Citrus aurantiumAroma for Anxiety in Patients with Acute Coronary Syndrome: A Double-Blind Placebo-Controlled Trial

Non-targeted metabolomic analysis reveals the mechanism of quality formation of citrus flower-green tea

BACKGROUND

Citrus flower-green tea (CT) is a scented tea processed from green tea (GT) and fresh citrus flower, which is favored by consumers due to its potential health benefits and unique citrus flavor. This study evaluated the quality of CT and revealed the mechanism of its quality formation.

RESULTS

The CT had a significant citrus flavor and a good antioxidant activity, and its sensory quality was superior to that of GT. Headspace solid-phase microextraction-gas chromatography-mass spectrometry (HS-SPME-GC-MS) analysis revealed that the scenting process resulted in a significant increase of alkenes such as β-pinene, trans-β-ocimene, α-farnesene, isoterpinolene, and γ-terpinene, as well as a significant decrease of alcohols such as α-terpineol, l-menthol, and linalool in CT in comparison with GT. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis revealed that the levels of flavonoids (such as neohesperidin, hesperidin, tangeritin, hesperetin 5-O-glucoside, and nobiletin) and alkaloids (such as trigonelline and theobromine) in CT increased significantly after scenting process, while the levels of amino acids (such as valine and l-phenylalanine) and organic acids (such as ascorbic acid) decreased significantly.

CONCLUSION

These observations showed that the scenting process promoted the absorption of aroma from citrus flowers by GT and the changes in its non-volatile metabolites, leading to the formation of citrus flavor quality in CT. © 2024 Society of Chemical Industry.

The effect of aromatherapy on patients with acute coronary syndrome: A systematic review and meta-analysis

OBJECTIVE

To systematically investigate the efficacy of aromatherapy in patients with acute coronary syndrome (ACS).

METHODS

We conducted a comprehensive search for papers published until November 2023 using the following databases: PubMed, Embase, and Cochrane Library. This study was conducted following the PRISMA and Cochrane Guidelines. The inclusion criteria were randomized controlled trials (RCTs) performed to assess the comparative effectiveness of inhalation aromatherapy versus controls in individuals diagnosed with ACS. The Jadad rating method was used to assess the quality of the included studies, and a meta-analysis was performed using the RevMan 5.4 software. Heterogeneity was quantified using the Higgins I2 (%) test.

RESULTS

A total of 12 RCTs with 476 patients with ACS were included. Aromatherapy has been shown to reduce anxiety scores significantly (standard mean difference [SMD]: -1.18, 95 % confidence interval [CI]: -1.33 to -1.03; P < 0.00001) along with reduction in systolic blood pressure (MD = -8.78, 95 % CI [-13.92, -3.65], P = 0.008); diastolic blood pressure (MD = -7.76, 95 % CI [-11.39, -4.12], P < 0.001); mean artery pressure MD = -9.68, 95 % CI [-13.93.-5.44]; P < 0.0001). However, no significant effects were reported on the heart rate (MD = -6.98, 95 % CI [-15.46, 1.50], P = 0.11) and respiratory rate (MD = -0.67, 95 % CI [-2.52, 1.19], P = 0.48). A greater frequency of aromatherapy was associated greater anxiety -1.80 incidence, with 95 % CI [-2.04, -1.56]. Citrus essential oils exhibited the strongest effect (SMD = -1.97, 95 % CI [-3.34, -0.60], P = 0.005) in reducing anxiety levels.

CONCLUSION

Aromatherapy appears to be an effective non-pharmacological intervention for reducing blood pressure and anxiety in individuals with ACS. This suggests that aromatherapy more than twice a day is effective in reducing anxiety levels. However, aromatherapy had no statistically significant impact on the heart or respiratory rates. Moreover, additional high-quality RCTs should be conducted to verify these results and explore the efficacy and mechanism of aromatherapy in patients with ACS.

Flower Power: An Overview on Chemistry and Biological Impact of Selected Essential Oils from Blossoms

Natural raw materials such as essential oils have received more and more attention in recent decades, whether in the food industry, as flavorings and preservatives, or as insecticides and insect repellents. They are, furthermore, very popular as fragrances in perfumes, cosmetics, and household products. In addition, aromatherapy is widely used to complement conventional medicine. This review summarizes investigations on the chemical composition and the most important biological impacts of essential oils and volatile compounds extracted from selected aromatic blossoms, including Lavandula angustifolia, Matricaria recutita, Rosa x damascena, Jasminum grandiflorum, Citrus x aurantium, Cananga odorata, and Michelia alba. The literature was collected from PubMed, Google Scholar, and Science Direct. Blossom essential oils discussed in this work are used in a wide variety of clinical issues. The application is consistently described as safe in studies and meta-analyses, although there are notes that using essential oils can also have side effects, especially dermatologically. However, it can be considered as confirmed that essential oils have positive influences on humans and can improve quality of life in patients with psychiatric disorders, critically ill patients, and patients in other exceptional situations. Although the positive effect of essential oils from blossoms has repeatedly been reported, evidence-based clinical investigations are still underrepresented, and the need for research is demanded.

Effects of Aromatherapy on Anxiety and Blood Pressure in Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Introduction: Patients with acute coronary syndrome (ACS) often experience high levels of anxiety, which can significantly impact their prognosis. However, evidence regarding anxiety reduction by aromatherapy in patients with ACS is lacking. This study aimed to investigate the effects of aromatherapy on anxiety in patients with ACS. Methods: The literature search was conducted using PubMed, CINAHL, Embase, Web of Science, Cochrane Library, and PsycINFO from their inception until February 21, 2024. Based on inclusion criteria, randomized controlled trials (RCTs) on aromatherapy in patients with ACS aged ≥ 18 years were included. The risk of bias in the included studies was assessed using the revised Cochrane risk-of-bias tool for RCTs. Results: A total of 14 studies were included in the final analysis. Aromatherapy significantly reduced anxiety among patients with ACS, with a large effect size (standardized mean difference [SMD] = -1.66, 95% confidence interval [CI]: -2.47 to -0.85). The effect on systolic blood pressure (SBP) was -0.65 (95% CI: -1.15 to -0.15), indicating a moderate effect size, whereas there was no significant effect on diastolic blood pressure. Inhalation therapy demonstrated a large effect size (SMD = -1.70, 95% CI: -2.33 to -1.08), whereas massage therapy did not show a significant effect on reducing anxiety. Discussion/Conclusions: The findings show that aromatherapy can effectively reduce anxiety and SBP in patients with ACS. In particular, inhalation therapy showed a significant effect on reducing anxiety levels. Applying aromatherapy in clinical settings to reduce anxiety among patients with ACS should be considered. However, the limited number of studies analyzed hinders a comprehensive evaluation of the effectiveness of massage therapy. Hence, further research is necessary to elucidate its potential role in reducing anxiety among patients with ACS.

The effect of aromatherapy with Lavender-Neroli oil and music in management of pediatric dental anxiety: a randomized control trial

AIM

This study aimed to evaluate the efficacy of aromatherapy with Lavender-Neroli essential oil combined with background music in reducing dental anxiety and pain during anesthesia in children.

MATERIALS AND METHODS

A total of 56 children aged 6-10 years old who needed dental treatment with inferior alveolar nerve injection (IANB) were randomly divided into two groups: Group 1 (Experimental, n = 28) aromatherapy with music group, and Group 2 (Control, n = 28) the placebo group. Children in the group 1 were asked to inhale the aromatic blend of Lavender-Neroli essential oil using a nasal mask similar to one that is used for nitrous oxide after modifying it by adding a 3D printed box on its circle hole and listening to their favorite music as a background before 5 min and during anesthesia, meanwhile in the placebo group children were asked to wear an empty nasal mask. Anxiety and pain were been assessed before and after anesthesia using the self-report anxiety scale Facial image scale (FIS), Observational pain assessment scale Face-Legs-Activity-Cry-Consolability (FLACC), heart rate, SPO2 saturation, diastolic and systolic blood pressure.

RESULTS

Dental anxiety and vital signs except SPO2 saturation were significantly lower in the aromatherapy with music group when compared to the control group (p < 0.05), with no differences in pain perception between groups (p = 0.176).

CONCLUSIONS

Aromatherapy with Lavender-Neroli oil combined with music seems to be a useful and safe non-pharmacologic technique for managing dental anxiety in children.

Effect of Dill (Anethum graveolens) Oil on Pruritus and Quality of Life of Hemodialysis Patients: A Randomized Double-Blind Three-Arm Controlled Trial

Introduction

Anethum graveolens (AG), commonly known as dill, is a plant from the Apiaceae family that has been traditionally used as a skin softener and purifying agent in Persian medicine. In a previous study conducted on male rats, dill was found to have anti-inflammatory effects. The current study aimed to examine the efficacy of topical application of Anethum graveolens oil on pruritus severity, skin dryness, sleep quality, and quality of life in patients undergoing hemodialysis.

Methods

In the current clinical trial, the participants were randomly assigned to one of these groups: topical AG preparation, sesame oil, or a control group receiving no treatment. The study was double-blind and placebo-controlled. The topical treatment was applied twice a day for one month to areas of the skin affected by pruritus. The outcome measures included the severity of skin dryness, the Pittsburgh Sleep Quality Index, Duo's Uremic Pruritus Severity Scale, and the Itchy QoL questionnaire.

Results

This study involved 106 hemodialysis patients, and after intervention for one month, the medication group had a significantly lower mean score of sleep quality (3.24 ± 2.41) than the placebo (4.54 ± 3.11) and control (5.05 ± 3.21) groups (P=0.032). The mean change in pruritus severity was significantly greater in the medication group (-17.28 ± 8.938) than the placebo (-5.91 ± 5.398) and control (-3.43 ± 3.228) groups (P < 0.001). Moreover, a significant difference was observed in the mean changes in quality of life between the medication, placebo, and control groups, with values of -14.88 ± 7.89, -5.34 ± 4.50, and -1.92 ± 2.86, respectively (P < 0.001). Furthermore, both the medication and placebo groups showed improvement in skin dryness compared to the control group having the values of -1.65 ± 0.91, -1.11 ± 0.79, and -0.38 ± 0.54, respectively (P < 0.001).

Conclusion

Topical Anethum graveolens preparation significantly improved the sleep quality and quality of life and reduced skin pruritus and dryness in hemodialysis patients. It could be considered as a simple therapeutic modality to control pruritus in hemodialysis patients. This trial is registered with IRCT2017022032671N1.

Essential oils for treating anxiety: a systematic review of randomized controlled trials and network meta-analysis

Background and purpose

The findings of clinical studies exploring essential oils (EOs) for anxiety remain disputed, and no studies have yet clarified the differences in the efficacy of EOs. The purpose of the study was to directly or indirectly compare the efficacy of different types of EOs on anxiety by pooling the results of randomized controlled trials (RCTs).

Methods

PubMed, Cochrane Library, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to November 2022. Only full texts of RCTs that investigated the effects of EOs on anxiety were included. The trial data were extracted and the risk of bias was assessed by two reviewers independently. Pairwise meta-analysis and network meta-analysis were performed by Stata 15.1 or R 4.1.2 software.

Results

Forty-four RCTs (fifty study arms) involving 10 kinds of EOs and 3419 anxiety patients (1815 patients in EOs group and 1604 patients in control group) were included. Pairwise meta-analyses showed that EOs were effective in reducing State Anxiety Inventory scores (SAIS) [WMD = -6.63, 95% CI-8.17, -5.08] and Trait Anxiety Inventory scores (TAIS) [WMD = -4.97, 95% CI-6.73, -3.20]. Additionally, EOs could decrease systolic blood pressure (SBP) [WMD = -6.83, (95% CI -10.53, -3.12), P < 0.001] and heart rate (HR) [WMD = -3.43, (95% CI -5.51, -1.36), P < 0.001]. Network meta-analyses demonstrated that regarding the outcome of SAIS, Jasminum sambac (L.)Ait. (jasmine) was the most effective with a weighted mean difference (WMD) of-13.61 (95% CrI-24.79, -2.48). Followed by Citrus (citrus aurantium L.), which had a WMD of-9.62 (95% CrI-13.32, -5.93). Moderate effect sizes were observed for Rosa rugosa Thunb. (damask rose) (WMD = -6.78, 95% CrI-10.14, -3.49) and Lavandula angustifolia Mill. (lavender) (WMD = -5.41, 95% CrI-7.86, -2.98). Regarding the results of TAIS, citrus aurantium L. was the best ranked intervention with a WMD of-9.62 (95% CrI-15.62, -3.7). Moderate-to-large effect sizes were observed for Citrus limon (L.) Burm. F. (lemon) (WMD:-8.48; 95% CrI-16.67, -0.33) and lavender (WMD:-5.5; 95% CrI-8.7, -2.46).

Conclusion

According to the comprehensive analysis, EOs are effective in reducing both state anxiety and trait anxiety, and citrus aurantium L. essential oil seems to be the most recommended type of EO for treating anxiety because of its significant effects in reducing SAIS and TAIS.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022331319.

A review of citrus plants as functional foods and dietary supplements for human health, with an emphasis on meta-analyses, clinical trials, and their chemical composition

Fruits, flowers, leaves, essential oils, hydrosols, and juices of citrus spp. Are utilized to prepare various forms of food products. Along with their nutritional values, in the health industry, different parts of the plants of the citrus genus have been used as supplements or remedies to prevent or control diseases. This review focused on reported meta-analyses and clinical trials on the health benefits of citrus plants as functional foods. Also, chemical compounds of various citrus species were reviewed. The following information sources were used for data collection: Google Scholar, the Web of Science, Scopus, and PubMed. Various keywords, including "citrus AND chemical compounds," "citrus AND phytochemicals," "citrus species," "citrus AND meta-analysis," "nutritional and therapeutical values of citrus spp.," "clinical trials AND citrus," "clinical trials AND Rutaceae," "health benefits of citrus spp.," "citrus edible or non-edible applications," and scientific names of the citrus plants were utilized to collect data for the review. The scientific name and common name of all twenty-eight citrus species, along with any of the above keywords, were also searched in the mentioned databases. Scientific papers and data sources were sought to review and discuss the citrus plant's nutritional and therapeutic importance. Several meta-analyses and clinical trials have reported beneficial effects of citrus spices on a variety of cancer risks, cardiovascular risk factors, neurologic disorders, urinary tract conditions, and gastrointestinal tract conditions. They have shown anxiolytic, antimicrobial, and pain-alleviating effects. Some of them can be helpful in managing obesity and cardiovascular risk factors.

Effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted into intensive care units: A systematic review

PURPOSE

This review aims to evaluate the effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted to an intensive care unit.

MATERIALS AND METHODS

A systematic search for published and unpublished studies across nine databases and sources were conducted. Randomised Controlled Trials and Controlled Clinical Trials, which assessed the effectiveness of aromatherapy on anxiety and sleep quality among intensive care unit patients, were included in this review. Only studies that used aromatherapy as a single intervention were included. Narrative synthesis was conducted across all outcomes due to high heterogeneity across studies.

RESULTS

A total of 26 studies involving 2176 participants across six countries were included in this review. Most studies had an overall high risk of bias. Publication bias was detected in the studies. Findings have shown that aromatherapy may be effective in reducing anxiety based on the low GRADE certainty of evidence, and improving sleep quality based on the very low GRADE certainty of evidence. Inconsistencies in findings were also observed.

CONCLUSION

Aromatherapy might be beneficial on anxiety and sleep quality among intensive care unit patients, however, the level of evidence is very low, based on the low quality of studies. Considerations can be made to incorporate aromatherapy into existing interventions that improve anxiety and sleep quality in the intensive care unit. Due to inconsistencies in findings, further research can be done to investigate and strengthen these evidence.

IMPLICATION FOR CLINICAL PRACTICE

This review has demonstrated that aromatherapy may have benefits on anxiety and sleep quality. Despite uncertain evidence, aromatherapy may still be considered as a complementary or alternative option to improve anxiety and sleep quality among intensive care patients as it is relatively safe, cost-effective and easy to implement (Buckle, 2014). However, proper training by a professional clinical aromatherapist is needed to ensure there is screening of patients for suitability, proper technique for administering aromatherapy, safe handling of essential oils and monitoring for adverse events (Farrar & Farrar, 2020).

Effect of Citrus aurantium Aroma on the Happiness of Pre-Hospital Emergency Staff: A Randomized Controlled Trial

Happiness is a positive internal experience and an indicator of mental health. Having happy and efficient employees is one of the ideals of healthcare organizations, given its impact on the quality of healthcare services. Emergency healthcare staff members face various unpleasant and stressful events. It has been suggested that fragrant herbs such as Citrus aurantium can have cheerfulness effects on individuals. Therefore, this study was conducted to investigate the effect of Citrus aurantium aroma on the happiness of pre-hospital emergency staff. A randomized placebo controlled clinical trial was carried out on 167 prehospital emergency medical staff who were randomly assigned into two groups of aromatherapy and placebo. The participants received Citrus aurantium aromatherapy and placebo for five work shifts and for two consecutive weeks. Aromatherapy was performed using 10% Citrus aurantium scent applied via a pendant containing 1.5 cc of Citrus aurantium scent. The distance from the nose to the container was about 20 cm with the neck straight and the head in a balanced position. Data regarding staff happiness were collected using the Oxford Happiness Questionnaire, which were analyzed using descriptive and inferential statistics. The mean level of happiness did not differ between the intervention and control groups (p = 0.99). Work experience had a statistically significant inverse association with happiness (coefficient = -0.76, 95% CI: -1.49, -0.03). The findings of this randomized controlled trial indicate that Citrus aurantium aroma has no effect on the happiness of prehospital emergency medical services workers. There is a need to study the effect of a combination of complementary and alternative methods on the creation of positive psychological feelings among pre-hospital emergency staff.

Natural essential oils: A promising strategy for treating cardio-cerebrovascular diseases

ETHNOPHARMACOLOGICAL RELEVANCE

Essential oils (EO) are volatile compounds obtained from different parts of natural plants, and have been used in national, traditional and folk medicine to treat various health problems all over the world. Records indicate that in history, herbal medicines rich in EO have been widely used for the treatment of CVDs in many countries, such as China.

AIM OF THE STUDY

This review focused on the traditional application and modern pharmacological mechanisms of herbal medicine EO against CVDs in preclinical and clinical trials through multi-targets synergy. Besides, the EO and anti-CVDs drugs were compared, and the broad application of EO was explained from the properties of drugs and aromatic administration routes.

MATERIALS AND METHODS

Information about EO and CVDs was collected from electronic databases such as Web of Science, ScienceDirect, PubMed, and China National Knowledge Infrastructure (CNKI). The obtained data sets were sequentially arranged for better understanding of EO' potential.

RESULTS

The study showed that EO had significant application in CVDs at different countries or regions since ancient times. Aiming at the complex pathological mechanisms of CVDs, including intracellular calcium overload, oxidative stress, inflammation, vascular endothelial cell injury and dysfunction and dyslipidemia, we summarized the roles of EO on CVDs in preclinical and clinical through multi-targets intervention. Besides, EO had the dual properties of drug and excipients. And aromatherapy was one of the complementary therapies to improve CVDs.

CONCLUSIONS

This paper reviewed the EO on traditional treatment, preclinical mechanism and clinical application of CVDs. As important sources of traditional medicines, EO' remarkable efficacy had been confirmed in comprehensive literature reports, which showed that EO had great medicinal potential.

Salvia officinalis L. Essential Oil: Characterization, Antioxidant Properties, and the Effects of Aromatherapy in Adult Patients

The purpose of this study is to reveal the chemical and biochemical characteristics and the potential aromatherapy applications of the essential oil (EO) of Salvia officinalis (common sage) within a hospital environment. The chemical composition was determined by gas chromatography with mass spectrometry and ATR-FTIR spectroscopy. Three types of sage EOs were included in this study: two commercial oils and one oil obtained by in-house hydrodistillation. Based on the findings, these EOs were included in different chemotypes. The first two samples were similar to the most common chemotype (α-thujone > camphor > 1,8-cineole > β-thujone), while the in-house sage EO revealed a high content of 1,8-cineole, borneol, α-thujone, similar to the Dalmatian type. The latter sample was selected to be evaluated for its antioxidant and medical effects, as borneol, a bicyclic monoterpene, is known as a substance with anesthetic and analgesic effects in traditional Asian medicine. The study suggests that the antioxidant capacity of the sage EO is modest (33.61% and 84.50% inhibition was determined by DPPH and ABTS assays, respectively), but also that the inhalation of sage EO with high borneol content by hospitalized patients could improve these patients’ satisfaction.

Aromas Influencing the GABAergic System

Aromas have a powerful influence in our everyday life and are known to exhibit an array of pharmacological properties, including anxiolytic, anti-stress, relaxing, and sedative effects. Numerous animal and human studies support the use of aromas and their constituents to reduce anxiety-related symptoms and/or behaviours. Although the exact mechanism of how these aromas exert their anxiolytic effects is not fully understood, the GABAergic system is thought to be primarily involved. The fragrance emitted from a number of plant essential oils has shown promise in recent studies in modulating GABAergic neurotransmission, with GABA_A receptors being the primary therapeutic target. This review will explore the anxiolytic and sedative properties of aromas found in common beverages, such as coffee, tea, and whisky as well aromas found in food, spices, volatile organic compounds, and popular botanicals and their constituents. In doing so, this review will focus on these aromas and their influence on the GABAergic system and provide greater insight into viable anxiety treatment options.

Effectiveness of nursing Intervention on anxiety, psychology and self-efficacy among elderly patients with acute coronary syndrome after percutaneous coronary intervention: An observational cohort study

The aim of the present study is to investigate effect nursing intervention on anxiety, psychology and self-efficacy among elderly patients with acute coronary syndrome after percutaneous coronary intervention, and the correlation between patients' anxiety, psychology and self-efficacy and nursing intervention.One hundred thirty six patients with acute coronary intervention were randomly divided into the experimental group (n = 68) and the control group (n = 68). The experimental group received nursing intervention measures, and control group received routine nursing. We measured the depression, anxiety score of the 2 groups before and after nursing and multiple regressions was to analysis the correlation between patients' anxiety, psychology and self-efficacy and nursing intervention.The nursing intervention effect of the 2 groups after intervention were improved before intervention (P < .05), and the Hospital Anxiety and depression scale (HADS) in the was decreased than that of the control group after psychological intervention. The general self-efficacy scale scores of experimental group were obviously improved after receiving the intervention, and the scores in the experimental group were much higher than the control group after receiving the intervention, namely (P < .05). Furthermore, Single regression analysis showed that single (Marital status) (r = 0.367, P < .001), divorced or separated (Marital status) (r = 0.338, P < .001), Widowed (Marital status) (r = 0.458, P < .001), nursing intervention (r = 0.431, P < .001) and Length of hospital stay (r = 0.276, P = .003) showed a significant correlation with patients' anxiety, psychology and self-efficacy. Multiple regression analysis showed that Length of hospital stay (P = .001) and nursing intervention (P < .001) were significantly correlated with patients' anxiety, psychology and self-efficacy.Nursing intervention maybe significantly improve patients' anxiety, psychology and self-efficacy, and nursing intervention was significantly correlated with patients' anxiety, psychology and self-efficacy. Considering the limited number of studies analyzed, large sample-size clinical trials are necessary to verify the effect nursing intervention on anxiety, psychology and self-efficacy among elderly patients with acute coronary syndrome after percutaneous coronary intervention.

Medicinal Plants for Insomnia Related to Anxiety: An Updated Review

Sleep disorders are common among the general population and can generate health problems such as insomnia and anxiety. In addition to standard drugs and psychological interventions, there are different complementary plant-based therapies used to treat insomnia and anxiety. This review aimed to find and examine the most recent research on the use of herbal medicines for treating anxiety and insomnia as compiled from clinical trials, as well as to assess the safety and efficacy of these medicines and to elucidate their possible mechanisms of action. The process entailed a search of PubMed, Scopus, and the Cochrane Library databases from 2010 to 2020. The search terms included "sleep disorder", "insomnia", "sedative", "hypnotic", "anxiety", "anxiolytic", and "clinical trial", combined with the search terms "herbs" and "medicinal plants", in addition to individual herbal medicines by both their common and scientific names. This updated review, which focuses mainly on clinical trials, includes research on 23 medicinal plants and their combinations. Essential oils and their associations have also been reviewed. The efficacy of medicinal plants depends on treatment duration, types of study subjects, administration route, and treatment method. More clinical trials with an adequate, standardized design are necessary, as are more preclinical studies to continue studying the mechanisms of action. As a result of our work, we can conclude that the 3 plants with the most potential are valerian, passionflower, and ashwagandha, with the combination of valerian with hops and passionflower giving the best results in the clinical tests.

Self-treatment and adverse reactions with herbal products for treating symptoms associated with anxiety and depression in adults from the central-western region of Mexico during the Covid-19 pandemic

ETHNOPHARMACOLOGICAL RELEVANCE

There are plant species used in the Mexican traditional medicine for the empirical treatment of anxiety and depression.

AIM OF THE STUDY

This work assessed the prevalence of self-medication with medicinal plants and the prevalence of the concomitant use of prescribed psychiatric drugs and medicinal plants for treating symptoms associated with anxiety and depression during the Covid-19 lockdown in Mexico.

MATERIALS AND METHODS

The suspected adverse reactions associated with drug-herb interactions were assessed. The factors associated with self-medication, the concomitant use of herb-drug combinations, and the presence of adverse reactions due their combined use is also reported. The study was descriptive and cross-sectional using an online questionnaire conducted among population with symptoms associated with anxiety and depression (n = 2100) from seven states of central-western Mexico.

RESULTS

The prevalence of the use of herbs (61.9%) and the concomitant use of drug-herb combinations (25.3%) were associated with being diagnosed with mental illness [OR:2.195 (1.655-2.912)] and the use of psychiatric medications [OR:307.994 (178.609-531.107)], respectively. The presence of adverse reactions (n = 104) by the concomitant use of drug-herb combinations was associated with being unemployed [p = 0.004, OR: 3.017 (1.404-6.486)].

CONCLUSION

Health professionals should be aware if their patients concomitantly use medicinal plants and psychiatric drugs. Public health campaigns should promote the possible adverse reactions that might produce the concomitant use of drug-herb combinations for mental illnesses.

A Comparison Study on Traditional Mixtures of Herbal Teas Used in Eastern Mediterranean Area

Multipurpose herbal teas with numerous ingredients, in which flowers are the main component, are common in the traditional medicine and pharmacy of Greece and the Eastern Mediterranean countries. In this study, we combine ethnobotany and ethnopharmacology field work techniques and botany and pharmacognosy laboratory methods for the study of traditional herbal mixtures with flowers, we identify their botanical ingredients and record the local medicinal uses of these mixtures, in Greece, Lebanon, Syria, Iran and Turkey. These, and their industrial versions, are analyzed, using morphological and multivariate analysis techniques in order to determine marker species, relevant patterns of combination and local styles. The medicinal properties attributed to the different flowers are discussed in relation with their role in the mixtures. These blends are consumed for their relaxing, digestive, and anti-infective properties. These mixtures are not consumed as a treatment when one is sick but rather to avoid getting sick, as a preventive measure. The formulations can reach forty ingredients (sarantha in Greek, arbain in Arabic language of Palestine), usually entire or coarsely chopped in the more traditional formulations, leading to extreme variability of individual doses. We ask what biological signification this randomness can have. To give an answer requires new and more comprehensive pharmacological approaches. The flowers of Rosaceae, Asteraceae, Lamiaceae, Malvaceae and Fabaceae species characterize these mixtures in which other materials (roots, leaves, and fruits) and other species are present as well. Flowers of some species, particularly of Fabaceae, are exclusively used in mixtures, and their use in monospecific herbal teas is not yet recorded. We draw attention on the urgent need in exhaustively recording in Greece and the Near East, the formulation and use of traditional herbal mixtures and their numerous local variants. To consider these mixtures and the contribution of flowers (most mixtures receive the general name of tea of flowers) merits further extensive study.

Essential Oils: Pharmaceutical Applications and Encapsulation Strategies into Lipid-Based Delivery Systems

Essential oils are being studied for more than 60 years, but a growing interest has emerged in the recent decades due to a desire for a rediscovery of natural remedies. Essential oils are known for millennia and, already in prehistoric times, they were used for medicinal and ritual purposes due to their therapeutic properties. Using a variety of methods refined over the centuries, essential oils are extracted from plant raw materials: the choice of the extraction method is decisive, since it determines the type, quantity, and stereochemical structure of the essential oil molecules. To these components belong all properties that make essential oils so interesting for pharmaceutical uses; the most investigated ones are antioxidant, anti-inflammatory, antimicrobial, wound-healing, and anxiolytic activities. However, the main limitations to their use are their hydrophobicity, instability, high volatility, and risk of toxicity. A successful strategy to overcome these limitations is the encapsulation within delivery systems, which enable the increase of essential oils bioavailability and improve their chemical stability, while reducing their volatility and toxicity. Among all the suitable platforms, our review focused on the lipid-based ones, in particular micro- and nanoemulsions, liposomes, solid lipid nanoparticles, and nanostructured lipid carriers.

Pharmacology of Herbal Sexual Enhancers: A Review of Psychiatric and Neurological Adverse Effects

Sexual enhancers increase sexual potency, sexual pleasure, or libido. Substances increasing libido alter the concentrations of specific neurotransmitters or sex hormones in the central nervous system. Interestingly, the same pathways are involved in the mechanisms underlying many psychiatric and neurological disorders, and adverse reactions associated with the use of aphrodisiacs are strongly expected. However, sexual enhancers of plant origin have gained popularity over recent years, as natural substances are often regarded as a safer alternative to modern medications and are easily acquired without prescription. We reviewed the psychiatric and neurological adverse effects associated with the consumption of herbal aphrodisiacs Areca catechu L., Argemone Mexicana L., Citrus aurantium L., Eurycoma longifolia Jack., Lepidium meyenii Walp., Mitragyna speciosa Korth., Panax ginseng C. A. Mey, Panax quinquefolius L., Pausinystalia johimbe (K. Schum.) Pierre ex Beille, Piper methysticum G. Forst., Ptychopetalum olacoides Benth., Sceletium tortuosum (L.) N. E. Brown, Turnera diffusa Willd. ex. Schult., Voacanga africana Stapf ex Scott-Elliot, and Withania somnifera (L.) Dunal. A literature search was conducted on the PubMed, Scopus, and Web of Science databases with the aim of identifying all the relevant articles published on the issue up to June 2020. Most of the selected sexual enhancers appeared to be safe at therapeutic doses, although mild to severe adverse effects may occur in cases of overdosing or self-medication with unstandardized products. Drug interactions are more concerning, considering that herbal aphrodisiacs are likely used together with other plant extracts and/or pharmaceuticals. However, few data are available on the side effects of several plants included in this review, and more clinical studies with controlled administrations should be conducted to address this issue.

Effects of aromatherapy on anxiety: A meta-analysis of randomized controlled trials

SCOPE

The effects of aromatherapy on relieving anxiety were controversial. The purpose of this meta-analysis was to evaluate the effects of aromatherapy on anxiety in patients.

METHODS AND RESULTS

We searched randomized controlled trials (RCTs) about aromatherapy on decreasing anxiety on PUBMED, WEB OF SCIENCE (January 1990 to October 2019), COCHRANE LIBRARY, EMBASE (updated to October 2019), and the Chinese databases CNKI, WanFang and CBMD. Twenty-five articles (Thirty-two trials) were included in this meta-analysis. The data of scale scores of Spielberger State-Trait Anxiety Inventory (STAI) were extracted. The pooled results demonstrated that inhalation and massage aromatherapy significantly decreased anxiety levels in different conditions. The weighted mean difference was -5.16 for State Anxiety Inventory (SAI) (95%CI: -5.78, -4.55, p<0.001) and -2.85 for Trait Anxiety Inventory (TAI) (95%CI: -3.95, -1.75, p<0.001). No side effects were mentioned in all of studies.

CONCLUSION

The meta-analysis suggested that aromatherapy with different essential oils could alleviate anxiety significantly no matter the reason of anxiety. However, the proper dosage of essential oils needs further research.

Modification of brain waves and sleep parameters by Citrus reticulata Blanco. cv. Sai-Nam-Phueng essential oil

Background

Citrus essential oil (EO) has been used for mood elevation and sedative hypnotic purposes. However, scientific proofs of its central nervous system (CNS) action remained largely unexplored. This study investigated chemotypes, electrical brain waves and sleep-wake effects of the essential oil from Citrus reticulata in rat model.

Methods

Chemical contents of citrus EO were analyzed using gas chromatography-mass spectrometry (GC–MS). Male Wistar rats implanted with electrodes on the frontal and parietal skulls were used for electroencephalographic (EEG) recording while inhaling the citrus EO (200 μl on cotton wool). Diazepam (10 mg/kg, p.o.) was used as a standard anxiolytic drug. EEG frequency analyses were performed by using Fast Fourier transform. All data were statistical analyzed using One-way ANOVA followed by Tukey's test.

Results

GC–MS analysis revealed d-limonene (95.7%) as a major constituent of citrus EO. The EEG results showed that overall EEG patterns of citrus EO effects were relatively similar to that of diazepam. However, significant differences between treatments were seen from sleep-wake analyses. Diazepam significantly increased episode numbers of awake and non-rapid eye movement (REM) sleep and reduced averaged episode duration. On the other hand, the citrus EO significantly decreased REM sleep latency and increased total time and episode numbers of REM sleep.

Conclusion

These findings demonstrated unique CNS effects of C. reticulata EO with EEG fingerprints and sleep-wake profiles. The data might be useful for citrus essential oil sub-classification and clinical application.