Use of traditional medicine in middle-income countries: a WHO-SAGE study

Methodological challenges in pilot trials of herbal medicine: barriers to evidence-based practice

OBJECTIVES

The growing popularity of herbal medicine (HM) underscores the need for high quality clinical trials to support its evidence-based integration. Pilot trials are essential for addressing methodological challenges in this field. This study evaluates the design quality, feasibility, and reporting of HM pilot trials, with a focus on their capacity to inform future full-scale studies.

STUDY DESIGN AND SETTING

A comprehensive collection of HM pilot trials was conducted using PubMed, Web of Science, and Embase, based on predefined inclusion criteria. Data were extracted on trial characteristics, reporting quality, and progression to full-scale studies. To gather additional information on follow-up studies, authors of selected trials were contacted directly by email. Adherence to Consolidated Standards of Reporting Trials (CONSORT) guidelines for pilot trials was evaluated, and Poisson regression was applied to identify factors influencing reporting completeness.

RESULTS

A total of 123 HM pilot trials were reviewed, predominantly from Asia (78.1%). Trials most commonly addressed respiratory (14.6%), nervous (14.6%), and reproductive systems (13.0%). Key gaps in reporting included feasibility assessments (13.1%), sample size rationale (47.2%), and randomization methods (35.8%). HM-specific details, including ingredient processing, quality control, and safety assessments, were inconsistently reported. Among the trials, 4 (3.3%) progressed to full-scale studies. Factors such as trial registration (incidence rate ratio (IRR) = 1.20, 95% CI: 1.11-1.30) and protocol publication (IRR = 1.16, 95% CI: 1.08-1.24) were positively associated with reporting completeness. Moreover, an analysis of the origin of HMs revealed that modern HM trials were 4.7 times more likely to progress to full-scale studies compared to traditional HM trials (odds ratio = 4.70, 95% CI: 0.37-252.91), although the result did not reach statistical significance (P = .300).

CONCLUSION

HM pilot trials, as they stand, are not yet equipped to reliably guide full-scale studies. Core issues in methodological rigor, particularly in feasibility assessment, sample size justification, and randomization processes, limit their effectiveness and integration into evidence-based practice. A dedicated checklist that merges pilot study standards with the unique needs of HM trials is essential.

PLAIN LANGUAGE SUMMARY

HM is increasingly used worldwide, but there are challenges in ensuring its effectiveness through clinical trials. This study aimed to evaluate the quality and reporting of pilot trials involving HM, which are smaller studies conducted before larger trials. Pilot trials are essential to identify potential issues in study design and ensure the reliability of future full-scale trials. We reviewed 123 trials from 21 countries and found that many lacked clear details on key aspects, such as sample sizes, randomization, and feasibility. These gaps make it difficult for pilot trials to reliably inform full-scale studies. Apart from this, the pilot trials reporting checklist did not include important details specific to herbal treatments, such as ingredient processing and quality control. In addition, only a few trials progressed to larger studies, often due to funding problems or other practical issues. Our study highlights the need for better reporting standards tailored to HM trials, with clear guidelines to address the unique aspects of herbal treatments. By improving the methodological rigor of pilot trials, we can ensure that HM becomes a more reliable and integral part of evidence-based health care.

Diagnosis of cancer in the South and North of Nigeria: duration and causes of delay

INTRODUCTION

Nigeria has a growing cancer burden, with late presentation and delayed diagnosis contributing to poor outcomes. We explored the durations and causes of the delay in the diagnosis of four common and treatable cancer types (breast, colorectum, head and neck, and uterine cervix) in Nigeria.

METHODS

Retrospective study based on interviews with cancer patients following the Aarhus framework for designing and reporting such studies. The study focused on the first two of WHO's three main designated stages of cancer diagnosis: duration from symptom to presentation and presentation to histological diagnosis. Our hospital-based study involved 264 patients recruited from tertiary care facilities in the Northwestern (Kano) and Southwestern (Ibadan) regions of Nigeria. We obtained quantitative data to measure the duration of delay by stage, while interview data were collected to explore the causes of delay. We analysed the data by computing the median duration for the two stages of delay, and framework analysis was used to identify themes on the causes of delay.

RESULTS

The median time to receive a cancer diagnosis after noticing the first symptoms was 12 months (interquartile range 5 to 27 months), with head and neck cancer patients reporting the most prolonged (15-month) delay. Patients waited a median of 3 months (interquartile range 12 months) before presenting their first cancer symptom to a healthcare professional. The median time for patients to receive a cancer diagnosis after the first presentation of symptoms to a formal healthcare professional was 5 months (interquartile range 12 months). There was wide variance for all time intervals. Patients reported visiting a median of 3 health facilities before diagnosis in a formal hospital setting. Qualitative findings identified two main reasons patients reported delays in cancer pathway to care: patient-related factors and health system issues.

CONCLUSION

Long delays were observed, and more than half the delay followed presentation to the local health sector.

Health Professionals' Attitudes Towards Traditional Healing for Mental Illness: A Systematic Review

Combining modern treatments with traditional healing approaches has been proposed as one way to address mental health problems, especially in low-income countries where the costs of pharmaceuticals often prevent or reduce their use. Despite health professionals' involvement being crucial for the integration of this approach, their involvement has been limited to date. This systematic review is designed to explore the attitudes of health professionals towards traditional healing practices for mental illness. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines were followed. The studies were identified from Scopus, EMBASE, PubMed, PsycINFO, and the Web of Sciences. The qualities of the included articles were assessed using the Mixed Method Appraisal Tool (MMAT) Version 2018, and mixed-method synthesis was used to narrate the results. Of the 2115 identified articles, 36 were included in the data synthesis. From the extracted data, health professionals had negative, mixed, and positive views towards traditional healing approaches for mental illness. Their negative attitude towards traditional healing approaches were due to their concerns that traditional healing may cause harm to service users, and they have no trust in the scientific basis, education, or practices of healers. Despite the fact that it is crucial for healthcare professionals to comprehend the cultural backgrounds of those receiving mental health services in order to offer care appropriately, health professionals' negative and mixed attitudinal expressions towards traditional healing approaches limit their involvement. This might be improved by identifying barriers from the perspective of practitioners and creating culturally appropriate guidelines for communication and referral between traditional healing approaches and biomedical care.

Thymus syriacus Essential Oil Extract: Potential Antileishmanial Activity Induced by an Apoptotic-like Death

Background: Chemotherapy continues to be the cornerstone for the management of leishmaniasis. The preferred medications are pricey and have a number of unfavorable side effects. These restrictions make it necessary to produce novel antileishmanial chemicals, and plants have opportunities in this respect. Objectives: This study aimed to evaluate the antileishmanial properties of Thymus syriacus essential oil and its mechanisms of action. Results: Our findings demonstrated that Thymus syriacus essential oil, rich in thymol, exhibited potent antileishmanial activity, with an IC50 value of approximately 1 µg/mL against L. tropica promastigotes. Furthermore, the cell cycle arrest at the sub-G0-G1 phase supported the theory that the leishmanicidal effect was mediated by apoptosis. Methods: The essential oil was characterized using gas chromatography-tandem mass spectrometry. Antileishmanial activity against L. tropica promastigotes was assessed, with mechanisms confirmed via flow cytometry. Conclusions: These results confirm the potential of Thymus syriacus essential oil as a promising therapeutic candidate for the treatment of leishmaniasis.

Antinociceptive and antineuropathic effects of Trifolium resupinatum L. on formalin-induced nociception and cervical spinal cord hemi-contusion: Underlying Mechanisms

ETHNOPHARMACOLOGICAL RELEVANCE

Trifolium resupinatum L. (Fabaceae), known as Persian clover, ethnomedicinally used in Persian folk medicine to treat peritoneal inflammation, rheumatism, and back pain.

AIM OF THE STUDY

To investigate the antineuropathic and antinociceptive activities of Trifolium resupinatum leaves essential oil (TREO) in male Wistar rats, as well as to explore the potential mechanisms of action.

MATERIALS AND METHODS

The antinociceptive activity of TREO and its main constituents, quercetin (Qc) was assessed using the formalin-induced paw licking test. Moreover, the potential mechanisms of antinociception were evaluated through various competitive and non-competitive antagonisms. Additionally, the antineuropathic potential was investigated using the cervical spinal cord hemi-contusion (CCS) model, and the role of phosphorylated Stat-3 was analyzed using Western blotting.

RESULTS

TREO exerted significant antinociceptive activity (P < 0.01) in both phases of the formalin-induced test; however, its effects were more pronounced in the second phase. Modulators of the NO-cGMP-K+ channel pathway significantly reversed the antinociceptive activity of TREO (P < 0.05). Additionally, antagonists of TRPV1 and TRPV2, as well as CB1 and GABAA receptors, significantly reversed the antinociceptive effects of TREO (P < 0.05). In another study, both TREO and Qc significantly attenuated hyperalgesia and mechanical allodynia (P < 0.01) when evaluated using the CCS-induced nociception model. Notably, TREO also reduced the expression levels of interleukin-1 beta, interleukin-2, and tumor necrosis factor alpha in CCS-induced rats (P < 0.05).

CONCLUSION

TREO and Qc exhibit both antinociceptive and anti-neuropathic activities. The antinociceptive effects are partially mediated through the NO-cGMP-K+ channel pathways, along with the activation of TRPV, GABA, and cannabinoid receptors. Furthermore, the anti-neuropathic activity of TREO may be partially regulated through the inhibition of cytokines.

Traditional herbal medicine legislative and regulatory framework: a cross-sectional quantitative study and archival review perspectives

Background

The World Health Organization (WHO) reports that a significant portion of the global population relies on traditional herbal medicine (THM) due to limited access to safe and high-quality modern medical care. In developing countries, it is difficult to guarantee the safety and quality of THM due to weak enforcement of the legal and regulatory framework. Hence, the study attempted to evaluate the country's legislative and regulatory framework by comparing it with developed and developing countries that have well-established systems and identify gaps for future roadmaps in the THM landscape.

Methods

A cross-sectional study and archival review were performed from November 2021 to March 2022 G.C. to contrast the legislative and regulatory framework for THM regulation with other selected countries like Africa, India, and China. A total of 237 regulatory personnel participated in the study. Data were collected through an archive assessment, self-administrative questionnaires, and literature searches. Secondary data were extracted from the archival review, and the findings were summarized and presented in tabular and text formats. The quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) software version 26, with outputs presented in text, table, and figure form.

Results

The archival review of the study found that Ethiopia's THM legislative and regulatory framework is still in a developmental phase, particularly when compared with countries that have more established systems. A cross-sectional study indicated that approximately 79.7% of participants were aware of THM-related content in the current legislation. However, 82.3% reported they had not received any formal training on THM regulations. For future roadmaps, 73.8% of respondents believed the government showed a commitment to supporting THM regulation, though 51.9% of participants noted limited knowledge and awareness of THM practices and product regulations. In terms of quality, safety, efficacy, rational use, and storage conditions, 49.8% of respondents rated regulatory implementation practice as not satisfactory. In this study, most study participants raised concerns about the performance of quality control parameters. Among regulatory experts, weak performance was identified in the practical implementation of THM regulatory activities, with 70.2% of weak performance observed at the federal level and 41.7% at the regional level. Key barriers to effective regulation included a lack of research on herbal medicines (90.3%) and insufficient regulatory mechanisms (87.8%). Additional challenges for regulatory offices included traditional healers' reluctance to engage with scientific communities (56.5%), inadequate inspections (55.3%), and limited data on the safety, quality, and efficacy of certain medicinal plants (54.4%).

Conclusion

Overall, the Ethiopian Food and Drug Authority (EFDA) is significantly strengthening the legislative and regulatory framework for traditional herbal medicines (THM), although full implementation is still forthcoming. This study highlights the need for comprehensive policy development, improved training initiatives, and reinforced regulatory systems to effectively monitor and regulate THM practices. For future roadmaps, collaboration among traditional healers, regulatory bodies, and scientific communities, along with supporting evidence-based research, could further enhance THM regulation in Ethiopia. These collaborative endeavors are critical for promoting the safety and quality of products derived from herbal medicines.

In vitro and in silico approaches manifest the anti-leishmanial activity of wild edible mushroom Amanita princeps

Visceral Leishmaniasis, caused by Leishmania donovani, is the second most deadly parasitic disease, causing over 65,000 deaths annually. Synthetic drugs available in the market, to combat this disease, have numerous side effects. In this backdrop, we aim to find safer antileishmanial alternatives with minimal side effects from mushrooms, which harbour various secondary metabolites with promising efficacy. Robust screening of sixteen extracts from eight different wild mushrooms reveals that the hydroalcoholic extract of Amanita princeps has outstanding antileishmanial activity against Leishmania donovani. Metabolomic profiling of this lead extract identifies 50 bioactive mycocompounds and among them, 10 were selected for in-silico study against five major targets-arginase, spermidine synthase, ornithine decarboxylase, trypanothione reductase and SOD, crucial for thiol-redox balance in parasites in the polyamine synthesis pathway. Molecular docking analysis against our prioritised targets identified two mycompounds Ergosterol and Taraxacolide 1-O-b-D-glucopyranoside from Amanita princeps having the highest binding affinity of -15.8 and -11.8 kcal/mol respectively against the ornithine decarboxylase of polyamine synthesis pathway. However, MD simulations and free energy calculation using MM-GBSA analysis revealed the better stability of ergosterol with PASP receptors suggesting its promising role as an anti-leishmanial compound. Further results of in vitro arginase, SOD, and NO enzyme assays also corroborated with in-silico findings, reinforcing the anti-leishmanial efficacy of the Amanita princeps extract. Thus, both in silico and in vitro analyses suggest the efficacy of both Ergosterol and Taraxacolide 1-O-b-D-glucopyranoside compounds resourced from Amanita princeps as potent antileishmanial agents.

Graphical abstract

Sustainability of a Non-pharmacological, Self-Managed Intervention for Chronic Musculoskeletal Pain: 3-group Randomized Controlled Pilot Trial

Background

Chronic musculoskeletal pain (CMP) affects around 1.7 billion people globally, causing significant physical, psychological, and economic burdens. Current treatments often involve medications with risks, creating an urgent need for accessible alternatives. Interventionist-administered Auricular Point Acupressure (APA) has shown effectiveness in reducing pain. To explore whether this low-risk, non-invasive, non-pharmacologic, and non-opioid pain relief method can be expanded digitally, this study developed a self-managed APA program using mobile health technology and coaching videos, allowing individuals to self-administer APA and evaluate its impact and sustainability.

Methods

A 3-group pilot randomized controlled trial was conducted among 37 participants with CMP. The participants were randomly assigned to in-person APA (n=14) with face-to-face APA instruction, self-guided APA (n=12) with remote APA coaching, or control (n=11). All received conventional healthcare, with the APA groups also receiving adjuvant APA intervention for a 4-weeks supplemented with mobile app coaching videos, followed by monthly monitoring for three months. Data on pain intensity, physical disability, physical function, anxiety, depression, fatigue, sleep disturbance, fear avoidance of work, and satisfaction were collected at baseline, immediately following the 4-week APA intervention, and during the 2-month and 3-month follow-ups post-intervention.

Results

Both the in-person and self-guided APA groups experienced a 47% reduction in pain intensity. Over 50% of participants achieved at least a 30% reduction in pain, and more than 17% had a 30% reduction in physical disability. Improvements included an 18% boost in physical function, decreased fatigue, improved sleep disturbance, and less depression (with increases noted in the control group), a 50% reduction in fear-avoidance of work, and only 3.8% reported not being satisfied with the APA at the 3-month follow-up. No adverse effects related to APA were reported.

Conclusion

APA improved physical and mental health in participants with CMP, enhanced readiness to return to work, and demonstrated sustainability for at least three months. Coaching videos delivered via a mobile app proved to be a feasible approach for teaching APA, increasing the accessibility of the intervention. This study highlights the impact of APA and recommends further research into its mechanisms and long-term benefits to support integration into standard practice.

In Vitro Biological Activities of Paederia grandidieri Leaf Extracts

In many developing countries, human health problems are solved using local plants. Knowledge of their chemical composition and biological activities can contribute to the creation of natural-based products usefully employed in human health. In this work, we analysed Paederia grandidieri leaves extracted with diverse eco-compatible procedures and subjected to chemical, microbiological, and cellular compatibility assays. Fresh leaves of P. grandidieri were harvested in southern Madagascar, where most of the population relies on P. grandidieri for daily dental care. Leaves were dried and powdered. Distilled water and ethanol at 25 °C and 60 °C from 6 to 24 h were used for extraction. Polyphenol composition, antioxidant activity, and antibacterial, prebiotic, and cytotoxic properties of the extracts were analysed. The aqueous extracts contained higher levels of flavan-3-ols and flavanones, while the hydro-alcoholic extracts were richer in flavonols and flavones. The aqueous extracts showed the highest total phenolic and total flavonoid contents, and antioxidant activity. The hydro-alcoholic extracts showed antibacterial effects against Listeria monocytogenes and Pseudomonas aeruginosa, two key foodborne and environmental pathogens, while the aqueous extracts showed prebiotic effects against Streptococcus salivarius. The cytotoxic effects of P. grandidieri leaf extracts were evaluated using the MTT assay on mouse fibroblasts (L929 cell line). The most cytotoxic extract was the aqueous extract at 25 °C. Given that P. grandidieri is routinely employed by the southern Madagascar population with healthy and strong teeth with fewer cases of tooth decay with respect to other regions, and in light of the significant chemical and microbiological properties, we maintain that P. grandidieri can be a suitable candidate for the production of pro-health products for the oral cavity. More in-depth studies will ensure a broader picture of the impact of extracts, especially for possible oral use.

Herbal extracts in orofacial pain: a systematic review and direct and indirect meta-analysis

The pharmaceutical industry has been primarily focused on developing synthetic drugs to address orofacial pain (OFP)-related conditions. There is limited knowledge regarding the efficacy of the use of herbal extracts in treating OFP. A systematic review and a meta-analysis of 62 randomized controlled trials assessing the analgesic effects of herbal extracts on pain intensity in various orofacial conditions was conducted. The intervention comprised the use of herbal extracts compared with a placebo and/or standard treatment. The primary outcome was pain intensity assessed before and after the intervention. The pain scores were compared with the baseline scores in each treatment. When compared with standard therapy, the pooled results of the patients who received herbal extracts revealed lower pain intensity in periodontal pain (MD = -0.92[-6.69, 4.85]), oral surgery pain (MD = 18.80[8.80, 28.79]), oral neuropathic pain (MD = 20.34[6.16, 34.52]), endodontic pain (MD = -8.04[-11.72, -4.37]), oral mucosal pain (MD = 8.74[2.76, 14.73]), and temporomandibular pain (MD = 30.94[6.04, 55.83]). The findings indicated a pain-attenuating effect of herbal extracts such as cannabis, turmeric, capsaicin, licorice, ginger, chamomile, clove, Hypericum perforatum, and Arnica montana. These findings revindicate that herbal extracts may be valuable alternatives to traditional pain medications and promising source for the development of new active ingredients for pharmaceuticals.

Investigating the Antibacterial, Antioxidant, and Anti-Inflammatory Properties of a Lycopene Selenium Nano-Formulation: An In Vitro and In Vivo Study

BACKGROUND

The potent antioxidant lycopene has attracted a large amount of research attention given its potential health benefits. We aimed to assess the antimicrobial, anti-inflammatory, and antioxidant properties of lycopene (Lyc), selenium nanoparticles (Se-NPs), and lycopene selenium nanoparticles (Lyc-Se-NPs).

METHODS

FTIR, polydispersity index, and zeta potential evaluations provided a complete characterization of the synthesized Lyc-Se-NPs. The broth dilution method and a crystal violet microtiter plate assay were employed to assess the antibacterial and antibiofilm activity, respectively. The rat wound infection model was performed to study the anti-inflammatory effect.

FINDINGS

The Lyc-Se-NPs had a zeta potential range of -16.93 to -31.04 mV and a mean particle size of 126.6 ± 3.12 nm. All peaks' percentage transmittance decreased, according to the FTIR analysis of the Lyc-Se-NPs, with the exception of one peak at 2924.22 cm-1, which is suggestive of C-H stretching. The mean scavenging concentrations for Lyc-Se-NPs in the DPPH and ABTS radical scavenging experiments were 3.85 ± 0.65 and 4.26 ± 0.7 µg/mL, respectively. For S. aureus, the Lyc-Se-NPs' MIC values varied from 64 to 1024 µg/mL. CLSM verified that S. aureus treated with sub-MICs of Lyc-Se-NPs showed a significant reduction in biofilm formation. Furthermore, the group treated with 50 mg of Lyc-Se-NPs showed the quickest rate of wound healing. They demonstrated a notable elevation of the HO-1 content in skin tissues, together with the greatest downregulation of TNF-α, IL-1β, and COX-2.

CONCLUSIONS

The distinguishing features of Lyc-Se-NPs reveal that this unique compound is a promising antibacterial, antioxidant, and anti-inflammatory agent.

Topical use of chicory root extract gel on the incidence and severity of radiodermatitis in breast cancer patients: a randomized controled trial

BACKGROUND AND PURPOSE

Nearly 95% of women treated with radiotherapy for breast cancer experience some degree of radiodermatitis. Radiation therapy's most frequent side effect is skin damage. Managing radiation-induced skin reactions while maintaining treatment continuity is a challenging issue. The chicory plant has known anti-inflammatory properties. This study aimed to assess the effect of chicory root extract gel on the incidence and severity of radiodermatitis in breast cancer patients.

MATERIALS AND METHODS

This three-blind clinical trial was conducted in the radiation therapy department of Ayatollah Yasrebi Hospital in Kashan from September 2022 to February 2023. Forty-four breast cancer patients undergoing radiation therapy with a linear accelerator were randomly assigned to either the intervention group (n = 21) or the placebo group (n = 20). Participants applied topically chicory root extract gel or placebo twice daily, starting with their radiation therapy. The incidence and severity of dermatitis were assessed using the Radiation Therapy Oncology Group (RTOG) scale. Participants' characteristics were collected through a researcher-designed questionnaire. Data analysis was performed using chi-square tests, Fisher's exact test, independent t-tests, Mann-Whitney U tests, and generalized linear models with a Poisson distribution, using SPSS version 16 software.

RESULTS

No significant differences were found between the two groups regarding individual and clinical characteristics at the beginning of the study. The results indicated that the number of patients who did not develop dermatitis in later weeks was higher in the intervention group compared to the placebo group (P < 0.001). In the second and third weeks, grade 1 and 2 dermatitis incidence was higher in the placebo group than in the intervention group (P < 0.001). A comparison of the incidence of dermatitis between the two groups, in terms of the number of days to develop grade 1 dermatitis, showed that the average duration was longer in the intervention group than in the placebo group (P > 0.05). This comparison was insignificant for grade 3 dermatitis in either group. Additionally, when considering body mass index (BMI) as a confounding variable and adjusting for its effect, the results revealed that the intervention group developed grade 1 dermatitis significantly later than the placebo group (P < 0.001).

DISCUSSION AND CONCLUSION

Chicory root extract gel offers an effective, low-risk option for managing radiodermatitis in breast cancer patients. This aligns with the goals of supportive cancer care, which emphasize minimizing side effects, maintaining treatment efficacy, and improving the patient's quality of life.

TRIAL REGISTRATION

The study was registered in the Clinical Trials Center of Iran ( https://irct.behdasht.gov.ir ) with the number cod: IRCT20220601055055N1 on July 2, 2023.

A Review on the Approach to Herbal Medicine in Cuban Healthcare System

Background:Cuban healthcare system, emphasizing a holistic approach with herbal medicine as a key component, has achieved significant advancements in a multitude of health indicators. The aim of this study was to investigate the approach of Cuban healthcare system to Herbal medicine. Methods: The study conducted a review in the year 2024 in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple databases, namely PubMed, Scopus, ProQuest, and the Cochrane database of systematic reviews were searched and the quality of the studies was assessed using the AACODS checklist. Finally, a thematic analysis was conducted on the data. Results: 7 studies included within the study. The quality assessment scores presented high level of quality of the final studies with low level of bias. The thematic analysis resulted in six themes including: International collaboration, Universal coverage, Education and encouragement, Utilization, integration, and innovation, Efficiency and sustainability, and Prevention-focused and strategic approach. The Cuban healthcare system incorporates global herbal medicine knowledge, particularly from China, and provides free, regionalized services. It emphasizes the "Green Pharmacy" concept in each neighborhood and integrates herbal medicine into service delivery through a sustainable, prevention-focused policy. Conclusion: The Cuban healthcare system has implemented a multifaceted program on herbal medicine.

Versatile properties of Opuntia ficus-indica (L.) Mill. flowers: In vitro exploration of antioxidant, antimicrobial, and anticancer activities, network pharmacology analysis, and In-silico molecular docking simulation

Opuntia ficus-indica (L.) Mill. has been used in folk medicine against several diseases. The objectives of the present study were to investigate the chemical composition of the methanolic extract of O. ficus-indica (L.) Mill. flowers and their antioxidant, antimicrobial, and anticancer properties. Besides, network pharmacology and molecular docking were used to explore the potential antitumor effect of active metabolites of O. ficus-indica (L.) Mill. against breast and liver cancer. The results revealed many bioactive components known for their antimicrobial and anticancer properties. Furthermore, scavenging activity was obtained, which indicated strong antioxidant properties. The plant extract exhibited antimicrobial activities against Aspergillus brasiliensis (MIC of 0.625 mg/mL), Candida albicans, Saccharomyces cerevisiae, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa at MICs of 1.25 mg/mL. The results revealed proapoptotic activities of the O. ficus-indica (L.) Mill. extract against MCF7, MDA-MB-231, and HepG2 cell lines, where it induced significant early apoptosis and cell cycle arrest at sub-G1 phases, besides increasing the expression levels of p53, cyclin D1, and caspase 3 (p <0.005). The network pharmacology and molecular docking analysis revealed that the anticancer components of O. ficus-indica (L.) Mill. flower extract targets the PI3K-Akt pathway. More investigations might be required to test the mechanistic pathways by which O. ficus-indica (L.) Mill. might exhibit its biological activities in vivo.

Unveiling the apoptotic potential of antioxidant-rich Bangladeshi medicinal plant extractives and computational modeling to identify antitumor compounds

Nowadays, there has been a significant surge in the exploration of anticancer compounds derived from medicinal plants due to their perceived safety and efficacy. Therefore, our objective was to investigate the antioxidant and antiproliferative properties, along with the phytoconstituents, of methanol extracts from various parts of 15 selected Bangladeshi medicinal plants. Standard spectrophotometric methods and confocal microscopy were utilized to assess the antioxidant and antiproliferative potential of these extracts. Additionally, phytochemical profiling was executed through gas chromatography-mass spectrometry (GC-MS) analysis. Among the extractives, Bombax ceiba bark exhibited the highest scavenging capacity against DPPH (IC50: 10.3 ± 0.7 μg/mL) and hydroxyl (IC50: 3.9 ± 0.1 μg/mL) free radicals. Furthermore, the total antioxidants, reducing power, and polyphenols of B. ceiba bark were higher than those of other extracts. B. ceiba bark also showed significant antiproliferative capacity against MCF-7 cells (86.67 %) in the MTT assay, followed by Cocos nucifera roots (83.92 %), Bixa orellana leaves (44.09 %), and Leea macrophylla roots (25 %). Moreover, B. ceiba bark, L. macrophylla roots, C. nucifera roots, and B. orellana leaves-treated Ehrlich ascites carcinoma (EAC) cells demonstrated growth inhibition rates of 87.27 %, 80.45 %, 42.9 %, and 37.27 %, respectively. Fluorescence microscopic analysis of EAC cells treated with these extracts revealed apoptotic features such as condensed chromatin, cell shrinkage, nucleus fragmentation, and membrane blebbing compared to untreated EAC cells. The GC-MS analysis of B. ceiba bark identified 18 compounds, including various alcohols, alkenes, and esters. Additionally, a molecular docking study revealed oxalic acid, cyclohexyl dodecyl ester as the most potent compound (-6.5) active against breast cancer. In summary, our results demonstrate that B. ceiba bark possesses robust antioxidant and antiproliferative properties, along with potent antitumor compounds, which could be utilized in the treatment of carcinoma.

The Prevalence of Complementary and Alternative Medicine Use among Infertile Patients: A Global Systematic Review and Meta-Analysis

There is a significant increase in the use of complementary and alternative medicine (CAM) by infertile patients. This study aimed to assess the prevalence of CAM use by infertile patients. This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The required data were obtained by searching English databases (PubMed and Web of Science) as well as Google Scholar as an additional source of records. We included cross-sectional studies published in English journals up to March 2023 that examined the prevalence of CAM use among infertile patients in different countries. The retrieved articles were independently assessed by two reviewers. Discrepancies were resolved by discussion with the intent to reach a consensus. We reviewed 1192 documents. From these, 29 studies were included in this systematic review and meta-analysis. The results of meta-analysis conducted on 32, 804 infertile patients showed a prevalence rate of CAM use between 26.3% [95% confidence interval (CI): 21.7%-31.3%] and 96.1% (95% CI: 95.7%-96.5%) in various countries. The pooled prevalence rate calculated by the random effects model showed that, overall, 54% (95% CI: 46%-61%) of both infertile women and men used CAM, whereas 55% (95% CI: 47%-67%) of infertile women and 29% (95% CI: 17%-41%) of infertile men reported treatment with CAM. More than half of the infertile patients used CAM. Therefore, healthcare practitioners need to be aware of this practice to better provide care for infertile patients. Further studies should examine the reasons for CAM use by infertile patients.

Mitigating Hyperglycaemic Oxidative Stress in HepG2 Cells: The Role of Carica papaya Leaf and Root Extracts in Promoting Glucose Uptake and Antioxidant Defence

Background/Objectives: Diabetes often goes undiagnosed, with 60% of people in Africa unaware of their condition. Type 2 diabetes mellitus (T2DM) is associated with insulin resistance and is treated with metformin, despite the undesirable side effects. Medicinal plants with therapeutic potential, such as Carica papaya, have shown promising anti-diabetic properties. This study explored the role of C. papaya leaf and root extracts compared to metformin in reducing hyperglycaemia-induced oxidative stress and their impact on liver function using HepG2 as a reference. Methods: The cytotoxicity was assessed through the MTT assay. At the same time, glucose uptake and metabolism (ATP and ∆Ψm) in HepG2 cells treated with C. papaya aqueous leaf and root extract were evaluated using a luminometry assay. Additionally, antioxidant properties (SOD2, GPx1, GSH, and Nrf2) were measured using qPCR and Western blot following the detection of MDA, NO, and iNOS, indicators of free radicals. Results: The MTT assay showed that C. papaya extracts did not exhibit toxicity in HepG2 cells and enhanced glucose uptake compared to the hyperglycaemic control (HGC) and metformin. The glucose levels in C. papaya-treated cells increased ATP production (p < 0.05), while the ∆Ψm was significantly increased in HGR1000-treated cells (p < 0.05). Furthermore, C. papaya leaf extract upregulated GPx1 (p < 0.05), GSH, and Nrf2 gene (p < 0.05), while SOD2 and Nrf2 proteins were reduced (p > 0.05), ultimately lowering ROS (p > 0.05). Contrarily, the root extract stimulated SOD2 (p > 0.05), GPx1 (p < 0.05), and GSH levels (p < 0.05), reducing Nrf2 gene and protein expression (p < 0.05) and resulting in high MDA levels (p < 0.05). Additionally, the extracts elevated NO levels and iNOS expression (p < 0.05), suggesting potential RNS activation. Conclusion: Taken together, the leaf extract stimulated glucose metabolism and triggered ROS production, producing a strong antioxidant response that was more effective than the root extract and metformin. However, the root extract, particularly at high concentrations, was less effective at neutralising free radicals as it did not stimulate Nrf2 production, but it did maintain elevated levels of SOD2, GSH, and GPx1 antioxidants.

Prevalence and factors associated with the use of traditional medicine in individuals with hypercholesterolemia, hyperglycaemia, and arterial hypertension in Ecuador: results from a population-based study in two health districts

BACKGROUND

While traditional medicine (TM) is employed by a significant portion of the global population for managing health issues, clinical guidelines and state recommendations often overlook this practice. The aim of this study was to describe the frequency of use of TM to control 3 metabolic risk factors (MRF): hypertension, hypercholesterolemia, and hyperglycaemia; and the sociodemographic, economic, and clinical characteristics associated with the use of TM.

METHODS

Cross-sectional descriptive study that analyses data obtained from a representative population survey in 2 health districts, one urban in the south of Quito and another in a forested rural area with diverse ethnic groups in Esmeraldas, Ecuador. We include 602 individuals with at least one MRF. We calculated the proportion of people reporting the regular use of TM (herbal or traditional remedy) to control their MRF and we assessed potential associations with sociodemographic, economic, and clinical characteristics with a multivariable logistic regression model.

RESULTS

In two very different sociocultural contexts in Ecuador we found that use of TM to control MRF was frequent (39.4% in Esmeraldas, 31.1% in Quito), frequently in combination with CM. There is a notable percentage of people, 33.9% in Esmeraldas and 39.0% in Quito, who did not take any treatment for their MRF, and the remainder used CM alone. In both settings, an individual's education lever was significantly associated with TM use. Whereas in Quito individuals with higher education more frequently treated their MRF with TM (aOR 2.04, 95% CI 1.03-3.90), in the rural, hard-to-reach context of Esmeraldas, it was more frequent among people with no formal schooling (aOR: 3.76; 95%CI 1.59-8.88), as well as those of younger age (aOR by year: 0.97; 95% CI 0.95-0.99) and afro ethnicity (aOR: 2.13; 95%CI 1.02-4.45).

CONCLUSION

Traditional medicine is used by a significant proportion of the population in Ecuador, highlighting the need for a more accessible and intercultural healthcare approach. The health system should ensure access to the necessary information and resources for the management of their metabolic risk factors.

The wound healing and hypoglycemic activates of date palm (Phoenix dactylifera) leaf extract and saponins in diabetic and normal rats

INTRODUCTION

Indigenous plants have historically been crucial in treating human diseases across various cultures worldwide. Research continues to uncover new therapeutic uses for indigenous plants, from treating infectious diseases to managing chronic conditions such as diabetes and wound care. This study aimed to examine the effect of palm tree leaves "Phoenix dactylifera L" extract and its topical film formulation on wound healing and blood glucose levels.

METHODS

Palm leaves were collected, authenticated, powdered, and extracted with ethanol by cold maceration. Saponins were isolated. The dried extract was analyzed using reverse-phase high-pressure liquid chromatography to identify the phytochemicals present. Diabetes mellitus was induced by a single intraperitoneal injection of Streptozotocin (40mg/kg). Rats with blood glucose levels ≥ 200 mg/dl were used to determine the reduction in blood glucose with or without the oral extract. Incision and excision wounds were induced in both diabetic and normal rats. Topical films containing extract or saponin and inert films were applied to the wounds every other day, and wound sizes were recorded until the wound was completely healed.

RESULTS

The presence of six flavonoids, Naringin, Rutin, Quercetin, Kaempferol, Apigenin, and Catechin, and five phenolic acids, Syringic acid, p Coumaric acid, Caffeic acid, Ferulic acid, Ellagic acid were detected in the dried extract. A significant reduction in blood sugar in diabetic rats and wound diameter in the treated group compared to the control group in both diabetic and normal rats was observed, confirming the promising role of palm leaf extract on diabetes and wound care. Macroscopic, morphometric, and histological data suggested that the cutaneous wound healing in rats treated with the leaf extract was better and faster than the control or inert groups.

CONCLUSIONS

Our research findings highlight the marked effect of Phoenix dactylifera extract as a supportive or alternative treatment for both hyperglycemia and incision or excision wounds. Further research and clinical trials are warranted to validate these findings and explore the underlying mechanisms of action.

Ethnobotanical study of medicinal plants in Dibatie district, Metekel zone, Benishangul Gumuz Regional State, western Ethiopia

BACKGROUND

Herbal medicine has been used for the treatment of human and livestock ailments since ancient times. Numerous rural and urban communities in Ethiopia practice traditional medicine and transfer the knowledge verbally from generation to generation. Thus, this study was conducted to document the traditional medicinal plants and associated indigenous knowledge in Dibatie district, Metekel zone, Benishangul Gumuz Regional State, western Ethiopia.

METHODS

Three hundred seventy-four (374) informants from 11 kebeles (the smallest administrative units) were selected and participated in the data delivery. The ethnobotanical data collection was carried out using semi-structured interviews, preference ranking, direct matrix ranking, field observation, market surveys, and focus group discussions, including voucher specimen collections. The ethnobotanical data were analyzed using descriptive statistics (frequency and percentage), ranking, comparison, and quantitative ethnobotanical techniques such as informant consensus factor, fidelity level index, Jaccard's coefficient of similarity, and use value index.

RESULTS

A total of 170 plant species were recorded to treat 79 human and 29 livestock ailments. Fabaceae (with 20 species) and Asteraceae (with 18 species) were the most dominant medicinal plant families in the area. Most remedial plants were herbs (61 species, 35.88%), followed by shrubs (39 species, 22.94%). The majority (135 species, 79.41%) of medicinal plants were harvested from wild sources and mainly possessed multiple remedy parts (41.17%) that are usually prescribed in fresh form (60.13%). The most commonly reported human ailment was snake venom, while blackleg was mostly reported among livestock diseases. The herbal medicines were mostly administered orally (52.20%), followed by dermal (17.62%) application. Embelia schimperi Vatke, Glinus lotoides L., Haplosciadium abyssinicum Hochst., Mucuna melanocarpa Hochst. ex A. Rich., and Phragmanthera macrosolen (Steud. ex A. Rich.) M.G.Gilbert had the highest fidelity level values (100%) against the corresponding ailments.

CONCLUSION

The study area is rich in a diversity of potential medicinal plants and associated indigenous knowledge. Thus, appropriate conservation actions and careful utilization are essential to counteract the rise of anthropogenic threats and to ensure the continuity of plants with the related indigenous knowledge. Additionally, the medicinal plants should be validated through experimentation to integrate local knowledge with modern medications.

An Empirical Analysis of Sacha Inchi (Plantae: Plukenetia volubilis L.) Seed Proteins and Their Applications in the Food and Biopharmaceutical Industries

Sacha Inchi (Plukenetia volubilis L.) is a plant native in the Amazon rainforest in South America known for its edible seeds, which are rich in lipids, proteins, vitamin E, polyphenols, minerals, and amino acids. Rural communities in developing nations have been using this plant for its health benefits, including as a topical cream for rejuvenating and revitalising skin and as a treatment for muscle pain and rheumatism. Although Sacha Inchi oil has been applied topically to soften skin, treat skin diseases, and heal wounds, its protein-rich seeds have not yet received proper attention for extensive investigation. Proteins in Sacha Inchi seeds are generally known to have antioxidant and antifungal activities and are extensively used nowadays in making protein-rich food alternatives worldwide. Notably, large-scale use of seed proteins has begun in nanoparticle and biofusion technologies related to the human health-benefitting sector. To extract and identify their proteins, the current study examined Sacha Inchi seeds collected from the Malaysian state of Kedah. Our analysis revealed a protein concentration of 73.8 ± 0.002 mg/g of freeze-dried seed flour. Employing liquid chromatography-tandem mass spectrometry (LC-MS/MS) and PEAKS studio analysis, we identified 217 proteins in the seed extract, including 152 with known proteins and 65 unknown proteins. This study marks a significant step towards comprehensively investigating the protein composition of Sacha Inchi seeds and elucidating their potential applications in the food and biopharmaceutical sectors. Our discoveries not only enhance our knowledge of Sacha Inchi's nutritional characteristics but also pave the way for prospective research and innovative advancements in the realms of functional food and health-related domains.

Health system description and assessment: a scoping review of templates for systematic analyses

BACKGROUND

Understanding and comparing health systems is key for cross-country learning and health system strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems, which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing templates, their content and the way data is presented.

MAIN BODY

Based on the WHO building blocks framework, we defined templates as having (1) an overall framework, (2) a list of indicators or topics, and (3) instructions for authors, while covering (4) the design of the health system, (5) an assessment of health system performance, and (6) should cover the entire health system. We conducted a scoping review of grey literature published between 2000 and 2023 to identify templates. The content of the identified templates was screened, analyzed and compared. We found 12 documents that met our inclusion criteria. The building block `health financing´ is covered in all 12 templates; and many templates cover ´service delivery´ and ´health workforce'. Health system performance is frequently assessed with regard to 'access and coverage', 'quality and safety', and 'financial protection'. Most templates do not cover 'responsiveness' and 'efficiency'. Seven templates combine quantitative and qualitative data, three are mostly quantitative, and two are primarily qualitative. Templates cover data and information that is mostly relevant for specific groups of countries, e.g. a particular geographical region, or for high or for low and middle-income countries (LMICs). Templates for LMICs rely more on survey-based indicators than administrative data.

CONCLUSIONS

This is the first scoping review of templates for standardized descriptions of health systems and assessments of their performance. The implications are that (1) templates can help analyze health systems across countries while accounting for context; (2) template-guided analyses of health systems could underpin national health policies, strategies, and plans; (3) organizations developing templates could learn from approaches of other templates; and (4) more research is needed on how to improve templates to better achieve their goals. Our findings provide an overview and help identify the most important aspects and topics to look at when comparing and analyzing health systems, and how data are commonly presented. The templates were created by organizations with different agendas and target audiences, and with different end products in mind. Comprehensive health systems analyses and comparisons require production of quantitative indicators and complementing them with qualitative information to build a holistic picture.

CLINICAL TRIAL REGISTRATION

  Not applicable.

The Genetic Diagnostics of Hemochromatosis: Disparities in Low- Versus High-Income Countries

This study provides a comprehensive overview of hereditary hemochromatosis (HH), a genetic condition characterized by iron overload due to excessive iron absorption. It elucidates diverse inheritance patterns and clinical manifestations by exploring mutations in critical genes such as HFE (hemochromatosis), HJV (hemojuvelin), HAMP (hepcidin antimicrobial peptide), TfR2 (transferrin receptor 2), and FP (ferroportin). The significance of early screening, diagnosis, and personalized management strategies based on genetic classification is emphasized, particularly in terms of high-income vs. low-income countries. Addressing challenges in diagnosis, genetic testing accessibility, and healthcare disparities, the study highlights the importance of early detection, cost-effective screening strategies, and enhancing healthcare outcomes globally. Advanced genetic testing in high-income countries facilitates early diagnosis and management, reducing complications such as liver disease and cardiomyopathy. In contrast, low-income populations face several barriers, including limited access to genetic testing, high costs, and inadequate healthcare infrastructure. Cost-effective serum ferritin (SF) and transferrin saturation (TS) tests and emerging point-of-care (POC) tests offer affordable diagnostic options for low-resource settings. Additionally, the ongoing development of hepcidin measurement methods holds promise for enhancing diagnostic capabilities. Implementing these strategies can aid healthcare providers in improving global HH management and reducing the burden of iron overload complications. Furthermore, the study underscores the need for public health initiatives to raise awareness about HH, promote routine screenings, and advocate for equitable healthcare policies. Collaborative efforts between governments, healthcare organizations, and research institutions are crucial in addressing the global burden of HH. By fostering international cooperation and resource-sharing, it is possible to bridge the gap between high-income and low-income countries, ensuring all individuals have access to the necessary diagnostic and treatment options. This holistic approach can ultimately lead to better health outcomes and improved quality of life for individuals affected by HH worldwide. This comprehensive examination of HH not only illuminates the genetic and clinical aspects of the condition but also provides a roadmap for addressing the multifaceted challenges associated with its diagnosis and management.

Immunomodulatory Compounds from the Sea: From the Origins to a Modern Marine Pharmacopoeia

From sea shores to the abysses of the deep ocean, marine ecosystems have provided humanity with valuable medicinal resources. The use of marine organisms is discussed in ancient pharmacopoeias of different times and geographic regions and is still deeply rooted in traditional medicine. Thanks to present-day, large-scale bioprospecting and rigorous screening for bioactive metabolites, the ocean is coming back as an untapped resource of natural compounds with therapeutic potential. This renewed interest in marine drugs is propelled by a burgeoning research field investigating the molecular mechanisms by which newly identified compounds intervene in the pathophysiology of human diseases. Of great clinical relevance are molecules endowed with anti-inflammatory and immunomodulatory properties with emerging applications in the management of chronic inflammatory disorders, autoimmune diseases, and cancer. Here, we review the historical development of marine pharmacology in the Eastern and Western worlds and describe the status of marine drug discovery. Finally, we discuss the importance of conducting sustainable exploitation of marine resources through biotechnology.

Utilization of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) Practitioners' Services Among Older Adults: Results From the Longitudinal Aging Study in India

BACKGROUND

Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy (AYUSH) form an alternative system of medicine in India. Understanding the utilization of AYUSH practitioners' services is crucial to substantiating the current government initiatives to mainstream AYUSH in the Indian health system. The utilization of AYUSH practitioners' services among different sub-populations, including older adults, for various health conditions is underexplored. The present study explores the utilization of AYUSH practitioners' service among older Indian adults and its correlates.

METHODS

During 2017-2018, the Longitudinal Aging Study in India (LASI) conducted a nationally representative study among adults aged 45 years or more and their spouses. The study leveraged this data from publicly available LASI. Descriptive analysis and cross-tabulation were performed using a subset of older adults (age ≥ 60 years, n = 31,464). The utilization of AYUSH practitioners' services was taken as the outcome variable. A logistic regression model was employed to understand the independent effect of various explorative variables on the use of AYUSH practitioners' services.

RESULTS

One in 14 older adults utilized the services of AYUSH practitioners. The socio-demographic factors that were looked at, including religion, residence, and caste were significant independent factors for AYUSH consultation. Among chronic conditions, hypertension (use-5.6%, AOR: 1.24, CI: 1.09-1.40), diabetes (use-4.2%, AOR: 1.31, CI: 1.09-1.57), and arthritis (use-9.1%, AOR: 0.59, CI: 0.52-0.67) were independent determinants of AYUSH practitioners' service utilization. In the fully adjusted model, the effect of explanatory variables is almost similar to that in the minimally adjusted model. Only the effect of the female gender was accentuated in magnitude, whereas the effect of diabetes was partially attenuated.

CONCLUSION

The preference for AYUSH practitioners' service among older adults is determined by the complex interplay between socio-demographic factors and disease conditions. Though utilization of AYUSH practitioners' service was high among certain underprivileged sections, it is assuring that education and income do not affect older populations' preference for AYUSH practitioners' service.

Factors associated with the consumption of medicinal plants for the prevention of COVID-19 in peruvian population: a cross-sectional study

OBJECTIVES.

Motivation for the study. No study conclusively recommends the use of medicinal plants to treat COVID-19 symptoms, and their indiscriminate use may present health risks. Main findings. Sixty percent of participants consumed medicinal plants to prevent COVID-19. This was particularly true for those living in the Peruvian highlands and individuals with family members diagnosed or deceased from COVID-19, who perceive a higher risk of infection and use medications or chlorine dioxide as preventive measures. Implications. Communication strategies emphasizing validated preventive practices and educating about the risks of consuming medicinal plants should be tailored to the predominant characteristics of the consumer. Determine the factors associated with the consumption of medicinal plants as a preventive measure against COVID-19 in the Peruvian population.

MATERIALS AND METHODS.

A population over 18 years of age, living in Peru and without a history of COVID-19 disease, was evaluated. The factors associated with the consumption of medicinal plants were evaluated using a Poisson regression model with robust variances.

RESULTS.

Of the 3231 participants included, 84.6% were young adults (18-29 years old), 62.7% were women, and 59.7% consumed a medicinal plant to prevent COVID-19 infection. The factors associated with the consumption of medicinal plants to prevent COVID-19 infection were residing in the Peruvian highlands, having had a family member diagnosed with COVID-19, having had a family member die from COVID-19, considering their family to be at increased risk of infection, having used medications or chlorine dioxide to prevent COVID-19, having medical information as the main source of information about COVID-19, thinking that medicinal plants are effective in preventing COVID-19 disease, or not being informed about their effectiveness.

CONCLUSION.

Sixty percent of the participants reported having consumed a medicinal plant to prevent COVID-19. Authorities must apply communication strategies about the implications of consuming medicinal plants, prioritizing population groups with higher consumption patterns.

Digital roots: harnessing digital platforms in advancing traditional and complementary medicine for cancer care in Sub-Saharan Africa

The rise in cancer rates in Sub-Saharan Africa (SSA), combined with limited access to Western pharmaceuticals, has sparked growing adoption of traditional and complementary medicine (T&CM) for cancer treatment in the region. However, many challenges exist, including the lack of reliable evidence-based research on these products, scarcity of standardized documentation as part of cancer registries, limited physician expertise, and negative effects on mortality. Nonetheless, herbal medicines also present opportunities for further research, development, and stakeholder education, potentially benefiting the regional healthcare systems in SSA countries and global health as whole. Recent trends highlight the willingness of patients to use mobile-based applications that provide accurate information on herbal therapeutics, reflecting the increasing adoption of internet and smart/mobile phone services in SSA. To maximize the potential benefits of traditional and complementary medicine, it is necessary to bridge the trust gap between the public, local practitioners, and Western healthcare providers. Sustained funding and policy support are needed to complement these initiatives. Our preliminary survey hopes to inspire the community and policymakers to embrace innovative solutions, fostering a forward-looking approach to cancer care in SSA.

Spasmolytic Activity of Gentiana lutea L. Root Extracts on the Rat Ileum: Underlying Mechanisms of Action

The roots of Gentiana lutea L. are utilized in the preparation of various beverages and herbal remedies, serving as a traditional remedy for gastrointestinal ailments. The spasmolytic activity that could substantiate the traditional use of G. lutea root had not been investigated. The main objective goal of the study was to determine the validity of its use as a traditional remedy. The extraction of G. lutea root was performed using a 50% hydroethanolic solvent with three different extraction techniques: ultrasound-assisted extraction (UAE), heat-assisted extraction, and percolation. The spasmolytic activity was tested on isolated rat ileum. The mechanism of action was monitored using the models of spontaneous contractions and acetylcholine-, histamine-, CaCl2-, Bay K8644-, L-NAME-, ODQ-, apamin-, BaCl2-, charybdotoxin-, glibenclamide-, TRAM-34-, and quinine-modified contractions. UAE, having the best bioactivity, was further subjected to a liquid-liquid extraction fractionation. HPLC phytochemical analysis was performed for all tested extracts and fractions. Gentian root extracts were rich in secoiridoids, xanthones, and flavonoids. The UAE has shown better results on spontaneous contractions in comparison to its fractions, leading to the more detailed testing of its spasmolytic mechanism of activity. The extract's activity is primarily mediated through intermediate conductance Ca2+-activated K+ channels, ATP-sensitive K+ channels, voltage-sensitive K+ channels, and mechanisms that activate Ca2+ channels. Overall, the G. lutea root shows great potential in the treatment of spasmodic gastrointestinal ailments.

The potential of Ethiopian medicinal plants to treat emergent viral diseases

Ethiopians have deep-rooted traditions of using plants to treat ailments affecting humans and domesticated animals. Approximately 80% of the population continues to rely on traditional medicine, including for the prevention and treatment of viral diseases. Many antiviral plants are available to and widely used by communities in areas where access to conventional healthcare systems is limited. In some cases, pharmacological studies also confirm the potent antiviral properties of Ethiopian plants. Building on traditional knowledge of medicinal plants and testing their antiviral properties may help to expand options to address the global pandemic of COVID-19 including its recently isolated virulent variants and prepare for similar outbreaks in the future. Here, we provide an ethnobotanical and pharmacological inventory of Ethiopian medicinal plants that might contribute to the prevention and treatment of viral diseases. We identified 387 species, about 6% of Ethiopia's known flora, for which records of use by local communities and traditional herbalists have been documented for the treatment of viral diseases. We provide a framework for further investigation and development of this vital resource much anticipated to help combat emergent viral diseases along with existing ones in Ethiopia and elsewhere.

Knowledge, attitude, and utilization of traditional medicine within the plural medical system in West Java, Indonesia

BACKGROUND

The concept of 'medical pluralism' has become more popular among scholars in applied health science and prevalent in societies where one medical system alone cannot adequately meet the health care needs of the entire population.

METHODS

The data collection is focused on the knowledge-belief-practice and the utilization of three medical systems in Kabupaten Bandung, West Java, Indonesia. Participants were purposively selected from households with at least one member experienced one of the listed diseases in the questionnaire. The extensive survey using a structured questionnaire has been undertaken to collect data on people's health care utilization behaviour. The dataset is further analyzed using multivariate analysis through non-canonical correlation, with the analytical data provided by Statistical Package for Social Sciences (SPSS).

RESULTS

With regards to the total utilization by patients, the traditional medical system presents as the dominant medical system in the research area, accounting for 59.3% (n = 419) of total utilization, followed by the modern medical system (33.0%, n = 233), and transitional medical system (7.7%, n = 54). This study identified that village category, illness, illness duration, occupation, belief in traditional medicine, knowledge of modern medicine, accessibility, cost, proximity to the medical service, and insurance have significant (χ2 = 0.000) relationship with the utilization of medical systems. The results of the multivariate analysis show that the block of the predisposing socio-demographic factors and the block of the predisposing psycho-social factors correlate strongly with the utilization of medical systems.

CONCLUSIONS

In general, people in Kabupaten Bandung, West Java, Indonesia seeks treatment from various sources, which in the context of the medical system, consists of the traditional, transitional, and modern medical system; therefore, it adopts the patterns of transcultural health care utilization. In terms of the knowledge, beliefs, and practices of traditional medicine in West Java, the inhabitants of the five research villages were commonly familiar with medicinal plants and speak profoundly about their knowledge of traditional medicine, which in the research area is perceived as accessible, efficacious, affordable and culturally appropriate with Sundanese community.

Phytochemical characterization, in vivo and in vitro biological activities of Atriplex lindleyi Moq. subsp. inflata

ETHNOPHARMACOLOGICAL RELEVANCE

Atriplex lindleyi Moq. subsp. inflata from Algeria is known for its traditional use for therapeutic properties.

AIM OF THE STUDY

We analysed quantitatively and qualitatively the infusion and diethyl ether, n-butanol and ethereal extracts of A. lindleyi, as well as assessed their acute toxicity, anti-inflammatory, antinociceptive and antioxidant activities.

MATERIALS AND METHODS

The total phenolic and flavonoid contents were quantified. The anti-inflammatory effect was assessed using a carrageenan-induced paw oedema assay and the antinociceptive effect was evaluated using an acetic acid-induced writhing method. In addition, antioxidant activity was examined by three tests: DPPH, reducing power and phenanthroline assays.

RESULTS

The quantity of total phenols in the roots of A. lindleyi was larger than in the aerial parts, while the amounts of total flavonoids were larger in the aerial parts than in the roots. The HPLC profiles allowed us to identify 32 compounds belonging to the phenolic acid and flavonoid classes. Intraperitoneal administration of the infusions and phenolic extracts in mice did not cause any symptoms of toxicity or mortality. Results revealed that the aerial parts and roots of A. lindleyi had potential anti-inflammatory and antinociceptive activities and were higher than diclofenac and paracetamol, respectively. The diethyl ether extract (DEE) of aerial parts and roots showed the greatest antioxidant activity in comparison to the other tested extracts.

CONCLUSION

The phenolic composition attempted to be identified by HPLC confers this plant's pharmacological potential. The antioxidant potential may be due to active ingredients, including ascorbic acid, in the two studied parts of A. lindleyi, which is a bioactive molecule with strong antioxidant properties. Also, detecting salicylic acid, the active antinociceptive ingredient of aspirin, gallic and ferulic acids may justify this subspecies' antinociceptive and anti-inflammatory potentials.

Exploring the Potential Role of Phytopharmaceuticals in Alleviating Toxicities of Chemotherapeutic Agents

BACKGROUND

Chemotherapy is the mainstay of cancer treatment, bringing patients optimism about recurrence and survival. However, the clinical effectiveness of chemotherapeutic drugs is frequently jeopardized by their intrinsic toxicity, resulting in side effects affecting the quality of life of cancer patients. This analysis explores the ethnopharmacological impact of phytopharmaceuticals, highlighting their traditional use in many cultures. The present study, which takes its cues from indigenous knowledge, aims to close the knowledge gap between traditional medicine and modern medicine in reducing the toxicities of chemotherapy treatments.

AIM

The present in-depth study aims to highlight the current research and upcoming developments in phytopharmaceuticals for reducing the toxicity of chemotherapeutic drugs. Further, we address the mechanisms through which phytopharmaceuticals may reduce chemotherapy-induced side effects that include nausea, vomiting, myelosuppression, nephropathy, neuropathy, and cardiotoxicity using data from a variety of preclinical and clinical investigations.

MATERIALS AND METHODS

The literature search was carried out by employing search engines such as PubMed and Google Scholar with keywords such as cancer, chemotherapy, CNS toxicity, hematopoietic toxicity, renal toxicity, GI toxicity, CNS toxicity, and phytopharmaceuticals.

RESULTS

Bioactive chemicals found in plants, such as fruits, vegetables, herbs, and spices, are being studied for their capacity to improve the safety and acceptability of chemotherapy regimens. The current review also dives into the investigation of phytopharmaceuticals as adjuvant medicines in cancer treatment, which is a viable path for addressing the pressing need to lessen chemotherapy-induced toxicities.

CONCLUSION

The present review revealed that the potential of phytopharmaceuticals in alleviating chemotherapeutic drug toxicities would pave the way for better cancer treatment and patient outcomes, harmonizing with the larger trend towards personalized and holistic approaches to chemotherapy.

Prevalence of herbal and traditional medicine in Ethiopia: a systematic review and meta-analysis of 20-year studies

BACKGROUND

The widely accepted prevalence of traditional medicine (TM) in Ethiopia was about 80 %, of which 95 % were sourced from plants. The purpose of this study was to update knowledge of the prevalence of herbal medicine or TM in Ethiopia and describe the characteristics of the population mostly relying on herbal medicine or TM to inform health policy-makers.

METHODS

PubMed, Google Scholar, Hinari, Scopus, and the Directory of Open Access Journals (DOAJ) were searched. The methodological quality of each included study was assessed using the quality assessment checklist for prevalence studies. Meta-analysis was conducted using STATA version 17, and the heterogeneity between studies was assessed using I2 test statistics based on the random effect model. Forest and funnel plots were used to present the data. Subgroup analysis was done by the study population, region, and setting.

RESULTS

Thirty-six studies with a total of 16,288 participants met the inclusion criteria. Meta-analysis of the study revealed that the prevalence of herbal medicine use in Ethiopia is 46 % (95 % CI, 37-54 %), with significant heterogeneity among the studies (I2 = 99.19 %). Egger's test for publication bias of herbal medicine use revealed significant results (Egger, P = 0.002) which indicates possible missing of small sample size studies. The prevalence of TM use in Ethiopia is 65 % (95 % CI, 52-77 %) with significant heterogeneity among the studies (I2 = 99.18 %). Egger's test for publication bias of TM use revealed non-significant results (Egger, P = 0.275). The subgroup analysis by the study setting and the region revealed variability amongst the studies. Community-based studies and Oromia National Regional State showed higher prevalence. By population type, a higher prevalence of TM use was observed amongst children and lowest amongst malaria suspects.

CONCLUSIONS

The current study revealed that TM/herbal medicine utilization remained an important source of primary healthcare in Ethiopia. In comparison to the commonly reported prevalence of TM/herbal medicine, there is a considerable decline in TM/herbal medicine prevalence. High TM/herbal medicine use tendency during pregnancy necessitates safety studies to optimize the utilization.

Nephroprotective effect of PHYMIN-22 on ethylene glycol induced urolithiasis rat model

The present study was designed to evaluate the antiurolithiatic effect of PHYMIN-22 against ethylene glycol-induced urolithiasis in rats. Healthy Albino male rats with 200-230 g body weight were randomly divided into five groups, each with 5 animals, control group, EG group (0.75%), PHYMIN-22 treatment group (0.75% EG 14 days and 100 mg/kg PHYMIN-22 next 14 days), PHYMIN-22 drug control group (100 mg/kg) and cystone treatment group (0.75% EG 14 days and 750 mg/kg cystone next 14 days). Biochemical testing was adopted for measuring the blood and urine parameters, as well as the level of antioxidants including superoxide dismutase (SOD), Catalase (Cat), Glutathione peroxidase (GPx) and glutathione (GSH) in kidney tissues. Hematoxylin and eosin (HE) staining was utilized to observe the histopathological changes in the kidney tissue. End of the experiment the PHYMIN-22 treatment reduced the urine and serum calcium (p < 0.01; p < 0.01), oxalate (p < 0.01; p < 0.01), phosphate (p < 0.01; p < 0.01), uric acid (p < 0.001; p < 0.001), protein (p < 0.001; p < 0.001), and creatinine (p < 0.001; p < 0.001) respectively, serum indicators ALT (p < 0.001) and AST (p < 0.001) level and non-enzymic antioxidant GSH (p < 0.001) compared to EG induced urolithiasis animals (Diseased control group). PHYMIN-22 treatment significantly increased urine volume, pH, and body weight, and antioxidants include CAT (p < 0.001; p < 0.001), SOD (p ˃ 0.05; p < 0.05), and GPX (p < 0.01; p < 0.001) compared to Diseased control group animals. The effect of PHYMIN-22 on EG-induced urolithiasis animals could be by improving kidney function, normalizing the urine and serum parameters, maintaining the kidney antioxidants, eliminating crystal deposition, and excretion of unwanted ions from the kidney and urinary tract.

Use of traditional and complementary medicine by ethnic Indian women living with polycystic ovary syndrome: a global survey

BACKGROUND

Traditional, complementary, and integrative medicine (TCIM) is commonly used by those living with Polycystic Ovary Syndrome (PCOS) but little is known about the use of TCIM such as yoga and Ayurveda in ethnic Indian women with PCOS living worldwide. This survey aimed to explore the prevalence and types of TCIM used and in particular the pattern of use of yoga and Ayurveda including reasons for not using and future interest in using them among non-users.

METHOD

An online, international cross-sectional survey was conducted using a pre-designed survey tool. Participants were ethnic Indian women of reproductive age who reported that they were medically diagnosed with PCOS. Descriptive analysis was used to identify the proportion of TCIM users, while a multivariable binary logistic regression was used to analyze their characteristics.

RESULTS

Data from 3130 respondents were analysed. The prevalence of TCIM use was 80% (2515/3130). Yoga and Ayurveda were the most frequently practised TCIM modalities with a prevalence of 57% and 37% respectively. We found a high future interest in using yoga (81%) and Ayurveda (70%) among the non-users. The motivation for most Ayurveda use was a recommendation from family/friends (66%), rather than personal choice (38%) or the internet (19%). Most women used Ayurveda because it has natural ingredients (64%) and it is safe (60%) and cited its use to be safe and somewhat helpful. The majority of women were currently practising yoga (73%) up to four times a week (54%) at home (93%). Yoga was primarily used to improve overall health (67%), manage weight (64%), stress (54%) hormonal imbalance (49%) and emotional well-being (48%). Barriers to practising yoga were common among the current users and non-users and included lack of motivation (59% and 59%), time constraints (48% and 39%), and non-availability of yoga teachers specialised in PCOS (31% and 23%). Most women found yoga to be helpful and preferred individual one-on-one (52%) yoga sessions specifically tailored for PCOS (58%).

CONCLUSION

This is the first international study that discovered the prevalence and pattern of TCIM use among ethnic Indian women with PCOS living worldwide. We support the urgent need for more research, education, and regulation of different TCIM modalities to promote safe and effective practices globally.

Challenges in natural product-based drug discovery assisted with in silico-based methods

The application of traditional medicine by humans for the treatment of ailments as well as improving the quality of life far outdates recorded history. To date, a significant percentage of humans, especially those living in developing/underprivileged communities still rely on traditional medicine for primary healthcare needs. In silico-based methods have been shown to play a pivotal role in modern pharmaceutical drug discovery processes. The application of these methods in identifying natural product (NP)-based hits has been successful. This is very much observed in many research set-ups that use rationally in silico-based methods in combination with experimental validation techniques. The combination has rendered the use of in silico-based approaches even more popular and successful in the investigation of NPs. However, identifying and proposing novel NP-based hits for experimental validation comes with several challenges such as the availability of compounds by suppliers, the huge task of separating pure compounds from complex mixtures, the quantity of samples available from the natural source to be tested, not to mention the potential ecological impact if the natural source is exhausted. Because most peer-reviewed publications are biased towards "positive results", these challenges are generally not discussed in publications. In this review, we highlight and discuss these challenges. The idea is to give interested scientists in this field of research an idea of what they can come across or should be expecting as well as prompting them on how to avoid or fix these issues.

A delve into the pharmacological targets and biological mechanisms of Paederia foetida Linn.: a rather invaluable traditional medicinal plant

Drug development from herbal medicines or botanical sources is believed to have a prominent role in the exploration of novel counteractive drugs that has sparked much interest in recent times. Paederia foetida is one such medicinal plant used in both traditional and folkloric medicine. Several parts of the herb are locally utilised as a natural curative agent for several ailments since time immemorial. Paederia foetida indeed possesses anti-diabetic, anti-hyperlipidaemic, antioxidant, nephro-protective, anti-inflammatory, antinociceptive, antitussive, thrombolytic, anti-diarrhoeal, sedative-anxiolytic, anti-ulcer, hepatoprotective activity, anthelmintic and anti-diarrhoeal activity. Furthermore, growing evidence shows many of its active constituents to be effective in cancer, inflammatory diseases, wound healing and spermatogenesis as well. These investigations shed light on possible pharmacological targets and attempts to establish a mechanism of action for these pharmacological effects. These findings contrast the significance of this medicinal plant for further research and for the exploration of novel counteractive drugs to establish a mechanism of action before being employed to healthcare. Pharmacological activities of Paederia foetida and their mechanism of action.

Contamination of herbal medicinal products in low-and-middle-income countries: A systematic review

The use of herbal medicinal products (HMPs) has grown significantly across low-and-middle-income countries (LMICs). Consequently, the safety of these products due to contamination is a significant public health concern. This systematic review aimed to determine the prevalence, types, and levels of contaminants in HMPs from LMICs. A search was performed in seven online databases, i.e., Africa journal online (AJOL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Directory of Open Access Journals (DOAJ), Health Inter-Network Access to Research Initiative (HINARI), World Health Organization Global Index Medicus (WHO GIM), Scopus, and PubMed using appropriate search queries and reported as per the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) guidelines. Ninety-one peer-reviewed articles published from 1982 to 2021 from 28 different countries across four continents were included in the study. Although metals, microbial, mycotoxins, pesticides, and residual solvents were the reported contaminants in the 91 articles, metals (56.0%, 51/91), microbial (27.5%, 25/91), and mycotoxins (18.7%, 17/91) were the most predominant. About 16.4% (1236/7518) of the samples had their contaminant levels above the regulatory limits. Samples tested for microbial contaminants had the highest proportion (46.4%, 482/1039) of contaminants exceeding the regulatory limit, followed by mycotoxins (25.8%, 109/423) and metals (14.3%, 591/4128). The proportion of samples that had their average non-essential metal contaminant levels above the regulatory limit was (57.6%, 377/655), 18.3% (88/480), 10.7% (24/225), and 11.3% (29/257) for Pb, Cd, Hg, and As, respectively. The commonest bacteria species found were Escherichia coli (52.3%, 10/19) and Salmonella species (42.1%, 8/19). This review reported that almost 90% of Candida albicans and more than 80% of moulds exceeded the required regulatory limits. HMP consumption poses profound health implications to consumers and patients. Therefore, designing and/or implementing policies that effectively regulate HMPs to minimize the health hazards related to their consumption while improving the quality of life of persons living in LMICs are urgently needed.

Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review

Introduction

Medication non-adherence is an important public health issue, associated with poor clinical and economic outcomes. Globally, self-reported instruments are the most widely used method to assess medication adherence. However, the majority of these were developed in high-income countries (HICs) with a well-established health care system. Their applicability in low- and middle-income countries (LMICs) remains unclear. The objective of this study is to systematically review the applicability of content and use of self-reported adherence instruments in LMICs.

Method

A scoping review informed by a literature search in Pubmed, EBSCO, and Cochrane databases was conducted to identify studies assessing medication adherence using self-reported instruments for patients with five common chronic diseases [hypertension, diabetes, dyslipidemia, asthma, or Chronic Obstructive Pulmonary Disease (COPD)] in LMICs up to January 2022 with no constraints on publication year. Two reviewers performed the study selection process, data extraction and outcomes assessment independently. Outcomes focused on LMIC applicability of the self-reported adherence instruments assessed by (i) containing LMIC relevant adherence content; (ii) methodological quality and (iii) fees for use.

Findings

We identified 181 studies that used self-reported instruments for assessing medication adherence in LMICs. A total of 32 distinct types of self-reported instruments to assess medication adherence were identified. Of these, 14 self-reported instruments were developed in LMICs, while the remaining ones were adapted from self-reported instruments originally developed in HICs. All self-reported adherence instruments in studies included presented diverse potential challenges regarding their applicability in LMICs, included an underrepresentation of LMIC relevant non-adherence reasons, such as financial issues, use of traditional medicines, religious beliefs, lack of communication with healthcare provider, running out of medicine, and access to care. Almost half of included studies showed that the existing self-reported adherence instruments lack sufficient evidence regarding cross cultural validation and internal consistency. In 70% of the studies, fees applied for using the self-reported instruments in LMICs.

Conclusion

There seems insufficient emphasis on applicability and methodological rigor of self-reported medication adherence instruments used in LMICs. This presents an opportunity for developing a self-reported adherence instrument that is suitable to health systems and resources in LMICs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42022302215.

Utilisation of traditional healers among older people living with HIV in South Africa: a WHO SAGE well-being of older people study

BACKGROUND

Within the African region, there are an estimated 8 million people living with HIV (PLHIV) in South Africa. Seeking healthcare services from traditional healers (TH) is one of the alternative and complementary approaches to HIV/AIDS treatment. Identifying the associated factors of TH utilisation among older PLHIV is crucial in developing healthcare interventions that cater to the unique needs of this vulnerable group. This study investigated the factors associated with TH utilisation among older PLHIV.

METHODS

We studied 516 older PLHIV using data from the WHO SAGE Well-Being of Older People Study (2011-2013). Chi-square, bivariate and multivariate logistic regression were computed in STATA Version 14. The results were presented with both crude and adjusted odds ratio (AOR) and at 95% confidence interval (CI).

RESULTS

Of the 516 participants, 15.89% utilised TH. The major reason for TH utilisation among older PLHIV was the perception of receiving better healthcare services from TH (51.2%) and the flexibility to pay with goods instead of money (14.6%). The factors associated with TH utilisation were age [AOR = 0.05; CI  0.01, 0.37], being hypertensive [AOR = 2.07; CI  1.04, 4.11], and having more than four servings of fruits [AOR = 10.64; CI  2.95, 38.34]. TH utilisation was significantly lower among those who visited the clinic once or twice [AOR = 0.17; CI  0.05, 0.63], three to six times [AOR = 0.16; CI  0.05, 0.56], and more than 6 times [AOR = 0.09; CI  0.03, 0.34] compared to those who had no clinic visits.

CONCLUSION

In conclusion, a low proportion of TH utilisation was reported among older PLHIV in South Africa. TH utilisation is associated with age, hypertension status, frequency of clinic visits and fruit servings consumed. Our study suggests that being hypertensive was a motivating factor for older PLHIV to utilise TH. Therefore, it is imperative for the South African health department to integrate the services of TH into the mainstream health system to manage non-communicable diseases, particularly hypertension, among older PLHIV.

The potential therapeutic effect of Nigella sativa and Zingiber officinale extracts versus Nitazoxanide drug against experimentally induced cryptosporidiosis in laboratory mice

In this study, the potential anti-cryptosporidial effect of Nigella sativa (black seeds) and Zingiber officinale (ginger) alcoholic extracts versus Nitazoxanide (NTZ) medication was investigated in immunosuppressed (IS) laboratory mice. Parasitological, histopathological studies were used to assess their therapeutic efficacy. Serum level and tissue expression percentage of IFN-γ was also used. Nigella extract succeeded to reduce the mean oocyst counts in the feces of immunosuppressed mice followed by NTZ. Ginger-treated ones showed the lowest reduction percentage. Nigella sativa showed the best results in terms of restoring the normal architecture of ileal epithelium in histopathological sections stained with H&E. NTZ treatment sub-groups showed mild improvement, followed by ginger-treated mice, which showed a slight improvement in small intestine microenvironment. A significant substantial rise in serum and intestinal tissue IFN-γ cytokine levels were recorded in Nigella subgroups compared to those of NTZ and ginger respectively. According to our findings Nigella sativa outperformed Nitazoxanide in terms of anti-cryptosporidial effectiveness and regeneration characteristics revealing a promising medication. When compared to the commonly used Nitazoxanide medication or Nigella extracts, the outcomes of ginger extract were suboptimal.

The Role of Bitter Melon in Breast and Gynecological Cancer Prevention and Therapy

Phytotherapy has long represented a widely accepted treatment alternative to conventional therapy. Bitter melon is a vine with potent antitumor effects against numerous cancer entities. To date, no review article has, however, been published on the role of bitter melon in breast and gynecological cancer prevention and therapy. The current work constitutes the most comprehensive, up-to-date review of the literature, which highlights the promising anticancer effects of bitter melon on breast, ovarian, and cervical cancer cells and discusses future research recommendations.

Unravelling the potential of insects for medicinal purposes - A comprehensive review

Entomotherapy, the use of insects for medicinal purposes, has been practised for centuries in many countries around the world. More than 2100 edible insect species are eaten by humans, but little is known about the possibility of using these insects as a promising alternative to traditional pharmaceuticals for treating diseases. This review offers a fundamental understanding of the therapeutic applications of insects and how they might be used in medicine. In this review, 235 insect species from 15 orders are reported to be used as medicine. Hymenoptera contains the largest medicinal insect species, followed by Coleoptera, Orthoptera, Lepidoptera, and Blattodea. Scientists have examined and validated the potential uses of insects along with their products and by-products in treating various diseases, and records show that they are primarily used to treat digestive and skin disorders. Insects are known to be rich sources of bioactive compounds, explaining their therapeutic features such as anti-inflammatory, antimicrobial, antiviral, and so on. Challenges associated with the consumption of insects (entomophagy) and their therapeutic uses include regulation barriers and consumer acceptance. Moreover, the overexploitation of medicinal insects in their natural habitat has led to a population crisis, thus necessitating the investigation and development of their mass-rearing procedure. Lastly, this review suggests potential directions for developing insects used in medicine and offers advice for scientists interested in entomotherapy. In future, entomotherapy may become a sustainable and cost-effective solution for treating various ailments and has the potential to revolutionize modern medicine.

The use of traditional medicine practitioner services for childhood illnesses among childbearing women: a multilevel analysis of demographic and health surveys in 32 sub-Saharan African countries

BACKGROUND

Insights into the use of traditional medicine practitioners (TMP)-for common childhood diseases such as diarrhea and respiratory infections are important to understand the role of Traditional Medicine (TM) in reducing the increasing childhood morbidity and mortality in sub-Saharan Africa (SSA). However, a comprehensive picture of TMP utilisation and its associated factors for childhood illness in SSA is lacking. This study aimed to estimate the prevalence of the use of traditional medicine practitioner services to treat childhood illnesses among women with children under five years old and to identify individual and community-level factors associated with TMP use in SSA.

METHODS

The analysis used Demographic and Health Surveys (DHS) dataset collected between 2010 and 2021 among 353,463 under-fives children from 32 SSA countries. Our outcome variable was the use of TMP for childhood illness, defined as having diarrhoea or fever/cough or both. Using STATA v14, we employed the random effect meta-analysis to estimate the pooled prevalence of TMP use for childhood illness and a two-level multivariable multilevel modelling to determine the individual and community-level factors associated with consultation of a TMP.

RESULTS

Approximately [2.80% (95%CI: 1.88-3.90)] women who sought healthcare for childhood illnesses utilised the service of a TMP with the highest occurring in Cote d'Ivoire [16.3% (95%CI: 13.87-19.06)] and Guinea (13.80% (95%CI: 10.74-17.57)] but the lowest in Sierra Leone [0.10%(95%CI:0.01-1.61)]. Specifically, approximately [1.95% (95%CI: 1.33-2.68)] and [1.09% (95%CI:0.67-1.60)] of women sought the service of a TMP for childhood diarrhea and fever/cough, respectively. Women with no formal education [AOR = 1.62;95%CI:1.23-2.12], no media access [AOR = 1.19;95%CI:1.02-1.39), who lived in a male-headed household [AOR = 1.64;95%CI:1.27-2.11], without health insurance [AOR = 2.37;95%CI: 1.53-3.66], who considered it a problem getting permission to visit a health facility [AOR = 1.23;95%CI:1.03-1.47] and who perceived the size of their children at birth to be above average[AOR = 1.20;95%CI:1.03-1.41] had higher odds of using TMP for childhood illnesses.

CONCLUSIONS

Although the prevalence of TMP for childhood illnesses appeared low, our findings highlight that TMPs continue to play a critical role in managing childhood illnesses in SSA. It is essential that policymakers and service providers should incorporate the potential role of TMPs in the design, review and implementation of child health policies in SSA. Also, the interventions for curtailing childhood illnesses should be focused on the characteristics of women who use TMPs for childhood diseases identified in our study.

Anti-arthritis Effects of Zingiberaceae Extracts on Models of Inflammatory Joint Disease

Due to this becoming an aging society, the number of arthritis cases has been increasing. Unfortunately, some currently available medications can cause adverse effects. Using herbal remedies as a form of alternative medicine is becoming increasingly popular. Zingiber officinale (ZO), Curcuma longa (CL), and Kaempferia parviflora (KP) are herbal plants in the Zingiberaceae family that have potent anti-inflammatory effects. This study investigates the anti-inflammatory and chondroprotective effects of ZO, CL, and KP extracts on in vitro and ex vivo inflammatory models. The combinatorial anti-arthritis effect of each extract is also evaluated in an in vivo model. ZO extract preserves cartilaginous proteoglycans in proinflammatory cytokines-induced porcine cartilage explant in a fashion similar to that of CL and KP extracts and suppresses the expression of major inflammatory mediators in SW982 cells, particularly the COX2 gene. CL extract downregulates some inflammatory mediators and genes-associated cartilage degradation. Only KP extract shows a significant reduction in S-GAGs release in a cartilage explant model compared to the positive control, diacerein. In SW982 cells, it strongly suppresses many inflammatory mediators. The active constituents of each extract selectively downregulate inflammatory genes. The combined extracts show a reduction in inflammatory mediators to a similar degree as the combined active constituents. Reductions in paw swelling, synovial vascularity, inflammatory cell infiltration, and synovial hyperplasia are found in the combined extracts-treated arthritic rats. This study demonstrates that a combination of ZO, CL, and KP extracts has an anti-arthritis effect and could potentially be developed into an anti-arthritis cocktail for arthritis treatment.

Angiotensin converting enzyme (ACE) inhibitors activity from purified compounds Fructus Phaleria macrocarpa (Scheff) Boerl

BACKGROUND

Mahkota Dewa [Phaleria macrocarpa (Scheff) Boerl.] fruit in vitro and in- vivo can decrease and prevent elevation of the blood pressure, lower plasma glucose levels, possess an antioxidant effect, and recover liver and kidney damage in rats. This study aimed to determine the structure and inhibitory activity of angiotensin-converting enzyme inhibitors (ACE) from the Mahkota Dewa fruit.

METHODS

The fruit powder was macerated using methanol and then partitioned by hexane, ethyl acetate, n-butanol, and water. The fractions were chromatographed on the column chromatography and incorporated with TLC and recrystallization to give pure compounds. The structures of isolated compounds were determined by UV-Visible, FT-IR, MS, proton (¹H-NMR), carbon (¹³C-NMR), and 2D-NMR techniques encompassing HMQC and HMBC spectra. The compounds were evaluated for their ACE inhibitory activity, and the strongest compound was determined by the kinetics enzyme inhibition.

RESULTS

Based on the spectral data, the isolated compounds were determined as 6,4-dihydroxy-4-methoxybenzophenone-2-O-β-D-glucopyranoside (1), 4,4'-dihydroxy-6-methoxybenzophenone-2-O-β-D-glucopyranoside (2) and mangiferin (3). IC₅₀ values of the isolated compounds 1, 2 and 3 were 0.055, 0.07, and 0.025 mM, respectively.

CONCLUSION

The three compounds have ACE inhibitor and mangiferin demonstrated the best ACE inhibitory activity with competitive inhibition on ACE with the type of inhibition kinetics is competitive inhibition.

Bisbenzylisoquinolines from Cissampelos pareira L. as antimalarial agents: Molecular docking, pharmacokinetics analysis, and molecular dynamic simulation studies

Malaria is a major global health issue due to the emergence of resistance to most of the available antimalarial drugs. There is an urgent need to discover new antimalarials to tackle the resistance issue. The present study aims to explore the antimalarial potential of chemical constituents reported from Cissampelos pareira L., a medicinal plant traditionally known for treating malaria. Phytochemically, benzylisoquinolines and bisbenzylisoquinolines are the major classes of alkaloids reported from this plant. In silico molecular docking revealed prominent interactions of bisbenzylisoquinolines such as hayatinine and curine with Pfdihydrofolate reductase (-6.983 Kcal/mol and -6.237 Kcal/mol), PfcGMP-dependent protein kinase (-6.652 Kcal/mol and -7.158 Kcal/mol), and Pfprolyl-tRNA synthetase (-7.569 Kcal/mol and -7.122 Kcal/mol). The binding affinity of hayatinine and curine with identified antimalarial targets was further evaluated using MD-simulation analysis. Among the identified antimalarial targets, the RMSD, RMSF, the radius of gyration, and PCA indicated the formation of stable complexes of hayatinine and curine with Pfprolyl-tRNA synthetase. The outcomes of in silico investigation putatively suggested that bisbenzylisoquinolines may act on the translation of the Plasmodium parasite to exhibit antimalarial potency.

Antimicrobial Potential of Pithecellobium dulce Seed Extract against Pathogenic Bacteria: In Silico and In Vitro Evaluation

Clinical multi-drug-resistant bacteria continue to be a serious health problem. Plant-derived molecules are an important source of bioactive compounds to counteract these pathogenic bacteria. In this paper, we studied the chemical composition of the methanol (80%) extract from Pithecellobium dulce seed (Hail, Saudi Arabia) and its ability to inhibit the growth of clinically relevant multi-drug-resistant bacteria. Molecular docking analysis was performed to predict the best compounds with low binding energy and high affinity to interact with two Staphylococcus aureus receptors. Data showed that P. dulce extract is a rich source of D-turanose (55.82%), hexadecanoic acid (11.56%), indole-1-acetic acid (11.42%), inositol (5.78%), and octadecanoic acid (4.36%). The obtained extract showed antibacterial activity towards tested clinical bacterial strains with MIC values ranging from 233 mg/mL for Acinetobacter baumannii to 300 mg/mL for S. aureus and Escherichia coli. Turanose interaction has resulted in -7.4 and -6.6 kcal/mol for 1JIJ and 2XCT macromolecules, while inositol showed energy values (-7.2 and -5.4 kcal/mol) for the same receptors. Multiple identified compounds showed desirable bioavailability properties indicating its great potential therapeutic use in human. Overall, current investigation highlights the possible use of P. dulce extract as a valuable source for drug development against pathogenic drug-resistant bacteria.

Revealing the Underlying Mechanism of Acacia Nilotica against Asthma from a Systematic Perspective: A Network Pharmacology and Molecular Docking Study

Acacia Nilotica (AN) has long been used as a folk cure for asthma, but little is known about how AN could possibly modulate this disease. Thus, an in-silico molecular mechanism for AN's anti-asthmatic action was elucidated utilizing network pharmacology and molecular docking techniques. DPED, PubChem, Binding DB, DisGeNET, DAVID, and STRING were a few databases used to collect network data. MOE 2015.10 software was used for molecular docking. Out of 51 searched compounds of AN, eighteen compounds interacted with human target genes, a total of 189 compounds-related genes, and 2096 asthma-related genes were found in public databases, with 80 overlapping genes between them. AKT1, EGFR, VEGFA, and HSP90AB were the hub genes, whereas quercetin and apigenin were the most active components. p13AKT and MAPK signaling pathways were found to be the primary target of AN. Outcomes of network pharmacology and molecular docking predicted that AN might exert its anti-asthmatic effect probably by altering the p13AKT and MAPK signaling pathway.

Knowledge, Attitudes and Practices Regarding Traditional and Complimentary Medicine in Oman

Objectives

This study aimed to assess the knowledge, attitudes and practices regarding traditional medicine (TM) in Oman and examine the factors that necessitate its use.

Methods

This cross-sectional, questionnaire-based study was conducted among the general population from November 2019 and March 2020. All Omani nationals above the age of 18 were eligible to be enrolled. The questionnaire consisted of questions on the knowledge, attitudes and use regarding traditional medicine in Oman.

Results

A total of 598 responses to the questionnaire were received (response rate: 85.4%), of which 552 were deemed complete. Most responses were received from males (62.5%) and the sample had a mean age of 33.6 ± 7.7 years. A majority of the respondents (90%) were aware of the different types of TM in Oman; a high percentage (81.5%) felt that it was effective. Most (67.8%) had tried at least one method of TM use. Individuals who were older had tried TM compared to those who had not (34.5 ± 7.8 years versus 31.8 ± 7.2 years; P <0.001); in addition, more males than females (72.2% versus 27.8%; P <0.001) and those with full-time employment than those without had tried TM (84.2% versus 14.2%; P <0.001). Herbal medications (65.8%) and traditional massage (60.4%) were the most common forms of TM practice. Among females, herbal medications (69.2%) and massage (63.5%) are most often used; among males, cupping (65.2%) followed by herbal medications (64.4%) and massage (59.3%) were used more often. Notably, back pain (74.3%) was the most common condition for which TM was reportedly used, with only a small percentage (8.3%) reporting any concomitant side-effects.

Conclusion

There is widespread use of TM among Oman's urban population. An improved understanding of their benefits will facilitate their incorporation into modern health care services.