BackgroundThere is a need for evidence-informed guidance on the use of complementary and alternative medicine (CAM) for insomnia because of its widespread utilization and a lack of guidance on the balance of benefits and harms. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs). The quality of the eligible guidelines was appraised to assess the credibility of these recommendations.MethodsFormally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The NCCIH website and six websites of international guideline developing institutions were also retrieved. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively.ResultsSeventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits.ConclusionsExisting guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=369155, identifier: CRD42022369155.
Hemant Bhargav, Bharath Holla, Kishore Kumar Ramakrishna
et al.
Background: There is growing evidence and increasing interest for systemic integration of medicine (synergistic and evidence-based combination of different systems along with conventional biomedicine). The National Institute of Mental Health and Neurosciences (NIMHANS), an Institute of National Importance and a tertiary mental and neurological healthcare hospital situated in Bengaluru, India, has established one such integrative model. The present manuscript traces the history and describes the important steps followed in this integrative approach. Methodology: The NIMHANS model followed a stage-wise two-step approach: (1) First stage – Starting with Integration of Yoga: The process began more than a decade ago, with integrating yoga into a clinical department (rather than an exclusive research-based approach) of the institute which had relatively high clinical service load (For example, Department of Psychiatry in NIMHANS). Yoga was gradually formalized into academic and clinical activities (outpatient and inpatient services) by appointing a Yoga faculty with a medical background with an MD/PhD in Yoga. The research was primarily directed by the clinical observations of patients receiving yoga therapy. (2) Second stage: Adding an appropriate and compatible discipline from Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy (AYUSH) system (Ayurveda in this case): The center for yoga gradually evolved into the Department of Integrative Medicine with the appointment of faculty from the Ayurveda stream. In this model, specialists from each discipline provide clinical inputs after simultaneous consultation with the patient through systemic integration in clinical, academic, and research domains rather than mere co-location of AYUSH services with mainstream medicine. Conclusion: The NIMHANS model of integration suggests the application of yoga into mainstream clinical service as the first step toward integration. Yoga should be added as a formalized clinical discipline with systemic integration. Gradually, other feasible systems of traditional medicine from AYUSH can be integrated at a later stage in a step-by-step manner based on clinical practice and evidence.
Regina Appiah-Opong PhD, Kojo Agyemang MPhil, Eunice Dotse MPhil
et al.
Malaria affects about half of the world's population. The sub-Saharan African region is the most affected. Plant natural products have been a major source of antimalarial drugs; the first (quinine) and present (artemisinin) antimalarials are of natural product origin. Some secondary metabolites demonstrate adjuvant antioxidant effects and selective activity. The focus of this study was to investigate the anti-plasmodial activity, cytotoxicities and antioxidant properties of eight (8) Ghanaian medicinal plants. The anti-plasmodial activity was determined using the SYBR green assay and the tetrazolium-based colorimetric assay (MTT) was employed to assess cytotoxicity of extracts to human RBCs and HL-60 cells. Antioxidant potential of plant extracts was evaluated using Folin-Ciocalteu and superoxide dismutase assays. Phytochemical contstituents of the plant extracts were also assessed. All the extracts demonstrated anti-plasmodial activities at concentrations <50 μg/ml. Parkia clappertoniana and Terminalia ivorensis elicited the strongest anti-plasmodial activities with 50% inhibitory concentrations (IC 50 ) of 1.13 μg/ml and 0.95 μg/ml, respectively. This is the first report on anti-plasmodial activities of Baphia nitida, Tabernaemontana crassa and Treculia Africana. T. Africana showed moderate anti-plasmodial activity with IC 50 value of 6.62 µg/mL. Extracts of P. clappertoniana, T. Africana and T. ivorensis (0.4 mg/mL) showed >50% antioxidant effect (SOD). The extracts were not cytotoxicity towards RBCs at the concentration tested (200 μg/ml) but were weakly cytotoxic to HL-60 cell. Selectivity indices of most of the extracts were greater than 10. Our results suggest that most of the plant extracts have strong anti-plasmodial activity and antioxidant activity which warrants further investigations.
The north-eastern region of India accounts for a total of 37,448 cancer cases reported from 11 population-based cancer registries (PBCRs) from 2012 to 2014. Studies suggest that with the holistic approach adopted by homoeopathy, not only the symptoms like cancer pain are alleviated, but also the overall well-being of the patient. Homoeopathy can be beneficial to minimize the treatment-induced adverse effects like radiation-induced mucositis, skin reactions, postoperative seroma, bleeding, and complications associated with the use of surgery, chemotherapy, and radiation therapy. This study intends to provide homoeopathic services as an add-on to conventional treatment to the patients referred for homoeopathic treatment after their due consent. The primary objective is to study the usefulness of homoeopathic medicines for combating the suffering of cancer patients having complaints other than cancer. A sample size of 70 patients per group in two arms (Arm A: standard allopathic drug and Arm B: standard allopathic drug + homoeopathic treatment) will be recruited using simple random sampling without repetition. Cancer patients reporting complaints other than cancer itself and suffering from the after-effects of cancer treatment with chemotherapy and radiation therapy to any reputed cancer institute will be screened and will be recruited according to inclusion and exclusion criteria. After completion of the six months study duration, results will be able to predict the role of homoeopathic treatment as an add-on to conventionally treated cancer patients to minimize the suffering other than cancer and the after-effects of chemotherapy and radiation therapy. If found significant, this could prove to be a contribution in the health care system in handling cancer cases that are very difficult to treat. Further, the cost-effectiveness of homoeopathy will enable developing countries to manage such a disease effectively.
Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Dionysis Tsintzas, Seema Mahesh, George Vithoulkas
Background: Bone marrow edema lesions around the knee are a common magnetic resonance image finding. They constitute a central component of a wide variety of inflammatory and noninflammatory conditions affecting the knee joint. Those lesions are not only a significant source of pain, but are also connected to many musculoskeletal pathologies. Case Report: We describe 2 cases of bone marrow edema of the knee joint treated with the aid of Classical Homeopathy. In both of the cases, Arnica montana was the chosen homeopathic remedy. Conclusions: The results of the treatment are promising, encouraging for more research on this area.
Background: The incidence of pregnancy associated breast cancers is on the rising trend in different parts of the world. There are occasional studies dealing with the fine needle aspiration cytology (FNAC) and clinicopathological characteristics of these tumors. Objectives: To study the cytomorphology and clinicopathological characteristics of pregnancy associated breast cancers and review the existing literature on the pathological characteristics. Methods: This is a retrospective study which includes cases of breast cancer which were diagnosed during peripartum period. FNAC was performed for all the cases from primary and metastatic sites along with correlation of the clinicopathological characteristics. Results: In the study group, 4 cases were lactating at the time of diagnosis, 1 patient presented at 37 weeks of her pregnancy and another patient presented 1 week after ruptured tubal ectopic pregnancy. Histologically two cases of infiltrating duct carcinoma -not otherwise specified (IDC-NOS), one case of invasive duct carcinoma with mucinous differentiation, one case of invasive duct carcinoma with concomitant lactating adenoma and one case each of metaplastic carcinoma and malignant phyllodes tumor. Only a single case was found to be positive for both the estrogen and progesterone receptors and another case only for estrogen receptors. None of the cases were found to positive for Her -2 neu. Conclusion: FNAC still serves as a reliable diagnostic measure inspite of the close mimics, especially when combined with cell block preparation. Further documentation of the clinicopathological features is essential for establishing the prognostic parameters and treatment guidelines for these peripartum breast cancers.
Due to an imbalance between aggressive factors known as hydrochloric acid (HCl), pepsin, leukotrienes, refluxed bile, defensive factors and reactive oxygen species, the peptic ulcer is formed in the stomach and duodenum which mostly include the function of prostaglandins, mucus bicarbonate barrier, enzymatic antioxidants, and some growth factors. H. pylori infection remained one of the considerable causes of peptic ulcer as it caused hypochlorhydria and struck off the defense mechanism of the stomach. The nonsteroidal anti-inflammatory drugs (NSAIDs) and stress are the most prevailing causes of peptic ulcer disease. Lack of physical exercise, little rest and due to poor leisure cause the peptic ulcer disease. Candies, chocolate, coffee, cigarettes, stress, and alcohol are the cause of peptic ulceration and suppression of acid in the stomach due to the utilization of antacid medication. Most of the ancient medical practices in the traditional alternative medicinal system include Unani, Ayurveda, Siddha, Homeopathy, Naturopathy, Chinese customary medicine, African conventional medicine, and Native American medicine. Without a hostile effect, the rate of curing the disease is the significance of natural products research. Peptic ulcer disease is the widespread nature of peptic ulcer in all class of population, which mostly may be due to rapidly changing the food habits and stress, causing the imbalance between gastric offensive and defensive factors. Curcuma longa is the most effective plant for the cure of peptic ulcer. Curcuma longa has anti-inflammatory and antioxidant activity. Curcuma longa remarkably reduces the level of inflammatory mediator (IL1) and (TNF) which was increased during the formation of an ulcer. In the rhizome of Curcuma longa , yellow pigment is present and widely used for the treatment of ulcer and decrease the inflammatory response. Symptoms include abdominal pain after taking a meal, nausea, vomiting, Anorexia and lose weight.
Shivashankar Kengadaran, Anusha Divvi, Pradeep R. Kumar
et al.
Introduction
This study compares the efficacy of herbal,
homeopathic, and conventional dentifrices, on oral
microflora using antibiotic susceptibility tests.
Methods
Three strains of microorganisms, Streptococcus
Mutans, Escherichia Coli, and Candida Albicans, were taken
and incubated in Mutans media, Mueller Hilton agar, and
Sabouraud Dextrose agar, respectively. Different dilutions
(1:5, 1:10 and 1:15) of several brands of commercial
toothpaste with different compositions were made. Sterile
disks were incorporated with an equal amount of prepared
toothpaste formulations using a micropipette. These disks
were then placed equidistant to each other, and the plates
were incubated for 24 hours.
Results
The zone of inhibition against S. Mutans is found to
be higher in homeopathic dentifrice 24 mm, 19 mm, and 20
mm, followed by herbal dentifrice 19 mm, 17 mm, and 13
mm, and the least by conventional dentifrice 17 mm, 15 mm
and no inhibition, at 1:5, 1:10 and 1:15 dilution, respectively.
The zone of inhibition against E. Coli is found to be higher
in herbal dentifrice 18 mm, 17 mm and 16 mm followed by
conventional dentifrice 18 mm, 17 mm, and 14 mm, and no
inhibition by homeopathic dentifrice at 1:5, 1:10 and 1:15
dilution, respectively. Zone of inhibition against C. Albicans
is found to be higher in herbal dentifrice 14 mm, 12 mm and
9 mm followed by conventional dentifrice 14 mm, 9 mm,
and no inhibition, and the least by homeopathic dentifrice
10 mm, 9 mm and 7 mm, at 1:5, 1:10 and 1:15 dilutions,
respectively.
Conclusions
Toothpaste formulations containing
homeopathic and natural antimicrobial agents were more
effective in controlling the oral microflora compared to
toothpaste containing synthetic antimicrobial agents like
triclosan.
Medicinal plants are targeted in the search for new antimicrobial agents. Nowadays, there is an alarmingly increasing antimicrobial resistance to available agents with a very slow development of new antimicrobials. It is, therefore, necessary to extensively search for new agents based on the traditional use of herbal medicines as potential source. The antibacterial activity of 80% methanol extracts of the leaves of Verbena officinalis (Vo-80ME), Myrtus communis (Mc-80ME), and Melilotus elegans (Me-80ME) was tested against 6 bacterial isolates using agar well diffusion technique. In each extract, 3 concentrations of 10, 20, and 40 mg/well were tested for each bacterium. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were also determined. Vo-80ME and Mc-80ME exhibited promising antibacterial activity against Staphylococcus aureus with the highest zone of inhibition being 18.67 and 26.16 mm, respectively at concentration of 40 mg/well. Regarding gram-negative bacteria, Vo-80ME exhibited an appreciable activity against Escherichia coli and Salmonella typhi . Mc-80ME displayed remarkable activity against all isolates including Pseudomonas aeruginosa with the maximum zone of inhibition being 22.83 mm. Me-80ME exhibited better antibacterial activity against E coli, but its secondary metabolites had little or no activity against other gram-negative isolates. The MIC values of Vo-80ME ranged from 0.16 to 4.00 mg/mL. The lowest MIC was observed in Mc-80ME, with the value being 0.032 mg/mL. Mc-80ME had bactericidal activity against all tested bacterial isolates. Mc-80ME showed remarkable zone of inhibitions in all tested bacterial isolates. Besides, Vo-80ME showed good antibacterial activity against S aureus , E coli , and S typhi. Conversely, Me-80ME has shown good activity against E coli only. Generally, M communis L and V officinalis have good MIC and MBC results.
Ranvijay Singh, Nishitha Shetty, Maryam Naveed
et al.
Aim: The aim of this study is to determine the clinical profile of neurotuberculosis in the age group of 6 months to 10 years and its association with biochemical analysis of cerebrospinal fluid (CSF) and neuroradiological findings. Methods: Retrospective assessment of the medical records of confirmed cases of neurotuberculosis from January 2010 to June 2014 was carried out. Results: Of the 46 cases studied, mean age at presentation was 3.4 years. Male-to-female ratio was 1.55:1. Fever, vomiting, headache, seizures, and focal neurological deficits were the most common presenting clinical symptoms. Protein–energy malnutrition (PEM) was detected in 39 cases. On systemic examination, the order of involvement of cranial nerves was VII, II, III, IV, VI, and V. Positive Mantoux test was present in only 11 cases. CSF findings showed lymphocytic predominance, raised protein levels with a decreased to normal glucose levels. Neuroimaging by computed tomography scan/magnetic resonance imaging of the brain gave a definite diagnosis in thirty cases of which hydrocephalus, basal exudates, tuberculoma, and infarctions were the most common findings. The primary focus of tuberculosis was found in the lungs on chest roentgenogram in 12 cases. Conclusions: Neurotuberculosis occurs with increased frequency in the age group of 1–5 years. Fever may be of short duration at presentation in contradiction to current medical literature. PEM is a predisposing factor for the development of the disease. A tuberculin sensitivity test may be negative in cases of neurotuberculosis. CSF analysis and neuroimaging are pivotal in the establishment of a diagnosis.
Daniel Benor MD, John Rossiter-Thornton MD, FRCP, Loren Toussaint PhD
In this pilot study, a convenience sample of 24 chronic pain patients (17 with chronic fatigue syndrome/fibromyalgia) were randomized into WHEE treatment and wait-list control groups for 6 weeks. Assessments of depression, anxiety, and pain were completed before, during, and at 1 and 3 months after treatment. Wait-listed patients then received an identical course of WHEE and assessments. WHEE decreased anxiety ( P < .5) and depression ( P < .05) compared with the control group. The wait-list-turned-WHEE assessments demonstrated decreased pain severity ( P < .05) and depression ( P < .04) but not pain interference or anxiety. WHEE appears a promising method for pain, anxiety, and depression in patients with chronic pain, compared to standard medical care alone. Though a small pilot study, the present results suggest that further research appears warranted. An incidental finding was that a majority of patients with chronic pain had suffered psychological trauma in childhood and/or adulthood.
Control efforts to reduce infection from the parasitic flatworm Opisthorchis viverrini have progressed through understanding the epidemiology of Opisthorchis viverrini , antiparasitic drug developments, technological innovations, health education promoting cooking of fish, and improved hygienic defecation. Yet the problem persists. The case study method was used to examine the fundamental cause of the liver fluke infection problem. Evidence shows that the liver fluke–infected population does not care about living a long life. For them, suffering and death are simply a part of life, and expected. Thus, the cause(s) leading to death is not important. They believe morally bad actions, and predetermined fate associated with kamma in Buddhism, play a big role whether or not one is infected with the liver fluke. Health interventions may be made more effective if they take into account the liver fluke–infected population’s worldviews about ethics, morality, life, and death. We researchers should not feel concerned only about medically determined causes of death.
Background: Seasonal allergic rhinitis (hay fever) is common and can considerably reduce the quality of life of sufferers. Despite the wide everyday application and promising results with homeopathy, scientific evidence of its effectiveness for most ailments is scarce. Aim: The assessment of the clinical effectiveness of homeopathic remedies in the alleviation of hay fever symptoms in a typical clinical setting. Methods: We performed a clinical observational study of eight patients in the treatment of hay fever symptoms over a two-year period (2012 and 2013) using Measure Yourself Medical Outcome Profile (MYMOP) self-evaluation questionnaires at baseline and again after two weeks and four weeks of homeopathic treatment. The individualized prescription – either a single remedy or multiple remedies – was based on the totality of each patient's symptoms. Results: The average MYMOP scores for the eyes, nose, activity and wellbeing had improved significantly after two and four weeks of homeopathic treatment. The overall average MYMOP profile score at baseline was 3.83 (standard deviation, SD, 0.78). After 14 and 28 days of treatment the average score had fallen to 1.14 (SD, 0.36; P < 0.001) and 1.06 (SD, 0.25; P < 0.001) respectively. Conclusions: Individualized homeopathic treatment was associated with significant alleviation of hay fever symptoms, enabling the reduction in use of conventional treatment. The results presented in this study can be considered as a step towards a pilot pragmatic study that would use more robust outcome measures and include a larger number of patients prescribed a single or a multiple homeopathic prescription on an individualized basis.
Background: Thrombocytopenia has been defined as a subnormal number of platelets in the circulating blood and may result from four processes: Artifactual thrombocytopenia, deficient production of platelets, accelerated destruction, and abnormal distribution or pooling of the platelets. Aims: To find out the etiology of thrombocytopenia with clinicopathological correlation, to grade it on the basis of platelet count, and to know the age and sex distribution of the cases. Materials and Methods: The study was conducted from January 2015 to June 2015. A total of 300 cases of thrombocytopenia were selected. All the patients with platelet counts less than 150 Χ 10 3 / micro liter (μL), were included. On the basis of platelet count, the cases were divided into the four grades and clinicopathological correlation was done. Statistical Analysis: Simple random sampling, mean, and percentage. Results: The most common cause for thrombocytopenia was infection. Alcoholic liver disease was the most common noninfective cause. Maximum number of patients were in the age group of 20-39 years. The commonest grade of thrombocytopenia was Grade 1, the least common being Grade 4. Conclusion: Thrombocytopenia is usually associated with infections such as malaria, dengue, sepsis, and viral diseases. It is less common in noninfective conditions, for example alcoholic liver disease. It is seen mainly in adults, significantly more in males, and present as Grade I.
André-Michael Beer MD, PhD, Ievgeniia Burlaka MD, PhD, Stephen Buskin MBBCH
et al.
In order to better understand the global approach and country differences in physicians’ usage, knowledge, and attitudes towards natural remedies and homeopathy in pediatric practice, an online survey involving 582 general pediatricians and general practitioners treating pediatric diseases was conducted in 6 countries. Overall, 17% of the pediatric prescriptions refer to phytotherapy and 15% refer to homeopathic preparations. Natural remedies and homeopathic preparations are more frequently used in upper respiratory tract infections, infant colic, sleep disturbances, and recurrent infections. In the majority of cases, they are used together with chemical drugs. Both treatment options are typically used if parents are concerned about side effects of conventional drugs or prefer natural remedies for themselves. Physicians express high interest in natural remedies and homeopathy; however, their knowledge is variable. Lack of proven efficacy, knowledge on mechanism of action, and information on indications are main factors that limit their usage.