HERBAL MEDICINE USE DURING PREGNANCY IN A FEDERAL TEACHING HOSPITAL IN NORTHERN NIGERIA- A CROSS-SECTIONAL STUDY

Introduction

The use of herbal medicine is common in the general population. However, it has not been well-studied among pregnant women in Nigeria, especially in the northeast. Knowledge of herbal medicine use in this population is important in improving maternal and child care.

Objectives

1. To determine the prevalence of herbal medicine use during pregnancy among the study population. 2. To determine the association between herbal medicine use and pregnancy-related outcomes.

Methodology

The study was conducted among 339 women attending the postnatal clinic of Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, from July to September 2022. Interviewer-administered questionnaires were administered to participants selected through consecutive sampling. Information about the antenatal care details of the participants was retrieved from their folders. Data analysis was conducted using Epi Info version 7.2.5.0 software produced by the Centers for Disease Control, USA. Ethical approval for the study was obtained from the Ethics Review Committee of the Hospital.

Results

The lifetime prevalence of herbal medicine use was 38.1% among the study participants. In their last pregnancies, over a quarter (27.1%) of the participants had used herbs. This group was significantly less likely to use routine hematinic (folic acid and iron tablets) than participants who did not use herbs while pregnant (X2=22.9, p<0.00000). Family income and religion were associated with herbal medicine use in pregnancy on logistic regression (p=0.02 and 0.008 respectively).

Conclusions

Herbal medicine use is common during pregnancy in the study population and is strongly associated with a low uptake of iron and folic acid.

Comprehensive Review on Phytoconstituents-based Nanomedicine for the Treatment of Atopic Dermatitis

Atopic dermatitis (AD) is known as a chronic disease characterized by eczematous and pruritus skin lesions. The pathology behind atopic dermatitis etiology is loss of epidermal barrier, which prevents the production of protein filaggrin that can induce T-cell infiltration and inflammation. Treatment of AD is majorly based on limiting skin repair as well as reducing inflammation and itching. There are several remedies available for the treatment of AD, such as Janus kinase and calcineurin inhibitors, topical corticosteroids, and phosphodiesterase-4 inhibitors. The conventional formulations in the market have limited safety and efficacy. Hence, effective treatment of atopic dermatitis requires the development of novel, efficacious, reliable, and specific therapies. Recent research data have revealed that some naturally occurring medicinal plants have potential applications in the management of AD through different mechanisms. The nanotechnology-based therapeutics have gained a lot of attention in the last decade for the improvement in the activity of drugs having low absorption due to poor solubility, thus leading to lesser bioavailability. Therapies based on nanotechnology can be an effective way to overcome these obstacles. Due to their effective propensity to provide better drug diffusion and bioavailability as well as drug targeting potential at the desired site of action, these approaches may have decreased adverse drug effects, better penetration, and enhanced therapeutic efficacy. Hence, this review highlights the potential of phytoconstituents-based novel formulations for the treatment of atopic dermatitis. Furthermore, recent patents on therapeutic approaches to atopic dermatitis have also been briefly described.

Herbal Medicine- A Friend or a Foe of Cardiovascular Disease

BACKGROUND

Herbal remedies are used by 80% of the Asian population in primary health care as per WHO. According to current research, the herbal medicine market was valued at nearly USD 166 billion in 2021 and is expected to reach approximately USD 348 billion by 2028. Increased incidence of chronic conditions such as diabetes, asthma, coronary artery disease, osteoarthritis, has fueled the growing interest in traditional herbal and plant-derived treatments among researchers. In addition, rural communities in developing nations have renewed interest in herbal treatments due to lower cost and easy availability.

OBJECTIVE

Aim of the paper is to highlight the role of five of more commonly used herbal medicines that are Ginkgo biloba, Garlic, Flaxseed, Ginseng, Salvia miltiorrhiza in cardiovascular disorders.

METHODS

A PubMed search was done using the keywords Herbal Medicine, Ginkgo biloba, Garlic, Flaxseed, Ginseng, Salvia miltiorrhiza. Articles which were available for free access were utilized. No formula inclusion or exclusion criteria was followed. A total of 42 papers were included for the study.

CONCLUSION

Although there have been encouraging outcomes with the use of these herbal medications, many of these products are poorly monitored and are yet to be studied in detail regarding their adverse effects. Moreover, these medicinal products are known to interact with various drugs. To compete with the expanding pharmaceutical industry, more medicinally helpful herbal items must be used and scientifically validated.

Network pharmacology approaches for research of Traditional Chinese Medicines

Pharmacodynamics material basis and effective mechanisms are the two main issues to decipher the mechnisms of action of Traditional Chinese medicines (TCMs) for the treatment of diseases. TCMs, in "multi-component, multi-target, multi-pathway" paradigm, show satisfactory clinical results in complex diseases. New ideas and methods are urgently needed to explain the complex interactions between TCMs and diseases. Network pharmacology (NP) provides a novel paradigm to uncover and visualize the underlying interaction networks of TCMs against multifactorial diseases. The development and application of NP has promoted the safety, efficacy, and mechanism investigations of TCMs, which then reinforces the credibility and popularity of TCMs. The current organ-centricity of medicine and the "one disease-one target-one drug" dogma obstruct the understanding of complex diseases and the development of effective drugs. Therefore, more attentions should be paid to shift from "phenotype and symptom" to "endotype and cause" in understanding and redefining current diseases. In the past two decades, with the advent of advanced and intelligent technologies (such as metabolomics, proteomics, transcriptomics, single-cell omics, and artificial intelligence), NP has been improved and deeply implemented, and presented its great value and potential as the next drug-discovery paradigm. NP is developed to cure causal mechanisms instead of treating symptoms. This review briefly summarizes the recent research progress on NP application in TCMs for efficacy research, mechanism elucidation, target prediction, safety evaluation, drug repurposing, and drug design.

Does supplementing laying hen diets with a herb mixture mitigate the negative impacts of excessive inclusion of extruded flaxseed?

OBJECTIVE

This study investigated the effects of extruded flaxseed with and without herbs mixture on egg performance, yolk fatty acids (FAs), lipid components, blood biochemistry, serological enzymes, antioxidants, and immune system of Hy-Line W-36 hens for nine weeks.

METHODS

Two hundred forty laying hens were randomly distributed to eight treatments, resulting in six replicates with five hens. Graded levels of dietary extruded flaxseed (0, 90, 180, and 270 g/kg) with and without herbs mixture (24 g/kg: garlic, ginger, green tea, and turmeric 6 g/kg each) were designed as treatments.

RESULTS

The two-way analysis of variance indicated that hens fed herbs mixture had a higher value of egg production, yolk high-density lipoprotein (HDL), superoxide dismutase, glutathione peroxidase, and white blood cell and lower contents of yolk cholesterol, glucose, and blood low-density lipoprotein than those fed diets without herb mixtures (p<0.05). The Flx27 (270 g/kg flaxseed) (153.5 g/kg n-3 FAs) and Flx27+H (270 g/kg flaxseed plus 24 g/kg herbs mixture) (150.5 g/kg n-3 FAs) groups were the most promising treatments in terms of yolk n-3 FAs content. In-teraction effect (herbs- flaxseed) for blood cholesterol, HDL, malondialdehyde, glutaredoxin, alanine transaminase, (ALT), aspartate transaminase (AST), haemoglobin and immune parameters was significant (p<0.05). The results showed layers fed herbs mixture (Flx9+H, Flx18+H, and Flx27+H) had a better value of total antibody, immunoglobulin M, immunoglobulin G, ALT, AST, and blood HDL as compared with representative flaxseed levels without herbs.

CONCLUSION

High inclusion levels of extruded flaxseed (270 g/kg) without herbs to enrich eggs with n-3 appears to impair the antioxidant system, immunohematological parameters, and sero-logical enzymes. Interestingly, the herbs mixture supplementation corrected those effects. Therefore, feeding layers with flaxseed-rich diets (270 g/kg) and herbs mixture can be a promising strategy to enrich eggs with n-3 FAs.

The Effect of Dracocephalum Extract on Sleep Quality in Post-Menopausal Women: A Randomized Placebo-Controlled Trial

Objective: Sleep disturbance is one of the most prevalent problems in post-menopausal females. The current research intended to evaluate the effects of Dracocephalum on sleep disorder in post-menopausal females. Method : The current study is a randomized, double-blind controlled trial, in which 110 post-menopausal women were randomly allocated to Dracocephalum or placebo groups. The intervention group took Dracocephalum capsules containing 250 mg Dracocephalum extract twice daily for one month. While, the placebo group took the same capsule containing 250 mg of starch twice daily for one month. Pittsburgh Sleep Quality Index was completed by the participants of both groups before and after the treatment and the data obtained were analyzed with Chi-square, paired and independent t-test in SPSS (version 20). Results: The mean score of sleep quality before and after the treatment was 12.69 ± 3.98 and 8.58 ± 1.97 in the treatment group, respectively. Also, the score of sleep quality in the placebo group was 13.48 ± 2.60 and 11.21 ± 2.74 at the beginning and end of the research, respectively. The symptoms of sleep disorder in the intervention group significantly improved after the treatment (P < 0.001), while this was not the case with the placebo group (P = 0.155). Besides, there was a significant difference between the two groups in the mean score of sleep quality after the treatment (P = 0.012). Conclusion: Dracocephalum extracts are effective in reducing symptoms of sleep disorders in post-menopausal women.

Individualized Diagnosis and Prescription in Traditional Medicine: Decision-Making Process Analysis and Machine Learning-Based Analysis Tool Development

While pattern identification (PI) is an essential process in traditional medicine (TM), it is difficult to objectify since it relies heavily on implicit knowledge. Therefore, this study aimed to propose a machine learning (ML)-based analysis tool to evaluate the clinical decision-making process of PI in terms of explicit and implicit knowledge, and to observe the actual process by which this knowledge affects the choice of diagnosis and treatment in individual TM doctors. Clinical data for the development of the analysis tool were collected using a questionnaire administered to allergic rhinitis (AR) patients and the diagnosis and prescription results of TM doctors based on the completed AR questionnaires. Explicit knowledge and implicit knowledge were defined based on the doctors' explicit scoring and feature evaluations of ML models, respectively. There were many differences between the explicit and implicit importance scores in this study. Implicit importance is more closely related to explicit importance in prescription than in diagnosis. The analysis results for eight doctors showed that our tool could successfully identify explicit and implicit knowledge in the PI process. This is the first study to evaluate the actual process by which explicit and implicit knowledge affect the choice of individual TM doctors and to identify assessment tools for the definition of the decision-making process in diagnosing PI and prescribing herbal treatments by TM clinicians. The assessment tool suggested in this study could be broadly used for the standardization of precision medicine, including TM therapeutics.

Chinese Medicine in the Treatment of Ulcerative Colitis: The Mechanisms of Signaling Pathway Regulations

Ulcerative colitis (UC) is a common clinical inflammatory bowel disease characterized by repeated attacks, difficult treatment, and great harm to the physical and mental health of the patients. The occurrence and development of UC were closely related to the physiological and pathological processes, such as intestinal inflammatory reaction, oxidizing reaction, and immune response. Treatment of ulcerative colitis using Western medicine is often associated with a number of limitations and adverse events. There is a long history of using traditional Chinese medicine in dealing with this medical condition. Commonly used traditional Chinese medicines for the treatment of UC include Caulis Sargentodoxae, Flos Lonicerae, Fructus Cnidii, etc. Additionally, classic prescriptions such as Gegen Qinlian Formulae and Zuojin Pills can also be used to treat UC. To enrich the traditional Chinese medicine theory, the cognitive theory and perspective of network pharmacology and bioinformatics research of cell signal transduction mechanism of UC are emerging rapidly. Modern pharmacological studies focus on underlying mechanisms for the management of UC with Chinese medicine monomers, single Chinese medicines, and traditional Chinese medicine formulations, alleviating the symptoms of UC, controlling the development of intestinal inflammation, and restoring intestinal function through the regulation of key molecular signaling pathways, including PI3K/Akt, NF-[Formula: see text]B, JAK/STAT, MAPK and Notch. By summarizing current research progressions, this review provides key references for the in-depth exploration of the mechanisms focused on signaling pathways for the clinical management of UC using traditional Chinese medicine.

Effect of Palm Pollen and Pomegranate Peel Supplementation on Sperm Development in Male Rabbits

The use of plants, plant extracts, and folk remedies for the treatment of human diseases has been known as traditional medicine. It is approved that the use of herbal medicine dates far back to 60,000 years ago in Iraq. This study aimed to investigate the possible effects of pomegranate and palm pollen, as two powerful herbal remedies with antioxidant, anti-inflammatory, and anti-bacterial effects, on fertility in the male rabbits. A total of 15 healthy New Zealand White male adult rabbits were randomly assigned to three groups (n=5 in each group). Group A: 5 rabbits did not receive herbal treatment (control group). Group B: 5 rabbits were treated with palm pollen at a dose of 2 g by oral gavage daily. Group C: 5 rabbits were treated with pomegranate peel (2 g) treated by oral gavage daily. All animals were euthanized 90 days after the beginning of the experiment. Following the euthanasia, the testis was removed. For sperm recovery, the epididymis was dissected from the testicles and the tail of the epididymis was minced in the sperm washing medium and incubated for 15 min in an atmosphere of humidified 5% CO2, 95% The samples were evaluated by using computerized semen analyzer apparatus (CASA). After 90 days, the treated groups with palm pollen and pomegranate peel (groups B and C) demonstrated a significant increase in the sperm concentration, compared to group (A). Moreover, the recorded data revealed that the sperm concentration in group C was significantly higher than that in group B. The study indicated that the total sperm motility was increased significantly in groups B and C, as compared to that in the control group, while the total sperm motility in group C increased significantly, compared to group B. The histological evolutions signified that in the control group, the epithelial of seminiferous tubules were at different stages of spermatogenesis, the spermatocytogenesis (primary and secondary) with the spermogenesis (spermatids) were found in a cluster at the cavity of the tubule. Furthermore, the results of histological evaluations in groups B and C were distinguished by a significant augmentation of the seminiferous tubules with primary and secondary spermatocytes, as well as some degrees of spermogenesis (round spermatids), compared to group A. Moreover, increased angiogenesis was observed in groups B and C. In conclusion, the results pointed out that herbal remedies have a significant effects in the treatment of reproductive disorders.

Dietary Supplements for Pain Relief in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Pain is the most frequently encountered symptom by patients with fibromyalgia (FM). Dietary supplements (DSs) in particular have a proven impact as a possible adjunctive therapy for symptom management in FM. However, there is currently no conclusive review outlining the evidence for DSs in pain management in FM. This study aims to assess currently available studies evaluating the use of DSs for pain relief in FM. Randomized controlled trials regarding the use of DSs on adult FM patients were included for evidence synthesis. Study results indicated that DSs significantly relieved pain in FM (SMD 1.23; 95% CI 0.02-2.43, P = 0.046) but did not improve quality of life (QoL) (SMD 0.73; 95% CI -0.07-1.53, P = 0.075) in the data. Adverse events of DSs varied from mild to severe, with the most common being gastrointestinal symptoms and androgenic side effects in 5.7% and 3.9% of patients, respectively. More well-designed RCTs are required in the future. The protocol for this review has been published on PROSPERO (CRD42020149941).

The Effects of Nutraceuticals and Bioactive Natural Compounds on Chronic Periodontitis: A Clinical Review

The paper aims to review the current clinical evidence of various herbal agents as an adjunct treatment in the management of chronic periodontitis patients. Gingivitis and periodontitis are two common infectious inflammatory diseases of the supporting tissues of the teeth and have a multifactorial etiology. An important concern about chronic periodontitis is its association with certain systemic disease. New treatment strategies for controlling the adverse effects of chronic periodontitis have been extensively assessed and practiced in sub-clinical and clinical studies. It has been shown that the phytochemical agents have various therapeutic properties such as anti-inflammatory and antibacterial effects which can be beneficial for the treatment of periodontitis. The findings of this review support the adjunctive use of herbal agents in the management of chronic periodontitis. Heterogeneity and limited data may reduce the impact of these conclusions. Future long-term randomized controlled trials evaluating the clinical efficacy of adjunctive herbal therapy to scaling and root planing are needed.

Berberine on the Prevention and Management of Cardiometabolic Disease: Clinical Applications and Mechanisms of Action

Berberine is an alkaloid from several medicinal plants originally used to treat diarrhea and dysentery as a traditional Chinese herbal medicine. In recent years, berberine has been discovered to exhibit a wide spectrum of biological activities in the treatment of diverse diseases ranging from cancer and neurological dysfunctions to metabolic disorders and heart diseases. This review article summarizes the clinical practice and laboratory exploration of berberine for the treatment of cardiometabolic and heart diseases, with a focus on the novel insights and recent advances of the underlying mechanisms recognized in the past decade. Berberine was found to display pleiotropic therapeutic effects against dyslipidemia, hyperglycemia, hypertension, arrhythmia, and heart failure. The mechanisms of berberine for the treatment of cardiometabolic disease involve combating inflammation and oxidative stress such as inhibiting proprotein convertase subtilisin/kexin 9 (PCSK9) activation, regulating electrical signals and ionic channels such as targeting human ether-a-go-go related gene (hERG) currents, promoting energy metabolism such as activating adenosine monophosphate-activated protein kinase (AMPK) signaling pathway, modifying gut microbiota to promote transforming of berberine into its intestine-absorbable form, and interacting with non-coding RNAs via targeting multiple signaling pathways such as AMPK, mechanistic target of rapamycin (mTOR), etc. Collectively, berberine appears to be safe and well-tolerated in clinical practice, especially for those who are intolerant to statins. Knowledge from this field may pave the way for future development of more effective pharmaceutical approaches for managing cardiometabolic risk factors and preventing heart diseases.

Exploring the Use of Herbal Treatments During Pregnancy Among Saudi Women: An application of the knowledge-attitude-practice model

Objectives

Herbal treatments are commonly used by Saudi women during pregnancy. However, the inappropriate use of some herbs can have side-effects for both the mother and the fetus. Thus, a comprehensive understanding of their use during pregnancy is crucial. This study aimed to explore the use of herbal treatments by Saudi women during pregnancy using the knowledge-attitude-practice model.

Methods

This cross-sectional study was conducted from September 2019 and April 2020 in Riyadh, Saudi Arabia, on a convenience sample using an online Arabic-language questionnaire. Saudi women aged between 18-58 years who were pregnant or had been pregnant and were living in the Riyadh were included.

Results

A total of 400 individuals participated in this study. All participants lacked knowledge about the side-effects of herbal treatment but 63% knew about unsafe herbs in general. Most participants (66%) had a neutral attitude towards herbal treatments. Almost half of the participants (48%) did not use herbs during pregnancy and a similar number (47%) sometimes used herbal treatments during pregnancy. There was a significant positive correlation between attitude and practice and a negative correlation between knowledge and attitude as well as between knowledge and practice (P <0.0001 each).

Conclusion

While the participants' knowledge were generally poor, their attitudes and practices regarding the use of herbal treatments during pregnancy were good. It is recommended that more efforts be made by healthcare providers to target attitudes towards herbal treatments by providing accurate knowledge and reinforcing healthy practices among Saudi women.

Chinese herbal medicine might be associated with a lower rate of joint replacement in patients with osteoarthritis: A 12-year population-based matched cohort analysis

ETHNOPHARMACOLOGICAL RELEVANCE

To determine whether adjuvant Chinese herbal medicine (CHM) treatment is associated with the risk of joint replacement in osteoarthritis (OA) patients.

MATERIALS AND METHODS

This retrospective study used a population-based national health insurance (NHI) database from 2000 to 2012 in Taiwan. A total of 125,023 newly diagnosed OA patients were selected from one million beneficiaries of longitudinal health insurance database. Based on applying ten selected frequently used CHM formulas for OA, patients were divided into CHM user and non-CHM user. One-CHM to four-non-CHM user were propensity score matched with age, gender, monthly income, urbanization, comorbidities, Nonsteroidal anti-inflammatory drugs (NSAIDs) and index year were adjusted to reduce selection bias and confounding. Cox regression model was used for comparing the hazard ratios (HR) for the risk of joint replacement and Kaplan-Meier curve for the proportion of joint replacement.

RESULTS

OA patients who were female, younger (20-60 years), higher income and lived in urbanization location were found to preferred using CHM. Younger CHM users had a lower adjusted HR (0.63) of the risk of joint replacement (95% confidence interval (CI) = 0.42-0.94). Compared to non-CHM user, HR among CHM users (≥225 days annually) is 0.48 (95% CI = 0.31-0.76). The proportion of joint replacement in younger non-CHM user began to rise notably with time (log-rank test, p = 0.026). However, this benefit by CHM did not apply to older (over 60 years) OA patients.

CONCLUSION

This study suggested that adjuvant CHM might be associated with a lower rate of joint replacement in OA patients. CHM therapy might be considered in OA patients to reduce the need of joint replacement.

A systematic review on nephron protective AYUSH drugs as constituents of NEERI-KFT (A traditional Indian polyherbal formulation) for the management of chronic kidney disease

Chronic Kidney Disease (CKD) is a major health problem characterized by kidney dysfunction with progressive segmental glomerulosclerosis to end-stage renal disease (ESRD). Due to lack of scientific data and comprehensive reports, the current systematic review provides an inclusive understanding and prospective associated with phytopharmacology of NEERI-KFT in CKD. The data was collected from more than five databases such as Science Direct, Google Scholar, Elsevier, PubMed, Springer, ACS publication etc using keywords like CKD/Kidney disease, epidemiology/prevalence, modern therapies for CKD management, NEERI-KFT and its role in kidney disease. The study was performed based on scientific reports screened by experts according to inclusion and exclusion criteria. The pre-clinical and clinical findings suggested that NEERI-KFT has promising effects as nephroprotective and considered safe and well effective in primary care of kidney against disease. Phytopharmacological evaluation of NEERI-KFT suggest that it exhibit substantial potential against oxidative and inflammatory stress induced apoptosis by exerting antioxidants, nephroprotective and immunomodulatory effects. Hence, it can be enlighten that NEERI-KFT have potential herbs which exerts significant antioxidants, nephroprotective and immunomodulatory effects in the patients associated with renal dysfunction or CKD thus improving altered renal architecture and renal physiology. Clinically, it is concluded that NEERI-KFT works kidney malfunction and cease ESRD progression or even reduce the number of dialysis.

Utilization of Acupuncture and Herbal Ointment Instead of Skin Graft Surgery for the Treatment of Burn Injuries: A Case Series and Literature review

Skin graft surgery is a standard treatment that increases the survival rate of patients with burn injuries; however, it leaves many sequelae. Conventional external preparations for the treatment of burns also have various side effects. In this retrospective case study, we assessed the cases of four patients with topical third-degree burns who did not wish to undergo the skin graft surgeries recommended by medical doctors and were thus treated using traditional medicine alone. A Korean medicine doctor administered integrative traditional medicine treatment to the patients using acupuncture and herbal ointments. Analysis of the patients' treatment photographs, quantitative evaluation indices, and vivid narratives suggested that their skin recovered well without adverse effects. Traditional Korean medicine treatment, including acupuncture and herbal ointment treatment, can be a new alternative therapeutic strategy for the treatment of patients with topical burns who do not want to undergo skin graft surgery or who have higher risks for poor surgical outcomes.

Effects of topical application of a tri-herb formula on inflammatory dry-skin condition in mice with oxazolone-induced atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is a chronic relapsing inflammatory and pruritic skin disease, affecting 10-20% of the population worldwide. Paeonia suffruticosa Andrews (Paeoniaceae) (Cortex Moutan) and Mentha haplocalyx Briq. (Labiatae) (Herba Menthae) have shown beneficial effects on AD. Calendula officinalis L. (Asteraceae) is commonly used for treating skin rashes and wounds.

PURPOSE

In the present study, a three-herbs formula including Cortex Moutan and Herba Menthae, together with C. officinalis at 1:1:1 weight ratio was used as a topical agent and its therapeutic effects on AD was investigated.

METHODS

In vitro effects of individual herbs and three-herbs formula (0.125-1 mg/ml) were examined using cytokine release assay on human mast HMC-1 cells, inflammation test on murine macrophage RAW cells and human keratinocyte (HaCaT) cells, and migration scratch assay on human umbilical vein endothelial cells (HUVEC). The contributing functional pathway of three-herbs formula in AD was explored using Western Blot assay in HMC-1 cells. Oxazolone-induced AD-like mice model was also used to investigate the in vivo therapeutic effect of the topical application of the three-herbs formula.

RESULTS

Herba Menthae, Cortex Moutan, and three-herbs formula significantly reduced the production of IL-6 and tumor necrosis factor (TNF)-α in HMC-1 cells, inhibited the expression of IL-6, IL-8 and CCL2 in TNF-α/IFN-γ stimulated HaCaT cells, and suppressed the lipopolysaccharide (LPS)-induced nitric oxide (NO) production in RAW 264.7 cells. Moreover, Herba Menthae and three-herbs formula significantly suppressed CCL2 and TNF-α production in LPS-induced RAW 264.7 cells. C. officinalis and three-herbs formula promoted wound healing in HUVEC. For intracellular mechanisms, three-herbs formula inhibited the expressions of molecules in STAT1 and STAT3-dependent pathways. In vivo model showed that topical application of three-herbs formula on challenged ear reduced ear swelling and mice scratching frequencies. H&E and toluidine blue staining of the challenged ear tissue demonstrated that three-herbs formula reduced the epidermal thickness and mast cell infiltration, respectively.

CONCLUSION

The three-herbs formula of Cortex Moutan, Herba Menthae and C. officinalis at 1:1:1 (w/w) exhibited anti-inflammatory effect and promotion of cell migration in vitro. It also alleviated ear redness, swelling, epidermal thickness and inflammation of the OXA-induced AD mice. These findings suggest a potential beneficial role of the topical application of the three-herbs formula for treatment of AD.

High anticancer efficacy of solid lipid nanoparticles containing Zataria multiflora essential oil against breast cancer and melanoma cell lines

Background

The cancer burden is rising rapidly worldwide, and it annually causes about 8.8 million deaths worldwide. Due to chemical drugs’ side effects and the emergence of resistance, the development of new green drugs has received much attention. We aimed to investigate whether solid-lipid nanoparticles containing essential oil of Zataria multiflora (ZMSLN) enhanced the anticancer efficacy of the essential oil against breast cancer (MDA-MB-468) and melanoma (A-375) cells.

Results

ZMSLN was prepared by the high-pressure homogenizer method; particle size 176 ± 8 nm, polydispersity index 0.22 ± 0.1, entrapment efficiency 67 ± 5%. The essential oil showed a dose-dependent antiproliferative effect on MDA-MB-468 and A-375 cells at all examined concentrations (75, 150, 300, 600, and 1200 μg/mL). Interestingly, after treating both cells with 75 μg/mL of ZMSLN, their viabilities were reduced to under 13%.

Conclusion

The finding showed that ZMSLN had a distinct antiproliferative efficacy; it could thus be considered a green anticancer candidate for further in vivo and in vivo studies.

Sweating as a Preventive Care and Treatment Strategy in Traditional Persian Medicine

Proper and regular sweating plays a significant thermoregulatory role. It is a common perception that, sweating has other important homeostatic functions such as clearance of excessive micronutrients, waste products of metabolic processes, and toxins from the body, which helps to maintain human good health. In addition, sweating, thermotherapy, and sauna are commonly used to treat various diseases such as cardiovascular, respiratory and joint diseases. In traditional Persian medicine (PM) textbooks, sweating is considered a preventive care and treatment strategy as well. In this study, we aim to explain the beneficial effects of sweating in human health and its role in the management of various diseases, as well as introducing the therapeutic applications of some diaphoretic plants from the viewpoint of PM. We reviewed the most famous PM textbooks such as Kamil al-Sinaa al-Tibbiya, Al-Qānūn fī al-Tibb, Zakhireye Kharazmshahi, Kholasat al-Hikmat, Exir-e-Azam, and Hifzos-sihhat-e Naseri. Also, current evidence was searched in PubMed, Web of Science, Scopus, and other relevant databases related to the topic. The results of this study revealed that PM scientists believed proper sweating removes waste products and maintains the body’s health, thus, any disturbances in the excretion of these waste products can cause diseases. They recommended the induction of sweating through hot and dry baths, sun bath, sand bath and also the use of diaphoretic herbs for the management of various diseases. Therefore, further researches are recommended to evaluate the effectiveness of these diaphoretic plants.

Advances in Nanoparticle Delivery System for Erectile Dysfunction: An Updated Review

INTRODUCTION

The use of current available treatment for male erectile dysfunction (ED) has some limitations that are related to efficacy and adverse effects. Nanotechnology has been used as a new tool in medicine to improve these limitations and new medications potentially to alleviate and cure ED.

AIM

To review the currently literature on new nano medications for ED based on scientific and clinical studies, efficacy, safety, mechanisms of action, and to identify gaps for future research.

METHODS

A comprehensive literature review was conducted via Google Scholar, Science Direct, and PubMed on English publications using different keywords such as "erectile dysfunction", "emerging treatments", "nanotechnology", and "herbal medicine". The retrieved papers were organized into groups according to the sections covered in this review paper.

MAIN OUTCOMES MEASURES

We reviewed novel ED treatments such as nanotechnological phosphodiesterase inhibitors, papaverine hydrochloride, sialorphin, adipose tissue-derived stem cells, sonic hedgehog, and herbal medicine.

RESULTS

Numerous preclinical studies have addressed novel phosphodiesterase 5 inhibitors nanoparticle, and their recent delivery systems. Nitric oxide, sialorphin, sonic hedgehog, and herbal medicine loaded nanoparticles and nano adipose tissue-derived stem cells as a potential new treatment for ED. In addition, papaverine-containing nanoparticles have been reported. A limited number of randomized clinical studies have determined the mechanism of these treatments.

CONCLUSION

A literature review on the application of nanotechnology in ED therapy was successfully conducted. New nano medications are promising to treat ED. However, further studies are warranted to further assess their efficacy and safety. Masuku NP, Unuofin JO, Lebelo SL. Advances in Nanoparticle Delivery System for Erectile Dysfunction: An Updated Review. Sex Med 2021;XX:XXXXXX.

The next step of neurogenesis in the context of Alzheimer's disease

Among different pathological mechanisms, neuronal loss and neurogenesis impairment in the hippocampus play important roles in cognitive decline in Alzheimer's disease (AD). AD is a progressive and complex neurodegenerative diseases, which is very debilitating. The purpose of this paper is to review recent research into neurogenesis and AD and discuss how pharmacological drugs and herbal active components have impacts on neurogenesis and consequently improve cognitive functions. To date, despite huge research, no effective treatment has been approved for AD. Therefore, an avenue for future research and drug discovery is stimulating adult hippocampal neurogenesis (AHN). Evidence suggests that neurogenesis is regulated by the pharmacological treatment that may be recommended as a part of prophylaxis and therapeutic options for AD. However, the underlying mechanisms of regulating neurogenesis in AD are not well understood. To this point, we highlight to achieve an efficient treatment in AD by manipulating neurogenesis, it's necessary to target all steps of neurogenesis.

Herbal Medicine and Acupuncture Combined Treatment Attenuates Colitis in Rats

This study aimed to verify the efficacy of a combined treatment of Jakyakgamcho-tang (JGT) and acupuncture (CV12, ST25, CV4) on colitis induced by dextrane sulfate sodium (DSS). Changes in immuno-mediated factors and metabolites were investigated. Colitis symptoms such as body weight loss and elevated disease activity index were alleviated by the combined treatment. Moreover, treatment with JGT and acupuncture restored the disturbed architecture of colon by suppressing inflammatory cytokine levels of IFN-[Formula: see text] ([Formula: see text] < 0.05), IL-5 ([Formula: see text] < 0.05), and IL-13 ([Formula: see text] < 0.0001) compared with the DSS group. Analysis of metabolic profiles of serum revealed that treatment groups were clearly separated from the DSS group, suggesting that JGT and acupuncture treatment altered serum metabolites. Furthermore, treatments caused opposite metabolite patterns for dimethylbenzimidazole, 1,5-anhydro-D-glucitol, proline, phosphate, glycolic acid, aspartic acid, tryptophan, phthalic acid, ornithine, and glutamic acid compared with the DSS group. The combined treatment group induced more effective metabolite patterns than the JGT group, implying that acupuncture treatment can restore metabolic changes caused by DSS induction. These results indicate that the simultaneous treatment of JGT administration and acupuncture procedure provides better management of the immune function and inflammatory expression of colitis than a single treatment. It is assumed that intestinal microbial control can be achieved by acupuncture stimulation as well as by taking herbal medicine.

Botanical Medicine and Natural Products Used for Erectile Dysfunction

INTRODUCTION

Erectile dysfunction is the persistent or recurrent inability to achieve or maintain an erection sufficient for intercourse. Despite various treatment options, not all patients respond adequately and their usefulness is limited by adverse effects and cost. Botanical medicine and natural products have been and continue to be invaluable and untapped sources of new drugs, including potentially those to treat erectile dysfunction.

OBJECTIVES

To review the current literature on botanical medicine traditionally used as aphrodisiacs and treatment of erectile dysfunction, in particular, scientific and clinical investigations that have been performed, possible active phytoconstituents, and mechanisms of action and to identify gaps in current knowledge to better guide future research efforts.

METHODS

A comprehensive literature search was conducted via PubMed, Scopus, Science Direct, and Web of Science on English publications, using various keywords, for example, "herb", "natural product", combined with "erectile dysfunction", "aphrodisiac", and "sexual performance".

RESULTS

369 relevant articles studying medicinal plants used for erectile dysfunction were analyzed. A total of 718 plants from 145 families and 499 genera were reported to be used traditionally as aphrodisiacs and treatment of erectile dysfunction. Top plants used include Pausinystalia johimbe, Lepidium meyenii, and Panax ginseng. Different plant parts are used, with roots being the most common. Less than half of these plants have been evaluated scientifically, using various research methodologies. Clinical trials conducted were collated. Current scientific investigation shows mixed results about their usefulness in enhancing sexual performance. A limited number of studies have attempted to elucidate the mechanisms of action of these medicinal plants.

CONCLUSION

A comprehensive literature review on botanical medicine and natural products used for treatment of erectile dysfunction was successfully conducted. Although medicinal plants serve as a potential source of lead compounds for erectile dysfunction drugs, further studies are warranted to further evaluate their efficacy and safety. SinVJ-E, Anand GS, Koh H-L. Botanical Medicine and Natural Products Used for Erectile Dysfunction. Sex Med Rev 2020;XX:XXX-XXX.

Herbal Medicine Treatment for Influenza: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

The aim of this research is to evaluate the clinical evidence of an herbal medicine (HM) treatment on influenza and describe the potential benefits and adverse events by reviewing all relevant randomized controlled trials. All papers published from 2010 to 2019 in all languages in six databases were searched, including all randomized controlled trials on adults and children, testing herbal medicine for treatment of influenza, alone or in combination with conventional antiviral therapy. The main outcome parameters of interest were total effective rate, time to resolution of fever, adverse events, complications, and duration of viral shedding. 25 trials of 3044 patients were included. Herbal medicine compared to placebo significantly reduced time to fever resolution by 4.96[Formula: see text]h (mean difference, [Formula: see text]4.96; 95% CI, [Formula: see text]7.11 to [Formula: see text]2.80; [Formula: see text]), herbal medicine compared to oseltamivir showed no significant difference (mean difference, [Formula: see text]1.82; 95% CI, [Formula: see text]6.08 to 2.44; [Formula: see text]), and herbal medicine plus oseltamivir combined treatment significantly reduced duration of fever by 7.84[Formula: see text]h compared to a single treatment with oseltamivir (mean difference, [Formula: see text]7.84; 95% CI, [Formula: see text]12.51 to [Formula: see text]3.17; [Formula: see text]). Herbal medicine compared to placebo showed a significantly better total effective rate (risk ratio, 1.90; 95% CI, 1.18 to 3.07; [Formula: see text]), herbal medicine compared to oseltamivir indicated significantly better effective rate (risk ratio, 1.15; 95% CI, 1.03 to 1.29; [Formula: see text]), and combined treatment showed a significantly better total effective rate compared to a single treatment with oseltamivir (risk ratio, 1.20; 95% CI, 1.06 to 1.36; [Formula: see text]). Regarding safety, no serious adverse events were reported in HM treatment. HM presented fewer adverse events compared to oseltamivir, but the difference was not significant (risk difference, [Formula: see text]0.04; 95% CI, [Formula: see text]0.09 to 0.00; [Formula: see text]), and the combined treatment did not increase adverse events compared to oseltamivir (risk difference, [Formula: see text]0.02; 95% CI, [Formula: see text]0.06 to 0.02; [Formula: see text]). Research findings show that herbal medicine treatments have beneficial therapeutic effects on influenza and could decrease duration of fever and improve total effective rate. In addition, herbal medicine plus oseltamivir combined therapy could increase the therapeutic effect compared to a single treatment with oseltamivir.

Effect of Zhongyi paste on inflammatory pain in mice by regulation of the extracellular regulated protein kinases 1/2-cyclooxygenase-2-prostaglandin E2 pathway

Background

Zhongyi paste is a traditional Chinese medicine herbal paste that is externally applied to reduce inflammation and relieve pain.

Methods

An acute foot swelling inflammation model in C57BL/6J mice was established by carrageenan-induced pathogenesis. Zhongyi paste raised the pain threshold and also reduced the degree of swelling in mice with carrageenan-induced foot swelling.

Results

Analysis indicated that serum tumor necrosis factor-alpha, interleukin-1 beta, and prostaglandin E₂ (PGE₂) cytokine levels and PGE₂ levels in the paw tissue of the mice were decreased by Zhongyi paste treatment. The quantitative polymerase chain reaction and western blot results showed that Zhongyi paste downregulated the mRNA and protein expression of extracellular signal-regulated kinase 1/2 (ERK1/2), and cyclooxygenase-2 (COX-2), and also downregulated the mRNA expression of PGE₂. At the same time, the Zhongyi paste exerted a stronger effect as an external drug than that of indomethacin, which is an oral drug, and voltaren, which is an externally applied drug.

Conclusions

Our results indicated that Zhongyi paste is a very effective drug to reduce inflammatory swelling of the foot, and its mechanism of action is related to regulation of the ERK1/2–COX-2–PGE₂ pathway.

Effects of Herbal Medicines on Pain Management

Pain is an unpleasant sensory and emotional experience in many diseases and is often caused by intense or damaging stimuli. Pain negatively affects the quality of life and increases high health expenditures. Drugs with analgesic properties are commonly used to relieve pain, but these Western medications could be overwhelmed by side effects including tolerance and addiction. Herbal medicines may provide alternative measures for pain management. In this review paper, after introduction of Chinese medicine theory and treatment modality, emphasis is placed on the application of Chinese herbs and herbal formulations in pain management. Three of the most commonly used herbs, i.e., Corydalis yanhusuo, Ligusticum chuanxiong, and Aconitum carmichaeli, are reviewed. Subsequently, using this ancient medical remedy, Chinese herbal formulation in treating common medical conditions associated with pain, such as headache/migraine, chest pain, abdominal pain, low back pain, neuropathic pain, osteoarthritis, and cancer pain, is presented. Chinese herbal medicines could be considered as a complementary and integrative approach in the modern armamentarium in combating pain.

Prevalence and Factors Influencing Use of Herbal Medicines During Pregnancy in Hail, Saudi Arabia: A cross-sectional study

Objectives

The increasing prevalence of herbal medicine use is a global public health concern. Critically, many women continue to use herbal medicines during pregnancy despite potential maternofetal risks. The current study aimed to determine the prevalence of and factors associated with herbal medicine use during pregnancy in Saudi Arabia.

Methods

This cross-sectional study was conducted between February and May 2017. An Arabic-language 33-item survey assessing herbal medicine use was designed and distributed to 879 random women attending outpatient clinics at governmental and private hospitals in Hail, Saudi Arabia. Only women who were pregnant or had been pregnant in the previous 10 years were included.

Results

The mean age of the participants was 29.5 years, with 49% under 30 years old. Overall, 33% of the respondents claimed to have used herbal medicines during pregnancy. The most common reasons for doing so were to improve lactation (73%), improve the course of the pregnancy (56%) and facilitate labour (49%). Women who worked full-time and those with high school diplomas or above were significantly more likely to use herbal medicines during pregnancy (P <0.001 each).

Conclusion

To the best of the authors' knowledge, this is the first study to determine the prevalence and associated factors of herbal medicine use during pregnancy in Hail. The results showed a high prevalence of herbal medicine use among pregnant women in the region. Healthcare providers should therefore ensure that patients disclose the use of herbal medicines during pregnancy to avoid treatment complications or adverse herb-drug interactions.

Preventive Efficacy of Dried Lime (Citrus aurantifulia) in Common Cold Among Hajj Pilgrims: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Background

Dried lime (Citrus aurantifulia) is one of the herbal preparations used especially by Iranian pilgrims as a preventative agent and self-remedy for respiratory tracts symptoms in folklore medicine. Therefore, we evaluated the preventive efficacy of dried lime preparation in common cold among Iranian pilgrims.

Materials and Methods

In this randomized, double-blinded, clinical trial patients in the drug group received dried lime capsules, 500 mg in a single dose per day for four weeks. In the placebo group, the patients received placebo capsules using the same method. The primary outcome measure in this trial was the severity of cold symptoms assessed by a self-administered questionnaire.

Results

There were no significant differences between the two groups in terms of the trend of cold symptoms severity during the study period. However, in the second week, the severity of all the cold symptoms in the drug group was less, compared to the placebo, but at the end of the study, comparison of the two groups revealed no significant difference in any of the investigated options.

Conclusion

The findings revealed that although the severity of all the cold symptoms in the drug group was less as compared to the placebo group, the dried lime capsule showed no statistically significant effect on the control of these symptoms in Iranian pilgrims.

Hospital diet for COVID-19, an acute respiratory infectious disease: An evidence-based Protocol of a Clinical Trial

BACKGROUND

COVID-19 caused a global pandemic problem. No confident management is introduced for it yet. This study aimed to propose a dietary protocol for hospitalized patients with the diagnosis of acute respiratory infectious disease caused by COVID-19 based on Persian Medicine.

METHODS

This study was conducted in three phases. In the first phase, any diseases that could be matched with the clinical features of infection with COVID-19 were searched in selected PM references. In the second phase, medicinal herbs and foods that were available and could be used in the hospital diet were extracted and summarized. In the third phase, the new documentation of these pharmaceutical and food items was conducted.

RESULTS

The signs and symptoms of infectious respiratory disease caused by COVID-19 can be categorized in the field of Zato al-rieh that can mainly be matched with pneumonia. Based on the described criteria, some nutrients and medicinal materia medica have been introduced for acute respiratory infection including Cydonia oblonga, Honey, Citrus sinensis, Malus domestica, Citrus medica, Crocus sativus, Raisin, Rosa Damas Cena, D.Carota, Camellia Sinensis, Anethum graveolens dhi, Punica granatum, Petroselinum Crispum, Coriandrum sativum, Urtica dioica, Allium sativum, Sesamum indicum.

CONCLUSION

Most materia medica has documents in current articles including anti-cough suppressants, antiviral properties, anti-bacterial, anti-inflammatory, antioxidant, immunomodulatory etc. A protocol of hospital diet for patients with infectious respiratory syndrome caused by COVID-19 has been introduced in this manuscript.

Analgesic Medicinal Plants in Shahrekord, Southwest of Iran: An Ethnobotanical Study

Background:

Identification of indigenous medicinal plants, including the gathering of information regarding the uses of these plants can help find out their traditional pharmacological activities and their benefits for the community’s healthcare system. In this study, an ethnobotanical investigation was conducted in Shahrekord city, southwest of Iran to indicate the ethnobotanical knowledge about analgesic medicinal plants in the region and the methods of using them.

Materials and Methods:

To this end, plant antioxidants and analgesic medicinal plants were identified. For this purpose, a questionnaire was used to obtain indigenous knowledge from traditional therapists in Shahrekord regarding pain relief using medicinal plants. This ethnobotanical study was conducted in 2018 with the participation of 29 traditional therapists of the region under purpose. Finally, the data drawn from the questionnaires were analyzed using the Excel software. The frequency of plants use was also calculated.

Results:

Our study showed that in Shahrekord, 23 species of medicinal plants are used to relieve pain. The highest frequency of use was obtained for Eugenia caryophylata (44%), followed by Alhagi maurorum (31%), Tribulus terrestris (27%), and angustifolia (24%). The Laminaceae family (7 species) was the most frequently used plant family for pain relief. The most frequently used plant organ to relieve the pain was flower (25%), followed by the stem (22%) and leaves (19%).

Conclusion:

Given the high importance of medicinal plants in Shahrekord, the results of this study and additional scientific investigations can help produce more effective and less harmful drugs from medicinal plants.

Investigating the Effect of Melissa Officinalis on After-Pains: A Randomized Single-Blind Clinical Trial

Introduction: Regarding high prevalence of postpartum pain and side-effects of pharmaceutical analgesics on maternal and neonatal health, the present study aimed to explore the effect of Melissa officinalis on after-pain among mothers hospitalized in Asgariyeh Hospital, Isfahan, 2016.

Methods: In this single-blind clinical trial, 110 women with moderate to severe after-pain were divided into two M.officinalis and mefenamic acid groups by random allocation. Samples in the first group received 250mg of mefenamic acid and the second group received 395mg of M.officinalis oral capsules every 6hours for 24hours following childbirth. The primary outcome (After-pain) was assessed using a numeric 10-point scale before intervention, 1,2 and 3hours after the first intervention and every 6hours to 24hours after delivery for each of second, third and fourth interventions. Data were analyzed, using SPSS by independent t-test, Mann-Whitney and chi-square test.

Results: The demographic and obstetric variables and after-pain severity before the intervention in both groups were homogenous. Pain intensity wasn’t significantly different between the two groups during first and second hours after the first intervention, but there was a significant difference in the third hour, The severity of pain was significantly different between the two groups in different assessments including: an hour after the second, third and fourth intervention (P<0.05). A significant difference was found between mefenamic acid and M.officinalis in pain relief.

Conclusion: M.officinalis can reduce the severity of after-pain, because it eliminates the need for pharmaceutical analgesics and works much better than mefenamic acid.

Nephrotoxicity and Chinese Herbal Medicine

Chinese herbal medicine has been practiced for the prevention, treatment, and cure of diseases for thousands of years. Herbal medicine involves the use of natural compounds, which have relatively complex active ingredients with varying degrees of side effects. Some of these herbal medicines are known to cause nephrotoxicity, which can be overlooked by physicians and patients due to the belief that herbal medications are innocuous. Some of the nephrotoxic components from herbs are aristolochic acids and other plant alkaloids. In addition, anthraquinones, flavonoids, and glycosides from herbs also are known to cause kidney toxicity. The kidney manifestations of nephrotoxicity associated with herbal medicine include acute kidney injury, CKD, nephrolithiasis, rhabdomyolysis, Fanconi syndrome, and urothelial carcinoma. Several factors contribute to the nephrotoxicity of herbal medicines, including the intrinsic toxicity of herbs, incorrect processing or storage, adulteration, contamination by heavy metals, incorrect dosing, and interactions between herbal medicines and medications. The exact incidence of kidney injury due to nephrotoxic herbal medicine is not known. However, clinicians should consider herbal medicine use in patients with unexplained AKI or progressive CKD. In addition, exposure to herbal medicine containing aristolochic acid may increase risk for future uroepithelial cancers, and patients require appropriate postexposure screening.

Effects of a food product (based on Daucus carota) and education based on traditional Persian medicine on female sexual dysfunction: a randomized clinical trial

Background

Globally, female sexual dysfunction is a serious concern based on negative family and social consequences, high side effects of medications and lack of effective treatment. Thus, the evaluation of treatment approach for this problem is an important priority for healthcare systems. Sexual life and its related disorders are considered the main aspects of a healthy lifestyle in traditional Persian medicine (TPM).

Objective

The present study aimed to determine and compare the effects of food products containing Daucus carota, TPM-based training program, and a combination of these two interventions on the improvement of female sexual dysfunction.

Methods

This randomized clinical trial was conducted on 96 women with sexual dysfunction based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5®), aged 18–35 years who referred to the Gynecology Clinic of Mashhad University of Medical Sciences, Mashhad, Iran, during 2016 and 2017. The patients were randomly divided into three groups (n=32) and received the intervention over an eight-week period. The first group was provided with TPM-based sexual health training, the second group received 30 g of a traditional food product (wild carrot halva: mixed Daucus carota and several herbs with honey) on a daily basis, and the third group received a combination of this traditional food product plus education. Data analysis was performed using Chi square test, repeated measures ANOVA, two-way ANOVA, ANCOVA, post hoc Bonferroni, Friedman and Wilcoxon signed-rank test in SPSS version 11.5.

Results

According to the results of this study, there was a significant difference in terms of sexual desire (p=0.002), lubrication (p=0.002), orgasm (p=0.004) and pain (p<0.001) after eight weeks of the intervention among the three groups.

Conclusion

The use of two interventions of TPM including a food product containing Daucus carota and this product with TPM-based education improved desire, arousal, lubrication, orgasm, satisfaction and pain in females with sexual dysfunction. Furthermore, TPM-based education alone, led to the improvement of all domains of sexual dysfunction, except for pain in the females with sexual dysfunction.

Trial registration

The trial was registered at the Iranian Registry of Clinical Trials with the IRCT ID: IRCT2015122425681N1).

Funding

The present study was supported by a grant from the Research Council, Mashhad University of Medical Sciences, Mashhad, Iran (ref. no.: 941503).

Comparison of Albizia Julibressin and Silver Sulfadiazine in Healing of Second and Third Degree Burns

BACKGROUND

Large numbers of population suffer from burn annually. The promising treatment of burn has not been identified yet. Albizia julibressin (A. julibressin) in Fabaceae family is popular for its antiseptic activity. This prospective study was designed to compare the wound healing effects of A. julibressin gel (AG) with silver sulfadiazine (SSD).

METHODS

This single blind clinical trial was performed on 40 patients with second and third degree burns. 20 patients treated with SSD and 20 other patients received A. julibressin. The percentage of the wound healing was evaluated with pain, irritation, edema, itching, erythema, purulent discharges and skin discoloration symptoms. Also, the patients' satisfaction and adverse drug reactions were determined.

RESULTS

The severity of pain (p=0.03), inflammation (p=0.02) and purulent secretions (p=0.03) were significantly relieved in A. julibressin group. The healing time significantly reduced in second degree burns (p=0.03) and third degree burns (p=0.04) with treating by A. julibressin. No significant adverse drug reactions were detected with A. julibressin.

CONCLUSION

It seems that A. julibressin improves the different therapeutic aspects of burn injuries and could be considered as a new herbal remedy in wound healings.

Acupuncture and Traditional Herbal Medicine Therapy Prevent Deliriumin Patients with Cardiovascular Disease in Intensive Care Units

The aim of this study was to determine the effect of combination therapy consisting of acupuncture and traditional herbal medicine (Kampo medicine) for reducing the incidence rate of delirium in patients with cardiovascular (CV) disease in ICUs. Twenty-nine patients who had been urgently admitted to the ICU in the control period were treated with conventional intensive care. Thirty patients in the treatment period received conventional therapy plus a combination therapy consisting of acupuncture and herbal medicine. Acupuncture treatment was performed once a day, and the herbal formula was administered orally three times a day during the first week of the ICU stay. The standard acupuncture points were GV20, Ex-HN3, HT7, LI4, Liv3, and KI3, and the main herbal preparation was Kamikihito. The incident rates of delirium, assessed using the confusion assessment method for ICU, in the treatment and control period were compared. The incidence rate of delirium was significantly lower in the treatment group than in the control group (6.6% vs. 37.9%, [Formula: see text]). Moreover, sedative drugs and non-pharmacological approaches against aggressive behavior of patients who were delirious were used less in the treatment group than in the control group. No serious adverse events were observed in the treatment group. Combination therapy consisting of acupuncture and herbal medicine was found to be effective in lowering the incidence of delirium in patients with CV disease in ICUs. Further studies with a large sample size and parallel randomized controlled design would be required to establish the effects of this therapy.

Complementary and Alternative Medicines Used by Patients With Inflammatory Bowel Diseases

Patients and physicians often have many questions regarding the role of complementary and alternative medicines (CAMs), or nonallopathic therapies, for inflammatory bowel diseases (IBDs). CAMs of various forms are used by more than half of patients with IBD during some point in their disease course. We summarize the available evidence for the most commonly used and discussed CAMs. We discuss evidence for the effects of herbs (such as cannabis and curcumin), probiotics, acupuncture, exercise, and mind-body therapy. There have been few controlled studies of these therapies, which have been limited by their small sample sizes; most studies have been uncontrolled. In addition, there has been a lack of quality control for herbal preparations. It has been a challenge to design rigorous, randomized, placebo-controlled trials, in part owing to problems of adequate blinding for psychological interventions, acupuncture, and exercise. These barriers have limited the acceptance of CAMs by physicians. However, such therapies might be used to supplement conventional therapies and help ease patient symptoms. We conclude that physicians should understand the nature of and evidence for CAMs for IBD so that rational advice can be offered to patients who inquire about their use. CAMs have the potential to aid in the treatment of IBD, but further research is needed to validate these approaches.

Expert2OWL: A Methodology for Pattern-Based Ontology Development

The formalization of expert knowledge enables a broad spectrum of applications employing ontologies as underlying technology. These include eLearning, Semantic Web and expert systems. However, the manual construction of such ontologies is time-consuming and thus expensive. Moreover, experts are often unfamiliar with the syntax and semantics of formal ontology languages such as OWL and usually have no experience in developing formal ontologies. To overcome these barriers, we developed a new method and tool, called Expert2OWL that provides efficient features to support the construction of OWL ontologies using GFO (General Formal Ontology) as a top-level ontology. This method allows a close and effective collaboration between ontologists and domain experts. Essentially, this tool integrates Excel spreadsheets as part of a pattern-based ontology development and refinement process. Expert2OWL enables us to expedite the development process and modularize the resulting ontologies. We applied this method in the field of Chinese Herbal Medicine (CHM) and used Expert2OWL to automatically generate an accurate Chinese Herbology ontology (CHO). The expressivity of CHO was tested and evaluated using ontology query languages SPARQL and DL. CHO shows promising results and can generate answers to important scientific questions such as which Chinese herbal formulas contain which substances, which substances treat which diseases, and which ones are the most frequently used in CHM.

Efficacy and short-term safety of topical Dwarf Elder (Sambucus ebulus L.) versus diclofenac for knee osteoarthritis: A randomized, double-blind, active-controlled trial

ETHNOPHARMACOLOGICAL RELEVANCE

Sambucus ebulus L. (S. ebulus) has had long-standing application in Traditional Persian Medicine for joint pain and for a variety of bone and joint disorders. According to traditional use of S. ebulus and its relevant pharmacologic properties, this study was designed to evaluate the efficacy and short-term safety of topical use of S. ebulus in patients with knee osteoarthritis (OA).

METHODS AND MATERIALS

Seventy nine patients with knee OA were randomly enrolled in 2 parallel arms of a pilot randomized, double-blind, active-controlled clinical trial. The patients were treated by topical S. ebulus gel or 1% diclofenac gel, three times a day, as much as a fingertip unit for 4 weeks. Patients were assessed prior to enrollment and, then, 2 and 4 weeks subsequent to the intervention, in terms of scores of visual analogue scale (VAS) for self-grading of their knee joint pain, and according to 3 different domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Any observed adverse effects were also scrutinized.

RESULTS

The mean values of WOMAC pain score, total WOMAC score and VAS score for pain of the S. ebulus group were significantly lower compared with the diclofenac group (P=0.004, P=0.04, and P<0.001, respectively). In addition, no serious adverse effect was reported.

CONCLUSION

This pilot study showed that topical treatment with S. ebulus gel can be recommended for alleviating symptoms of patients with knee OA. However, longer trials involving larger samples size, are needed for achieving a comprehensive understanding about the efficacy and safety of S. ebulus in knee OA.

Effect of Saffron (Fan Hong Hua) On the Readiness of The Uterine Cervix In Term Pregnancy: A Placebo-Controlled Randomized Trial

Background

Readiness of the cervix is required for successful induction of labor, and there are a number of ways in which this can be achieved.

Objectives

The aim of the present study was to assess whether taking saffron orally could have an effect on the cervical readiness (primary outcome) and some delivery and neonatal outcomes (secondary outcomes) in women in the stage of term pregnancy.

Patients and Methods

In this double-blind trial, 50 women with a gestational age of 39 to 41 weeks, no indication of cesarean section, a Bishop’s score of less than 4, who had plan to have vaginal delivery at Shohada hospital of Bonab, Iran were randomized into two groups receiving three 250mg saffron or placebo pills in 24 hours. The readiness of the cervix was assessed using the Bishop’s score. The Mann-Whitney U test was used to compare the scores between the groups.

Results

There were no significant differences between the groups in terms of the Bishop’s score at the baseline (P = 0.792) and 10-12 hours after starting the intervention (P = 0.159). The Bishop’s score was significantly higher in the saffron group 20 - 24 hours after the intervention was started (P = 0.029) and just after onset of active uterine contractions (P = 0.003). In the saffron group, there was no cesarean section and 1 meconium staining of the fetus, but 3 and 4, respectively, in the placebo group. There was no statistically significant difference between the groups in terms of the timing of the onset of spontaneous active uterine contractions, the duration of the first and second stages of labor, the need for delivery augmentation, and the first and fifth minutes of neonatal Apgar (P > 0.05). No adverse event was reported in any of the groups.

Conclusions

Saffron can increase the readiness of the cervix in term pregnancies. However, the study limitations do not allow for any definite conclusions for its use in clinical practice, and more research is needed to assess its effect on delivery and neonatal outcomes.

Antibacterial Activity of Euphorbia hebecarpa Alcoholic Extracts Against Six Human Pathogenic Bacteria in Planktonic and Biofilm Forms

Background

Biofilm formation is a primary cause of considerable bacterial destruction.

Objectives

In an effort to combat these industrial and medical bacterial biofilm problems, our study aims to determine the antimicrobial effect of Euphorbia hebecarpa.

Materials and Methods

The inhibition efficiency of alcoholic extracts on the planktonic form of six pathogenic bacteria was evaluated using a disk diffusion technique. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) values were determined by means of a macrobroth dilution method. The effects of the extracts on biofilms were calculated using a microtiter plate method.

Results

The results of the disk diffusion assay (MBC and MIC) confirmed that E. hebecarpa ethanolic extracts were more efficient than methanolic extracts in the inhibition of planktonic forms of bacteria. Also, the inhibitory effect of the extracts in a broth medium was greater than in a solid medium. Extracts of E. hebecarpa were found to inhibit biofilm formation better than demolish of biofilm and preventing metabolic activity of bacteria in biofilm structures. The greatest inhibitory effects of E. hebecarpa extracts were observed for the biofilm formation of B. cereus (92.81%). In addition, the greatest demolition was observed for the S. aureus biofilm (74.49%), and the metabolic activity decrement of this bacteria was highest (78.21%) of all the tested bacteria.

Conclusions

The results of this study suggest that E. hebecarpa extracts can be used to inhibit the planktonic and biofilm forms of these selected bacteria.

Efficacy of Tribulus Terrestris Extract on the Serum Glucose and Lipids of Women with Diabetes Mellitus

BACKGROUND

Considering folkloric use of Tribulus terrestris (T. terrestris) in diabetes and proven anti-hyperglycemic and anti-hyperlipidemic effects of T. terrestris in animal studies, we aimed to evaluate the efficacy of the hydro alcoholic extract of T. terrestris on the serum glucose and lipid profile of women with diabetes mellitus.

METHODS

Ninety-eight diabetic women were randomly allocated to receive the T. terrestris (1000 mg/day) or placebo for three months. The patients were evaluated in terms of the fasting blood glucose, 2-hour postprandial glucose, glycosylated hemoglobin and lipid profile.

RESULTS

T. terrestris showed a significant blood glucose lowering effect in diabetic women compared to placebo (P<0.05). Also, the total cholesterol and low-density lipoprotein of the T. terrestris group was significantly reduced compared with placebo, while no significant effect was observed in the triglyceride and high-density lipoprotein levels.

CONCLUSION

This study showed preliminary promising hypoglycemic effect of T. terrestris in diabetic women.

A Review of Herbal Medicine in Iranian Traditional Manuscripts for Treatment of Participatory Gastric Headache

BACKGROUND

Participatory gastric headache is a type of headache described in Iranian traditional medicine. It is defined as a headache not originated from the head and neck disorders; rather the pain in the head is caused by gastric dysfunction and its disorders. Treatment of this type of headache is completely reliant on the treatment of the gastric complaint. Reviewing Iranian traditional medicine (ITM) literature, a broad spectrum of herbal medicines that could be useful in the treatment of this type of headache is described. Accordingly, this review was performed to gather and discuss the therapeutic management of this disorder in ITM and evaluating related characteristics of each medicinal herb.

METHODS

In this study, medicinal plants prescribed for gastric headache from different ancient Iranian literature is documented. The botanical name, family name, part used, temperaments, rout of administration and dosage forms are provided in this article.

RESULTS

About 40 plants, mainly used orally, were prescribed for the treatment of participatory gastric headache. Most of them have the astringent effect, which is related to their dryness temperament. Therefore, they could strengthen the stomach and prevent ascending vapors into the brain that in turn helps to get relief from headache. In addition, they possess reinforcement effect on the brain.

CONCLUSION

In general, herbal medicines with tonic characteristics could be effective in participatory gastric headache.

Properties Related to Bile as Viewed in Makhzan ol-Adviya

BACKGROUND

The human body has simple and compound organs that obtain their nourishment through four humors. One of them is bile (yellow bile). According to Iranian traditional medicine (ITM), there are various kinds of natural medicines with their specific mechanisms of action affecting on bile in the human body. Hakim Aghili Shirazi (18th century), one of the great scholars in ITM field, introduced all types of natural medicines influencing bile in his valuable book written in Persian, "Makhzan-ul-Adwiah", about single herbal medicines (mofradat). The aim of this review article was to introduce all types of natural medicines influencing bile in the human body.

METHODS

The classification of natural medicines influencing bile was studied in this article as viewed by Hakim Aghili Shirazi in Makhzan-ul-Adwiah.

RESULTS

Reviewing Makhzan-ul-Adwiah, this natural influencing bile is defined in ten categories. These are Haabes-e Safra (obstructive of bile), Daafe-e Safra (expellant of bile), Raafe-e Safra (resolver of bile), Ghaate-e Safra (stopper of bile), Ghaame-e Safra (suppressant of bile), Kaasere-e Safra (fractionating of bile), Mohregh-e Safra (burner of bile), Moder-e Safra (bile diuretic), Mosaken-e Safra (bile reliever), and Mos'hel-e Safra (bile laxative).

CONCLUSION

Each group has a specific function and mechanism on bile. Recognition of the precise mechanisms of these natural medicines is necessary to prescribe a suitable remedy for bilious diseases by traditional medicine specialists.

Acne Etiology and Treatments in Traditional Persian Medicine

BACKGROUND

Traditional Persian medicine (TPM) is based on humors theory. Temperament or mizaj is the result of a combination of four fundamental humors called blood, phlegm, yellow bile, and black bile. Like any other diseases, acne is the result of humoral imbalance. Acne is a highly prevalent dermatological problem, which has both physical and psychological effects on patients. The aim of this study was to determine the etiology of acne formation and natural remedies from the perspective of Persian scientists.

METHODS

The etiology and treatment of acne were collected and analyzed from selected TPM medical textbooks. Some selected plants in these books were assessed in tabular format and their anti-acne activities were compared with modern medicine's databases.

RESULTS

In the acne treatment, considering six essential schemes for health, diet and herbal remedies as well as manipulation are recommended. Although the mentioned herbs in acne treatment have antibacterial, anti-inflammatory, and antioxidant effects; however, some have special proven effects on the acne formation process. There is also a strong relationship between the digestive system and skin. This paper was rendered to show ancient Persian scholar's viewpoints on acne and its treatment.

CONCLUSION

Some reported remedies might be beneficial towards further studies on acne treatment.

Range of Motion Improvement in Ankylosing Spondylitis Patient with Persian Traditional Medicine; Case Report

BACKGROUND

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the skeletal system without definitive treatment. Nowadays, the aim of therapeutic interventions is preventing disease progression, but eventually many patients have different degrees of decreased range of motion, especially in the spine accompanied by pain and fatigue.

METHODS

A 44-year-old man with AS from 22 years ago was treated with NSAIDs and sulfasalazine. He visited for developed pain and stiffness in spine from 7 years ago. He did not confer with the rheumatologist from 2012 due to the lack of treatment satisfaction and maintained his treatment with 75 mg indomethacin daily. The patient was assessed in the Iranian traditional medicine clinic and other problems were chronic fatigue, interrupted sleep, and extreme dry skin. Diagnosis was general dryness and treatment started with oral and tropical moisture and nutritional advice.

RESULTS

In the third month of treatment, joint pain, morning stiffness and sleep disturbance improved. After 8 months, in addition to complete improvement of skin dryness, sleep disturbance and joint pain, range of motion in cervical and lumbar spine were increased. In cervical rotation, distance from the chin to acromion decreased from 24 to 15 cm in right rotation and 20 to 13 cm in left rotation. Additionally, in cervical flexion distance from the chin to sternal notch decreased from 16 to 8 cm after treatment. In the lumbar spine, an increased Schober's index was seen.

CONCLUSION

The use of Persian traditional medicine's viewpoints and treatment strategies can be effective in improving Ankylosing spondylitis prognosis and proposed for future clinical research.

The Efficacy of Boswellia Serrata Gum Resin for Control of Lipid Profile and Blood Glucose in Diabetic Patients

BACKGROUND

Regarding preclinical evidence for antidiabetic effects of Boswellia serrata, we evaluated anti-hyperglycemic and lipid-lowering effects of Boswellia serrate gum resin in type 2 diabetic patients in a double-blind randomized placebo-control trial.

METHODS

Fifty-six diabetic patients were randomly allocated to two groups to receive 250 mg of the Boswellia serrate gum resin or placebo twice daily for 8 weeks, in addition to their routine antidiabetic treatments. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), insulin level, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride of serum were measured before and after the intervention.

RESULTS

Although there was a considerable reduction after the intervention in FBS (P=0.04), HbA1c (P=0.02) and triglyceride (P=0.01) in the Boswellia serrate gum resin group, no significant difference was observed in all outcome measures between the two groups at the end of the study (FBS P=0.09, HbA1c P=0.20, total cholesterol P=0.31, LDL P=0.49, HDL P=0.10, triglyceride P=0.78 and insulin level P=0.86).

CONCLUSION

The current study showed the 8 weeks complementary use of Boswellia serrate gum resin with a daily dose of 500 mg had no better glucose and lipid lowering effect than placebo in diabetic patients.

Anti-Freckles Herbal Treatment in Iranian Traditional Medicine

BACKGROUND

Freckles are numerous pigmented spots of the skin, mainly confined to the face, even arms and back. Although freckles are light-brown macules, most frequently observed in individuals with red or blond hair, they are common to Asian people too. Freckles increase in number, size, and depth of pigmentation during the summer months. Histologically, freckles show increased production of melanin pigment by a normal number of melanocytes. Freckles commonly stop spreading before adolescence and last for life, but could sometimes be subtle in adulthood. Treatments are often requested for cosmetic purposes. Before the advent of lasers, treatment modalities for pigmentary disorders included surgical excision, dermabrasion, chemical bleaching, and peeling. These treatments may lead to unwanted side effects of potential scarring or undesired pigmentation changes. In Iranian traditional medicine (ITM), freckles have been known as well. "Namash" was the term used by ITM scholars to indicate freckles. There is a wide range of plants, which were prescribed by Iranian physicians for the treatment of freckles. The purpose of this study is to find the most frequent useful herbs for freckles as mentioned in ITM references.

METHODS

Seven ITM references were studied for anti-freckles medicines. The references were Canon of Medicine (Avicenna), Alhavi (Razes) Tuhfat ul-Momineen (Momen tonekaboni), Makhzan-ul-Adwiah (Aghili), Ikhtiyarat Badi'i (Ansari), Al-abnia An-Haghyegh el-advia (Heravi), and al-jāmi li-mufradāt al-adwiyawa al-aghdhiya (Ibn al-Baitar). Moreover, plants were ordered according to their repetition in the references. Afterwards, traditional names of the selected plants were matched with the scientific names using botanical text references.

RESULTS

This study demonstrated that Myristica fragrans Houtt, Cicer arietema L., Eruca sativa Lam., Lilium candidium L., Amygdalus communis L., Arum italicum L. were the most frequent herbs mentioned in ITM references for the treatment of freckles.

CONCLUSION

Herbs mentioned in this article could be appropriate candidates for future studies in the field of freckles treatment.

Comparison of the Effect of Aloe Vera Gel and Nitrofurazone 2% on Epithelialization and Granulation Tissue Formation Regarding Superficial Second-Degree Burns

BACKGROUND

Therapeutic effects of various treatment options in burn wound healing have been one of the most controversial issues in wound care. Aloe Vera is an herbal medicine, which has wound healing effects on chronic wound. The present study was carried out to examine and compare the effect of Aloe Vera gel and nitrofurazone 2% on epithelialization and granulation tissue formation with respect to superficial second-degree burns.

METHODS

This is a randomized clinical trial and the sampling method was used based on pre-defined inclusion criteria. The sample size was 30 patients that were admitted to Kerman burn center, including patients that had superficial burn in the symmetry limb, who were chosen based on depth burn and the qualifications needed for the study. One part of the burned area was dressed using ointment nitrofurazone 2% (according to routine care in the hospital) and the symmetry part was dressed using Aloe Vera gel. The tools for data collection included a demographic questionnaire, tools of bats-joints for checking epithelialization and granulation tissue. The burn wound epithelialization and granulation at the beginning of patient's admission and the first, second and third weeks after dressing were assessed and recorded.

RESULTS

In patients treated with Aloe Vera gel, epithelialization and granulation tissue of burn wounds were remarkably earlier than those patients treated with nitrofurazone 2% (P<0.05).

CONCLUSION

In conclusion, Aloe Vera gel enhanced epithelialization and granulation tissue of burn wounds in superficial second-degree burn patients better than nitrofurazone 2%. The mechanism of the remarkable efficacy of Aloe Vera gel in the epithelialization and granulation tissue of burn injuries may be explained by its hydrocolloid and moisturizing and anti-inflammatory effects.

Herbal Medicines for Leucorrhea According to Iranian Traditional Medicine

BACKGROUND

Leucorrhea or vaginal discharge is a conventional complaint. It is generally whitish, yellowish, or greenish vaginal discharge in females that might be normal or a symptom of infection. It is almost mucus discharge, which exhibit exfoliation of vaginal epithelial cells due to estrogen influence on the vaginal mucosa. It is important to identify the differences between physiologic and pathologic discharges. Leucorrhea is a well-known disease in Iranian traditional medicine (ITM). In their manuscripts, the word "Sayalan-e rahem" was used by Avicenna and some other Iranian traditional practitioners to describe this condition. Ancient practitioners believed that excessive residue (kesrate fozool) and weakness of digestion (Za'afe hazm) were the main causes of leucorrhea, for which herbal therapy was the main proposed treatment. In the present study, medicinal plants used in ITM for leucorrhea are introduced.

METHODS

In this research, six Iranian traditional textbooks including Canon of Medicine (Avicena 980-1037 AD), A-Hawi (Razes 865-925 AD), Tuhfat ul-Momineen (Mo'men tonekaboni, 17th century), Makhzan-ul-Adwiah (Aghili 18th century), Ikhtiarat Badi'i (Ansari 1329-1404 AD), and al-jāmi li-mufradāt al-adwiyawa al-aghdhiy (Ibn al-Baitar 1197 AD) were studied and searched for anti-leucorrhea medicines. Then the herbal medicines were selected and scored depending on their frequency in the above-mentioned textbooks. Additional attention was paid to provide the most suitable scientific name for each plant.

RESULTS

This study introduced many Materia Medica with anti-leucorrhea activity and among them seven herbs including Rubus fruticosus L., Rhus coriaria L., Phoenix dactylifera L., Pimpinella anisum L., Rumex acetosa L., Olea europaea L. and Quercus lusitanica Lam. showed the most repetition in ITM prescriptions.

CONCLUSION

These herbs can be introduced as new anti-leucorrhea herbal medicines for clinical research.