ten patients reported taking an HP that could potentially exacerbate their asthma and 18 patients reported using an HP that could interact with other medications or cause other types of adverse events.

CONCLUSIONS

An obvious lack of documentation for HP use was observed in the medical records reviewed. Because a number of HPs that are commonly used by residents along the border can interact with antiasthmatic agents and/or result in compromised asthma control, questions about HP use should be included in routine history taking.