Prevalence of herbal medicines in patients with chronic allergic disorders in Western Saudi Arabia

Ethnobotanical study on medicinal plants used in the Aseer province, Southwestern Saudi Arabia

BACKGROUND

Aseer province is a semi-arid region in Southwestern Saudi Arabia. It represents a rich source of ethnobotanical knowledge and plant biodiversity. However, this knowledge has been passed verbally devoid of documentation.

METHODS

In the present work, we carried out for the first time an ethnobotanical survey, using quantitative parameters (relative frequency of citation (RFC); informant consensus factor (ICF); fidelity level (FL%); relative popularity level (RPL), and rank-order priority (ROP)), to provide insights into the traditional use of medicinal plants (MPs) in the Aseer province.

RESULTS

One hundred and fifty informants, aged 18 to over 60, mentioned 80 different plant species belonging to 38 families of angiosperms to treat 9 ailments. A comparison with the literature in nearby areas revealed 10 species used as MPs only in the Aseer region. Syzygium aromaticum and Mentha spicata had the highest RFC (0.71). The level of agreement among the informants, for plant species used against dermatological problems, was remarkably high (ICF = 0.88). A lower level of agreement (ICF = 0.66-0.86) was noticed among the informants concerning the use of MPs to treat insect bites, diabetes, gastrointestinal disorders, hypertension, skeletomuscular disorders, toothache, mouth inflammation, stress and insomnia, and cold and respiratory tract diseases. In addition, 36 plant species, mentioned by at least 9 informants, had healing efficacity (FL%) ranging between 32 and 100. Among these species, 12 were grouped as popular (RPL = 0.54-1).

CONCLUSION

The present documentation on MPs can efficiently provide as a basis for additional pharmacological and phytochemical research and conservation studies.

Boswellia carteri Birdw. Resin Extract Induces Phase-I Cytochrome P-450 Enzyme Gene Expressions in Human Hepatocarcinoma (Hep G2) Cells: In vitro and in silico Studies

Introduction

Boswellia carteri (B. carteri) resin is widely recognized for its anti-inflammatory, wound-healing, and immunomodulatory properties. This study examines the ability of its aqueous extracts to modulate the expression of key cytochrome P450 (CYP) enzymes-CYP1A2, CYP2B6, and CYP3A4-in Hep G2 cells, emphasizing pharmacokinetic and toxicological implications.

Methods

Aqueous extracts were evaluated for endotoxin contamination and cytotoxicity to ensure suitability for in vitro experimentation. PCR analysis was employed to quantify CYP enzyme gene expression. Computational tools, including Protox-II, Swiss ADME, and molecular docking, were used to assess pharmacokinetics, CYP interactions, and biological targets. Competitive binding assays were performed to investigate the involvement of the constitutive androstane receptor (CAR) in CYP induction.

Results

The results suggest that several metabolites, particularly ursodeoxycholic acid and beta-sitosterol, show potential interactions with CYP enzymes, with ursodeoxycholic acid demonstrating the highest probability of biological effects on CYP and a strong binding affinity to the Constitutive Androstane Receptor (CAR). Moreover, a receptor competitive binding assay suggested that the primary mechanism of CYP 2B6 and 3A4 induction is through activation of the CAR receptor although additional confirmatory studies are necessary.

Discussion

The observed CYP enzyme induction through CAR receptor activation aligns with USFDA guidelines for CYP studies. However, the hepatotoxic potential of ursodeoxycholic acid and the associated toxicity risks of other metabolites underscore the need for caution. The findings highlight the potential for herb-drug interactions, particularly with pharmaceuticals metabolized by CYP enzymes.

Conclusion

In conclusion, there is a potential for interactions between B. carteri resins and pharmaceuticals metabolized by CYP enzymes; thus, we advise caution to consumers, patients, and healthcare providers regarding their concomitant use. Although our findings provide valuable insights, further in vivo studies are essential to validate the modulatory effects of B. carteri on CYP gene expression.

Evaluation of Herbal Products and Dietary Supplements Use in Patients with Respiratory Diseases Applied to Tertiary Health Institution

Objectives

In recent years, especially with the Coronavirus Disease of 2019 (COVID-19) pandemic, the use of herbal products for various health problems has been increasing worldwide. This study aimed to determine the frequency of herbal product/dietary supplement use, the most used products, and the factors affecting the use of these products in patients who applied to the Chest Diseases Clinic.

Materials and Methods

This descriptive survey study was conducted at Chest Diseases Clinic using a face-to-face interview technique. Adult individuals with subacute respiratory complaints for > 3 weeks or a diagnosis of chronic chest disease were included in the study. The questionnaire form included questions about personal characteristics, data related to disease and treatment, use of herbal products/dietary supplements, and attitudes toward these products. A total of 444 participants with all the data included in the study. Descriptive statistics, chi-square, and binary logistic regression tests were used.

Results

It was determined that 49.3% of the participants used herbal products/dietary supplements, and the most frequently used products were honey, linden, ginger, lemon, and carob. According to the results of the binary logistic regression test, it was determined that patients over 60 years old [odds ratio (OR)= 2.0, 95% confidence interval (Cl): 1.1-3.8, p= 0.042], those with a high education level (OR= 2.0, 95% Cl: 1.1-3.6, p= 0.018), those who live in urban (OR= 1.8, 95% Cl: 1.1-3.0, p= 0.018), and those with a diagnosis of post-COVID syndrome (OR= 2.7, 95%, Cl: 1.3-5.5, p= 0.007) are more likely to use these products. It was determined that 57.9% of the participants used these products to relieve the symptoms of the disease.

Conclusion

Considering the high probability of using these products in patients with respiratory tract disease, it is essential for public health that health professionals question the use of these products and provide counseling on this issue.

Atopic dermatitis: A global health perspective

The International Society of AD (ISAD) organized a roundtable on global aspects of AD at the WCD 2023 in Singapore. According to the Global Burden of Disease (GBD) consortium, at least 171 million individuals were affected with AD in 2019, corresponding to 2.23% of the world population, with age-standardized prevalence and incidence rates that were relatively stable from 1990 to 2019. Based on the panel experience, most AD cases are mild-to-moderate. Without parallel data on disease prevalence and severity, the GBD data are difficult to interpret in many regions. This gap is particularly important in countries with limited medical infrastructure, but indirect evidence suggests a significant burden of AD in low-and-medium resource settings, especially urban areas. The Singapore roundtable was an opportunity to compare experiences in World Bank category 1 (Madagascar and Mali), 3 (Brazil, China) and 4 (Australia, Germany, Qatar, USA, Singapore, Japan) countries. The panel concluded that current AD guidelines are not adapted for low resource settings and a more pragmatic approach, as developed by WHO for skin NTDs, would be advisable for minimal access to moisturizers and topical corticosteroids. The panel also recommended prioritizing prevention studies, regardless of the level of existing resources. For disease long-term control in World Bank category 3 and most category 4 countries, the main problem is not access to drugs for most mild-to-moderate cases, but rather poor compliance due to insufficient time at visits. Collaboration with WHO, patient advocacy groups and industry may promote global change, improve capacity training and fight current inequalities. Finally, optimizing management of AD and its comorbidities needs more action at the primary care level, because reaching specialist care is merely aspirational in most settings. Primary care empowerment with store and forward telemedicine and algorithms based on augmented intelligence is a future goal.

Microbial and heavy metal contamination in herbal medicine: a prospective study in the central region of Saudi Arabia

INTRODUCTION

Herbal medicine is a medical system based on the utilization of plants or plant extracts for therapy. The continual increase in global consumption and the trade of herbal medicine has raised safety concerns in many regions. These concerns are mainly linked to microbial contamination, which could spread infections with multi-resistant bacteria in the community, and heavy metal contamination that may lead to cancers or internal organs' toxicity.

METHODS

This study was performed using an experimental design. A total of 47 samples, herbal medicine products sold in local stores in Qassim region, were used in the experiments. They were tested for bacterial contamination, alongside 32 samples for heavy metal analysis. Bacterial contamination was determined by the streak plate method and further processed to determine their antimicrobial susceptibility patterns using MicroScan WalkAway96 pulse; heavy metals were determined using a spectrometer instrument.

RESULTS

A total of 58 microorganisms were isolated. All samples were found to be contaminated with at least one organism except three samples. The majority of the isolated bacterial species were gram negative bacteria, such as Klebsiella spp., Pseudomonas spp. and E. coli., which could be of fecal origin and may lead to pneumonia, skin, or internal infections. Furthermore, most of the gram-positive bacteria were found to be multi-drug resistant. Moreover, for heavy metals, all samples had levels exceeding the regulatory limits.

CONCLUSION

This study demonstrated the presence of bacteria and heavy metals in samples of herbal medicines. Using these contaminated products may spread resistant infections, metal toxicities, or even cancers in the community.

Public knowledge, attitudes, and practices towards herbal medicines; a cross-sectional study in Western Saudi Arabia

BACKGROUND

Herbal medicines, derived from medicinal plants, are among the most popular alternative remedies around the globe. In Saudi Arabia, herbal medicines are extensively used by public as part of the culture as well as religious norms. Therefore, this study aimed to evaluate knowledge, attitudes, and practices regarding herbal medicines among the general population in Saudi Arabia.

METHODS

A descriptive cross-sectional survey study was conducted on the general population of Jeddah city with the help of a validated and self-administered questionnaire. Sample size was calculated to be 450 with subjects between 20 and 60 years of either gender. Descriptive and inferential statistical analysis was performed using SPSS.

RESULTS

Results of our data showed that 173 (42.2%) of the total participants used herbal medicines, however, significant association was found between female gender and the usage of herbal medicines (p < 0.001). Approximately, more than half (56.0%) of the respondents agreed that herbal medicines could be used to promote health and treat illnesses, and 45% respondents agreed that herbal medicines are safe. 153 (37.4%) of the participants opined that herbal medicines could be taken with conventional or allopathic medicine. The data also showed a significant (p < 0.05) association between knowledge about the source of herbal medicine and gender where females were found to have more knowledge compared to males. Moreover, a significantly higher number of chronic disease patients were using herbal medicines compared to individuals with no medical problems (p < 0.001). Strikingly, majority (n = 204; 49.9%) of the respondents used herbal medicines as a first choice when sick, while a good number (n = 172; 42.1%) of respondents did not consult doctors before taking herbal medicines.

CONCLUSION

The use of herbal medicines is common among the general population of Jeddah. Although most of the participants believed that the herbal medicines are safe and do not require consultation, there is a dire need to increase awareness as well as to establish effective strategies to evaluate the safety, efficacy and quality of the herbal medicines for propitious consequences of this commonly used entity in the local society.

The prevalence of complementary and alternative medicines (CAM) usage among allergic rhinitis patients in Malaysia

PURPOSE

We conducted this study to estimate the prevalence of complementary and alternative medicines (CAM) usage among allergic rhinitis (AR) patients in Malaysia and understand the practice of CAM usage among them. We also included a literature review on the commonly used CAM for AR.

METHODS

A cross-sectional study which included a questionnaire-based study and information of allergic rhinitis from patient's clinic records. Patients with AR who attended the ORL-HNS department in Hospital Universiti Sains Malaysia and Hospital Sultanah Aminah, Malaysia were enrolled after consented, on a first-come first-serve basis as convenience sampling from July 2020 until February 2021. A pre-tested self-administered, 16-item questionnaire in Malay language was distributed to the participants. The questionnaire consists of a set of 16 questions with subsets to enquire about the sociodemographic data and pattern of usage of CAM and its effectiveness.

RESULTS

372 patients were enrolled in this study consisting of 217 (58.3%) female and 155 (41.7%) male patients. 231 (62.1%) participants had used CAM for AR in the past 10 years. A higher proportion of females (p = 0.015) and those with higher income (p = 0.004) had used CAM. Among the users, 87.9% found CAM to be effective. No differences were found in terms of age (p = 0.888) and education level (p = 0.057) for CAM usage.

CONCLUSION

CAM is widely used in Malaysia to alleviate AR symptoms, with a large proportion of users think it is effective. Therefore, more researches should be conducted to provide evidence and guidance to integrate CAM into AR management.

Complementary and alternative medicine use in children with asthma

OBJECTIVE

Complementary and Alternative Medicine (CAM) is increasingly used in the treatment of asthma in children. In the studies conducted, it was stated that there was a standardization problem in CAM methods. Moreover, this situation raises the question of "Which is the most widely used CAM method?" in asthma treatment. This study aimed to determine the use of CAM methods in children who are followed up with the diagnosis of asthma.

MATERIAL AND METHODS

The patients aged 4-10 years who were diagnosed with asthma by a physician in the past and who admitted to the Child Health and Diseases Polyclinic of a hospital issuing tertiary health service in Turkey were included in the study. The demographic data of patients and CAM methods used were examined.

RESULTS

The median age of a total of 164 asthmatic children included in the study was 6.3 (4-10) years, and 58.3% of them were observed to be male. The median time to diagnosis of the patients was 2.0 (1; 105) months, mostly having multiple cough attacks per day (33.1%), and the rate of children with cough attacks at least once a month to awaken from sleep at night was 47.6%. Honey (36.6%) was found to be one of the most preferred biological-based therapies for families and was followed by molasses (16.9%), which were derived from herbal and natural products.

CONCLUSIONS

There are varying rates of CAM use in asthmatic children all over the world, and it was found that honey was used the most in our study. Atopy can be found in the etiology of asthmatic patients. Therefore, it should not be forgotten that using different CAM methods at the same time may pose a risk.

Chemical characterization and antibacterial efficacy of Saudi sesame oil against human pathogenic bacteria

Bacterial infection and its resistance is a major health issue that affects millions of people throughout the world. There is always a need to search forth new and safest drug from natural resources to fight these challenges. Sesame seed essential oil is a rich source of protein with high medicinal value since the ancient time peoples are using for several remedies in Saudi Arabia.Therefore, the current study is aimed to discover the potential activity of the locally available sesame oil for antibacterial action based on ethnobotanical knowledge and traditional utilization as a therapeutic agent to treat several kinds of health problem in Saudi culture. Gas chromatography / mass spectrometry (GC/MS) analysis of sesame essential oil extracted from locally available sesame seeds represented 39 different chemical compounds. Sesamin and sesamol were the principal components alongwith fatty acids and triglycerides. Results indicated that the locally available sesame oil was found rich in sesamin contents (24.45%). The spectrum of antibacterial effect of sesame seed essential oil was exhibited significantly against Escherichia coli followed by Staphylococcus aureus, Streptococcus pyogenes, Klebsiella pneumoniae and Pseudomonas aeruginosa respectively. The results indicate that sesame oil was found most effective against three bacteria i.e. E. coli, S. aureus and S. pyogenes.

An overview of drug discovery efforts for eczema: why is this itch so difficult to scratch?

Introduction: Atopic dermatitis (AD) is a type of allergic/inflammatory dermatitis characterized by itch and an impairment in quality of life.Areas covered: Herein, the authors review drug discovery efforts for AD, highlighting the clinical efficacy of novel drugs, with a particular focus on the relief of pruritus. Topical agents include emollients, topical antihistamines, corticosteroids, calcineurin inhibitors and herbs. Recently, topical phosphodiesterase E4 (PDE4) inhibitors like crisaborole have become available and are efficacious for mild to moderate AD with few side effects. For more severe AD, monoclonal antibodies like dupilumab are considered as efficacious subcutaneous treatment options. In severe and recalcitrant AD, systemic treatment can ameliorate AD symptoms.Expert opinion: Many topical and systemic medications have demonstrated therapeutic benefits for AD. Indeed, randomized trials have shown that topical PDE4 inhibitors and subcutaneous dupilumab are safe and efficacious. Objective tools to evaluate itch and gauge treatment efficacy is important, but current methodology relies primarily on clinical scores. AD is a systemic atopic disease with a lot of complicated psychosocial issues. Suboptimal efficacy is often due to poor compliance and unrealistic expectation of curative treatment, rendering treatment difficult despite the existence of effective medications.