Transcutaneous absorption of topically massaged oil in neonates

OBJECTIVE

To study the transcutaneous absorption of traditionally massaged oil in newborns and to specifically compare the effects of (i) essential fatty acid (EFA) rich - safflower oil and (ii) saturated fat rich coconut oil, on fatty acid profiles of massaged babies.

DESIGN

A short term randomised controlled study.

SETTING

Tertiary care NICU of a large teaching hospital and a research laboratory of a University complex.

METHODS

120 study babies were randomly assigned to three oil groups (i) safflower oil (n = 40) (ii) coconut oil (n = 40) and (iii) no oil controls (n = 40). In each group, babies were selected in three subsets as per their gestational ages viz (a) less than 34 weeks, (b) 34-37 weeks, (c) greater than 37 weeks. 5 mL of the designated oil was massaged four times a day for five days under controlled conditions of temperature and feeding. Pre and post oil massage samples of blood were analysed for triglycerides and fatty acid profiles using gas chromatography.

RESULTS

Post oil triglyceride values were significantly raised in both the oil groups and also in controls. However, the quantum of rise was significantly higher in oil groups as compared to controls. Fatty acid profiles (gas chromatography) showed significant rise in EFAs (linolenic acid and arachidonic acid) in safflower oil group and saturated fats in coconut oil group. Changes were more evident in term babies. There were no side effects associated with the massage.

CONCLUSIONS

This study shows that topically applied oil can be absorbed in neonates and is probably available for nutritional purposes. The fatty acid constituents of the oil can influence the changes in the fatty acid profiles of the massaged babies.

Effect of a combination of isoflavones and Actaea racemosa Linnaeus on climacteric symptoms in healthy symptomatic perimenopausal women: a 12-week randomized, placebo-controlled, double-blind study

OBJECTIVE

To investigate the effects of a novel dietary supplement containing soy isoflavones and Actaea racemosa Linnaeus (formerly called Cimicifuga racemosa L.) on climacteric symptoms in healthy perimenopausal women.

DESIGN

In a multicenter, randomized, placebo-controlled, double-blind study, 124 women experiencing at least five vasomotor symptoms every 24 hours were randomized to receive daily either a phytoestrogen-containing supplement (n = 60) or placebo (n = 64) for 12 weeks. The modified Kupperman Index and Greene Climacteric Scale, a visual analogue scale designed to measure quality of life and the daily number and severity of hot flushes, was used in the screening period and in weeks 6 and 12. Changes in these scores from baseline were calculated.

RESULTS

At weeks 6 and 12, all scores in both groups had improved compared with baseline, though the overall difference in scores between the groups was not statistically significant.

CONCLUSION

The supplement containing soy isoflavones and A racemosa L. had no statistically significant effect on climacteric symptoms in perimenopausal women experiencing at least five vasomotor symptoms per day.

Can COX-2 inhibitor-induced increase in cardiovascular disease risk be modified by essential fatty acids?

Selective COX-2 inhibitors increase the risk of myocardial infarction and stroke. This has been attributed to their ability to inhibit endothelial COX-2 derived prostacyclin (PGI2) but not platelet COX-1 derived thromboxane A2 (TXA2). On the other hand, aspirin blocks both COX-1 and COX-2 enzymes without decreasing PGI2 but blocks TXA2 synthesis that explains its beneficial action in the prevention of coronary heart disease (CHD). The inhibitory action of aspirin on COX-1 and COX-2 enzymes enhances the tissue concentrations of dihomo-gamma-linolenic acid (DGLA), arachidonic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). These fatty acids form precursors to PGE1, PGI2, PGI3, lipoxins (LXs), and resolvins that have anti-inflammatory actions. In contrast, increase in the concentrations of DGLA, AA, EPA, and DHA is much less with specific COX-2 inhibitors since they do not block the formation of eicosanoids through COX-1 pathway. COX-2 inhibitors interfere with the formation of LXs and resolvins that have neuroprotective and cardioprotective actions. EPA and PGI2 have anti-arrhythmic action. EPA, DHA, and AA augment eNO formation that prevents atherosclerosis. This suggests that COX-2 inhibitors increase cardiovascular and stroke risk by interfering with the formation of eNO, PGI2, LXs, and resolvins and implies that combining EFAs with COX-2 inhibitors could prevent these complications.

Nonpharmacologic treatments for depression in patients with coronary heart disease

OBJECTIVES

We review nonpharmacologic treatments for depression in patients with coronary heart disease (CHD), including psychological therapies such as cognitive behavior therapy (CBT) and interpersonal therapy (IPT), aerobic exercise, St. John's wort (SJW), essential fatty acids (EFAs), S-Adenosylmethionine (SAMe), acupuncture, and chromium picolinate (CP).

METHOD

Medline searches and reviews of bibliographies were used to identify relevant articles. Each treatment was reviewed with particular attention paid to empirical support, as well as to potential mechanisms of action that might affect not only depression but also CHD endpoints.

RESULTS

Nearly all randomized controlled trials (RCTs) of depression treatments have been conducted with non-CHD patients. These studies have provided the most support for psychological treatments, particularly CBT and IPT. Aerobic exercise, SJW, and SAMe also have considerable empirical support in otherwise healthy persons, but SJW may have undesirable side effects for CHD patients. Data for EFAs, CP, and acupuncture are limited; however, the use of aerobic exercise shows considerable promise for cardiac patients.

CONCLUSIONS

There are few RCTs of patients with clinical depression and CHD, and those that exist have significant methodological limitations. Nonetheless, there is preliminary evidence that nonpharmacologic treatments are effective for cardiac patients with depression. In terms of reducing depression, the most evidence exists for psychological treatments, particularly CBT and IPT. However, there is little evidence that such treatment would also improve CHD risk factors. Aerobic exercise offers more promise to improve both mental and physical health due to its effect on cardiovascular risk factors and outcomes and thus warrants particular attention in future trials.

Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder

Use of complementary and alternative medicine (CAM) for treatment of attention-deficit hyperactivity disorder (ADHD) has become widespread in both referral and primary care populations. We review the purported mechanism of action and available evidence for selected CAM therapies for ADHD. Enduring controversies, such as elimination of artificial food additives, colors, and/or preservatives; the effect of sugar on behavior in children; and the use of EEG biofeedback, have been well studied but lack support as effective sole treatments for ADHD. The initial evidence for some emerging CAM therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy, and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. More rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD.

The clinical advantages of cold-pressed non-raffinated evening primrose oil over refined preparations

The non-triglyceride fraction of unrefined evening primrose oil has recently been shown to contain 3-O-trans-caffeoyl derivatives of betulinic, morolic, and oleanolic acid. These lipophilic pentacyclic triterpenes have free radical scavenging, cyclooxygenase and neutrophil elastase inhibitory activities, and are therefore likely to be of benefit to human health. However, biochemical assays have suggested that these lipophilic antioxidants only occur in trace amounts, if at all, in commercial samples of evening primrose oil. A newly available commercially available cold-pressed, non-raffinated evening primrose oil preparation was found to contain a pentacyclic triterpene ester. Given the potential benefits of the triterpene esters, it is suggested that such a cold-pressed, non-raffinated commercially available evening primrose oil product is likely to have greater health benefits than conventional evening primrose oil preparations.

Evidence for a role of the arachidonic acid cascade in affective disorders: a review

The treatment of affective disorders continues to present significant clinical challenges, notwithstanding the existence of available mood stabilizers and antidepressants. These difficulties include incomplete response, relapse, and intolerable medication side effects. Fundamental to the therapeutic impasse is incomplete knowledge concerning the neurobiology of mood disorders. Although some relevant biochemical pathways have been identified, including abnormalities of monoamine neurotransmission and of immunological functioning, a fuller understanding is likely to embrace other interrelated pathways. Arachidonic acid (AA) and prostaglandins (PGs) are important second messengers in the central nervous system that participate in signal transduction, inflammation and other vital processes. Their release, turnover, and metabolism represent the 'arachidonic acid cascade'. A significant body of diverse clinical and preclinical research suggests that the AA cascade may be important in affective states. This paper reviews the literature describing the association of affective illness with AA and its metabolites. Possible links between this and other prevailing hypotheses are considered, and implications for further research and for treatment are discussed.

Omega 3 oils and pregnancy

Women can safely commence omega 3 intake in early pregnancy to allow the full benefits to be incorporated into the body. Pregnant women should consider the intake of omega 3 oils and evening primrose oil throughout pregnancy in order possibly to prevent preterm delivery, promote an easier birth, assist the baby's brain and eye health and preprogram the baby's cell membranes for optimum lifelong wellness. Benefits to the mother may include prevention of postnatal depression and the comfort of knowing that she is giving her baby a healthy start in life.

Observer-blind, randomized, intrapatient comparison of a novel 1% coal tar preparation (Exorex) and calcipotriol cream in the treatment of plaque type psoriasis

BACKGROUND

In a recent pilot study a novel, patented fatty acid-based 1% coal tar preparation (Exorex) has been found to be similar in efficacy to calcipotriol in the treatment of psoriasis.

OBJECTIVES

Our aim was to investigate the therapeutic efficacy, safety and cosmetic acceptability of the new 1% coal tar preparation in comparison with calcipotriol cream in a larger patient cohort.

PATIENTS AND METHODS

Forty patients with chronic plaque type psoriasis were included in this randomized, observer-blind, intrapatient comparison trial. In each patient two comparable target plaques were treated twice daily with 1% coal tar preparation or calcipotriol cream. At the onset of therapy and at weeks 2, 4, 6 and 8, the response to treatment was determined by the psoriasis severity index (PSI) that assesses the degree of erythema, infiltration and scaling of the psoriatic lesions on a five-point scale. In addition, all treatment-related side-effects were recorded and cosmetic acceptability of both treatments was rated every second week by the patients. After complete or near complete clearing the patients were followed up until relapse or for a maximum period of 18 months.

RESULTS

Thirty-eight patients completed the study. At termination of the trial the mean +/- SD baseline PSI score of 9.2 +/- 1.5 was reduced to 3.0 +/- 2.9 by 1% coal tar preparation and to 2.8 +/- 2.7 by calcipotriol. The mean PSI reduction between baseline and final assessment did not differ significantly between 1% coal tar preparation and calcipotriol (P = 0.77). The mean intraindividual difference in reduction of PSI score between 1% coal tar preparation and calcipotriol was 0.1 score points (95% confidence interval - 0.84 to + 0.63). No difference between either preparation was observed with regard to time until relapse. Itching was caused by 1% coal tar preparation in four patients and by calcipotriol in one patient. Unpleasant odour or staining of the 1% coal tar preparation was reported by six patients, whereas one patient complained about the smell of the calcipotriol cream.

CONCLUSIONS

The novel 1% coal tar preparation was found to be comparably as effective as calcipotriol in treating psoriasis. Tolerability and cosmetic acceptability was better for calcipotriol. Taking into consideration that the coal tar preparation is considerably less expensive than calcipotriol this new product appears as a very useful topical medication for chronic plaque type psoriasis.

Nontraditional wound care: A review of the evidence for the use of sugar, papaya/papain, and fatty acids

With global travel and immigration, WOC nurses may see or be asked questions about wound care practices that are different from those traditionally taught in their educational programs. The purpose of this article is to review the evidence about 3 commonly used wound products, namely, sugar, papaya/papain, and essential fatty acids. Although these products are used in numerous countries, their application in Brazil will provide the examples of use in this article. Nontraditional wound care is still frequently practiced even in countries where access to evidence-based products is fairly good. Research studies about sugar, papain/papaya, and essential fatty acids generally are case reports/studies and descriptive. Protocols in the use of the products varied. Use of these products is often based on tradition and economics. WOC nurses need to be knowledgeable regarding nonstandard wound care products and procedures so they can respond appropriately in situations where these products are used.

Botanicals and dietary supplements in diabetic peripheral neuropathy

BACKGROUND

Many persons use botanicals and dietary supplements for chronic conditions that do not respond to traditional Western medications. Tricyclic antidepressants, a common treatment option for diabetic neuropathy, can have many side effects and are a poor choice in certain populations (eg, the elderly). As such, patients might turn to botanicals and dietary supplements, not realizing that these products are not well regulated.

METHODS

This article reviews botanicals and dietary supplements that have been involved in randomized controlled trials (RCTs) for diabetic neuropathy. We searched MEDLINE for English-language literature dating from 1966 to April 2001 using the following subject headings: (1) diabetes and botanical, herb, and supplement, (2) neuropathy and botanical, herb, and supplement, and (3) diabetic neuropathy and botanical, herb, and supplement.

RESULTS

Our search found agents that might improve symptoms of neuropathy (eg, evening primrose oil, alpha-lipoic acid, capsaicin) without affecting glucose control. Botanicals and dietary supplements involved in only one RCT or associated with little clinical benefit were reviewed in brief.

CONCLUSIONS

Evening primrose oil, alpha-lipoic acid, and capsaicin have received the greatest attention for their use in diabetic neuropathy, but further studies are needed to confirm their efficacy. Patients using these products need to be informed of potential drug interactions and side effects.

Evening primrose oil and fish oil for severe chronic mastalgia: a randomized, double-blind, controlled trial

OBJECTIVE

The purpose of this study was to evaluate the effect of evening primrose oil and fish oil on breast pain in premenopausal women with severe chronic mastalgia, in a randomized double-blind factorial clinical trial.

STUDY DESIGN

One hundred twenty women were placed randomly into four groups: (1) fish oil and control oil, (2) evening primrose oil and control oil, (3) fish and evening primrose oils, or (4) both control oils during 6 months. Corn oil and corn oil with wheat germ oil were used as control oils. The change in the percentage of days with breast pain after 6 months of treatment was analyzed on an intention-to-treat basis.

RESULTS

The decrease in days with pain was 12.3 % for evening primrose oil and 13.8% for its control oil (P =.73); the decrease in days with pain was 15.5% for fish oil and 10.6% for its control oil (P =.28).

CONCLUSION

All groups showed a decrease in pain. Neither evening primrose oil nor fish oil offered clear benefit over control oils in the treatment of mastalgia.

Gamma-linolenic acid in borage oil reverses epidermal hyperproliferation in guinea pigs

As dietary sources of gamma-linolenic acid [GLA; 18:3(n-6)], borage oil (BO; 24-25 g/100 g GLA) and evening primrose oil (PO; 8-10 g/100 g GLA) are efficacious in treating skin disorders. The triglycerol stereospecificity of these oils is distinct, with GLA being concentrated in the sn-2 position of BO and in the sn-3 position of PO. To determine whether the absolute level and/or the triglycerol stereospecificity of GLA in oils affect biological efficacy, epidermal hyperproliferation was induced in guinea pigs by a hydrogenated coconut oil (HCO) diet for 8 wk. Subsequently, guinea pigs were fed diets of PO, BO or a mixture of BO and safflower oil (SO) for 2 wk. The mixture of BO and SO (BS) diet had a similar level of GLA as PO but with sn-2 stereospecificity. As controls, two groups were fed SO and HCO for 10 wk. Epidermal hyperproliferation was reversed by all three oils in the order of BO > BS > PO. However, proliferation scores of group PO were higher than of the normal control group, SO. The accumulations of dihomo-gamma-linolenic acid [DGLA; 20:3(n-6)], an elongase product of GLA, into phospholipids and ceramides, of 15-hydroxyeicosatrienoic acid (15-HETrE), the potent antiproliferative metabolite of DGLA, and of ceramides, the major lipid maintaining epidermal barrier, in the epidermis of group BO were greater than of groups BS and PO. Group BS had higher levels of DGLA, 15-HETrE and ceramides than group PO. With primary dependence on absolute levels, our data demonstrate that the antiproliferative efficacy of GLA in the epidermis is preferably exerted from sn-2 stereospecificity of GLA in BO.

Attention-deficit/hyperactive disorder: making a case for multidisciplinary management

Attention Deficit/Hyperactivity Disorder (AD/HD) is characterized by a cluster of age-inappropriate behavioral abnormalities comprising inattentivity, hyperactivity and impulsivity. The definition is controversial and without an accurate diagnosis. Therefore, it seems prudent that a multidisciplinary treatment protocol should begin with non-drug psychological and behavioral strategies plus nutritional intervention.

Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial

BACKGROUND

There is evidence that offenders consume diets lacking in essential nutrients and this could adversely affect their behaviour.

AIMS

To test empirically if physiologically adequate intakes of vitamins, minerals and essential fatty acids cause a reduction in antisocial behaviour.

METHOD

Experimental, double-blind, placebo-controlled, randomised trial of nutritional supplements on 231 young adult prisoners, comparing disciplinary offences before and during supplementation.

RESULTS

Compared with placebos, those receiving the active capsules committed an average of 26.3% (95% CI 8.3-44.33%) fewer offences (P=0.03, two-tailed). Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks (n=172) was an average 35.1% (95% CI 16.3-53.9%) reduction of offences (P<0.001, two-tailed), whereas placebos remained within standard error.

CONCLUSIONS

Antisocial behaviour in prisons, including violence, are reduced by vitamins, minerals and essential fatty acids with similar implications for those eating poor diets in the community.

Exploration of "alternative" and "natural" drugs in dermatology

OBJECTIVE

To review some of the promising natural remedies within dermatology to explore their potential clinical benefit in supplementing conventional drugs.

DATA SOURCES

MEDLINE searches from January 1966 through October 2000 and Science Citation Index searches from January 1974 through October 2000 were conducted.

STUDY SELECTION

Primary importance was given to in vivo and in vitro controlled studies, the results of which encourage further exploration.

DATA EXTRACTION

The controls used, the statistical approach to analysis, and the validity of the experimental method analyzed were considered particularly important. Data were independently extracted by multiple observers.

DATA SYNTHESIS

Natural remedies seem promising in treating a wide variety of dermatologic disorders, including inflammation, phototoxicity, psoriasis, atopic dermatitis, alopecia areata, and poison oak.

CONCLUSIONS

The alternative medications presented seem promising, although their true effects are unknown. Many of the presented studies do not allow deduction of clinical effects. Further experimentation must be performed to assess clinical benefit.