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Zahed G, Fatahi S, Tabatabaee L, Imanzadeh N, Seraj SS, Wolters BH, Hosseini A. Efficacy of atypical antipsychotics in the treatment of fecal incontinence in children and adolescents: a randomized clinical trial. BMC Pediatr 2024; 24:7. [PMID: 38172808 PMCID: PMC10763209 DOI: 10.1186/s12887-023-04474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES Functional retentive overflow incontinence (retentive FI) is the most common cause of fecal soiling in children. Based on the clinical experiences, the treatment of retentive FI in patients with comorbid psychiatric disorders was accelerated when Risperidone was used as treatment for their psychiatric comorbidities; therefore, this study was conducted to evaluate the effect of risperidone in the treatment of retentive FI in children and adolescents. METHODS In this double-blind, randomized, placebo-controlled trial, 140 patients aged 4-16 years eligible for the study were randomized into two groups, receiving either 0.25-0.5 mg of Risperidone syrup (n = 70) or maltodextrin syrup (placebo group, n = 70) every 12 h daily for 12 weeks. Sociodemographic data, including age, sex, weight, height, BMI, BMI z-score, and socioeconomic status, was recorded, and the number of nocturnal FI, diurnal FI, and painful defecations was measured. RESULTS 136 participants (69 on Risperidone and 67 on placebo) were included in the study. Mean age of participants in the intervention and placebo groups were 7.2 ± 2.4 years and 8.0 ± 3.1 years, respectively. The mean number of nocturnal FI (Ptrend=0.39) and diurnal FI (Ptrend=0.48) in patients without psychiatric comorbidities, and the number of painful defecations for participants with and without psychiatric comorbidities (P = 0.49, P = 0.47, respectively) were not significantly different between the groups, but a significant effect was observed in diurnal FI after Risperidone treatment in patients with psychiatric comorbidities (P < 0.001). CONCLUSION Risperidone, when used along with other non-pharmacological interventions, may be helpful in treating FI in pediatric patients with psychiatric comorbidities.
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Affiliation(s)
- Ghazal Zahed
- Department of child and adolescent psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Tabatabaee
- Department of child and adolescent psychiatry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Imanzadeh
- School of pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaikh Sanjid Seraj
- Royal Shrewsbury Hospital, Shrewsbury and Telford NHS Trust, Shrewsbury, Shropshire, SY3 8XQ, UK
| | | | - Amirhossein Hosseini
- Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Choudhury A, Singh PA, Bajwa N, Dash S, Bisht P. Pharmacovigilance of herbal medicines: Concerns and future prospects. JOURNAL OF ETHNOPHARMACOLOGY 2023; 309:116383. [PMID: 36918049 DOI: 10.1016/j.jep.2023.116383] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The use of herbal medicines for prophylaxis, prevention, and treatment of various ailments is rising throughout the world because they are thought to be safer than allopathic treatments, which they are. However, several investigations have documented the toxicity and adverse drug reactions (ADR) of certain formulations and botanicals if not consumed wisely. AIM OF THE STUDY The goal of the current study is to address herbal medication pharmacovigilance (PV) modeling and related considerations for improved patient safety. Also, focus is laid on the comprehensive and critical analysis of the current state of PV for herbal medications at the national and international levels. MATERIALS AND METHODS Targeted review also known as focused literature review methodology was utilized for exploring the data from various scientific platforms such as Science Direct, Wiley Online Library, Springer, PubMed, Google Scholar using "pharmacovigilance, herbal medicine, traditional medicine, ADR, under reporting, herb toxicity, herb interactions" as keywords along with standard literature pertaining to herbal medicines that is published by the WHO and other international and national organizations etc. The botanical names mentioned in the present article were authenticated using World Flora Online database. RESULTS The historical developments paving the way for PV in regulatory setup were also discussed, along with various criteria's for monitoring herbal medicine, ADR of herbs, phytoconstituents, and traditional medicines, herb-drug interactions, modes of reporting ADR, databases for reporting ADR's, provisions of PV in regulatory framework of different nations, challenges and way forward in PV are discussed in detail advocating a robust drug safety ecosystem for herbal medicines. CONCLUSION Despite recent efforts to encourage the reporting of suspected ADRs linked to herbal medicines, such as expanding the programme and adding community pharmacists and other healthcare professionals as recognized reporters, the number of herbal ADR reports received by the regulatory bodies remains comparatively low. Since users often do not seek professional advice or report if they have side effects, under-reporting, is anticipated to be significant for herbal medications. There are inadequate quality control methods, poor regulatory oversight considering herbs used in food and botanicals, and unregulated distribution channels. In addition, botanical identity, traceability of herbs, ecological concerns, over-the-counter (OTC) herbal medicines, patient-physicians barriers requires special focus by the regulatory bodies for improved global safety of herbal medicines.
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Affiliation(s)
- Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India.
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
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Salvatore S, Battigaglia MS, Murone E, Dozio E, Pensabene L, Agosti M. Dietary Fibers in Healthy Children and in Pediatric Gastrointestinal Disorders: A Practical Guide. Nutrients 2023; 15:2208. [PMID: 37432354 DOI: 10.3390/nu15092208] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 07/12/2023] Open
Abstract
Dietary fibers include non-digestible plant carbohydrates, lignin and resistant starch. Dietary fibers provide immune, cardiovascular, metabolic and intestinal beneficial effects in humans. Fibers naturally present in foods (fruits, vegetables, legumes, cereals) or used as supplements have different physical, chemical and functional profiles. This narrative review provides an update to the knowledge on the effects of dietary fibers in healthy subjects and in children with gastrointestinal disorders. Soluble fibers are digested by gut bacteria, producing short-chain fatty acids and energy for colonocytes, and may exert prebiotic effects that promote the growth of bifidobacteria and lactobacilli. Non-soluble fibers are bulking agents and may improve intestinal transit. The exact amount and characteristics of the fiber requirement in infants and children need to be further established. There are limited data evaluating fibers in children with gastrointestinal disorders. The low intake of fibers has been associated with constipation, but the intake of excessive fibers is not recommended as it may cause flatulence and abdominal discomfort. Certain fibers (particularly psyllium in irritable bowel syndrome) have shown beneficial effects in children with gastrointestinal disorders, but the limited and heterogenous data do not currently allow a specific recommendation.
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Affiliation(s)
- Silvia Salvatore
- Pediatric Department, Hospital "F. Del Ponte", Via F. Del Ponte 19, University of Insubria, 21100 Varese, Italy
| | - Maria Serena Battigaglia
- Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy
| | - Elena Murone
- Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy
| | - Eugenia Dozio
- Dipartimento di Medicina e Chirurgia, University of Insubria, 21100 Varese, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy
| | - Massimo Agosti
- Pediatric Department, Hospital "F. Del Ponte", Via F. Del Ponte 19, University of Insubria, 21100 Varese, Italy
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Sayre CL, Yellepeddi VK, Job KM, Krepkova LV, Sherwin CMT, Enioutina EY. Current use of complementary and conventional medicine for treatment of pediatric patients with gastrointestinal disorders. Front Pharmacol 2023; 14:1051442. [PMID: 36778015 PMCID: PMC9911676 DOI: 10.3389/fphar.2023.1051442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Infants, children, and adolescents are at risk of experiencing a multitude of gastrointestinal disorders (GID). These disorders can adversely affect the quality of life or be life-threatening. Various interventions that span the conventional and complementary therapeutic categories have been developed. Nowadays, parents increasingly seek complementary options for their children to use concurrently with conventional therapies. Due to the high prevalence and morbidity of diarrhea, constipation, and irritable bowel syndrome (IBS) in children, in this review, we decided to focus on the current state of the evidence for conventional and complementary therapies used for the treatment of these diseases in children. Diarrhea treatment focuses on the identification of the cause and fluid management. Oral rehydration with supplementation of deficient micronutrients, especially zinc, is well established and recommended. Some probiotic strains have shown promise in reducing the duration of diarrhea. For the management of constipation, available clinical trials are insufficient for conclusive recommendations of dietary modifications, including increased use of fruit juice, fiber, and fluid. However, the role of laxatives as conventional treatment is becoming more established. Polyethylene glycol is the most studied, with lactulose, milk of magnesia, mineral oil, bisacodyl, and senna presenting as viable alternatives. Conventional treatments of the abdominal pain associated with IBS are poorly studied in children. Available studies investigating the effectiveness of antidepressants on abdominal pain in children with IBS were inconclusive. At the same time, probiotics and peppermint oil have a fair record of benefits and safety. The overall body of evidence indicates that a careful balance of conventional and complementary treatment strategies may be required to manage gastrointestinal conditions in children.
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Affiliation(s)
- Casey L. Sayre
- Division of Clinical Pharmacology, Pediatrics, School of Medicine, Salt Lake City, UT, United States,College of Pharmacy, Roseman University of Health Sciences, South Jordan, UT, United States
| | | | - Kathleen M. Job
- Division of Clinical Pharmacology, Pediatrics, School of Medicine, Salt Lake City, UT, United States
| | - Lubov V. Krepkova
- Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR), Moscow, Russia
| | - Catherine M. T. Sherwin
- Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Elena Y. Enioutina
- Division of Clinical Pharmacology, Pediatrics, School of Medicine, Salt Lake City, UT, United States,*Correspondence: Elena Y. Enioutina,
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Sepehr F, Shirafkan H, Behzad C, Memariani Z, Mozaffarpur SA. The effect of Cassia fistula L. syrup in geriatrics constipation in comparison with the lactulose: A randomized clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2022; 297:115466. [PMID: 35798138 DOI: 10.1016/j.jep.2022.115466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/16/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cassia fistula is widely used in traditional Persian Medicine as a mild laxative. The rate of chronic constipation increases above the age of 60. AIM OF THE STUDY This study aimed to investigate the effect of Cassia fistula syrup (CFS) on geriatric constipation. MATERIALS AND METHODS This clinical trial study was performed on 70 aged patients who were referred to the clinic of gastroenterology of Rouhani Hospital, Babol, North of Iran. Patients were randomly divided into two groups of CFS or Lactulose with a dose of 30 ccs/day. Patients were visited two weeks after entering the study to evaluate the frequency of defecation, feeling of incomplete emptying after defecation, manual maneuver, consistency of stool, and also the quality of life. RESULTS The frequency of defecation per week varied from 1.82 ± 1.16 to 8.36 ± 3.44 in the CFS group after 2 weeks of intervention that was significantly more than the Lactulose that changed from 2.16 ± 1.46 to 5.66 ± 2.96 (P-value = 0.023, partial eta square = 0.079, NNT = 4). The quality of life, the percent of straining, lumpy or hard stool, pain during defecation, and the consistency of stool based on VAS were significantly better in the CFS group. The sensation of incomplete defecation, anorectal obstruction, and manual maneuvering were not different significantly between groups. CONCLUSION CFS can be more effective than Lactulose on geriatric constipation.
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Affiliation(s)
- Farangiz Sepehr
- Department of Persian Medicine, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran.
| | - Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Catherine Behzad
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran.
| | - Zahra Memariani
- Department of Persian Medicine, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran.
| | - Seyyed Ali Mozaffarpur
- Department of Persian Medicine, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran; Traditional Medicine and History of Medical Sciences Research Center, Health, Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Rajindrajith S, Devanarayana NM, Benninga MA. Childhood constipation: Current status, challenges, and future perspectives. World J Clin Pediatr 2022; 11:385-404. [PMID: 36185096 PMCID: PMC9516492 DOI: 10.5409/wjcp.v11.i5.385] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/23/2021] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
- University Paediatric Unit, Lady Ridgeway Hospital for Children, Colombo 00800, Sri Lanka
| | | | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children Hospital, Amsterdam University Medical Center, Amsterdam 1105AZ, The Netherlands
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8
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Azimi M, Niayesh H, Raeiszadeh M, Khodabandeh-Shahraki S. Efficacy of the herbal formula of Foeniculum vulgare and Rosa damascena on elderly patients with functional constipation: A double-blind randomized controlled trial. JOURNAL OF INTEGRATIVE MEDICINE 2022; 20:230-236. [PMID: 35339396 DOI: 10.1016/j.joim.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/21/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Constipation is a common chronic bowel disorder with an incidence of more than 50% in the elderly population. Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipation used widely by the elderly. OBJECTIVE This study evaluates the efficacy of an herbal formula made from Foeniculum vulgare Mill. and Rosa damascena for the treatment of constipation in an elderly population and consequent changes to their quality of life. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION This double-blind randomized active controlled clinical trial, with parallel group allocation ratio of 1:1, was conducted in a referral clinic in Afzalipour Hospital, affiliated to Kerman University of Medical Sciences in Kerman, Southeastern Iran. Individuals over 60 years of age, diagnosed with functional constipation (based on the Rome IV criteria), were included in this study. Participants received a sachet of 10 g F. vulgare and R. damascena (herbal formula group) or polyethylene glycol 4000 (PEG 4000 group) with a glass of warm water two times a day for 4 weeks and were followed up for 4 additional weeks. MAIN OUTCOME MEASURES Constipation severity, stool consistency, and the quality of life were used as the primary outcomes. Drug side effects were used as a secondary outcome. The outcomes were assessed using the Constipation Assessment Scale, the Bristol Stool Form Scale, and the Patient Assessment of Constipation Quality of Life questionnaire. RESULTS A total of 25 participants in each group completed the four-week treatment cycle and the eight-week follow-up. At the end of the four-week treatment cycle, all clinical outcomes had significant improvements in both groups (P < 0.05). The analysis of constipation severity (P < 0.001), stool consistency (P < 0.001), and the quality of life (P < 0.001) showed significant improvements with fewer side effects (mild diarrhea) and a longer duration of symptom relief in the herbal formula group compared to the PEG 4000 group. CONCLUSION Although both interventions significantly improved the treatment outcomes, constipation severity, stool consistency and the quality of life were improved more effectively by the herbal formula than by PEG 4000; however, the mechanism of action is not yet understood. TRIAL REGISTRATION This trial was registered in the Iranian Registry of Clinical Trials (IRCTID: IRCT20200108046056N1).
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Affiliation(s)
- Maryam Azimi
- Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman 7716913555, Iran; Department of Traditional Medicine, School of Persian Medicine, Kerman University of Medical Sciences, Kerman 7716913555, Iran
| | - Hanieh Niayesh
- Student Research Committee, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman 7716913555, Iran
| | - Mahboobeh Raeiszadeh
- Herbal and Traditional Medicines Research Center, Kerman University of Medical Sciences, Kerman 7716913555, Iran
| | - Sedigheh Khodabandeh-Shahraki
- Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman 7716913555, Iran.
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Wegh CAM, Baaleman DF, Tabbers MM, Smidt H, Benninga MA. Nonpharmacologic Treatment for Children with Functional Constipation: A Systematic Review and Meta-analysis. J Pediatr 2022; 240:136-149.e5. [PMID: 34536492 DOI: 10.1016/j.jpeds.2021.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation. STUDY DESIGN Randomized controlled trials (RCTs) evaluating nonpharmacologic treatments in children with functional constipation which reported at least 1 outcome of the core outcome set for children with functional constipation. RESULTS We included 52 RCTs with 4668 children, aged between 2 weeks and 18 years, of whom 47% were females. Studied interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n = 3), Cassia Fistula emulsion (n = 2), and a cow's milk exclusion diet (n = 2 in a subpopulation with constipation as a possible manifestation of cow's milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao'er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture. CONCLUSIONS More well-designed high quality RCTs concerning nonpharmacologic treatments for children with functional constipation are needed before changes in current guidelines are indicated.
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Affiliation(s)
- Carrie A M Wegh
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands; Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands.
| | - Desiree F Baaleman
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands
| | - Hauke Smidt
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands
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Hakiminia S, Esmaeeli Z, Moghadamnia AA, Jorsaraei SGA, Feizi F, Khafri S, Memariani Z, Shirafkan H, Mozaffarpur SA. Effect of Cassia fistula L. aqueous extract in maternal reproductive outcome, some serum indices and fetal anomaly frequency in rat. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:475-483. [PMID: 35974950 PMCID: PMC9348213 DOI: 10.22088/cjim.13.3.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/18/2021] [Accepted: 02/26/2022] [Indexed: 11/19/2022]
Abstract
Background Cassia fistula was used traditionally as laxative in pregnant women. Nevertheless, its fetal and maternal effects in pregnancy have not been studied yet. Methods Oral (Lethal Dose, 50%) LD50 was determined in mice. In addition, a control group, pregnant rats in other 5 experimental groups (n=12) received orally C. fistula aqueous extract (500, 1000 and 2000 mg/kg), tween80 (10%) and distilled water during pregnancy up to the delivery (21-23 days). Some serum indices were evaluated in maternal blood samples after delivery. Histopathologic and histomorphometric evaluations were performed on the selected slices of newborn rats. Results Anthraquinone content of the aqueous extract was 0.34% w/w. Oral LD50 was obtained more than 5000mg/kg. No abortions and newborn anomalies were observed in groups. The height and weight of the offspring were significantly reduced by the administration of 500, and 2000 mg/kg of extract compared to control. There was no significant change in maternal blood urea and creatinine. Higher concentration (2000mg/kg) led to ALT elevation. ALS levels decreased dose-dependency in treatment groups comparing to control. Histopathological findings showed significant lung vascular congestion, and hypertrophy of heart in group tween80, and significant hepatic parenchymal inflammation in tween80 and 2000mg/kg and 1000mg/kg groups. In all tissues of all groups, malpighian body area and bowman's capsule space significantly increased compared to the control group. Conclusion It seems C. fistula extract is safe in pregnancy. Because of confounding role of tween80 in histopathological finding, more research is necessary.
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Affiliation(s)
- Saeed Hakiminia
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Esmaeeli
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | | | - Farideh Feizi
- Department of Anatomical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Sorayya Khafri
- Department of Biostatistics, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Memariani
- Department of Persian Medicine, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Hoda Shirafkan
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Seyyed Ali Mozaffarpur
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran ,Correspondence: Seyyed Ali Mozaffarpur, Department of Traditional Iranian Medicine, School of Traditional Iranian Medicine,Traditional Medicine and History of Medical Sciences Research Center, Babol University of Medical Sciences, Babol, Iran. E-mail: , Tel: 0098 1132194728-30, Fax: 0098 1132194728-30
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11
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Akram M, Thiruvengadam M, Zainab R, Daniyal M, Bankole MM, Rebezov M, Shariati MA, Okuskhanova E. Herbal Medicine for the Management of Laxative Activity. Curr Pharm Biotechnol 2021; 23:1269-1283. [PMID: 34387161 DOI: 10.2174/1389201022666210812121328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 11/22/2022]
Abstract
Constipation is one of the most common and prevalent chronic gastrointestinal conditions across the globe that is treated or managed through various methods. Laxatives are used for the treatment or management of chronic/acute constipation. But due to the adverse effects associated with these laxatives, herbal foods should be considered as alternative therapies for constipation. In this review, the laxative potential of plant-based medicines used for constipation were discussed. Constipation may be caused by various factors such as lifestyle, particular food habits, pregnancy and even due to some medication. Chronic constipation is responsible for different health issues. Pharmacological and non-pharmacological paradigms are applied for the treatment or management of constipation. In the pharmacological way of treatment, medicinal plants have a key role, because of their fibrous nature. Numerous plants such as Prunus persica (Rosaceae), Cyamopsis tetragonolobus (Leguminosae), Citrus sinensis (Rutaceae), Planta goovata (Plantaginaceae), Rheum emodi (Polygonaceae), Cassia auriculata (Caesalpinacea), Ricinus communis (Euphorbiaceae), Croton tiglium (Euphorbiaceae), Aloe barbadensis (Liliaceae), Mareya micrantha (Euphorbiaceae), Euphorbia thymifolia (Euphorbiaceae), Cascara sagrada (Rhamnaceae), Cassia angustifolia (Fabaceae) have laxative activity. Medicinal plants possess a significant laxative potential and support their folklore therefore, further, well-designed clinical-based studies are required to prove and improve the efficacy of herbal medicine for constipation. The present review showed that herbs laxative effect in various in-vivo/ in-vitro models.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | - Muthu Thiruvengadam
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul 05029. South Korea
| | - Rida Zainab
- Department of Eastern Medicine, Government College University Faisalabad. Pakistan
| | - Muhammad Daniyal
- Faculty of Eastern Medicine, Hamdard University, Karachi. Pakistan
| | - Marc Moboladji Bankole
- African Centre of Excellence (World Bank) Public Health and Toxicological Research (ACE-PUTOR) University of Port Harcourt, Rivers State. Nigeria
| | - Maksim Rebezov
- V. M. Gorbatov Federal Research Center for Food Systems of Russian Academy of Sciences, Moscow. Russian Federation
| | - Mohammad Ali Shariati
- K.G. Razumovsky Moscow State University of Technologies and Management (the First Cossack University), 109004, Moscow. Russian Federation
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12
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Santucci NR, Chogle A, Leiby A, Mascarenhas M, Borlack RE, Lee A, Perez M, Russell A, Yeh AM. Non-pharmacologic approach to pediatric constipation. Complement Ther Med 2021; 59:102711. [PMID: 33737146 DOI: 10.1016/j.ctim.2021.102711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 01/24/2023] Open
Abstract
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.
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Affiliation(s)
- Neha R Santucci
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Ashish Chogle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA
| | - Alycia Leiby
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E Borlack
- Division of Gastroenterology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Amanda Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Oregon Health and Science University, OR, USA
| | - Maria Perez
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Alexandra Russell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.
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13
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Aslam MS. Application of genus Cassia in the treatment of Constipation: A systematic review. F1000Res 2021; 8:256. [DOI: https:/doi.org/10.12688/f1000research.17893.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Purpose: Role of genus cassia in the treatment of Constipation Methods: Methodological analysis, systematic review, and meta-analysis of identified studies using RevMan Result and Discussion: Cassia fistula was partially effected in treating constipation however there is a need for improvement in the protocol of studies to reduce biases. These results were only limited to one species so it cannot be generalized among all species of Cassia. Conclusion: Cassia fistula is partially effective in reducing the pain and consistency of stool during constipation among children.
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14
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Tappin D, Grzeda M, Joinson C, Heron J. Challenging the view that lack of fibre causes childhood constipation. Arch Dis Child 2020; 105:864-868. [PMID: 32156695 PMCID: PMC7456542 DOI: 10.1136/archdischild-2019-318082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To assess evidence supporting the view that 'low fibre causes childhood constipation'. DESIGN Triangulation integrated three approaches: a systematic review NICE guideline CG99 examining effectiveness of increasing fibre; a cohort study, Avon Longitudinal Study of Parents and Children (ALSPAC), to assess if constipation (or hard stools) can precede fibre intake at weaning; and a literature search for twin studies to calculate heredity. SETTING CG99 examined the literature regarding the effectiveness of increasing fibre. ALSPAC asked parents about: hard stools at 4 weeks, 6 months and 2.5 years and constipation at age 4-10 years, as well as fibre intake at 2 years. Twin studies and data from ALSPAC were pooled to calculate concordance of constipation comparing monozygotic and dizygous twin pairs. PARTICIPANTS CG99 reported six randomised controlled trials (RCTs). ALSPAC hard stool data from 6796 children at 4 weeks, 9828 at 6 months and 9452 at 2.5 years plus constipation data on 8401 at 4-10 years were compared with fibre intake at 2 years. Twin studies had 338 and 93 twin pairs and ALSPAC added a further 45. RESULTS Increasing fibre did not effectively treat constipation. Hard stools at 4 weeks predated fibre and at 6 months predicted lower fibre intake at 2 years (p=0.003). Heredity explained 59% of constipation. CONCLUSIONS RCTs indicate that increasing fibre is not an effective treatment for constipation in children. Hard stools can precede and predict later fibre intake. Genetic inheritance explains most childhood constipation. Extended treatment with stool softeners may improve fibre intake and limit long-term damaging sequelae of constipation.
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Affiliation(s)
- David Tappin
- Scottish Cot Death Trust, University of Glasgow, Glasgow, UK
| | - Mariusz Grzeda
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Carol Joinson
- Population Health Sciences, University of Bristol, Bristol, UK,Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
| | - Jon Heron
- Population Health Sciences, University of Bristol, Bristol, UK
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15
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Araj-Khodaei M, Noorbala AA, Yarani R, Emadi F, Emaratkar E, Faghihzadeh S, Parsian Z, Alijaniha F, Kamalinejad M, Naseri M. A double-blind, randomized pilot study for comparison of Melissa officinalis L. and Lavandula angustifolia Mill. with Fluoxetine for the treatment of depression. BMC Complement Med Ther 2020; 20:207. [PMID: 32620104 PMCID: PMC7333290 DOI: 10.1186/s12906-020-03003-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Depression has rapidly progressed worldwide, and the need for an efficient treatment with low side effect has risen. Melissa officinalis L and Lavandula angustifolia Mill have been traditionally used in Asia for the treatment of depression. Many textbooks of traditional Persian medicine refer to these herbs for the treatment of depression while there are no adequate clinical trials to support this claim. The present study aimed to evaluate the efficacy of M. officinalis and L. angustifolia compared to fluoxetine for the treatment of mild to moderate depression in an 8-week randomized, double-blind clinical trial. Methods Forty-five adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) for major depression, were randomly assigned to 3 groups to daily receive either M. officinalis (2 g) or L. angustifolia (2 g) or fluoxetine (20 mg) and were assessed in weeks 0, 2, 4 and 8 by the Hamilton Rating Scale for Depression (HAM-D) including 17 items. Results Our study showed that M. officinalis and L. angustifolia effect similar to fluoxetine in mild to moderate depression. (F = 0.131, df = 2,42, p = 0.877). Conclusion Due to some restrictions in this study including absence of placebo group, large-scale trials are needed to investigate the anti-depressant effect of these two herbs with more details. Trial registration IRCT2014061718126N1. Registration date: 2015-06-04-“Retrospectively registered”.
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Affiliation(s)
- Mostafa Araj-Khodaei
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran.,Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Ali Noorbala
- Psychosomatic Medicine Research center, Psychosomatic Ward, Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blv, Tehran, Iran
| | - Reza Yarani
- Department of Pediatrics E, Copenhagen Diabetes Research Center (CPH-DIRECT), Herlev University Hospital, Herlev, 2730, Copenhagen, Denmark.,Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Emadi
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran.,Traditional Medicine Clinical Trial Research Center, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran
| | - Elham Emaratkar
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran
| | - Soghrat Faghihzadeh
- Department of Biostatistic and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Mahdavi St., Karmandan Town, Zanjan, Iran
| | - Zahra Parsian
- Emergency Medicine Research Team, Daneshgah St. Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Alijaniha
- Traditional Medicine Clinical Trial Research Center, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran
| | - Mohammad Kamalinejad
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Naseri
- Department of Traditional Medicine, School of Medicine, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran. .,Traditional Medicine Clinical Trial Research Center, Shahed University, 1471, North Kargar, Engelab Square, Tehran, Iran.
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16
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Paknejad MS, Motaharifard MS, Barimani S, Kabiri P, Karimi M. Traditional, complementary and alternative medicine in children constipation: a systematic review. ACTA ACUST UNITED AC 2019; 27:811-826. [PMID: 31734825 DOI: 10.1007/s40199-019-00297-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population. EVIDENCE ACQUISITION Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1-18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed. RESULTS 30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis. CONCLUSION The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. Graphical abstract.
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Affiliation(s)
- Maryam Sadat Paknejad
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Monireh Sadat Motaharifard
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Shahdis Barimani
- Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Kabiri
- Department of Biostatics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran.
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17
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Velasco-Benítez CA, García-Perdomo HA. Some flaws that could change the effect sizes and limit the extrapolation of these results. J Pediatr (Rio J) 2019; 95:374-375. [PMID: 30742797 DOI: 10.1016/j.jped.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/30/2018] [Indexed: 11/19/2022] Open
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18
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Velasco‐Benítez CA, García‐Perdomo HA. Some flaws that could change the effect sizes and limit the extrapolation of these results. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Abstract
Purpose: Role of genus cassia in the treatment of Constipation Methods: Methodological analysis, systematic review, and meta-analysis of identified studies using RevMan Result and Discussion: Cassia fistula was partially effected in treating constipation however there is a need for improvement in the protocol of studies to reduce biases. These results were only limited to one species so it cannot be generalized among all species of Cassia. Conclusion: Cassia fistula is partially effective in reducing the pain and consistency of stool during constipation among children.
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20
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Effect of Nepeta bracteata Benth. on Chronic Obstructive Pulmonary Disease: A Triple-Blinded, Randomized Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.80112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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21
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Use of fibers in childhood constipation treatment: systematic review with meta‐analysis. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2018.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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Piccoli de Mello P, Eifer DA, Daniel de Mello E. Use of fibers in childhood constipation treatment: systematic review with meta-analysis. J Pediatr (Rio J) 2018; 94:460-470. [PMID: 29474804 DOI: 10.1016/j.jped.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To gather current evidence on the use of fiber for constipation treatment in pediatric patients. SOURCE OF DATA Systematic review with meta-analysis of studies identified through Pubmed, Embase, LILACS and Cochrane databases published up to 2016. INCLUSION CRITERIA Randomized controlled trials; patients aged between 1 and 18 years and diagnosed with functional constipation receiving or not drug treatment for constipation; articles published in Portuguese, English, Spanish, French, and German in journals accessible to the researchers. SYNTHESIS OF DATA A total of 2963 articles were retrieved during the search and, after adequate evaluation, nine articles were considered relevant to the study objective. A total of 680 children were included, of whom 45% were boys. No statistical significance was observed for bowel movement frequency, stool consistency, therapeutic success, fecal incontinence, and abdominal pain with fiber intake in patients with childhood constipation. These results should be interpreted with care due to the high clinical heterogeneity between the studies and the methodological limitation of the articles selected for analysis. CONCLUSIONS There is a scarcity of qualified studies to evaluate fiber supplementation in the treatment of childhood constipation, generating a low degree of confidence in estimating the real effect of this intervention on this population. Today, according to the current literature, adequate fiber intake should only be recommended for functional constipation, and fiber supplementation should not be prescribed in the diet of constipated children and adolescents.
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Affiliation(s)
- Patricia Piccoli de Mello
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Diego Andre Eifer
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Radiologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elza Daniel de Mello
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
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23
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Motaharifard MS, Jafari Z, Paknejad MS, Oveidzadeh L, Karimi M. Prevention and treatment of constipation in children from the perspective of Iranian traditional medicine. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 14:429-435. [PMID: 27854194 DOI: 10.1016/s2095-4964(16)60278-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Constipation is one of the most common complaints of children and a common cause of referrals to pediatricians. Numerous reasons for this disease have been mentioned in the Iranian traditional medicine (ITM). It is believed that this disorder is mostly due to the lack of consideration of the six essential principles (Setteh-ye-Zarurieah), which are necessary to maintain health and prevent disease. In this descriptive study we collected and classified the concepts related to the topic by reviewing reliable ITM text books. Scientific databases were also searched for the most commonly used herbs in the treatment of constipation. The results showed that, from the perspective of ITM, the first step in treating constipation in children is making lifestyle changes. This includes giving appropriate training in the six essential principles, and making modification in existing habits where necessary. In the next steps, using some herbal remedies for topical or oral administration is recommended. On the other hand, a few clinical trials have been done concerning the effects of herbal medicines on pediatric constipation. Therefore, ITM's preventive and curative strategies can provide an efficient and cost-effective way to address constipation in children. This study can serve as a preface to performing clinical studies in this field.
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Affiliation(s)
| | - Zahra Jafari
- Department of Traditional Medicine, Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Laleh Oveidzadeh
- Department of Traditional Medicine, Faculty of Iranian Traditional Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehrdad Karimi
- School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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24
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Hajiheydari MR, Yarmohammadi ME, Izadi P, Jafari F, Emadi F, Emaratkar E, Reza Abtahi SH, Zargaran A, Naseri M. Effect of Nepeta bracteata Benth. on allergic rhinitis symptoms: A randomized double-blind clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:128. [PMID: 29259639 PMCID: PMC5721487 DOI: 10.4103/jrms.jrms_316_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/01/2017] [Accepted: 09/03/2017] [Indexed: 11/16/2022]
Abstract
Background: Allergic rhinitis (AR) is one of the health problems in the world. It is necessary to develop new treatment procedure for control of this disease. The aim of this study was to assess the effect of Zofa (Nepeta bracteata Benth) on AR patients. Materials and Methods: In this double-blind randomized clinical trial study, 71 patients (37 patients in treatment and 34 in placebo group) participated. In treatment group, N. bracteata syrup (NBS) was used for 4 weeks as three times a day. The efficacy of the drug regarding AR symptoms (rhinorrhea, sneezing, nasal obstruction, itchy nose, and ocular symptoms) were evaluated through a visual analog scale (VAS) by 0–10 before administration and at the end of the whole treatment period. The collected information was entered in the SPSS software (version 18) and was analyzed using the Fisher's exact test, Chi-square test, independent sample t-test, and paired sample test. Results: The improvement of AR symptoms in the group receiving NBS was significantly higher compared to control group (4.73 ± 1.84 vs. 0.38 ± 2.06; P < 0.0001). Furthermore, the mean of total VAS before and after the treatment (in case group) was 7.10 ± 1.92 and 2.37 ± 1.76, respectively (P < 0.001). Conclusion: The results of this study indicate that N. bracteata has significant effects on improving the symptoms of AR. Hence, it can be a good alternative to AR symptoms relief.
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Affiliation(s)
| | | | - Poopak Izadi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Farhad Jafari
- Department of Health and Social Medicine, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Fatemeh Emadi
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran.,Department of Traditional Iranian Medicine, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Elham Emaratkar
- Department of Traditional Iranian Medicine, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Sayed Hamid Reza Abtahi
- Department of Otolaryngology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arman Zargaran
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naseri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
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Atarzadeh F, Kamalinejad M, Dastgheib L, Amin G, Jaladat AM, Nimrouzi M. Cassia fistula: A remedy from Traditional Persian Medicine for treatment of cutaneous lesions of pemphigus vulgaris. AVICENNA JOURNAL OF PHYTOMEDICINE 2017; 7:107-115. [PMID: 28348966 PMCID: PMC5355816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pemphigus is a rare autoimmune disease that may be fatal without proper medical intervention. It is a blistering disease that involves both the skin and mucus membranes, in which the most important causes of death comprise superimposed opportunistic infections and complications of long-term high-dose corticosteroid therapy or prolonged consumption of immune suppressant drugs. Skin lesions are the most important sources of infection, and any local treatment decreasing the healing time of lesions and reducing the total dosage of drugs is favorable. MATERIALS AND METHODS Here, we review the probable mechanism of action of a traditional formulary of Cassia fistula (C. fistula) fruit extract in almond oil as a new topical medication for reducing the duration of treatment of pemphigus vulgaris erosions. RESULTS C. fistula fruit oil has lupeol, anthraquinone compounds as rhein and flavonoids. Previous in vitro and animal studies on C. fistula fruit have demonstrated wound healing, antioxidative, anti-leukotrienes, anti-inflammatory, antibacterial and antifungal effects of this plant. CONCLUSION It is hypothesized that C. fistula L. can be a botanical therapeutic choice for treatment of pemphigus erosions.
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Affiliation(s)
- Fatemeh Atarzadeh
- Department of Traditional Iranian Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamalinejad
- School of Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Ladan Dastgheib
- Molecular Dermatology Research Center, Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Amin
- Department of Traditional Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Mohammad Jaladat
- Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author: Tel: :+9821879500, Fax: +9821879500,
| | - Majid Nimrouzi
- Department of Traditional Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Yousefi M, Hoseini SM, Salari R. Evaluating the clinical efficacy of Guggulu resin on constipation: A randomised clinical trial. ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Tofighi Z, Golabi M, Toliyat T, Naseri M, Yassa N. Formulation and Evaluation of an Iranian Traditional Dosage Form Containing Linum and Ficus for Improvement of Functional Constipation. Jundishapur J Nat Pharm Prod 2016. [DOI: 10.17795/jjnpp-40069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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28
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Constipation and Laxative Herbs in Iranian Traditional Medicine. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.24574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Esmaeilidooki MR, Mozaffarpur SA, Mirzapour M, Shirafkan H, Kamalinejad M, Bijani A. Comparison Between the Cassia Fistula`s Emulsion With Polyethylene Glycol (PEG4000) in the Pediatric Functional Constipation: A Randomized Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e33998. [PMID: 27660721 PMCID: PMC5027133 DOI: 10.5812/ircmj.33998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/29/2015] [Accepted: 01/02/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND There are few effective drugs for pediatric functional constipation (FC). OBJECTIVES Comparing the effectiveness of Cassia fistula's emulsion (CFE) with Polyethylene glycol (PEG4000) in FC; and evaluation of safety of both drugs in the treatment of FC. MATERIALS AND METHODS A randomized open label, prospective, controlled, parallel-group clinical trial was carried on 109 children (M/F: 63/46; mean age ± SD: 59.7 ± 28.8 months) in Amirkola children's hospital, Babol, Iran. The inclusion criteria were based on diagnosis of FC according to the Rome III criteria and age range between 2 - 15 years. They received CFE or PEG randomly for 4 weeks. Frequencies of defecation, severity of pain, consistency of stool, fecal incontinence and retentive posturing were compared between the two groups and with baselines. Children were counted as improved when they exited from Rome III criteria of FC. RESULTS Fifty seven patients were assigned to receive PEG and 52 patients received CFE. After 4weeks of medication, 86.5% of children in CFE group and 77.1% in PEG group (RR = 1.121, CI95%:0.939 - 1.338) exited from the criteria of FC. All measurable criteria improved in both groups without any significant difference, except in the frequency of defecation that in CFE group (10.96 ± 5.7) was significantly more than PEG group (6.9 ± 3.5) (P < 0.0001). Compliances of PEG were significantly better in the 2 first weeks (P = 0.002, 0.008) but not in third and fourth week (P = 0.061, 0.062). None of these two drugs cause clinically significant side effects. CONCLUSIONS CFE can be as effective as PEG in the 4-weeks treatment of children with FC.
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Affiliation(s)
- Mohammad Reza Esmaeilidooki
- Department of Pediatrics, Non-Communicable Pediatric Disease Research Center, Babol University of Medical Sciences, Babol, IR Iran
| | - Seyyed Ali Mozaffarpur
- Traditional Medicine and History of Medical Sciences Research Center, Babol University of Medical Sciences, Babol, IR Iran
- Department of Traditional Iranian Medicine, Faculty of Traditional Iranian Medicine, Babol University of Medical Sciences, Babol, IR Iran
| | - Mohaddese Mirzapour
- Traditional Medicine and History of Medical Sciences Research Center, Babol University of Medical Sciences, Babol, IR Iran
- Department of Traditional Iranian Medicine, Faculty of Traditional Iranian Medicine, Babol University of Medical Sciences, Babol, IR Iran
| | - Hoda Shirafkan
- Department of Traditional Iranian Medicine, Faculty of Traditional Iranian Medicine, Babol University of Medical Sciences, Babol, IR Iran
- Departments of Statistics and Biostatistics, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Mohammad Kamalinejad
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ali Bijani
- Social Health Research Center, Babol University of Medical Sciences, Babol, IR Iran
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Maneenoon K, Khuniad C, Teanuan Y, Saedan N, Prom-In S, Rukleng N, Kongpool W, Pinsook P, Wongwiwat W. Ethnomedicinal plants used by traditional healers in Phatthalung Province, Peninsular Thailand. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2015; 11:43. [PMID: 26025447 PMCID: PMC4469324 DOI: 10.1186/s13002-015-0031-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/06/2015] [Indexed: 05/21/2023]
Abstract
BACKGROUND In rural communities of Thailand, traditional healers still play an important role in local health care systems even though modern medicine is easily accessible. Meanwhile, natural forests in Thailand which are important sources of materia medica are being greatly destroyed. This has led to an erosion of traditional Thai medicine. Furthermore, the concept of medicinal plant selection as medicine based on their tastes is still an important component of traditional Thai medicine, but no or little publications have been reported. Thus the aim of the present study is to collect ethnomedicinal data, medicinal plant tastes and relevant information from experienced traditional healers before they are lost. METHODS An ethnobotanical survey was carried out to collect information from nine experienced traditional healers on the utilization of medicinal plants in Phatthalung Province, Peninsular Thailand. Data were obtained using semi-structured interviews and participant observations. Plant specimens were also collected and identified according to the plant taxonomic method. RESULTS A total of 151 medicinal plants were documented and 98 of these are reported in the study. Local names, medicinal uses, parts used, modes of preparation, and the relationship between ailments and tastes of medicinal plant species are presented. CONCLUSIONS This research suggests that traditional healers are still considered important for public health among Thai communities and that many people trust the healing properties of medicinal plants. In the future, it is hoped that traditional Thai medicine will be promoted and therefore will help reduce national public health expense.
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Affiliation(s)
- Katesarin Maneenoon
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Chuanchom Khuniad
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
- Faculty of Health and Sports Science, Thaksin University, Phatthalung, 93110, Thailand.
| | - Yaowalak Teanuan
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
- Faculty of Science and Technology, Songkhla Rajabhat University, Songkhla, 90000, Thailand.
| | - Nisachon Saedan
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Supatra Prom-In
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Nitiphol Rukleng
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Watid Kongpool
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Phongsura Pinsook
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Winyu Wongwiwat
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
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Alijaniha F, Naseri M, Afsharypuor S, Fallahi F, Noorbala A, Mosaddegh M, Faghihzadeh S, Sadrai S. Heart palpitation relief with Melissa officinalis leaf extract: double blind, randomized, placebo controlled trial of efficacy and safety. JOURNAL OF ETHNOPHARMACOLOGY 2015; 164:378-84. [PMID: 25680840 DOI: 10.1016/j.jep.2015.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 01/26/2015] [Accepted: 02/03/2015] [Indexed: 05/20/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In Traditional Iranian Medicine (TIM), Melissa officinalis L. is commonly regarded as an effective therapy for heart palpitations. OBJECTIVE Heart palpitation is a common complaint that is often benign and associated with a marked distress that makes the condition difficult to treat. Herbal medicines provide an alternative to conventional drugs for treating various kinds of diseases. This study was done as a double blind randomized placebo-controlled clinical trial to evaluate the efficacy and safety of the dried extract of M. officinalis on adults suffering from benign palpitations. MATERIALS AND METHODS Eligible volunteers were randomly assigned as outpatients to a 14 day treatment with 500 mg twice a day of lyophilized aqueous extract of M. officinalis leaves (or placebo). Participants in the tests, physicians and researchers were blind to group assignments. Both primary and secondary outcomes were patient-reported. Primary outcomes were obtained from two measures: mean frequency of palpitation episodes per week, derived from patients׳ diaries, and mean intensity of palpitation estimated through Visual Analogue Scale (VAS) in a self-report questionnaire. Psychiatric symptoms (somatization, anxiety and insomnia, social dysfunction and severe depression) were evaluated as secondary outcomes by General Health Questionnaire-28 (GHQ-28), before and after intervention. RESULTS Fifty-five volunteers out of 71 recruited study subjects completed the trial. Results showed that 14-day of treatment with lyophilized aqueous extract of M. officinalis leaves reduced frequency of palpitation episodes and significantly reduced the number of anxious patients in comparison to the placebo (P=0.0001, P=0.004 resp.). Also, M. officinalis extract showed no indication of any serious side effects. CONCLUSION Lyophilized aqueous extract of M. officinalis leaves may be a proper and safe herbal drug for the treatment of benign palpitations.
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Affiliation(s)
- Fatemeh Alijaniha
- Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohsen Naseri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran.
| | - Suleiman Afsharypuor
- Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - Ahmadali Noorbala
- Psychosomatic Ward Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahmood Mosaddegh
- Dean Traditional Medicine and Materia Medica Research Center (TMRC) Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soghrat Faghihzadeh
- Department of Biostatistic and Epidemiology, School of Medicine, Zanjan University of Medical Science, Zanjan, Iran.
| | - Sima Sadrai
- Division of Biopharmaceutics and Pharmacokinetics, Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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Sharma J, Gairola S, Sharma YP, Gaur RD. Ethnomedicinal plants used to treat skin diseases by Tharu community of district Udham Singh Nagar, Uttarakhand, India. JOURNAL OF ETHNOPHARMACOLOGY 2014; 158 Pt A:140-206. [PMID: 25448505 DOI: 10.1016/j.jep.2014.10.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/29/2014] [Accepted: 10/04/2014] [Indexed: 05/27/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Tharu community is the largest primitive indigenous community of the Uttarakhand, India. In this article we have scientifically enumerated medicinal plants and herbal preparations used by the Tharu community to treat various skin diseases, and discussed dermatological properties of these plants in the light of previous ethnomedicinal, microbiological, pharmacological, toxicological, phytochemical and clinical studies. MATERIALS AND METHODS Ethnomedicinal survey was conducted in different villages of Tharu community located in district Udham Singh Nagar, Uttarakhand, India. Ethnomedicinal information on plants used to treat various skin diseases was collected from 122 individuals (93 males and 29 females), including 35 experienced herbal practitioners and 87 local villagers. For each of the recorded plant species the use value (UV) and fidelity level (FL) was calculated. The informant consensus factor (Fic) was also calculated to find out the homogeneity in the information given by the informants. RESULTS A total of 90 plant species belonging to 86 genera and 48 families were used by the Tharu community to treat various skin diseases viz., wounds (38 spp.), boils (32 spp.), cuts (18 spp.), leprosy (11 spp.), eczema (10 spp.), itching (7 spp.), ringworm (5 spp.), burns (4 spp.), leucoderma (4 spp.), cracked heels (2 spp.), dandruff (3 spp.), body infection (2 spp.), chilblains (2 spp.), hair fall (2 spp.) and toes infection (2 spp.). Information on botanical name, family, vernacular name, ailments treated, mode and dose of herbal preparations, UV and FL values are provided for each of the recorded species. According to UV value most preferred plant species used to treat skin diseases by Tharu community was Ricinus communis L. followed by Tridax procumbens (L.) L., Azadirachta indica A. Juss., Ageratum conyzoides and Allium cepa L. CONCLUSIONS The present study has revealed significant information on various medicinal plants used to treat skin diseases by Tharu community. Literature review has confirmed most of the claims made by the Tharu community regarding treatment of various skin diseases by the reported plants. The literature review has also revealed that products from very few of the reported plants are available in market, while most of the reported plants are still under preclinical or clinical trials. There are various known phytochemicals, and antibiotic, antibacterial, antiviral and antifungal agents present in these plants which may be synthesized or transformed to make pharmaceuticals. Some of the reported plants have shown promising results in preclinical trails and there is a need of clinical trials to see their safety and efficacy in treating various skin diseases. These plants may be targeted for development of new medicines, ointments or drugs for the treatment of skin diseases. However further toxicological, preclinical and clinical studies are needed to validate claims about little worked out plant species reported in the present study viz., Sida cordata (Burm. F.) Borss. Waalk., Millettia extensa (Benth.) Baker, Caesulia axillaris Roxb., Ehretia laevis Roxb., Vanda tessellate (Roxb.) Hook. Ex G.Don. and Eualaliopsis binata (Retz.) C.E. Hubb. Further studies on these plants are recommended to assess their potential in development of new skin care products.
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Affiliation(s)
- Jyotsana Sharma
- Department of Botany, University of Jammu, Jammu-Tawi 180006, Jammu and Kashmir, India.
| | - Sumeet Gairola
- Herbarium and Plant Systematics Section, Biodiversity and Applied Botany Division, CSIR-Indian Institute of Integrative Medicine, Jammu-Tawi 180001, Jammu and Kashmir, India.
| | - Yash Pal Sharma
- Department of Botany, University of Jammu, Jammu-Tawi 180006, Jammu and Kashmir, India
| | - R D Gaur
- Department of Botany, HNB Garhwal University, Srinagar Garhwal 246174, Uttarakhand, India
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