Abstract Background Viral infections are a real challenge of our time, given the high prevalence of viruses, their ability to constantly mutate and quickly adapt to their environment, and the fact that people (hosts) are highly mobile nowadays, travelling long distances within short time. In particular, acute respiratory viral infections are one of the most common groups of diseases characterized by a predominantly respiratory tract involvement, and are widespread in today’s societies all over the world. Methods The conducted research uses a complex of general scientific and special methods: theoretical, generalization, data systematization, comparison, methods of studying literary references, analysis, etc. Results A special pharmacotherapeutic place in the treatment of viral infections is occupied by phytoneering medicines that have multivector pharmacodynamics, namely, immunomodulatory, anti-inflammatory, antiviral and antibacterial effects. All of these types of pharmacological activity are present in BNO 1030 extract. This review aims to discuss those effects and their impact on the clinical manifestation of upper respiratory tract infections. The composition of BNO 1030 extract is leading to a unique synergistic selection/combination of medicinal herb extracts, namely: oak bark (contains tannins with unique antibacterial and antiviral effects); walnut leaves (synergy of natural antioxidants and antiviral activity); dandelion herb (cocktail of biologically active compound with a wide range of action and nutritional value; blockade of receptors to SARS-CoV-2); horsetail herb (immunomodulation without stimulation of apoptosis and necrosis); chamomile flowers (powerful anti-inflammatory and antibacterial effect); marshmallow root (antitussive effect, stronger than prenoxdiazine + expectorant); yarrow herb (essential oil with a rich content of biologically active compounds, including camphor and eucalyptol). Conclusions The unique pharmacodynamic potential of BNO 1030 extract, due to the extracts of seven medicinal herbs in its composition, justifies its use at all stages of viral infection. By reducing the number of ARVI complications, BNO 1030 extract reduces the need for antibacterials, provides pharmacoeconomic benefits and makes a significant contribution to solving a particularly urgent problem today – preventing the spread of antibiotic resistance.
M. B. Chandan, N. Anandaramajayan, Vasudha Kulkarni
Renal vasculature accounts for 20% of cardiac output. The branching pattern of the renal artery supplying the kidney relies on its embryological development. The prevalence of renal vascular abnormalities varies from 25% to 61%. During the routine dissection of a 70-year-old female cadaver at Department of anatomy, Akash institute of Medical Sciences and Research Centre, Bengaluru, we observed bilateral aberrant renal arteries supplying to the superior pole of the right and left kidneys. On further dissection, we observed two accessory renal arteries supplying the hilum of the right kidney and the left kidney. One of the accessory renal arteries bifurcated and then entered the hilum of the left kidney. Knowledge of these renal vascular variations is essential for radiologists, nephrologists, and urologists while performing angiographic studies, aneurysmorphic procedures, or while performing uroradiological procedures.
Abstract Introduction The prevalence of autoimmune disease (AD) is increasing in both paediatric and adult populations, resulting in a rise in healthcare utilisation for symptom management. With no known cure for ADs, management options include conventional medical treatment and/or complementary and alternative medicine (CAM) approaches. Despite the high cost of CAM therapy in Australia, its use continues to rise, especially among adults and children with chronic disease. Methods This review was guided by the JBI methodology for scoping reviews. We reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Database searched included OVID (Medline, Embase, PsycInfo) CINAHL, Scopus, Web of Science, ProQuest, and Google Scholar. Only primary empirical papers were included. Screening and data extraction were conducted by two reviewers independently with a third reviewer resolving discrepancies. Results Our review identified 42 primary research papers published between 1990 and 2021 that addressed parental management of AD with CAM. Commonly reported CAM practices included massage, homeopathy, chiropractic care, and acupuncture, with vitamins and minerals being the most frequently mentioned CAM products. Parents cited dissatisfaction with conventional medication, concerns about its side effects, and the perception of CAM as natural or safer than conventional medicine as primary reasons for CAM use. Parental CAM use strongly predicted child CAM use, yet there was low disclosure of CAM practices to conventional physicians. Reasons for non-disclosure included concerns about negative responses from physicians and perceptions of limited physician understanding of CAM. Parental educational level and family income were also predictive of CAM use. Conclusions This review highlights the widespread use of CAM by parents managing their children's AD and emphasises the need for improved communication between parents and healthcare providers. Methodological inconsistencies highlight the necessity for standardised protocols in future CAM research. Additionally, future studies should recognise the interplay between social structures and individual agency in shaping healthcare decisions. Clinical trial number Not applicable. Protocol registration DOI https://doi.org/10.17605/OSF.IO/9NJCE .
Objectives: The primary objective of this study was to evaluate the efficacy of Calendula officinalis in the wound healing of burn wound in comparison with standard povidone-iodine solution.
Materials and Methods: A prospective randomized controlled study with 3 weeks of intervention and follow-up was conducted at the Department of Burns, Plastic and Maxillofacial Surgery, Safdarjung Hospital and VMMC, New Delhi, in collaboration with Homeopathic Treatment Centre, Safdarjung Hospital, New Delhi, from January 1, 2017, to December 31, 2018. The patients between 15 and 60 years of age reporting to the burns outpatient department with burn wounds due to thermal bums having the involvement of 5%–20% of total body surface area within 24 h of injury were randomized to either the Calendula (n = 20) or Betadine (n = 20) group.
Results: There was no significant difference between the Calendula and Betadine groups, however, by day 14, 75% of cases in the Calendula group showed 80% and above epithelization as compared to 45.0% of cases in the Betadine group. Similarly, there was no significant difference between the wound discharges between the two groups but 95% had no discharge by the 14th day in the Calendula group as compared with 65% in the Betadine group. The Calendula group had a reduced incidence of wound infection when compared with Betadine.
Conclusion: Therefore, Calendula dressing had a positive influence in early epithelization, better control of wound discharge, and lesser infections but these need to be evaluated on adequate sample size for a definite outcome.
Chitikela P. Pullaiah, Vinod K. Nelson, Sushma Rayapu
et al.
Abstract Background Esculetin is a natural coumarin derivative from various plants with multiple pharmacological effects. Hence, the present study was undertaken to explore the cardio protective potential of esculetin against isoproterenol induced myocardial toxicity in rats. Methods The treatment schedule was fixed for 28 days and the rats were divided into five groups of six each. Rats of group I received the normal saline and served as normal control, group II was received ISO (100 mg/kg body weight) for last two consecutive days of the study and served as disease control. Groups III and IV received esculetin 10 and 20 mg/kg body weight respectively once a day per oral for 28 days along with ISO for last two consecutive days of the study. Cardiac biomarkers such as CK-MB and LDH, membrane bound Na+ /K+ ATPases activity, myocardial lysosomal enzymes activity and tissue antioxidants status were estimated in the heart tissue samples. The histopathological changes in the myocardium were also assessed. Further, DPPH assay was done to evaluate the free radicals scavenging potential of esculetin. Cytoxicity assay, intracellular ROS levels by DCFDA assay and m-RNA expression of TNF-α, IL-6 and NF-κB by quantitative RT-PCR in H9c2 cell lines. Results The increased levels of CK-MB, LDH, LPO, myocardial lysosomal enzymes and membrane bound Na+ /K+ ATPase levels by ISO administration was significantly increased with concomitant decrease in tissue antioxidant enzymes such as GSH, Catalase, and SOD. Pre-treatment with esculetin for 28 days has significantly decreased the levels of cardiac bio-markers, lysosomal enzymes, membrane bound Na+ /K+ ATPase levels as well as Lipid peroxides which is in contrary to the ISO group. Amelioration of the antioxidant levels were also found in esculetin treated groups. Histopathological examination of heart reveals that myocardial degeneration, mononuclear cell infiltration was noticed in ISO treated rats, whereas the same was restored with esculetin treatment. In H9C2 cell lines esculetin could effectively reduced intracellular ROS inhibition and m-RNA expression of pro-inflammatory cytokines including TNF-α, IL-6 and NF-κB to prevent apoptosis or cell necrosis. Conclusion The study provides the evidence of cardioprotective potentials of esculetin against isoproterenol induced myocardial infarction by antioxidant and myocardial membrane stabilization along with in vitro protection from arsenic induced ROS cell necrosis or apoptosis in H9C2 cells.
Ayobami Matthew Olajuyin, Adefunke Kafayat Olajuyin, Ziqi Wang
et al.
Abstract Background Calotropis procera leaf is one of the plants commonly utilized in phytomedicine in Nigeria. The present investigation explored the use of the extracts on cell viability and apoptosis respectively. In this study, the expression of the Cluster of differentiation 146 (CD146) in the blood of lung cancer patients on regulatory T cells (Tregs) was determined. The antioxidant and anti-proliferative effects of methanol extracts of Caloropis procera leaf on lung cancer cell H1299 were investigated. Methods From the flow cytometry, the expression of the CD146+ in the T cells were evaluated using the healthy patient, adenocarcinoma, squamous, and small cell lung cancer respectively. The apoptosis of granulocytes, monocytes, lymphocytes, CD4+, and Treg were determined by 7-amino-actinomycin D/Annexin V-Allophycocyanin (APC) staining during the resting stage and after 24 h respectively. Immunofluorescence was conducted. Cell viability assay, hydroxyl (OH), hydrogen peroxide (H2O2) and nitric oxide (NO) scavenging radicals were conducted. Reducing power and flavonoid content of Calotropis procera were investigated. The effect of the Calotropis procera at different concentrations at 24hrs was determined. Results From the flow cytometry, the expression of the CD146+ on the T cells includes 4.60 % in healthy patients, 10.10, 12.20, 9.80 % in adenocarcinoma, squamous and small cell lung cancer. The apoptosis of granulocytes, monocytes, lymphocytes, CD4+ and Treg were determined by 7-amino-actinomycin D/Annexin V-APC staining during the resting stage and after 24 h which indicate that apoptosis also occurred on Treg. Immunofluorescence shows the presence of CD146 in lung cancer patient’s tissues. The methanol extracts of Calotropis procera leaf have antioxidant and anti-proliferative effects. Methanol extract of Calotropis procera leaf reduced CD146 expression on blood cells at 24 h. Conclusion Increased CD146 expression in the Treg of lung cancer patients indicates that it may be a possible target for the treatment of lung cancer by utilizing potent immunotherapy or natural products such as methanol extract of Calotropis procera leaf which may ameliorate the expression of CD146. Calotropis procera has antioxidant, inhibitory capacity on H1299 lung cancer cells, and the ability to scavenge OH, H2O2, and NO radicals. Hence, this investigation strengthens the phyto-medicinal properties of Calotropis procera.
Hadiza Aliyu-Amoo, Hamza Ibrahim Isa, Emmanuel Mfotie Njoya
et al.
Abstract Background Terminalia avicennioides Guill and Perr (Combretaceae) is an important West African medicinal plant. The plant is used locally against microbes and parasites in both humans and animals and studies have demonstrated its cytotoxicity potential. Thus, this study was carried out to test the cytotoxic effect of the extracts and fractions of the root of the medicinal plant Terminalia avicennioides Guill and Perr (Combretaceae) in two different cell lines. Methods Methanol, ethanol, 30 % ethanol, hot water and cold water extracts and ethylacetate, hexane, chloroform, butanol and residual water fractions, were evaluated at 1000, 750, 500, 250, 100 and 50 µg/mL concentrations, with doxorubicin as positive control. The cells were incubated with the extracts for 48 h at 37 °C in a 5 % CO2 humidified incubator. The inhibition of cell viability, determined with the methyl blue thiazole tetrazolium bromide (MTT) assay, was used to assess the anti-proliferative effect of the extracts, in normal Vero Monkey kidney and human liver cancer (HepG2) cell lines. Results There was a concentration-dependent inhibition of cell viability in both the HepG2 and Vero cell lines. For HepG2 cells, antiproliferative effect was highest for the hexane fraction (viability ranged from 19.63 ± 1.10 % to 70.30 ± 1.78 % for 1000 and 50 µg/mL, respectively. For Vero cells, the highest antiproliferative effect, at 1000 µg/mL, was with hexane fraction (cell viability 21.37 ± 3.50 %), while at 50 µg/mL the chloroform fraction demonstrated the highest effect (viability of 86.10 ± 1.95 %). Conclusions The extracts and fractions from the root of Terminalia avicennioides have antiproliferative effect on the Vero and HepG2 cell lines tested. However, the extracts and fractions were not more toxic to the HepG2 than to the Vero cells. The cytotoxic effect of stem-bark and leaf extracts could be evaluated in the future to determine its anticancer potential.
Samuel Chijioke Attama, Patrick Emeka Aba, Chinwe Uchechukwu Asuzu
et al.
Abstract Background Vernonia amygdalina is a bitter culinary vegetable known to possess anti-diabetic principle. Baccharoides tenoreana belonging to the same species as V. amygdalina, is also used in cooking soup and it is comparatively non-bitter. However, its glycemic properties have not been studied. This study becomes imperative to find out if B. tenoreana possesses hypoglycemic and antioxidant properties and how it compares with V. amygdalina. Should B. tenoreana be better than V. amygdalina, it should be preferable since it is non-bitter and can comfortably be taken compared to V. amygdalina. This study investigated the comparative hypoglycemic and antioxidant potentials of V. amygdalina (VA) and B. tenoreana (BT). Methods Thirty male Albino wistar rats assigned into six groups of five rats per group were used for the study. Diabetes was induced in groups B-F rats by a single intraperitoneal injection of alloxan monohydrate at 160 mg/kg. Groups C-E rats were treated with VA (200 mg/kg), BT (200 mg/kg) and combination of VA & BT (100 mg/kg each) respectively. Group F rats were administered glibenclamide (2 mg/kg) whereas groups A and B rats were given distilled water. All treatments were through the oral administration, once daily for 21 consecutive days. Fasting blood glucose (FBG) levels were determined after 1 h, 3 h, 6 h, 24 h, 7 days, 14 days and 21 days while lipid profile, in vivo antioxidant and pancreatic histomorphology were assessed on day 21 post-treatment. Results The VA-treated rats recorded marginally reduced FBG, malondialdehyde and low-density lipoprotein levels when compared to the counterpart treated with BT. The high-density lipoprotein values were significantly higher in VA-treated rats than in BT-treated rats. The histomorphology of the pancreas of VA-treated rats expressed more islet cells compared to the counterpart treated with VT. Conclusion Both VA and BT exhibited hypoglycemic and antioxidant activities with varying potencies.
Abstract Background The present study was designed to investigate the therapeutic effects against oxidative stress and alleviative effects of Peganum harmala seeds (PH) in rats with Complete Freund’s Adjuvant (CFA) induced arthritis. Methods The extract was evaluated for its phytoconstituents, antiarthritic and antioxidant properties. The action of chloroform (PHC) and ethanolic (PHE) extracts of PH was evaluated in adult Lewis rats (150-200 g).with CFA induced arthritis. Arthritic rats received PH extracts 100 mg/kg orally for 28 consecutive days (Prophylactic treatment) and from 14th day of CFA injection (Therapeutic treatment). Results PHE significantly suppressed the arthritis severity in rats than PHC in 28 days. All complications shown significant reduction (p< 0.05) in arthritic rats including paw volume (63.09%), body weight loss, decreased locomotor activity, erythrocyte sedimentation rate and synovial/hepatic tissues lipid peroxidation and increase in cellular antioxidants superoxide dismutase (U/mg) activities and hemoglobin counts. The results showed the presence of alkaloids and flavonoids in PHE. Histology and radiographic analysis of arthritic ankle joints indicated abnormal changes. Marked reduction in inflammation and arthritic changes were observed after treatment with PHE. Conclusion Therefore, the investigation suggests that PHE at 100 mg/kg will be useful in the management of rheumatoid arthritis complications which may possibly be due to boosting the intracellular antioxidant defense.
Abstract Background Herbal medicines are used for the treatment of many infectious diseases throughout the history of mankind. The increasing antibiotic resistance exhibited by microorganisms has led to the phytochemical screening of medicinal plants for antimicrobial activity. Many infections can be treated by phytochemicals possessing potent antibacterial efficiency. The pharmacological activities of any plant is because of the presence of primary metabolites, secondary metabolites and its secretary products, comprising the phenolic compounds, alkaloids, tannins, saponins, carbohydrates, glycosides, flavanoids, steroids, etc. Helicteres isora L. is a medicinal plant used in traditional medicine. The root and bark are expectorant, demulcent, astringent to the bowels, antigalactagogue, lessen gripping; a cure for scabies when applied topically. Method Soxhlet extraction or hot continuous extraction: In this method, finely ground sample was placed in thimble chamber of the Soxhlet apparatus. Extraction solvents was heated in the bottom flask, vaporizes into the sample thimble, condenses in the condenser and drip back. When the liquid content reaches the siphon arm, the liquid contents emptied into the bottom flask again and the process is continued. Gram positive bacteria Staphylococcus aureus NCIM 2079, Gram negative bacteria Escherichia coli NCIM 2109, Fungi (Yeast) Candida albicans NCIM 3471, Fungi (Mould) Aspergillus niger NCIM 545 are used as reference Strain for antimicrobial activity. Antioxidant activity was tested by DPPH method. Result Chloroform Extracts of leaves, Stem and fruits of Helicteres isora L. exhibited potent antimicrobial activity against Escherichia coli, Staphylococcus aureus, Candida albicans and Aspergillus, niger. The stem extract showed highest antimicrobial activity against Escherichia coli with zone of inhibition of 19.24 mm and leaves lowest activity against Candida albicans with zone of inhibition of 11.26 mm. Antioxidant activity was tested by DPPH method. Conclusion The use of herbal crude drugs, in tracts and their remedies have significantly increased throughout the world. Efforts must be made to ensure safe, effective and affordable treatments for wide range of diseases by traditional methods which use locally available medicinal plants. The scientific and authentic researches on these aspects are to be done in order to exploit traditional knowledge of medicinal plants.
Mohammad Rashedul Islam, Jannatul Naima, Nawreen Monir Proma
et al.
Abstract Background The Bangladeshi rural and hilly areas people have long tradition to use various medicinal plants for treating different diseases. That’s why, the crude methanolic leaf extract of Ardisia solanacea with its different fractions (petroleum ether, carbon tetrachloride, n-hexane and chloroform fractions) were subjected to investigate bioactivities in swiss albino mice; namely analgesic, CNS, and Oral hypoglycemic activities, while in-vitro evaluation of cytotoxicity. Methods Central nervous system activity was investigated by various method such as Elevated plus maze, Hole board, Hole cross and Open field test apparatus. Analgesic activity was evaluated by both acetic acid induced and tail immersion method. Hypoglycemic activity was evaluated by oral glucose tolerance test and cytotoxicity was evaluated by Brine shrimp lethality bioassay. Results In CNS activity, among others fractions, ASCF fraction produced a significant anxiolytic activity in both elevated plus maze and Hole board test. During open-field test almost all the fractions of A. solanacea leaves extract display decreased locomotor activities that indicates significant sedative activity. The ASME and ASCF showed significant peripheral analgesic activity at a dose of 200 mg/kg and 400 mg/kg body weight (p < 0.05). In tail immersion method, among others extracts chloroform fractions exhibited significant (p < 0.05) elongation of reaction time 30 min after oral dose of 200 and 400 mg/kg body weight respectively. The methanolic and n-hexane extracts reduced blood glucose level significantly after 90 min with value of 53.94% and 48.15% respectively (p < 0.05). In case of cytotoxicity activity, among other fractions carbon tetrachloride fraction showed lowest LC50 values. Conclusions From the above results, it is clear that different fractions of A. solanacea showed significant pharmacological potentiality in different in-vitro and in-vivo study model. So, it will be very much possible source for an isolating lead compound for curing the numerous disorders.
Khaled Abo-EL-Sooud, Fatma A. Ahmed, Sayed A. El-Toumy
et al.
Abstract Background In traditional North Africa, medicine decoctions of the leaves of Periploca angustifolia are used to treat diarrhea, inflammation, ulcers, edema and diabetes. The aim of the study was to evaluate the phytochemical, anti-inflammatory, anti-ulcerogenic, and hypoglycemic activities of an ethanolic extract of P. angustifolia L. in rats. Methods An extract of air-dried powdered P. angustifolia plant was obtained using 96% ethanol. The extract was concentrated and the total phenolic and flavonoids contents were estimated colorimetrically. The phenolic and flavonoid compounds were quantified and identified using high performance liquid chromatography (HPLC). The anti-inflammatory, anti-ulcerogenic and hypoglycemic activities of the extract were evaluated in three rat models respectively: formaldehyde-induced paw edema, ethanol induced gastric damage and alloxan induced hyperglycemia. Results The total flavonoids and total phenolics constituted 15% and 2.69% of the extract, respectively and are expressed as quercetin equivalent and μg/mg gallic acid equivalent (GAE). Coumarin, resorcinol, isorhamnetin, quercetin, and naphthalene were isolated from the ethanolic extract of P. angustifolia. Oral administration of the ethanolic extract at 500 mg/kg body weight (b.wt.) significantly reduced paw inflammation, gastric lesions, ulcer index scores and blood glucose levels in normal and diabetic rats. Conclusion The crude ethanolic extract of P. angustifolia exhibited promising anti-inflammatory, anti-ulcerogenic, and hypoglycemic activities in accordance with the plant’s uses in folk medicine suggesting that P. angustifolia may be a safe alternative to chemical drugs.
Miguel Carro-Juárez PhD, Magdalena G. Rodríguez-Santiago PhD, Miguel Angel Franco MD
et al.
In the present study, the aphrodisiac properties of the purple corn ( Zea mays ) in male rats were analyzed. The aqueous crude extract of purple corn (at 25, 50, and 75 mg/kg) was administered to ( a ) copulating male rats and ( b ) anesthetized and spinal cord transected male rats. Behavioral parameters of copulatory behavior and parameters of the genital motor pattern of ejaculation previous to its inhibition, under the influence of the purple corn extract, are described. Administration of the aqueous crude extract of purple corn significantly facilitates the arousal and execution of male rat sexual behavior without significant influences on the ambulatory behavior. In addition, purple corn extract elicit a significant increase in the number of discharges of the ejaculatory motor patterns and in the total number of genital motor patterns evoked in spinal rats. The present findings show that the aqueous crude extract of purple corn possesses aphrodisiac activity.
India has a population of 1.21 billion people and there is a high degree of socio-cultural, linguistic, and demographic heterogeneity. There is a limited number of health care professionals, especially doctors, per head of population. The National Rural Health Mission has decided to mainstream the Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) system of indigenous medicine to help meet the challenge of this shortage of health care professionals and to strengthen the delivery system of the health care service. Multiple interventions have been implemented to ensure a systematic merger; however, the anticipated results have not been achieved as a result of multiple challenges and barriers. To ensure the accessibility and availability of health care services to all, policy-makers need to implement strategies to facilitate the mainstreaming of the AYUSH system and to support this system with stringent monitoring mechanisms.
L. Grimaldi-Bensouda, B. Bégaud, M. Rossignol
et al.
Background Prescribing of antibiotics for upper respiratory tract infections (URTI) varies substantially in primary care. Objectives To describe and compare antibiotic and antipyretic/anti-inflammatory drugs use, URTI symptoms' resolution and occurrence of potentially-associated infections in patients seeking care from general practitioners (GPs) who exclusively prescribe conventional medications (GP-CM), regularly prescribe homeopathy within a mixed practice (GP-Mx), or are certified homeopathic GPs (GP-Ho). Method The EPI3 survey was a nationwide population-based study of a representative sample of 825 GPs and their patients in France (2007–2008). GP recruitment was stratified by self-declared homeopathic prescribing preferences. Adults and children with confirmed URTI were asked to participate in a standardized telephone interview at inclusion, one-, three- and twelve-month follow up. Study outcomes included medication consumption, URTI symptoms' resolution and potentially-associated infections (sinusitis or otitis media/externa) as reported by patients. Analyses included calibration to account for non-respondents and groups were compared using multivate analyses adjusting for baseline differences with a propensity score. Results 518 adults and children with URTI (79.3% rhinopharyngitis) were included (36.9% response rate comparable between groups). As opposed to GP-CM patients, patients in the GP-Ho group showed significantly lower consumption of antibiotics (Odds ratio (OR) = 0.43, 95% confidence interval (CI): 0.27–0.68) and antipyretic/anti-inflammatory drugs (OR = 0.54, 95% CI: 0.38–0.76) with similar evolution in related symptoms (OR = 1.16, 95% CI: 0.64–2.10). An excess of potentially-associated infections (OR = 1.70, 95% CI: 0.90–3.20) was observed in the GP-Ho group (not statistically significant). No difference was found between GP-CM and GP-Mx patients. Conclusion Patients who chose to consult GPs certified in homeopathy used less antibiotics and antipyretic/anti-inflammatory drugs for URTI than those seen by GPs prescribing conventional medications. No difference was observed in patients consulting GPs within mixed-practice. A non-statistically significant excess was estimated through modelling for associated infections in the GP-Ho group and needs to be further studied.