Complementary and alternative medicine use amongst Palestinian diabetic patients

Prevalence, patterns, and disclosure of complementary and alternative medicine (CAM) use among patients with thyroid diseases: A cross-sectional study in Iran

Introduction

Complementary and alternative medicine (CAM) has gained popularity as a therapeutic approach outside conventional medicine for various medical conditions. This study aimed to assess the prevalence, patterns, and disclosure of CAM use among patients with thyroid diseases in Iran.

Methods

This descriptive-analytic cross-sectional study involved patients with thyroid diseases who were visiting Internal Medicine Clinics in Shiraz. The use of CAM was assessed by employing the Persian edition of the I-CAM-Q (I-CAM-IR) questionnaire.

Results

A total of 343 individuals took part in the study, and 85.4 % of them reported using CAM within the previous 12 months. Medicinal herbs were the most commonly used CAM modality (63 %). CAM use was primarily for enhancing overall well-being. Among self-care CAM practices, praying was the most frequently employed (70 %). Women exhibited a significantly higher CAM utilization rate (four times greater) compared to men (p < 0.001), with herbs being more commonly used by women (p < 0.001). A significant proportion of participants did not inform their physicians about their CAM use, and 46 % experienced significant benefits from using CAM.

Conclusion

This study highlights a high prevalence of CAM use, particularly herbal remedies, among Iranian patients with thyroid diseases.

Biological, phytochemical and molecular docking characteristics of Laurus nobilis L. fresh leaves essential oil from Palestine

BACKGROUND

The historical use of Laurus nobilis L., the plant is native to the Mediterranean region and has been cultivated for its aromatic leaves, which are used as a flavoring agent in cooking and for their potential therapeutic properties.

METHODS

The purpose of the current investigation was to characterize the essential oil composition of the fresh L. nobilis leaves from Palestine by using the gas chromatography-mass spectrometry (GC-MS) technique. DPPH (2,2-diphenyl-1-picrylhydrazyl), p-nitrophenyl butyrate, and 3,5-dinitro salicylic acid (DNSA) methods were employed to estimate the antioxidant, antiobesity, and antidiabetic effects of the essential oil. While MTS assay were used to evaluate their antiproliferative activities on panels of cell lines. Moreover, the docking studies were aided by the Prime MM GBSA method for estimating binding affinities.

RESULTS

The GC-MS investigation demonstrated that the fresh L. nobilis leaves essential oil has a variety of chemicals, about 31 different biochemicals were identified, and the major compounds were 1,8-cineole (48.54 ± 0.91%), terpinyl acetate (13.46 ± 0.34%), and α-terpinyl (3.84 ± 0.35%). Furthermore, the investigated oil demonstrated broad-spectrum antimicrobial activity against all tested bacterial and candidal strains and significantly inhibited the growth of MCF-7 cancerous cells more than the chemotherapeutic drug Doxorubicin. Furthermore, it contains robust DPPH free radicals, as well as porcine pancreatic α-amylase and lipase enzymes. Using the 1,8-cineole compound as the predominant biomolecule found in the L. nobilis essential oil, molecular docking studies were performed to confirm these observed fabulous results. The molecular docking simulations proposed that these recorded biological activities almost emanated from its high ability to form strong and effective hydrophobic interactions, this led to the getting of optimal fitting and interaction patterns within the binding sites of the applied crystallographic protein targets.

CONCLUSION

The results of these experiments showed that the fresh L. nobilis leaves essential oil has outstanding pharmacological capabilities, making this oil a potential source of natural medications.

Prevalence of Complementary and Alternative Medicine Use and Its Associated Factors among Iranian Diabetic Patients: A Cross-Sectional Study

Objective

This cross-sectional study aimed to assess the prevalence of complementary and alternative medicine (CAM) use and its associated factors among diabetic patients in Fasa, a city in southern Iran.

Methods

Data were collected from diabetic patients who visited the endocrinology clinics at Fasa University of Medical Sciences. A structured questionnaire was administered to gather information on CAM use, including the types of CAM modalities used, and reasons for use. The patient's demographic and clinical characteristics, such as age, gender, duration of diabetes, glycosylated hemoglobin (HbA1c) levels, and quality of life (QoL) were also recorded. Descriptive statistics were used to determine the prevalence of CAM use, while logistic regression analysis was employed to identify factors associated with CAM use.

Results

A total of 376 diabetic patients participated in the study, with more than 89% reporting CAM use within the past year. Herbal preparations were the most commonly used type of CAM, with a prevalence rate of 99.4%. Factors associated with CAM use included patients' psychological health, attitude towards the safety of CAM, belief in the synergistic effects of combining routine medications with CAM, and previous positive experiences with CAM.

Conclusion

The high prevalence of CAM use highlights the importance of considering it in diabetes management and the need for healthcare professionals' engagement in open discussions with patients about their CAM practices. Understanding the factors influencing CAM use can inform healthcare providers and policymakers in developing appropriate strategies for integrating CAM approaches into conventional diabetes care.

Interactions between local medical systems and the biomedical system: a conceptual and methodological review in light of hybridization subprocesses

Local medical systems (LMSs) are complex and dynamic, encompassing local perceptions of diseases, prevention and treatment strategies, and evaluations of therapeutic responses. These systems are not isolated and interact with other medical systems, such as the biomedical system. The interaction between these systems creates a "contact zone", which some authors refer to as intermedicality, involving both competitive and complementary interactions. However, there is limited discussion in the literature regarding the complexity of these interactions. Some studies seek to understand this interaction through the lens of hybridization, a concept introduced to ethnobiology by Ana Ladio and Ulysses Albuquerque. The authors conceptualize hybridization as "discrete structures and practices coming together to form a new practice not necessarily implying homogenization." They discuss hybridization in the context of medicinal plants used in urban settings and propose seven hybridization subprocesses to gain a deeper understanding of this phenomenon. In this study, we update these hybridization subprocesses, expanding the concepts to comprehend the specific interaction of resources from LMS and biomedical systems known and used by different human groups. In this context, we propose a new subprocess and have made adjustments to the existing subprocesses to encompass the diversity of possible interactions between medicinal plants and pharmaceuticals, providing evidence from the literature demonstrating interactions that can be classified within the proposed subprocesses. Furthermore, we discuss, from a theoretical standpoint, how these subprocesses may have implications for the resilience of medical systems. Moreover, we propose a flowchart that can be utilized to identify these hybridization subprocesses in intermedicality contexts in future studies. These classifications are crucial because they enable us to comprehend the complexity of interactions between medicinal plants and pharmaceuticals, as well as the impacts that these different interactions can have on the resilience of LMSs.

A descriptive survey study in endocrinology clinic: evaluation of the use of natural products

OBJECTIVE

The use of herbal products/dietary supplements (HP/DS) in endocrinal chronic diseases is growing. However, no studies have evaluated their use in patients who present to endocrinology and metabolic diseases clinics. This descriptive study aims to investigate the rate of HP/DS use and the factors affecting this in patients who presented to Karadeniz Technical University (KTU) Farabi Hospital Endocrinology and Metabolic Diseases Clinic, Türkiye between 01.11.2021 and 01.05.2022.

METHODS

Five hundred six questionnaires with acceptable data quality were included this investigation. The data were analyzed on SPSS version 23.0 software. The factors with the greatest effect on the use of HP/DS were determined using binary logistic regression analysis.

RESULTS

Analysis showed that 49.4% of the participants used HP/DS. The main factors affecting the use of herbal products were age, diagnosis of the disease, and treatment compliance problems. The most frequently used products were lemon, cinnamon, black cumin, ginger, turmeric, and dill. The participants main sources of information about HP/DS were friends/relatives, the internet/social media, and television, respectively. 74.8% of the participants using HP/DS did not inform their physcisian/pharmacist about such use, although 81.8% of these nevertheless wished to receive information from these occupational groups.

CONCLUSION

Herbal product monitoring in patients should be performed in collaboration with pharmacists, herbal product use should be investigated, and counseling services should be made available in order to maintain and promote public health.

In vitro and in vivo assessment of the anti-inflammatory activity of olive leaf extract in rats

Inflammation is a complex and crucial process that protects the body against pathogens. Here in our study, we propose to scientifically justify the anti-inflammatory activity of olive leaf (OL). Initially, we ensured the safety of olive leaf extract (OLE) through acute oral administration of graded doses up to 4 g\kg in Wistar rats. Thus, the extract was considered generally safe. We also evaluated the ability of the extract to reduce carrageenan-induced rat paw edema. Compared to diclofenac sodium (10 mg/kg PO), OLE showed significant (P < 0.05) anti-inflammatory activity, showing the maximum inhibition percentage at the fifth hour of measurement at 42.31% and 46.99%, at doses of 200 and 400 m/kg, respectively, compared to 63.81% for the standard drug. To elucidate the potential mechanism, we measured TNF, IL-1, COX-2 and NO inside the paw tissue. Interestingly, OLE at all tested doses reduced the concentration of TNF and IL-1 to a level that was lower than that obtained by the standard drug. Additionally, OLE at the dose of 400 mg/kg reduced the levels of COX-2 and NO inside the paw tissue to a level that was statistically equivalent to the level observed in the normal control group. Finally, olive leaf extract at doses of 100, 200 and 400 mg/kg doses significantly (P < 0.05) inhibited the heat-induced hemolysis of RBCs membrane by 25.62, 57.40 and 73.88%, respectively, compared to 83.89% produced by aspirin. Consequently, we concluded that olive leaf extract has a significant anti-inflammatory activity through the reduction of TNF, IL-1, COX-2 and NO.

Commiphora myrrha stimulates insulin secretion from β-cells through activation of atypical protein kinase C and mitogen-activated protein kinase

ETHNOPHARMACOLOGICAL RELEVANCE

Ayurvedic medicine has been used in the treatment of diabetes mellitus for centuries. In Arabia and some areas of Africa, Commiphora myrrha (CM) has been extensively used as a plant-based remedy. We have previously shown that an aqueous CM resin solution directly stimulates insulin secretion from MIN6 cells, a mouse β-cell line, and isolated mouse and human islets. However, the signaling pathways involved in CM-induced insulin secretion are completely unknown. Insulin secretion is normally triggered by elevations in intracellular Ca²⁺ ([Ca²⁺]_i) through voltage gated Ca²⁺ channels (VGCC) and activation of protein kinases. Protein and lipid kinases such as protein kinase A (PKA), Ca²⁺-calmodulin dependent protein kinase II (CaMKII), phosphoinositide 3-kinases (PI3Ks), protein kinase C (PKC) and mitogen-activated protein kinase (MAPK), specifically extracellular signal-regulated kinases (ERK1/2), may be involved in receptor-operated insulin secretion. Therefore, we hypothesized that CM may induce insulin secretion by modulating the activity of VGCC and/or one or more of the above kinases.

AIM OF THE STUDY

To investigate the possible molecular mechanism of action of CM-induced insulin secretion. The effects of aqueous CM resin extract on [Ca²⁺]_i and protein kinase activation from β-cells were examined.

METHODS

The effect of aqueous CM resin solution on [Ca²⁺]_i was assessed using Ca²⁺ microfluorimetry. The involvement of VGCC in CM-induced insulin secretion was investigated using static and perifusion insulin secretion experiments in the presence of either EGTA, a Ca²⁺ chelator, or nifedipine, a blocker of VGCC. The involvement of kinase activation in the stimulatory effect of CM on insulin secretion was examined by using static and perifusion insulin secretion experiments in the presence of known pharmacological inhibitors and/or downregulation of specific kinases. The effects of CM on phosphorylation of PKCζ and ERK1/2 were also assessed using the Wes™ capillary-based protein electrophoresis.

RESULTS

Ca²⁺ microfluorimetry measurements showed that exposing MIN6 cells to CM (0.5-2 mg/mL) was not associated with changes in [Ca²⁺]_i. Similarly, incubating MIN6 cells and mouse islets with EGTA and nifedipine, respectively, did not attenuate the insulin secretion induced by CM. However, incubating mouse and human islets with CM in the presence of staurosporine, a non-selective protein kinase inhibitor, completely blocked the effect of CM on insulin secretion. Exposing mouse islets to CM in the presence of H89, KN62 and LY294002, inhibitors of PKA, CaMKII and PI3K, respectively, did not reduce CM-induced insulin secretion. However, incubating mouse and human islets with CM in the presence of Ro 31-8220, a pan-PKC inhibitor, diminished insulin secretion stimulated by CM, whereas inhibiting the action of typical PKC (with Go6976) and PLCβ (with U73122) did not affect CM-stimulated insulin secretion. Similarly, downregulating typical and novel PKC by chronic exposure of mouse islets to phorbol 12-myristate 13-acetate (PMA) was also not associated with a decrease in the stimulatory effect of CM on insulin secretion. Interestingly, CM-induced insulin secretion from mouse islets was inhibited in the presence of the PKCζ inhibitor ZIP and a MAPK inhibitor PD 98059. In addition, Wes™ capillary-based protein electrophoresis indicated that expression of the phosphorylated forms of PKCζ and ERK1/2, a MAPK, was significantly increased following exposure of INS-1832/13 cells, a rat insulinoma cell line, to CM.

CONCLUSIONS

Our data indicate that CM directly stimulates insulin secretion through activating known downstream effectors of insulin-stimulus secretion coupling. Indeed, the increase in insulin secretion seen with CM is independent of changes in [Ca²⁺]_i and does not involve activation of VGCC. Instead, the CM stimulatory effect on insulin secretion is completely dependent on protein kinase activation. Our findings indicate that CM could induce insulin exocytosis by stimulating the phosphorylation and activation of PKCζ, which in turn phosphorylates and activates ERK1/2.

Habits, Traditions, and Beliefs Associated With the Use of Complementary and Alternative Medicine Among Diabetic Patients in Al-Qassim Region, Saudi Arabia

Background Since diabetes mellitus (DM) affects every aspect of a person's being, more and more people are using complementary and alternative therapies such as ingesting ginger and cinnamon in addition to conventional medical care and lifestyle changes to manage their condition and enhance their well-being. Although this population uses complementary and alternative medicine (CAM) at a high rate, it is unclear what causes this use. Objective We aim to know the habits, traditions, and beliefs associated with the use of complementary and alternative medicine among type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients in the Al-Qassim region of Saudi Arabia. Methods This is an observational cross-sectional study conducted among diabetes patients in Al-Qassim, Saudi Arabia, in 2022. Participants were selected via a non-probability sampling technique. Patients were interviewed in the diabetic clinics using validated questionnaires. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY, USA). Results A total of 444 validated responses were received in this study. The average age was 50 ± 16.9 years, and females represented the highest proportion (58.6%). Moreover, we found that most of the participants had type 2 diabetes (79.1%) and 93 (20.9%) had type 1 diabetes. Hypertension was the most reported chronic disease. Our results revealed that the prevalence of CAM usage was 29.1%. Regarding the sources of information on herbal medicines, we found that more than half of the respondents (57.4%) obtained information from friends, relatives, and neighbors. Ginger, vitamins and minerals, and cinnamon were the most frequently used herbals among our participants. Our results found that 38% of CAM users used herbal products on a regular basis. As regards the frequency of using herbal products, 29.5% of the respondents used herbal medicine weekly and 21.7% used it daily. In addition, we found that gender, marital status, and monthly income were significantly associated with the use of CAM (P value = 0.008, 0.011, and 0.011, respectively). The significantly higher CAM use was associated with females, married participants, and participants with a monthly income of 10,000-15,000 Saudi riyal (SAR). Conclusion According to our research, CAM use among diabetes patients in the Al-Qassim region was found to be relatively common. The prevalence of type 2 diabetes mellitus was higher (79.1%) in comparison to type 1 diabetes mellitus (20.9%). Also, the most commonly used herb was ginger (47.66%), followed by vitamins and minerals (44.53%), and cinnamon (42.19%). Patients with diabetes need to be informed of the significance of telling their doctors about their use of CAM.

Systematic review on chronic non-communicable disease in disaster settings

BACKGROUND

Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment.

METHODS

A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769).

RESULTS

Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity.

CONCLUSIONS

An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.

Investigation of the Effects of Complementary and Alternative Therapy Usage on Physical Activity and Self-Care in Individuals Diagnosed With Type 2 Diabetes

This study was carried out to investigate the effect of complementary and alternative therapy on physical activity and self-care power in individuals diagnosed with type 2 diabetes. The study was conducted on 63 individuals who had been diagnosed with type 2 diabetes for at least 6 months, and met the inclusion criteria. The Personal Information Form, International Physical Activity Questionnaire Short Form, and Diabetes Self-Care Scale were used to collect the data. Percentage, median, Mann-Whitney U tests, and Wilcoxon tests were used for data analysis. While 71.9% of the individuals were only on diabetic diet, 58% of the individuals were on diabetic diet together with complementary and alternative medicine (CAM) methods, and all those patients regularly measured their blood glucose levels; 19.4% of the individuals on both diabetic diet and CAM methods, and 21.9% of the individuals only on diabetic diet used more than one oral medication per day. The findings of this study revealed that 35.5% of the individuals both on diabetic diet and CAM methods and 40.6% of the individuals only on diabetic diet used insulin. The individuals who were both on diabetic diet and CAM methods stated that their health statuses improved in the previous month; however, the individuals who were only on diabetic diet did not report any improvement in that period. Physical activity levels and self-care behaviors of the individuals on diabetic diet and CAM methods together were found to be significantly better than those who were only on a diabetic diet. A positive relationship was found between physical activity level and self-care behaviors.

Complementary and alternative medicine use and its associated factors among hypertensive patients in Debre Tabor General Hospital, Ethiopia

BACKGROUND

Hypertensive patients have been using complementary and alternative medicine (CAM) to meet their primary healthcare needs within Ethiopia. The use of plant-based medicine is not only common rather it is also a culturally accredited practice, among the people of Ethiopia. However, studies conducted on the prevalence and correlates of herbal medicine (HM) use among hypertensive patients are lacking. Thus, this study aimed to assess CAM use and its associated factors among hypertensive patients.

METHODS

An institutional-based cross-sectional study was conducted on 450 hypertensive patients, visiting the hypertensive care service of Debre Tabor General Hospital from November 1 to December 28, 2020. Interview-guided self-administered questionnaires were used for data collection. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used for data analysis. Univariate and multivariate logistic regression was computed to identify associated factors of CAM use (age, sex, religion, residence, marital status, educational level, monthly income, presence of HTN complication, duration of HTN, and family history of HTN).

RESULTS

Out of the 450 hypertensive patients, 275 (67.8%) participants used complementary and alternative medicine. Herbal medicines used among hypertensive patients were M. stenoptela 105 (62.9%), O. lamiifolium 81 (48.5%), C. aurea 62 (37.1%), R. nepalensis 44 (26.3%), M. piperata 36 (21.6%), H. abyssinica 24 (14.4%), T. schimperi 19 (11.4%), R. abyssinicus 15 (9.0%), and T. foenumgraecum 9 (5.4%). Majority of CAM users 202 (73.5) did not discuss with health professionals about their CAM use. Families and friends 91 (33.1%) were the frontline source of information about CAM use. In a multivariate analysis, female gender patients over 45 years old, rural residence, higher educational level, high average monthly income, presence of complications, greater than 5 years duration of hypertension (HTN), and having a family history of HTN were the independent predictors of CAM use.

CONCLUSION

The prevalence of CAM use among hypertensive patients was high 275 (67.8%). Factors associated with CAM use are similar to those observed in previous studies, but further research is required to further clarify the opportunities and challenges correlated to CAM use in Ethiopia.

Complementary and alternative medicine use among pediatrics in Palestine: a cross-sectional study

BACKGROUND

Recent use of complementary and alternative medicine (CAM) is growing in children worldwide, so there is a need to evaluate CAM's use among pediatrics in Palestine. This study aimed to estimate the prevalence of CAM use among a sample of Palestinian children, investigate the factors that affect the use of CAMs, identify the types of CAM used, and assess the purposes of using them.

METHODS

A cross-sectional descriptive study of parents who had children aged 6 years and below was carried out. A convenient sample of about 420 participants was collected; from Primary care to Motherhood and Childhood Centers in Nablus city in Palestine. Parents who agreed to participate were asked to answer a survey that consists mainly of closed-ended questions. The analysis was performed using SPSS version 16.0.

RESULTS

The use of CAM was detected in all interviewers 420 (100%). The most common treatment used was herbal therapy (n = 400, 95.2%), and anise was the most common herbal therapy used (n = 334; 79.5%). A total of 371 (88.3%) of the respondents used CAM for digestive system problems. The main reason for using CAM was making the child more comfortable (n = 365; 86.9%). Parents who are 30 years or older were significantly using more CAM than younger parents (P = 0.001). In addition, regarding the number of children in the family, parents who have five children or more used more CAM subtypes significantly more than parents with less than this number (P = 0.025). Moreover, parents living in a refugee camp used more CAM than parents who lived in urban or rural areas (P = 0.031).

CONCLUSIONS

Parents of children use CAM frequently. All parents used CAM, and physicians were not mainly among the sources of CAM information, and almost all parents were unaware of the side effects of CAM. Future research is necessary to direct pediatricians in formulating recommendations for children on CAM modalities, including possible risks and benefits and interactions with conventional medications.

Prevalence and associated factors of herbal medicine use among adult diabetes mellitus patients at government hospital, Ethiopia: An institutional-based cross-sectional study

BACKGROUND

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Thus, this study aimed to assess the prevalence and factors associated with HM use among DM patients.

METHODS

A hospital-based cross-sectional study was conducted on 395 diabetic patients visiting the diabetes care service of Debre Tabor General Hospitalfrom August 1 to September 28, 2020. Interview guided self-administered questionnaire was used for data collection.

RESULTS

Out of 395 diabetic patients, 231(58.5%) participants were used herbal medicine. The most dominant herbal products used were M.stenoptela (53.2%), N. sativa (42.0%), Z. officinale (32.5%), A. sativum (20.8%), A. vera (13.4%), P.gracilis(10.4%), T.schimperi(7.5%), V. amygdalina (5.2%), T. foenumgraecum(3.5%),and D.penninervum(2.2%).The odds of HM use in female participants were 1.98 times (AOR=1.98, 95% CI=1.72, 3.25) higher compared to male participants. The odds of HM use among participants who develop DM complications were 1.77 times (AOR=1.77, 95% CI=1.03, 2.83) higher than in participants without DM complications. The odds of HM use among participants with a family history of DM were 2.89 times (AOR=2.89, 95% CI=1.42, 3.19) higher than in participants without a family history of DM.

CONCLUSION

The prevalence of herbal medicine use among diabetic patients was high. Educational level, gender, residence, educational level, duration of DM, presence of DM complication, and family history of DMwere the independent predictors' of HM use.

Global prevalence and types of complementary and alternative medicines use amongst adults with diabetes: systematic review and meta-analysis

AIM

This study aimed to undertake a systematic review and meta-analysis of global prevalence and types of complementary and alternative medicine (CAM) use amongst adults with diabetes.

METHODS

Nine databases, including MEDLINE and EMBASE, were searched for studies published between 2009 and 2019 which included extractable data for CAM use in adult patients with diabetes. Study characteristics, types of CAM, and overall and subgroup prevalence data in relation to CAM use were extracted. Meta-analysis of aggregate level data on prevalence and prevalence ratios (PRs) was performed using a random effects model.

RESULTS

From the 38 studies included in the review, a total of 37 types of CAM and 223 types of herbs were identified. Pooled prevalence of CAM use was 51%. A wide variation in prevalence rates (predictive interval 8-93%) was observed. In the context of high heterogeneity, we found no evidence that CAM use was associated with gender, chronicity or type of diabetes. Approximately one third of patients did not disclose their use of CAM to healthcare professionals (95% PrI 25%, 97%). Herbal medicines, acupuncture, homoeopathy and spiritual healing were the common CAM types reported.

CONCLUSIONS

A wide variation in prevalence of CAM use by patients with diabetes was identified. Healthcare professionals should be aware of their patients' use of CAM to ensure treatment optimization, avoid herb-drug interactions and promote medication adherence in diabetes. Diabetic reviews and clinical guidelines should incorporate exploration of patient use of CAM as many patients do not proactively disclose the use of CAM to their healthcare professionals.

REGISTRATION

The protocol for this study was registered with the Centre for Review and Dissemination (CRD). Protocol registration number CRD42019125036.

Prevalence and correlates of complementary and alternative medicine use among diabetic patients in a resource-limited setting

BACKGROUND

The use of Complementary and Alternative Medicine (CAM) among diabetic patients is rising to manage diabetes mellitus (DM) and its complications. The burden of DM in developing countries coupled with a high prevalence of CAM use and its associated risks among diabetic patients. Therefore, this study aimed to assess the prevalence and predictors of CAM use among DM patients.

METHODS

Diabetic patients visiting the diabetic clinics of Debre Tabor governmental hospital were invited to participate in a cross-sectional study. Interview guided self-administered questionnaire was used for data collection. Descriptive statistics like, frequency, percentage, mean, standard deviation, and median were conducted for each of the questions entered in order to detect outliers and validate data entry. Independent sample 't' test and ANOVA were used to test continuous variables and Chi-square test was used to compare categorical variables. Univariate and multivariate logistic regression were computed to identify associated factors (sex, age, religion, marital status, residence, employment status, educational level, monthly income, duration of DM, presence of DM complication, and family history of DM) of CAM use.

RESULTS

Out of 422 diabetic patients invited to participate in this study, a total of 395 completed the survey questionnaire with a response rate of 93.6%. The use of CAM was reported by 73.7% of diabetic patients. Patients' average age was 48.7 ± 12.6 years, with 53.2% females and 52.4% married. The odds of CAM use among older diabetic patients were higher compared to younger diabetic patients (AOR: 1.92; CI: 1.75-3.17). Compared to not married, married diabetic patients had higher odds of using CAM (AOR: 2.01; CI: 1.36-4.25). The odds of CAM use among respondents who develop diabetic complications were higher than patients without diabetic complications (AOR: 1.94; CI: 1.50-4.36). The odds of CAM use among respondents with a family history of DM were higher than participants without a family history of DM (AOR: 2.53; CI: 1.27-2.75). Among CAM users, 54.3% used CAM as a complementary treatment along with conventional medicine. Traditional healers (38.8%) were the most frequently reported source of recommendation about CAM use. The majority of CAM users 172 (59.1%) didn't disclose CAM use for their health care professionals.

CONCLUSION

The prevalence of herbal medicine use among diabetic patients was high. Age, marital status, residence, family history of DM, presence of diabetic complications, and duration of DM were found to be strong predictors of CAM use among diabetic patients. A rigorous struggle by the government, healthcare professionals, and educational institutions is required to increase the safe use of CAM by diabetic patients and to integrate modern diabetic treatment modalities with CAM therapies.

The Prevalence of Complementary and Integrative Health Approach Use and Quality of Life Among Patients With Heart Failure: A Cross-sectional, Descriptive, and Comparative Study

This study aimed to determine the prevalence of complementary and integrative health approach (CIHA) use in patients with heart failure (HF) and compare quality of life (QoL) between CIHA users and nonusers. This was a cross-sectional, descriptive, and comparative study including 130 patients with HF in Turkey. The data were collected using the sociodemographic and CIHA information form and the Kansas City Cardiomyopathy Questionnaire (KCCQ). The mean age was 64.51 ± 10.40 years. Furthermore, 26.1% of the participants had used at least one form of CIHA in the previous year. The most used CIHA was herbal therapies (94.2%). The total scores of the KCCQ were 47.70 ± 9.50 in the study, and a statistically significant difference was found in the total scores of the KCCQ between CIHA users and nonusers. The findings of this study revealed that more than a quartile of patients with HF used at least one form of CIHA. Further prospective studies are warranted to follow up with patients having HF who use any form of CIHA for a longer period and determine other parameters that directly influence QoL.

A Review of the Phytochemistry, Traditional Uses and Biological Activities of the Essential Oils of Genus Teucrium

The genus Teucrium is a large and polymorphic genus of the Lamiaceae family distributed in mild climate zones, particularly in the Mediterranean basin and Central Asia. Studies of nonvolatile constituents of Teucrium species showed that they are a rich source of neo-clerodane diterpenoids, considered as chemotaxonomic markers of the genus. In addition to the nonvolatile metabolites, there has been a large interest in the essential oils of this genus. In this review, a complete survey of the chemical composition and biological properties of the essential oils isolated from Teucrium taxa is provided. In traditional medicine, since ancient times, species of this genus have been widely implemented for their biological properties, including antimicrobial, anti-inflammatory, antispasmodic, insecticidal, anti-malaria, etc. Therefore, a complete review of all of the traditional uses of Teucrium taxa are also reported.

Nigella Plants - Traditional Uses, Bioactive Phytoconstituents, Preclinical and Clinical Studies

Nigella is a small genus of the family Ranunculaceae, which includes some popular species due to their culinary and medicinal properties, especially in Eastern Europe, Middle East, Western, and Central Asia. Therefore, this review covers the traditional uses and phytochemical composition of Nigella and, in particular, Nigella sativa. The pharmacological studies reported in vitro, in vivo, and in humans have also been reviewed. One of the main strength of the use of Nigella is that the seeds are rich in the omega-6 fatty acid linoleic acid and provide an extra-source of dietary phytochemicals, including the bioactive thymoquinone, and characteristics saponins, alkaloids, and flavonoids. Among Nigella species, N. sativa L. is the most studied plant from the genus. Due to the phytochemical composition and pharmacological properties, the seed and seed oil from this plant can be considered as good candidates to formulate functional ingredients on the basis of folklore and scientific knowledge. Nonetheless, the main limations are that more studies, especially, clinical trials are required to standardize the results, e.g. to establish active molecules, dosage, chemical profile, long-term effects and impact of cooking/incorporation into foods.

The use of complementary and alternative medicine during pregnancy: a cross-sectional study from Palestine

BACKGROUND

The use of complementary and alternative medicine (CAM) is increasing worldwide. To the best of knowledge, there is a lack of studies that assess CAM use by Palestinian women during pregnancy. This research aims to determine the prevalence of Palestinian women's use of CAM during pregnancy, the most frequently used CAM products during the pregnancy period, the main sources that encourage the use of CAM among pregnant women, and the causes of CAM use.

METHODS

A descriptive, cross-sectional study was conducted in Palestine using a questionnaire from April 2018 to March 2019. The samples were selected by convenience sampling, including currently pregnant or previously pregnant women in the Obstetrics and Gynecology (OBGYN) clinic at Rafedia Hospital and in primary health care clinics in Nablus city-Palestine. The questionnaire covered socio-demographic variables, health status, types and frequency of CAM used, patients' sources of information, causes of their usage, attitudes, and beliefs.

RESULTS

Four hundred currently or previously pregnant women participated. Three hundred fifty-five (91.5%) used at least one method of CAM during pregnancy. Most women used at least one method of biologically-based therapies during pregnancy (87.7%). One hundred and one pregnant women (26.7%) utilised at least one type of herb during pregnancy. The most-reported herb used by 12.3% of participants was anise. Of the mind-body therapies, prayer was the most commonly used method during pregnancy (8.3%). Two hundred and sixty-one (65.3%) participants used CAM because they believed CAM was not harmful to them or their babies during pregnancy. Participants gained most of their information about CAM from their families (43.8%) and friends (24.3%). Approximately two-thirds of participants (64.0%) thought that obstetricians should be able to advise on commonly used CAM.

CONCLUSIONS

During pregnancy, CAM products are commonly used, and it is important to determine what types are being used by women in Palestine. These findings supplement the body of knowledge on the use of CAM by pregnant women. Pregnancy care providers need to be aware to the familiar types of CAM that women use.

Patterns and predictors of complementary and alternative medicine use in people presenting with the non-communicable disease in an urban health facility, North India

Background: The rising burden of non-communicable diseases (NCDs) is a threat to India. Increasingly, individuals interested in improving their health and making healthy lifestyle changes are turning to complementary and alternative medicine (CAM) as a health-care option.

Design and Methods: The objective of this study was to determine the prevalence, pattern, and predictor of alternative medicine use among NCDs patients undergoing allopathic treatment in an urban health centre. The study design was a hospital-based crosssectional study, which was done in a government hospital, Srinagar, Pauri District, Uttarakhand, India among adult males and females aged above 20 years. The patients having NCDs were systematically sampled.

Result: Among 233 studied patients 57.1% were males. The mean age of the patients was 55.8 years (SD 13.5). Of the total studied patients 46.8% were diagnosed with DM, and 43.8% of HTN. Nearly one-fifth of the patients were known to have a CVD or COPD. A total of 49.8% of the studied NCD patients reported use of both allopathic and alternative medicine treatment and nearly 3.4% of the studied NCD patients in the last one year to seek exclusive alternative medicine treatment. The overall use of exclusive alternative medicine was low that is 3.7%, 1.0%, and 5% in diabetes, hypertension, and chronic lung disease patients, respectively. The most common form of alternative medicine used by studied patients was medicinal herbs/biological-based medicine (MB) (62.9%). Among MB commonly used were a bitter gourd, aloe vera, and others. 29.8% of the patients used Indian/Ayurveda medicine in total.

Conclusions: The use of exclusive alternative medicine is low in adult patients with NCD. However, medical pluralism is prevalent. A better understanding of practices especially that focuses on alternative medicine needs a qualitative study, which was beyond the scope of this study.

Middle East Medicinal Plants in the Treatment of Diabetes: A Review

Diabetes is a global health problem, and the number of diabetic patients is in continuous rise. Conventional antidiabetic therapies are associated with high costs and limited efficiency. The use of traditional medicine and plant extracts to treat diabetes is gaining high popularity in many countries. Countries in the Middle East region have a long history of using herbal medicine to treat different diseases, including diabetes. In this review, we compiled and summarized all the in vivo and in vitro studies conducted for plants with potential antidiabetic activity in the Middle East region. Plants of the Asteraceae and Lamiaceae families are the most investigated. It is hoped that this review will contribute scientifically to evidence the ethnobotanical use of medicinal plants as antidiabetic agents. Work has to be done to define tagetes, mechanism of action and the compound responsible for activity. In addition, safety and pharmacokinetic parameters should be investigated.

Commiphora myrrha stimulates insulin secretion from mouse and human islets of Langerhans

ETHNOPHARMACOLOGICAL RELEVANCE

Traditionally plant-based remedies such as Commiphora myrrha (CM) have been used as an ayurvedic medicine to treat diabetes mellitus in some region of Arabia and Africa. Previous reports have shown that CM reduced blood glucose levels and increased insulin concentrations in animal models of diabetes in vivo. However, the exact mechanisms by which CM improved glycemic control in these animals are not fully understood. We hypothesized that CM may have a direct insulinotropic activity on β-cells to increase insulin secretion.

AIM OF THE STUDY

The direct effects of CM were investigated using MIN6 β-cells and isolated mouse and human islets in static and perifusion insulin secretion experiments. Isolated mouse and human islets were used to investigate the rate and pattern of CM-induced insulin secretion.

MATERIALS AND METHODS

The effect of CM on insulin secretion was assessed by static and perifusion experiments using MIN6 cells, a mouse-derived β-cell line, and primary mouse and human islets. The effects of CM on cell viability and membrane integrity of MIN6 cells and mouse islets were assessed using an ATP viability assay and a trypan blue exclusion test. The mRNA expression profiles of preproinsulin and Pdx1, a major β-cell transcription factor, were determined by quantitative RT-PCR following chronic exposure to CM.

RESULTS

Exposing MIN6 cells to a CM resin solution (0.5-10 mg/ml) caused a concentration-dependent increase in insulin secretion in a static setting. Similarly, incubating mouse islets to CM (0.1-10 mg/ml) resulted in stimulation of insulin secretion in a concentration-dependent manner. CM concentrations at ≤ 2 mg/ml were not associated with reduction in cell viability nor with reduction in cell membrane integrity. However, higher concentrations of CM were accompanied with marked uptake of trypan blue dye and cell death. In a perifusion setting, CM (2 mg/ml) caused rapid and reversible increases in insulin secretion from both mouse and human islets at both sub-stimulatory and stimulatory glucose levels. The stimulatory effect of CM on insulin secretion did not change the total insulin content of β-cells nor the mRNA expression of preproinsulin and Pdx1.

CONCLUSIONS

These data indicate that aqueous CM resin solution has a direct stimulatory effect on β-cells without compromising plasma membrane integrity. CM stimulates insulin secretion from MIN6 cells, a mouse-derived β-cell line, and isolated primary mouse and human islets in vitro at both sub-stimulatory and stimulatory glucose concentrations. The mechanism by which CM may induce insulin secretion is most likely due to a stimulation of insulin granules release rather than insulin synthesis.

Use of complementary and alternative therapies by patients with eye diseases: a hospital-based cross-sectional study from Palestine

BACKGROUND

Generally, complementary and alternative therapies (CAT) are accepted methods of treatment by patients with various types of conditions. Their use is becoming especially prevalent among patients with eye problems even in developed countries. Thus, we aimed to determine the pattern of use of CAT in this patient population, to identify the patient characteristics associated with the use of CAT, and to assess the types of CAT used.

METHODS

A descriptive, cross-sectional study was conducted in Palestine at An-Najah National University Hospital between the time periods of October 2019 to May 2020, using questionnaire-based face to face interviews. Data were collected through convenience sampling. Patients responded to the questionnaire, which was focused on information adapted from previous research in this area, covering socio-demographic and clinical characteristics, types of CAT, source of information, and side effects on CAT use.

RESULTS

A total of 86 patients were interviewed for our study. Over two thirds, 67% reported using CAT for the specific purpose of improving their eye condition, and about one third (29.1%) received more than one therapy. The most common therapies reported were duea' (i.e. supplication) (47.1%) and herbal therapies (24.1%). It was shown that patients with bilateral involvement of their eyes were almost twice more likely to describe using CAT than patients with unilateral eye pathology (p = 0.006). Also, patients who underwent surgery as their route of treatment were significantly less likely to use CAT (p = 0.043). Most of our study participants mentioned a non-physician source as their source of information regarding CAT with family members being the most frequently mentioned (30.2%) followed by the internet (25.6%) and friends (19.8%).

CONCLUSIONS

The prevalence of CAT use among patients with eye disease is somewhat high in our study population. Because CAT may trigger adverse reactions, influence the progression of the disease, and interfere with conventional treatment, the ophthalmologist should frequently be asked patients with such diagnostics regarding the use of these therapies. Further work is required to analyze the mechanisms of action and to establish realistic guidelines for the use of these modalities.

Complementary and alternative medicine use in coronary heart disease patients: a cross-sectional study from Palestine

BACKGROUND

There is a lack of data on the use of complementary and alternative medicine (CAM) in patients with coronary heart disease (CHD). This study examined the use of CAM among patients with CHD, the reasons and factors influencing their use, the types of CAM used, and the relationship between patient's demographics and the use of CAM.

METHODS

In order to determine the prevalence and usage of CAM among Palestinian patients with CHD, a cross-sectional descriptive study was performed from three different hospitals. Using a convenient sampling method, a questionnaire was completed in a face-to-face interview with the patients. Descriptive statistics were used for socio-demographic, and clinical variables. Siahpush scale was used to examine the attitude of CHD patients toward CAM use.

RESULTS

Of the 150 patients that were interviewed, 128 (85.3%) of the patients completed the questionnaire. The majority of CAM users reported CAM use for health problems other than CHD, while a total of 59 (45.9%) patients have used CAM for their heart problems. On the other hand, it was found that the place of residency and pattern of CHD were significantly associated with CAM use (p = 0.039 and 0.044, respectively). In addition, religious practices were found to be the most common form of CAM used by patients, while body and traditional alternative methods were the least being used. A significant association between the attitudes of patients with CHD and their use of CAM was found (patients' attitudes towards alternative medicine and natural remedies were p = 0.011 and 0.044, respectively).

CONCLUSIONS

CAM use among our respondents is common. Despite a lack of evidence-based research supporting its potential benefits and side effects. Understanding the factors that affect CAM use by CHD patients offers healthcare workers and policymakers an opportunity to better understand CAM use and ultimately improve patient-physician interactions.

Integrating Traditional and Complementary Medicine Recommendations into Clinical Practice Guidelines for People with Diabetes in Need of Palliative and End-of-Life Care: A Scoping Review

Objectives: This study was conducted before an evidence review on Traditional and Complementary Medicine (TCM) to update the clinical practice guidelines (CPGs): "Deciding palliative and end-of-life (P/EoL) care for people with diabetes." The aim was to frame the PICO (population/problems, interventions/comparisons, and outcomes), ascertain their importance, and identify other modifying factors for grading recommendations. Design: A systematic scoping review mapped information about diabetes P/EoL problems and outcomes, TCM use, provision, benefits and risks, and stakeholder preferences and values. Thirteen electronic databases were searched in 2017/18 until no new information was identified. Relevant data were extracted, rated for quality, directness, and relevance, and synthesized using triangulation methods. Excluded was diabetes prevention or treatment, as this is not an important P/EoL problem. Results: Of the 228 included articles, except for diabetes P/EoL problems, insufficient direct evidence led to data being extrapolated from either adults with diabetes or any P/EoL diagnosis. The findings affirmed that caring for people with diabetes in need of P/EoL care is complex due to multiple fluctuating needs that are influenced by the P/EoL trajectories (stable, unstable, deteriorating, terminal, or bereaved), multimorbidity, and difficult-to-manage chronic and acute problems. The only problem specific to diabetes P/EoL care, was unstable glycemia. Over 50 TCM interventions commonly used by patients and/or provided by services were identified, of which, many might simultaneously address multiple problems and 18 had been appraised in systematic reviews. Physical and psychologic symptom reliefs were most often evaluated; however, these were only one aspect of a "good death." Other important outcomes were the quality and location of care, personal agency, relationships, preparations for the dying process, spirituality, and affirmation of the whole person. Other important modifying factors included opportunity costs, affordability, availability, preferences, cultural appropriateness, and alignment with beliefs about the meaning of illness and death. Conclusions: There is a role for TCM in the multidisciplinary holistic P/EoL care of people with diabetes. Due to the paucity of evidence specific to this population, the generalizability of some of these results is broader and the updated CPG will also need to consider indirect evidence from other patient groups. Along with recommendations about indications for TCM use, the CGP should provide guidance on ceasing unnecessary interventions, reducing polypharmacy and managing unstable glycemia is required. Before ceasing a TCM, a broader risk-benefit analysis is recommended, as unlike many conventional therapies, there may be multiple benefits warranting its continuation.

Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship?

Background

Diabetes mellitus (DM) is a major public health problem and one of the most challenging diseases worldwide. According to the World Health Organization (WHO), the Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes in the Middle East and seventh highest globally. Some diabetic patients may prefer to use alternative approaches such as herbal remedies to control their blood glucose level and this study aims to assess the prevalence of herbal usage and to evaluate users’ and doctors’ knowledge, attitudes and beliefs about herbal medicine as well as the patient/doctor relationship in this regard.

Method

A cross-sectional survey was conducted in several hospitals and medical centres in Makkah, KSA, between January and March 2019. Around 289 type II diabetic patients and 105 doctors were interviewed.

Results

We found that 68% of the participants were frequent consumers of herbal remedies, especially cinnamon, ginger and fenugreek. Patients’ knowledge of herbal usage was mainly gleaned from family and friends as well as social media, and we found that many (71.4%) did not bother to consult or inform their doctors about their choice to self-medicate with herbs. Patients had no concerns regarding the efficacy and safety of herbal usage use in diabetes, as around half of the participants believe that herbal medicine is effective (54%) and safe (46%) for treating symptoms of diabetes. Two-thirds of the doctors (66%) routinely ask patients whether they use herbs for their condition. Although 25% of the doctors took a positive view of herbal medicine in relation to diabetes, others expressed concerns with the rise in herb use and want to see more attention paid to safety aspects.

Conclusion

The study concludes that herbal remedies are commonly used by diabetic patients and that a gap exists in the relationship between patients and doctors concerning the disclosure of herbal remedy use and views on its safety.

Use of complementary medicine among people with diabetes in eastern Turkey: A descriptive study

PURPOSE

To measure the frequency, type, purpose of complementary medicine (CM) use among people with diabetes mellitus.

MATERIALS AND METHODS

The population of this descriptive study consisted of the patients hospitalized in the endocrine clinic of a university hospital in Eastern Turkey who were diagnosed with diabetes. Data were collected from 316 patients.

RESULTS

43.0% of the patients were using CM, and 97.0% of those using CM tried herbal methods. The patients who had variable glycated haemoglobin values (60.3%) and those who had DM-related complications (60.3%) used CM more.

CONCLUSION

It was determined that CM usage was prevalent among the patients. The most frequently used CM method was herbal therapy. We found that the use of CM was more common in patients with poor metabolic control. Therefore, healthcare professionals must be assess use of CM and provide suitable counseling.

Use and acceptance of complementary and alternative medicine among medical students: a cross sectional study from Palestine

BACKGROUND

Teaching Complementary and alternative medicine (CAM) in medical schools is becoming prevalent worldwide. Few studies have been conducted to evaluate medical students' knowledge and attitude toward CAM. Therefore, this study was designed to assess CAM knowledge, attitudes, and beliefs among Palestinian medical students.

METHODS

This study was developed in a cross-sectional design. It targeted medical students at An-Najah National University, between January and April of 2018. We gathered the data from students using a questionnaire printed as a hard copy. Medical students of both sexes in their 4th, 5th, or 6th year of studies were included in the survey. The questionnaire consisted of 3 sections: demographic characteristics and detailed practices of the participants, their attitude and held beliefs towards CAM, and their knowledge on CAM. Mann-Whitney U Test and Kruskal-Wallis Test were used to test if there were differences between knowledge about CAM and the characteristics of the participants.

RESULTS

Of the 300 medical students who were offered the questionnaire, 251 students (43.8% male and 56.2% female) were included in the final analysis. Out of a maximum of 8 points, the mean knowledge score of the participants was 2.0 ± 1.6. The Kruskal-Wallis test showed a statistically significant difference in overall knowledge score among students of different year groups, with students at lower levels obtaining higher scores (P < 0.001). Additionally, the highest knowledge scores were found in students with low income, and students who came from the Palestinian refugee camps (P < 0.001). Students frequently recommended CAM modalities, with herbal medicine being the most recognized and used CAM modality and Ayurvedic medicine being the least recognized and recommended one. Social media was the most popular source of information about CAM, cited by 72.9% of the participants. Participants generally had a good attitude towards CAM but held varying beliefs about it.

CONCLUSIONS

In the current study, a knowledge gap regarding CAM was found among medical students in our sample, despite their good attitude towards the subject. Also, there was a general acceptance to include materials on CAM within the curriculum of medical students.

A randomized controlled clinical trial evaluating the effect of Trigonella foenum-graecum (fenugreek) versus glibenclamide in patients with diabetes

Background

Herbal medicines long have been used in the management of diabetes mellitus (DM).

Objective

This study was conducted to ascertain if fenugreek compared with glibenclamide had any impacts on controlling blood glucose in patients with uncontrolled type II DM on conventional therapy.

Methods

A total of 12 patients with uncontrolled DM and on metformin were recruited and divided into two groups. Patients in group 1 received 2 g fenugreek per day, whereas those in group 2 received glibenclamide 5 mg once daily. The impacts of fenugreek on the glycemic control and lipid profile were measured before initiation of the regimen and then after 12 weeks.

Results

Only 9 of the 12 study participants completed the study. Fenugreek at 2 g/day caused an insignificant drop in fasting blood glucose (P = 0.63), but the fasting insulin level increased significantly (P = 0.04). The ratio of high- to low-density lipoprotein was significantly decreased from before to after treatment (P = 0.006). Fenugreek did not cause any notable adverse impacts on hepatic and renal functions throughout the study.

Conclusion

Fenugreek could be used as adjuvant therapy to anti-diabetic drugs to control blood glucose, and further studies are needed.

Antiobesity and Antioxidant Potentials of Selected Palestinian Medicinal Plants

We evaluated the antioxidant and porcine pancreatic lipase inhibition (PPLI) activities of 90 plants extracts. The antioxidant activity was measured using the free-radical scavenging capacity (DPPH) and reducing power (RP) assays. The pancreatic lipase inhibition assay was used to determine the PPLI activity of plant extracts. Among the 90 plant extracts examined, 41.0 % crude extracts showed antilipase activity of more than 50%. The most active plants by means of IC₅₀ value were Camellia sinensis (0.5 mg/ml), Ceratonia siliqua (leaves) (0.8 mg/mL), Curcuma longa (0.8 mg/mL), Sarcopoterium spinosum (1.2 mg/mL), and Mentha spicata (1.2 mg/mL). The antioxidant activity of plant extracts using the DPPH and RP assays reveals comparable results. The most active antioxidant extracts using both assays were the leaves and fruit epicarp of Rhus coriaria, areal parts of Sarcopoterium spinosum, and leaves of Ceratonia siliqua. Our results suggest natural resources that possess strong antioxidant and pancreatic lipase inhibitory activities with potential applications in the treatment and prevention of obesity and overweight. The extracts of Camellia sinensis, Ceratonia siliqua, Curcuma longa, Sarcopoterium spinosum, and Mentha spicata were proved to have a great potential as antioxidants and antiobesity agents.

Anti-Lipase Potential of the Organic and Aqueous Extracts of Ten Traditional Edible and Medicinal Plants in Palestine; a Comparison Study with Orlistat

Background: Herbs have played a fundamental and essential role in the humans life since ancient times, especially those which are used as food and/or folk medicinedue to both their nutritive and curative properties.This study aimed to investigate new antilipase agents from tentraditional Palestinian edible and medicinal plants through inhibition of the absorption of dietary lipids. Methods: The anti-lipase activity for ten plants was evaluated and compared with the reference compound Orlistat by using the porcine pancreatic lipase inhibitory test which was conducted by using a UV-visible spectrophotometer. Results: The aqueous extracts of Vitis vinifera and Rhus coriaria had the highest antilipase effects with IC₅₀ values 14.13 and 19.95 mcg/mL, respectively. Meanwhile, the organic extract of Origanum dayi had an IC₅₀ value 18.62 mcg/mL. V. vinifera showed the highest porcine pancreatic lipase inhibitory effects when compared with Orlistat, which has an IC₅₀ value 12.38 mcg/mL. Conclusions: According to the obtained results, V. vinifera, R. coriaria, and O. dayi can be considered a natural inhibitors of the pancreatic lipase enzyme as well as new players in obesity treatment. In fact, these plants can be freely and safely consumed in a daily diet or can be prepared as nutraceutical formulations to treat or prevent of obesity.

Effects of selected Palestinian plants on the in vitro exsheathment of the third stage larvae of gastrointestinal nematodes

Background

Gastrointestinal parasites are one of the main restrictions to small ruminant production. Their pathological importance is primarily related to the major production losses, in quantity or quality, induced by the direct action of worms. Control of these parasites is based exclusively on the frequent use of anthelmintic drugs. However, the resistance to anthelmintics in worm populations after commercialisation of chemical drugs is now widespread. Therefore, there is a need to find new natural resources to ensure sustainable and effective treatment and control of these parasites. The aim of this study was to evaluate the anthelmintic activity, as minimum inhibitory concentration (IC₅₀ mg/mL), of different plant extracts using larval exsheathment inhibition assay using a two-species but steady population of parasitic nematodes (ca. 20% Teladorsagia circumcinta and 80% Trichostrongylus colubriformis).

Results

The study showed that the ethanolic extracts of 22 out of the 48 plant extracts, obtained from 46 plant species, have an inhibitory effect >50% (at concentrations of 100 mg/mL) on the third stage larvae (L3) of the nematodes exhibited the strongest inhibition activity (94%) with IC₅₀ of 0.02 mg/mL, where other members of the Rhamnaceae family have shown to possess strong anthelmintic activity (70–89%).

Conclusions

Plant extracts are potential rich resources of anthelmintics to combat helminthic diseases. Our results suggest that extracts from Rhamnus elaternus, Epilobium hirsutum, Leucaena leucocephala and Rhamnus palaestinus have promising anthelmintic activity, with potential applications in animal therapeutics and feed.

Knowledge, attitude, and beliefs toward traditional herbal medicine use among diabetics in Jeddah Saudi Arabia

Herbs have long been used in the treatment of diabetes. Therefore, a cross-sectional study of a random sample of diabetic patients was conducted to assess their knowledge, attitude, and beliefs about the use of herbs to control diabetes. Approximately 64% of the patients had previously used herbs for controlling diabetes; 27%, 20.3%, 15.2%, and 10.8% used myrrh, black seeds, fenugreek, and aloe, respectively. Approximately 55.1% patients preferred using herbs to prescription drugs, while 75.2% used herbs with the prescribed medications. Only 38.3% patients informed their doctors about using herbs. Moreover, 54.2% of respondents experienced no side effects using herbs, and 64.5% noticed an improvement in blood sugar level while using herbs. No significant relationship between demographic characteristics and herbal medicine use was found. In conclusion, most diabetic patients exhibited low knowledge, attitude, and beliefs regarding herbal use. Therefore, the development of an awareness program is needed to improve these factors.

Community pharmacists' knowledge, practices and beliefs about complementary and alternative medicine in Palestine: a cross-sectional study

BACKGROUND

Complementary and alternative medicine (CAM) utilization is dramatically increasing among patients. As community pharmacies are a major provider of CAM products, community pharmacists need to have the sufficient knowledge and information to advice their patients, answer their inquiries and to be proactive in the healthcare process to ensure optimal therapy outputs and minimize both drug-drug and drug-herb interactions. Therefore, the main objective of this study was to assess the knowledge, beliefs, and practices of community pharmacists in Palestine about CAM.

METHODS

The study was conducted in a cross-sectional design in which a questionnaire was administered on a sample of licensed community pharmacists from Palestine. The questionnaire was of 5 sections: demographic and practice details of the participants, practice, beliefs, and knowledge about CAM. Mann-Whitney-U or Kruskal-Wallis tests were used to comparison of different issues as appropriate. P-values of <0.05 were considered significant.

RESULTS

A total of 284 community pharmacists were surveyed, however, 281 were included in the analysis as they met inclusion criteria. Out of the 281, 149 (53.0%) of the participants were males and the rest were females. About 40% of the participants were between 20 to 29 years old. Pharmacists frequently recommended CAM modalities. Exercises (84.0%) and food supplements (82.6%) were the most commonly recommended modalities. In the last year, vitamin B₁₂ was the most frequently prescribed supplement. The median knowledge score was 5 out of 8 and the median beliefs about CAM score was 4.0 out of 7.0.

CONCLUSIONS

CAM recommendations by pharmacists appear to be commonplace. Although their knowledge scores were fair to average, pharmacists still need more education and training about CAM in order to be more qualified to provide better pharmaceutical care and improve their patient's outcome.

Ethnopharmacological survey of home remedies used for treatment of hair and scalp and their methods of preparation in the West Bank-Palestine

Background

Natural products have many uses and purposes, including those linked to pharmaceutics and cosmetics. The aim of this study was to investigate the use of natural remedies for the treatment of hair and scalp disorders in the West Bank, Palestine.

Methods

An ethnopharmacological survey of herbal remedies and other natural products used in cosmetics and cosmeceuticals was carried out in the West Bank, Palestine. A questionnaire was distributed to 267 herbalists, traditional healers, hairdressers and rural dwellers. Collected information included: the names of plants and other natural products, the parts used, hair conditions, diseases and problems for which these products were used and also their methods of preparation. To identify the most important species used, the factor of informant’s consensus (F_ic), fidelity level (Fl) and the use-value (UV) were calculated.

Results

Collected data showed that 41 plants are utilized for the treatment of hair and scalp disorders, belonging to 27 families; among them Lamiaceae and Rosaceae, which were the most commonly used. Plant oils and their fruits are the most commonly used parts. Hair loss, dandruff, split hair endings and lice treatment, are reported as the most treated disorders. The number of plant species used consisted of 19, 14, 13, and again 13 with a factor of informant’s consensus (Fic) for these disorders corresponding to 0.93, 0.94, 0.95 and 0.92, respectively. Fl was 100% for many plants; the highest UV value (0.84) was registered for Lawsonia inermis, which belongs to the Lythraceae family.

Conclusions

This study showed that many natural remedies are still used in Palestine for the treatment of scalp and hair disorders as well as for cosmeceutical purposes. This study is of great importance as it allows us to have a greater perspective on our folkloric use of these natural products. A combined scientific effort between informants and the scientific community, working in this field, may help in the discovery of new cosmetics, cosmeceutical and nutraceutical products.

Complementary and alternative medicine use by diabetes patients in Kerala, India

The study assessed: (1) the prevalence of exclusive use of complementary and alternative medicine (CAM), exclusive use of modern medicine and combined use; (2) the factors associated with exclusive CAM use; and (3) the expenditure for CAM use among type-2 diabetes patients in rural Kerala. We surveyed 400 diabetes patients selected by multi-stage cluster sampling. Exclusive CAM use was reported by 9%, exclusive modern medicine by 61% and combined use by 30%. Patients without any co-morbidity were four times, those having regular income were three times and those who reported regular exercise were three times more likely to use exclusive CAM compared with their counterparts. Expense for medicines was not significantly different for CAM compared with modern medicine both in government and private sector. Patients with any co-morbidity were less likely to use CAM indicating that CAM use was limited to milder cases of diabetes.

Chemical characterisation and the anti-inflammatory, anti-angiogenic and antibacterial properties of date fruit (Phoenix dactylifera L.)

ETHNOPHARMACOLOGICAL RELEVANCE

Date fruit, Phoenix dactylifera L. has traditionally been used as a medicine in many cultures for the treatment of a range of ailments such as stomach and intestinal disorders, fever, oedema, bronchitis and wound healing.

AIM OF THE REVIEW

The present review aims to summarise the traditional use and application of P. dactylifera date fruit in different ethnomedical systems, additionally the botany and phytochemistry are identified. Critical evaluation of in vitro and in vitro studies examining date fruit in relation to anti-inflammatory, anti-angiogenic and antimicrobial activities are outlined.

KEY FINDINGS

The ethnomedical use of P. dactylifera in the treatment of inflammatory disease has been previously identified and reported. Furthermore, date fruit and date fruit co-products such as date syrup are rich sources of polyphenols, anthocyanins, sterols and carotenoids. In vitro studies have demonstrated that date fruit exhibits antibacterial, anti-inflammatory and anti-angiogenic activity. The recent interest in the identification of the numerous health benefits of dates using in vitro and in vivo studies have confirmed that date fruit and date syrup have beneficial health effects that can be attributed to the presence of natural bioactive compounds.

CONCLUSIONS

Date fruit and date syrup have therapeutic properties, which have the potential to be beneficial to health. However, more investigations are needed to quantify and validate these effects.

Knowledge and demand for medicinal plants used in the treatment and management of diabetes in Nyeri County, Kenya

ETHNOPHARMACOLOGICAL RELEVANCE

Non communicable diseases are currently a major health challenge facing humanity. Nyeri County has one of the highest diabetes prevalence in Kenya (12.6%), compared to the country's prevalence of 5.6%. The purpose of the study was to document; diabetes knowledge, medicinal plants and demand for the services of traditional medicine practitioners, in the management and treatment of diabetes.

METHODS

A cross-sectional study was carried out in the six constituencies in Nyeri, using pre-tested semi-structured questionnaires. Thirty practicing traditional medicine practitioners were purposively selected for the study. Field observation and identification was carried out on all plants that were cited during the interview. Plant samples were collected and voucher specimen deposited in the University of Nairobi Herbarium in the - School of Biological Sciences.

RESULTS

The study revealed 30 plant species in 28 genera and 23 families that are used by the traditional medicine practitioners to treat and manage diabetes. Demand for traditional medicine practitioners' services in the treatment of diabetes is low and often occurs when conventional drugs fail.

CONCLUSION

Interaction with the TMPs unveiled significant diversity of potential anti diabetic medicinal plants and in-depth ethnobotanical knowledge that they possessed. Preference for traditional herbal medicine was low despite wide ethnobotanical knowledge in the face of high prevalence of diabetes in the locality. The findings form the basis of pharmacological studies for standardization of the documented ethnomedicine used in the treatment and management of diabetes in the study area.

Use of complementary and alternative medicines in haemodialysis patients: a cross-sectional study from Palestine

BACKGROUND

Complementary and alternative medicine (CAM), and herbal therapies, are accepted worldwide, and have been important from medical, sociological and economic perspectives, among haemodialysis (HD) patients. The primary aim of this study was to evaluate the use of CAM among patients with end-stage renal disease (ESRD) who are undergoing HD.

METHODS

Face-to-face interviews of patients with ESRD undergoing HD from ten outpatient renal departments at a national level in Palestine were conducted from June 2014 to January 2015. A survey questionnaire, which included questions on socio-demographic and clinical characteristics, and on the CAM therapies that were used, was administered.

RESULTS

Out of 267 patients interviewed, 172 patients used at least one type of CAM in the last month prior to the interview, and thus the utilisation rate was 64.4 %. Forty one (15.4 %) patients reported using one type of CAMs, while 18.7 % used two different CAMs and 30.3 % used more than two types of CAMs for their health status. Of the patients who used CAM, herbal therapies were used most often (43.5 %), followed by honey (35.6 %), diet (22.8 %), and exorcism in Islam (16.9 %). The herbal therapies mentioned most often were Nigella sativa L. (18.7 %), followed by Salvia officinalis L. (16.9 %), and Pimpinella anisum L. (10.5 %).

CONCLUSIONS

In conclusion, the prevalence of CAM is relatively high in the selected population. Most patients used biological therapies such as herbal remedies, thus highlighting a greater need for patient education regarding CAM therapies and possible herb-drug interactions. Health care providers must be aware of the potential benefits and risks related to CAM use. There is a need for more clinical research pertaining to CAM to reach stronger evidence regarding potential benefits and risks related to CAM use.

Complementary and alternative medicine use among cancer patients in Palestine with special reference to safety-related concerns

ETHNOPHARMACOLOGICAL RELEVANCE

The use of CAM including herbal medicine as the most preferred CAM modality, among cancer patients who are taking prescription medications has shown to be highly prevalent worldwide as well as in several Middle Eastern countries, with a high percentage of the patients do not disclose their CAM use to treating physician.

AIM OF THE STUDY

The current study aimed to evaluate the patterns of CAM use among two cohorts of cancer patients in Palestine over a three-year period, and to identify socio-demographic factors that are associated with CAM use.

MATERIALS AND METHODS

Across-sectional survey of patients attending outpatient cancer clinics. The method was based on a semi-structured questionnaire. In order to identify safety-related concerns associated with the products listed, a literature search was conducted using different databases (PubMed, Micromedex, AltMedDex, and the Natural Medicine Comprehensive Database).

RESULTS

In 472 cancer patients including 372 of the 2011 cohort; and 100 of the 2014 cohort, the overall prevalence of CAM use was 69.5%. CAM users were more likely to be ≤65 years old, village resident, being in the midst of chemotherapy, to have high interest spiritual quest, and to have no other chronic diseases. A significant number of CAM users reported using herbal preparations (98.3%, and 89.6% in the two study cohorts, respectively). In the current study, a total of 40 plant taxa belonging to 23 botanical families were reported by ≥3 cancer patients in the two cohort groups. The top most commonly used plant in the 2011 cohort group was Arum palaestinum (43.5%), while Ephedra foeminea emerged as the top most commonly utilized plant (from 0.0% in 2011 to 55.2% in the 2014 cohort), mainly due to a recent publicizing and portraying of the plant in the local media as an effective cancer herbal remedy. Safety-related concerns were associated with 33 (82.5%) herbs, including herb-drug interactions with altered pharmacokinetics (8, 20% herbs), direct toxic effects (16, 40% herbs), and increased in vitro response of cancer cells to chemotherapy (30, 75% herbs).

CONCLUSIONS

CAM use, especially herbal medicine in cancer is highly prevalent in Palestine. This study has demonstrated the role of the media on the emergence of new CAM herbal therapies among cancer patients in Palestine, and discussed its potential implications on patients and for oncologists who are treating them. Some of the most widely used herbal medicines by cancer patients in the present work are known to interact with conventional anticancer drugs. Hence, the disclosure of the use of herbal remedies by patients to health professionals with sufficient training in CAM use is important for the later in order to assess whether there are any possible herbal drug interactions and/or harmful drug reactions.

Diabetes mellitus and its management with medicinal plants: A perspective based on Iranian research

ETHNOPHARMACOLOGICAL RELEVANCE

Complementary and alternative medicine has been increasingly used to treat chronic illnesses, such as diabetes mellitus. However, various limitations in terms of their application and efficacies exist. Furthermore, there is still much to be done to discover the right herbal medicine for diabetes.

AIM OF THE STUDY

This paper aims to evaluate previous herbal studies on the management of diabetes mellitus, to address their strengths and weaknesses and propose a general framework for future studies.

APPROACH AND METHODS

Data sources such as PubMed, ScienceDirect, Scopus, SpringerLink, and Wiley were searched, limited to Iran, using 36 search terms such as herbal, traditional, medicine, and phytopharmacy in combination with diabetes and related complications. Reviewed articles were evaluated regarding the use of botanical nomenclature and included information on (1) identity of plants and plant parts used, (2) the processing procedure, and (3) the extraction process. The main outcomes were extracted and then surveyed in terms of the efficacies of herbs in the management of diabetes mellitus. Then a comparative study was performed between Iranian and non-Iranian studies with respect to herbs best studied in Iran.

RESULTS

Of the 82 herbs studied in Iran, only six herbs were endemic and 19 were studied in detail. Although most of the reviewed herbs were found to decrease the level of blood glucose (BG) and/or glycated hemoglobin (HbA1C) in both Iranian and non-Iranian studies, information on their pharmacological mechanisms is scarce. However, the level of HbA1C was measured in a limited number of clinical trials or animal studies. Available information on both short- and long-term use of studied herbs on diabetes related complications and functions of involved organs as well as comorbid depression and/or simultaneous changes in lifestyle is also insufficient. Furthermore, little or no information on their phytochemical, toxicological, and herb-drug interaction properties is available. It is worth noting that the efficacy of the reviewed herbs has been studied scarcely in both humans and animals regarding both Iranian and non-Iranian studies. A significant number of reviewed articles failed to cite the scientific name of herbs and include information on the processing procedure and the extraction process.

CONCLUSIONS

Treatment of diabetes mellitus as a multifactorial disease using herbal medicines requires a comprehensive approach. In order to discover the right herbal medicine for the management of diabetes many other important factors than the levels of BG, HbA1C and insulin should be considered. According to our criteria, all the reviewed herbs suffered from inadequate investigation in human, animal and in vitro models in this respect, whereas they are worth investigating further. However, more research on endemic plants and the traditional history of herbal medicine is warranted. In our opinion, the pharmacological, toxicological, and phytochemical information should be obtained before clinical trials. Furthermore, information such as botanical scientific nomenclature, side effects, and toxicity will improve the quality and validity of publications in herbal research. In particular, designing a database covering all valid information about herbs and/or diseases will decrease unnecessary costs and increase the efficiency of research.

Ethnobotany of medicinal plants used in Antakya: A multicultural district in Hatay Province of Turkey

ETHNOPHARMACOLOGICAL RELEVANCE

We have compiled information about the medicinal plants used in folk medicine in the district of Antakya. Since its establishment by King Seleucus I in 300 B.C., Antakya (old Antioch) has hosted nearly 20 civilizations. Antakya, neighboring Northwestern Syria, is located on the western end of the "Silk Road" and was one of the great centers of Graeco-Roman world. Today, Antakya is a cosmopolitan city in which Arabic and Turkish are widely spoken, and where distinct ethnic and religious communities, such as Arab Alawite, Arab Christian, Arab Sunni, Turk Sunni, Armenian, and Jewish, have been living together in harmony for centuries. In addition, the rich flora in the vicinity of Antakya also renders the area interesting in terms of ethnobotanical fieldwork.

AIM OF THE STUDY

This study aimed to compile the information about plants used for medicinal purposes by local people in the district of Antakya. This city is a significant region in terms of ethnobotanical fieldwork, owing to its cosmopolitan structure, long history, relatively preserved traditional community structure, and rich flora. Furthermore, we sought to compare the ethnomedicinal data geographically, cross-culturally, and historically.

MATERIALS AND METHODS

The ethnobotany of medicinal plants used in the district of Antakya has been investigated through two separate studies; one was conducted in 1975, interviewing 29 people, and the other was conducted in 2011-2013, interviewing 182 people. The use value (UV) and informant consensus factor (FIC) values of the plants were calculated. In order to interpret the authenticity and sources of the compiled ethnomedicinal information, previous publications that contain information about the similar medicinal uses of plants identified in our region were reviewed and evaluated meticulously. A comparison with the data obtained from other regions of Turkey and from other Mediterranean regions, as well as a cross-cultural analysis between the ethnic groups within the study area, was performed by implementation of the Jaccard index (JI) RESULTS: Throughout the study, information about 202 medicinal plant taxa was compiled. Among these plants, 39 have either not yet been mentioned in ethnobotanical or medicinal studies, or have been used for a medicinal purpose other than those encountered in the literature review. The ethnomedicinal information we gathered from the study area exhibits close similarities to the ethnomedicinal information of other Southern and Eastern Mediterranean countries where Arabic is spoken, as well as to that of Northern and Western Mediterranean countries where Latin languages are spoken. In addition to these similarities, in most cases, this ethnomedicinal information shows hybrid features of ethnomedicinal knowledge from Eastern and Western Mediterranean countries.

CONCLUSION

Based on a literature survey, we found that the cited medicinal uses for 43 plants have also been corroborated by other various biological testings. This finding strongly suggests the importance of ethnobotanical studies in the development of new medicines. We believe that this study has compiled rich ethnomedicinal information that reflects the cosmopolitan structure of Antakya in a very good way.