The effect of equisetum arvense (horse tail) ointment on wound healing and pain intensity after episiotomy: a randomized placebo-controlled trial

Acute pain management after vaginal delivery with perineal tears or episiotomy

BACKGROUND

A vaginal delivery may be associated with acute postpartum pain, particularly after perineal trauma. However, pain management in this setting remains poorly explored.

OBJECTIVE

The aim of this systematic review was to evaluate the literature and to develop recommendations for pain management after a vaginal delivery with perineal trauma.

EVIDENCE REVIEW

MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) and systematic reviews assessing pain after a vaginal delivery with perineal tears or episiotomy until March 2023. Cochrane Covidence quality assessment generic tool and the RoB Vis 2 tool were used to grade the quality of evidence.

FINDINGS

Overall, 79 studies (69 RCTs and 10 systematic reviews and meta-analyses) of good quality of evidence were included. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment. Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring. Local anesthetic infiltration, topical local anesthetic, ointment application, and pudendal nerve block are not recommended due to insufficient or lack of evidence. Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use. Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants. When a perineal suture is indicated, a continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain. For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain.

CONCLUSIONS

Postpartum pain management after a vaginal delivery with perineal trauma should include acetaminophen, NSAIDs, and ice or chemical cold packs. Epidural morphine should be reserved for severe perineal tears. A surgical repair technique should depend on perineal tear severity.

A Systematic Review of Stem Cell Differentiation into Keratinocytes for Regenerative Applications

To improve wound healing or treatment of other skin diseases, and provide model cells for skin biology studies, in vitro differentiation of stem cells into keratinocyte-like cells (KLCs) is very desirable in regenerative medicine. This study examined the most recent advancements in in vitro differentiation of stem cells into KLCs, the effect of biofactors, procedures, and preparation for upcoming clinical cases. A range of stem cells with different origins could be differentiated into KLCs under appropriate conditions. The most effective ways of stem cell differentiation into keratinocytes were found to include the co-culture with primary epithelial cells and keratinocytes, and a cocktail of growth factors, cytokines, and small molecules. KLCs should also be supported by biomaterials for the extracellular matrix (ECM), which replicate the composition and functionality of the in vivo extracellular matrix (ECM) and, thus, support their phenotypic and functional characteristics. The detailed efficient characterization of different factors, and their combinations, could make it possible to find the significant inducers for stem cell differentiation into epidermal lineage. Moreover, it allows the development of chemically known media for directing multi-step differentiation procedures.In conclusion, the differentiation of stem cells to KLCs is feasible and KLCs were used in experimental, preclinical, and clinical trials. However, the translation of KLCs from in vitro investigational system to clinically valuable cells is challenging and extremely slow.

[Phytotherapy in uro-oncology]

BACKGROUND

Complementary and alternative medicine (CAM) is used by about 40-90% of all patients with cancer. CAM also includes phytotherapy, which is considered to be a biologically based therapy. Depending on the survey, the users of phytotherapy account for up to 80%. The intention of the users is to fight cancer or to alleviate its symptoms.

OBJECTIVES

Frequently used phytotherapeutics with their level of evidence and possible pitfalls are presented in a narrative review. Special attention is given to the uro-oncological context.

MATERIALS AND METHODS

Popular phytotherapeutics (mistletoe, pomegranate, aloe vera, sage, ginger, ginseng) as well as three uronephrological plants (juniper, horsetail, bearberry) are classified and evaluated according to existing guidelines and by using a selective literature search.

RESULTS

A total of nine plants were considered. Currently, there is no sufficient evidence for the use of pomegranate or mistletoe for tumor therapy. Guideline recommendations for or against symptom-oriented use exist for ginger (nausea; may be used), ginseng (fatigue; may be used), aloe vera (radiation dermatitis, should not be recommend), and bearberry (recurrent cystitis, may be used). A small number of studies on other symptoms and medicinal plants could be found (e.g., ginger - xerostomia, aloe vera - constipation, sage - oral mucositis or sweating).

CONCLUSIONS

An integration of phytotherapeutic drugs into uro-oncological treatments concept can be considered. The benefits and risks of complementary herbal medicines (e.g., potential interactions with tumor therapy) must always be carefully weighed.

Study on essential oil, antioxidant activity, anti-human prostate cancer effects, and induction of apoptosis by Equisetum arvense

In this study, we have reported the chemical composition of Equisetum arvense essential oil and the anti-cancer activity of the plant against the prostate cancer cell line. The essential oil was obtained using the hydro-distillation assay. The chemical composition was identified using the gas chromatographic methods including gas chromatography/flame ionization detector and gas chromatography/mass spectrometry. The antioxidant activity of the essential oil and extract was evaluated using classical methods. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was run to evaluate the cytotoxic effect of the essential oil and extract on the prostate cancer cell line of lymph node carcinoma of the prostate. The induction apoptosis of the extract was analyzed by a flow cytometer. Thymol acetate (14.7%), trans-carveol (12.5%), thymol (11.8%), and δ-elemene (9.4%) were identified as the main compounds for the essential oil. The extract scavenged the free radical of 2,2-diphenyl-1-picrylhydrazyl with a half maximal inhibitory concentration (IC50) of 15.2 ± 1.4 μg/mL for the plant extract. In the MTT assay, the IC50 of the extract and essential oil were 25.2 ± 0.3 and 218.9 ± 10.7 μg/mL after 72 h. The highest apoptosis was 31.6% for the plant extract. The obtained results of the present study revealed that E. arvense can be introduced as a potent agent to prevent the growth of prostate tumors.

Early Postnatal Care: Exploring Primary Caregivers' Experiences of Continuity of Care After Discharge at Selected Districts in Limpopo Province South Africa

BACKGROUND

Early postnatal discharge is perceived as a factor that contributes to possible maternal, neonatal complications and deaths during the first week of delivery. Continuing with provision of home-based postnatal care by the primary caregivers is crucial to prevent morbidity and mortality.

PURPOSE

The purpose was to explore the experiences of primary caregivers of continuing with the provision of early postnatal care at home.

METHOD

A qualitative research approach, which was explorative, descriptive, and contextual was conducted in the three selected districts of different ethnic groups at Limpopo Province in October 2019. A non-probability, purposive sampling was used to conveniently sample 20 primary caregivers of postnatal women. Data were collected during the first 2 weeks of delivery through in-depth individual semi-structured interviews until data saturation was reached. Data were analysed through a thematic analysis framework applying Tesch's open coding method. The study was done in Limpopo district, South Africa.

FINDINGS

The findings revealed a theme, namely, knowledge and skills of providing community-based postnatal care and three sub-themes; early postnatal care to detect and prevent possible complications to the mother; general postnatal care, and early neonatal care to detect and prevent possible complications.

CONCLUSION

Primary caregivers displayed acceptable indigenous skills and knowledge of providing early postnatal care. However, the skills of detecting potential danger signs were not adequately displayed. It was recommended that midwives need to create awareness to primary caregivers from the antenatal through postnatal care period. Community Health Workers to assist during immediate postnatal check-ups (mother and neonate) which is done within 72hours of delivery. The health education, counseling, and community-based awareness campaigns are to be done with a focus on the detection and prevention of possible complications to mother and baby.

Physicochemical Characteristics of Chitosan-Based Hydrogels Modified with Equisetum arvense L. (Horsetail) Extract in View of Their Usefulness as Innovative Dressing Materials

This work focused on obtaining and characterizing hydrogels with their potential application as dressing materials for chronic wounds. The research included synthesizing chitosan-based hydrogels modified with Equisetum arvense L. (horsetail) extract via photopolymerization, and their characteristics determined with regard to the impact of both the modifier and the amount of crosslinker on their properties. The investigations included determining their sorption properties and tensile strength, evaluating their behavior in simulated physiological liquids, and characterizing their wettability and surface morphology. The release profile of horsetail extract from polymer matrices in acidic and alkaline environments was also verified. It was proved that hydrogels showed swelling ability while the modified hydrogels swelled slightly more. Hydrogels showed hydrophilic nature (all contact angles were <77°). Materials containing horsetail extract exhibited bigger elasticity than unmodified polymers (even by 30%). It was proved that the extract release was twice as effective in an acidic medium. Due to the possibility of preparation of hydrogels with specific mechanical properties (depending on both the modifier and the amount of crosslinker used), wound exudate sorption ability, and possibility of the release of active substance, hydrogels show a great application potential as dressing materials.

Evaluation the effect of Silybum marianum ointment on episiotomy wound healing and pain intensity in primiparous women: a randomized triple blind clinical trial

BACKGROUND

Episiotomy is the most commonn surgical procedure in midwifery which as any other wounds can cause infection or delay in healing. The current study aimed to determine effect of Silybum marianum ointment on pain severity and healing of episiotomy wound in primiparous women referring to Shahid Nourani Hospital at 2019.

METHODS

This research was done as a randomized, triple-blind clinical trial on 87 priiparous women (44 indivdiuals in Silybum marianum ointment group and 43 indivdiuals in placebo group) referred to Shahid Nourani Hospital in Talesh (Guilan Province), Iran at September 2019. After labor and performing episiotomy, twice a day for 10 days as a fingertip size of the ointment was prescribed to be topically used on the episiotomy incision for both groups (Silybum marianum ointment or placebo ointment). Data gathering was done using demographic and midwifery information questionnaire, Episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation)REEDA Scale (REEDA Scale: Redness(R); Edema (E), Ecchymosis(E), Discharge from the wound(D); Approximation of the perineal tissues(A))(scale, and visual analogue scale of pain. Examination of healing status of the perinea incision was performed during first 12 h, fifth day and tenth day after labor.Kolmogrov-Smirnov test was used in order to investiagte nomrality of data distribution of quantitative data, and two- independent samples t test, Chi square, repeated measures two factorial analysis of variance and Fischer's exact test were used. SPSS software version 23 was used to analyze data and 0.05 was considered as signifcance level.

RESULTS

Both groups of Silybum marianum and placebo groups did not differ regarding demographic and midwifery characteristics, hygiene status prior to intervention (P > 0.05). Mean difference of pain severity and REEDA scale in Silybum marianum ointment group in 12 h after labor, at fifth day and tenth day after labor was significant comparing to control group which indicates decline in episiotomy pain severity and faster wound healing (P < 0.001).

CONCLUSIONS

Silybum marianum ointment ointment accelerates episiotomy wound healing rate due to its healing properties and decreases pain severity.

TRIAL REGISTRATION

This study was registered in Iranian Registry of Clinical Trials in 10/08/2019 with the IRCT ID: IRCT201811100411603N1.

The effectiveness and safety of complementary health approaches to managing postpartum pain: A systematic review and meta-analysis

Background

Women experience pain from a number of causes during the postpartum period. Although pharmacological pain relief has shown to be effective, the efficacy of non-pharmacological methods of pain relief will be of interest to breastfeeding women. The aim of this systematic review was to examine the efficacy and safety of complementary approaches to manage postpartum pain.

Methods

A search of English language databases from their inception to 2020 was undertaken for randomised controlled trials and included primiparous and multiparous women who experienced postpartum pain up to two weeks post birth. The primary outcome was pain. The risk of bias was assessed using the Cochrane risk of bias tool.

Results

Thirty trials were included in the review, 25 trials (2,413 women) were included in the meta-analysis. Two trials of massage found a reduction in pain following caesarean birth within the first 24 h post birth (MD -2.64, 95–2.82 to -2.46, 184 women, I² 0%), and at seven days postpartum (MD -1.91, 95%CI -2.42 to -1.40, 2 trials, 120 women I² 37%). Two trials conducted with women receiving an episiotomy found reduction in perineal pain from herbal ointments within 24 h (MD -1.33, 95% CI -.96 to -0.70, 221 women) and at 14 days postpartum (MD -0.74, 95% CI -1.02 to -0.47, 4 trials). Few trials reported on safety, few trials were at an overall low risk of bias, and overall the quality of evidence was very low.

Conclusion

Further high quality trials are needed to determine the safety and effectiveness of herbal ointment and massage during the early postpartum period.

The effect of the Verbascum Thapsus on episiotomy wound healing in nulliparous women: a randomized controlled trial

Background

The pain and discomfort caused by episiotomy affect the quality of life of the mothers, so rapid and complete repair of the episiotomy is very important. Due to the effective ingredients of Verbascum Thapsus, it has been used since ancient times to treat wounds. Therefore, this study aimed to evaluate the effect of Verbascum Thapsus on episiotomy wound healing.

Methods

The study was designed as a randomized, double-blind, controlled clinical trial. Ninety-three primiparous women who were referred to Fatemeh Zahra Hospital in Saveh in 2015 were randomly divided into two groups of intervention (Verbascum Thapsus) and control (placebo). Both groups covered the episiotomy wound twice a day for 10 days with 2 cm of prescribed creams. Wound healing was assessed using the REEDA scale before the intervention and on days 1,3 and 10 after the intervention.

Results

Before the intervention, there was no statistically significant difference in terms of demographic characteristics, obstetrics, and REEDA scores between the two groups (p < 0.05). The mean scores of REEDA on days 1 and 3 in the intervention group were better than the control group but were not statistically significant. However, on the tenth day after the intervention, the mean scores of REEDA were significantly better in the Verbascum group than the placebo (p = 0.01).

Conclusions

According to the results of this study, it seems that Verbascum Thapsus is effective in repairing episiotomy wounds. The researchers hope that the results of this study can provide clinical evidence for the use of this herbal medicine in the wound healing process.

Trial registration

This study was registered in the Iranian Registry of Clinical Trials (IRCT) with the code “IRCT201404073106N15” on 02/12/2015.

Phytochemistry and Pharmacology of the Genus Equisetum (Equisetaceae): A Narrative Review of the Species with Therapeutic Potential for Kidney Diseases

The Equisetum genus, Equisetaceae family, is widely distributed worldwide and may be the oldest nonextinct genus on Earth. There are about 30 known species, which are very often used in traditional medicine with diverse applications. This review aimed to compile scientific reports about Equisetum species with relevant pharmacological properties and/or therapeutic potential for kidney diseases. Our bibliographic survey demonstrates that the most widespread traditional use of Equisetum is as a diuretic, followed by the treatment of genitourinary diseases (kidney diseases, urethritis, kidney stones, and others), inflammation, wound healing, rheumatic diseases, prostatitis, and hypertension. The most popular species from the Equisetum genus with medicinal use is E. arvense L., whose diuretic effect was confirmed in animal models and clinical trials. The species E. bogotense Kunth also demonstrated the beneficial effect of inducing diuresis in both experimental and clinical assays. Several other species have also been studied regarding their therapeutic potential, showing different biological actions. Regarding the chemical composition, it contains many active constituents, such as alkaloids, flavonoids, phenol, phytosterols, saponins, sterols, silicic acid, tannin, triterpenoids, and volatile oils. However, despite the widespread traditional use, many species need to be explored in detail for scientific validation of popular use. Indeed, the species of the Equisetum genus have great potential in the management of kidney disorders.

Herbal Medicinal Product Use During Pregnancy and the Postnatal Period: A Systematic Review

Synthesis of pooled data on herbal medicinal products used during and after pregnancy highlights the need for robust safety studies.

OBJECTIVE:

To report the incidence and nature of herbal medicinal products' adverse events and herb–drug interactions used by some pregnant and postnatal women.

DATA SOURCES:

The Allied and Complementary Medicine Database, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, the Cochrane Library, MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov were searched from inception until August 2018.

METHODS OF STUDY SELECTION:

Any studies reporting adverse events, herb–drug interactions or absence thereof associated with herbal medicinal products used during pregnancy or the postnatal period were included. Conference abstracts, pilot studies, and nonhuman studies were excluded. All included studies were critically appraised by two independent reviewers.

TABULATION, INTEGRATION AND RESULTS:

Database searches retrieved 3,487 citations. After duplicate removal and review of titles, abstracts, and full-text, 115 articles were critically appraised. After excluding irrelevant and low-quality articles, 74 articles were included for data extraction and synthesis. Adverse drug reactions, congenital malformations, fetal growth retardation or herb–drug interactions were the primary study objective reported by 19 of the 74 included studies, 16 cohort studies, one cross-sectional survey, and two randomized controlled trials. A total of 47 herbal medicinal products and 1,067,071 women were included in this review. Use of almond oil was associated with preterm birth (odds ratio 2.09, 95% CI 1.07–4.08), oral raspberry leaf was associated with cesarean delivery (adjusted odds ratio [AOR] 3.47, 95% CI 1.45–8.28); heavy licorice use was associated with early preterm birth by 3.07-fold (95% CI 1.17–8.05). African herbal medicine mwanaphepo was associated with maternal morbidity (AOR 1.28; 95% CI 1.09–1.50), and neonatal death or morbidity. Fourteen studies reported absence of adverse events. Four studies reported herb–drug interactions, but none studied adverse events arising from them.

CONCLUSION:

The use of herbal medicinal products during pregnancy and the postnatal period should be discouraged until robust evidence of safety is available.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42017081058.

Impact of ethanolic extract of Equisetum arvense (EA1) on pancreatic carcinoma AsPC-1 cells

The current research was focused on evaluation of the cytotoxic and suppressive action of ethanolic extract of Equisetum arvense (EA1) against human pancreatic carcinoma cell line ASPC-1 after treatment with 25 µg/mL, 50 µg/mL, 100 µg/mL and 200 µg/mL EA1, using MTT assay and Antioxidant activity. Detailed investigations led to reveal the ability of cell patronage through the dreadful upshot of free radicals. The current approach followed MTT assays to examine the long-lasting ability and growth of cells as EA1 restrained the cell viability and growth of ASPC-1. At the end, EA1 showed its potential cytotoxicity and reduced the cellular proliferation of ASPC-1 cells through a pattern, which appeared to be concentration dependent. Our results can form the basis to explore the molecular mechanisms underlying Ethanolic Extract of Equisetum arvense induced cell death in pancreatic cancer cell lines and may serve as an alternative anticancer agent for the treatment of pancreatic carcinoma (PC) with no or least side effects to the patient.

[Evidence-Based Practices in Episiotomy Care]

AIM

The aim of this study was to systematically evaluate the research associated with wound healing process in episiotomy care.

METHOD

The search for this study was conducted through the international databases of Cochrane, Science Direct, Medline, Medine Complete, CIHANL, Scopus, AcademicSearch Complete, Complementary Index and ULAKBIM medical database among the National Databases between May 1 and July 17, 2017. "Episiotomy care" and "episiotomy wound healing" were used as key words during the search. A total of 23 publications compliant with the inclusion criteria were included in the study and were evaluated in terms of comparisons, restrictions, and results.

RESULTS

Studies about episiotomy care were evaluated under four headings such as the use of antiseptic solutions, use of dry/wet and hot and cold applications, laser and light therapy, and the use of aromatic oils and phytotherapy in episiotomy care. Among the 23 studies included in this study, 17 were designed as experimental and 6 as half-experimental and a total of 2.408 puerperal women participated in this study.

CONCLUSION

The results of this literature review revealed a limited number of research findings on the care of episiotomy wounds and a necessity of performance of new studies on this subject was established.

Impact of Hypericum Perforatum Ointment on Perineal Pain Intensity Following Episiotomy: a Randomized Placebo-Controlled Trial

Introduction:The present study was conducted to evaluate the effects of Hypericum Perforatum ointment on perineal pain intensity following episiotomy among primiparous women.

Methods This triple-blind clinical trial was performed on 98 eligible primiparous women referring to selected educational hospital of Tehran University of Medical Sciences for normal vaginal delivery. Block Randomization (in 1; 1 ratio) was used to categorize the participants continuously into two groups: intervention (using Hypericum Perforatum ointment) and control (using placebo ointment). Participants in each group used ointments (about 3 grams each time) on episiotomy site, twice a day and for a period of ten days. Our primary outcome was the pain intensity in different intervals following episiotomy. The data were analyzed by SPSS software (version 13) using student's t test, Mann-Whitney U test and chi-square test.

Results: We missed 14 participants during the study and analyzed the data from 42 participants in each group. The mean of pain scores revealed no significant differences before (mean difference=-0.33; P=0.46) and four hours (mean difference=0.57; P=0.13) after ointments use, between the intervention and control groups, while these differences were significant after eight hours (mean difference=2.17; P<0.001), five days (mean difference=2.20; P<0.001) and ten days (mean difference=2.21; P<0.001) following the intervention.

Conclusion: Using Hypericum Perforatum ointment as a noninvasive, simple and effective topical formulation, can significantly reduce pain intensity of episiotomy site.

Structural, rheological and antioxidant properties of pectins from Equisetum arvense L. and Equisetum sylvaticum L

The pectins were isolated from sterile stems of E. arvense (EA, yield 5.9%) and E. sylvaticum (ES, yield 4.8%) (Equisetaceae) using ammonium oxalate extraction after preliminary treatment with dilute HCl (рH 4.0). The pectins possessed high molecular weight (Mw, 340-360 kDa), high GalA content (ca. 85%), low degrees of methyl-esterification (14-16%) and acetylation (3-8%). NMR analysis indicated extensive regions of partially methyl-etherified and 3-O-acetylated HG and minor regions of low branched RG in the fragment isolated after hydrolysis of pectin EA by pectinase. Pectin EA produced a higher viscosity solution, formed a stronger and more rigid ionotropic hydrogel than pectin ES. The pectins scavenged DPPH and hydroxyl radicals, but not the superoxide radical and hydrogen peroxide. Phenolic compounds (0.11 and 0.23%) associated with polysaccharide moieties were apparently responsible for the differences in the anti-DPPH scavenging activity of pectins EA and ES (63 and 49%). The findings suggested that pectin from E. arvense should be more perspective than pectin from E. sylvaticum on their use as components of wound healing remedies.