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Biomedical subjects

M H Pittler

Publications and source records attributed to M H Pittler.

54 records · Page 3Linked to original sources
PubMed2000

Efficacy of kava extract for treating anxiety: systematic review and meta-analysis.

Synthetic anxiolytic drugs are effective for treating anxiety, but they are burdened with adverse effects. Constraints on resources and time often render therapies such as psychologic interventions impracticable. Thus, an effective oral medication with few adverse effects would be a welcome addition to the therapeutic repertoire. This systematic review and meta-analysis was aimed at assessing the evidence for or against the efficacy of kava extract as a symptomatic treatment for anxiety. Systematic literature searches were performed in the computerized databases MEDLINE, EMBASE, BIOSIS, AMED, CISCOM, and the Cochrane Library (all from their respective inception to June 1998). The search terms used were kava, kawa, kavain, Piper methysticum, and Rauschpfeffer (German term for Piper methysticum). Experts on the subject were contacted to provide further information. There were no restrictions regarding the language of publication. Double-blind, randomized, placebo-controlled trials of oral kava extract for the treatment of anxiety were included. All publications were blinded before assessment by a person not involved in the study. Data were extracted in a standardized, predefined fashion independently by the two reviewers. The methodologic quality of all trials was assessed. Superiority of kava extract over placebo was suggested by all seven reviewed trials. The meta-analysis of three trials suggests a significant difference in the reduction of the total score on the Hamilton Rating Scale for Anxiety in favor of kava extract (weighted mean difference, 9.69; 95% confidence interval, 3.54-15.83). These data imply that kava extract is superior to placebo as a symptomatic treatment for anxiety. Therefore, kava extract is an herbal treatment option for anxiety that is worthy of consideration.

Anti-Anxiety Agents↗
PubMed1999

The efficacy of ginseng. A systematic review of randomised clinical trials.

OBJECTIVE: Ginseng is one of the most popular herbal remedies, and a number of health claims are made for it. This systematic review provides an evaluation of the current evidence for or against the efficacy of ginseng root extract. METHODS: Searches of the computerised literature databases Medline, Embase, Biosis, CISCOM and the Cochrane Library were performed to retrieve double-blind, randomised, placebo-controlled trials of ginseng root extract for any indication. Manufacturers and experts were contacted to provide additional information. There were no restrictions regarding the language of publication. The outcome and methodological quality of all trials were independently assessed by two reviewers. RESULTS: Sixteen trials met the inclusion criteria and were reviewed. These trials related to physical performance, psychomotor performance and cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections. The evidence found for ginseng root extract is compelling for none of these indications. CONCLUSION: Based on these data, it is concluded that the efficacy of ginseng root extract is not established beyond reasonable doubt for any of these indications. The widespread use of ginseng as a herbal remedy warrants more rigorous investigations to assess its efficacy and safety.

Adjuvants, Immunologic↗
PubMed1999

Experts' opinions on complementary/alternative therapies for low back pain.

BACKGROUND: Complementary/alternative therapies are used for low back pain more frequently than for any other indication, yet evidence for or against their efficacy is fragmentary. Notwithstanding this void, the high prevalence of such therapies drives their integration into our health care systems. Expert opinions on the use of complementary/alternative therapies for low back pain could therefore be helpful until more data from randomized, controlled trials become available. OBJECTIVE: A postal questionnaire survey was designed to generate opinion from a systematically identified expert panel on the clinical effectiveness of complementary/alternative therapies for low back pain. METHODS: Computerized searches were conducted to systematically identify by objective criteria 50 clinical experts on low back pain. Each panel member received a questionnaire to assess the perceived clinical effectiveness of complementary/alternative therapies for 4 defined categories of low back pain. RESULTS: For acute uncomplicated low back pain, osteopathy and chiropractic were rated as effective by most experts. For chronic uncomplicated low back pain, most experts considered acupuncture as effective. Experts perceived homeopathy generally as ineffective for any type of low back pain. Clinical experience with herbalism as a treatment for low back pain was insufficient to form an opinion. CONCLUSION: Experts' opinion is in favor of the effectiveness of osteopathy and chiropractic for acute uncomplicated low back pain. Acupuncture is judged to be of some value for chronic, uncomplicated low back pain. Homeopathy is perceived as ineffective for any type of low back pain. Insufficient experience with herbalism as a treatment for low back pain prevents firm conclusions.

Acute Disease↗
PubMed1999

Randomized, double-blind trial of chitosan for body weight reduction.

BACKGROUND: Overweight and obesity is a prevalent and costly threat to public health. Compelling evidence links overweight and obesity with serious disorders such as cardiovascular diseases and diabetes. Dietary regimen are notoriously burdened with poor compliance. Chitosan is promoted in the US and other countries as an oral remedy to reduce fat absorption and has now been incorporated as a major constituent into several over-the-counter remedies. The primary aim of this study is to investigate the clinical effectiveness of oral chitosan for body weight reduction. METHODS: Thirty-four overweight volunteers were included in a randomized placebo-controlled double-blind trial. Subjects were assigned to receive either four capsules of chitosan or indistinguishable placebo twice daily for 28 consecutive days. Measurements were taken at baseline, after 14 and 28d of treatment. Subjects maintained their normal diet and documented the type and amount of food consumed. Adverse effects were assessed and compliance monitored. RESULTS: Data from 30 subjects were entered into an intention-to-treat analysis. After four weeks of treatment, body mass index, serum cholesterol, triglycerides, vitamin A, D, E and beta-carotene were not significantly different in subjects receiving chitosan compared to those receiving placebo. Vitamin K was significantly increased after four weeks in the chitosan group compared with placebo (P<0.05). Compliance was 91.5% and 96.0% for chitosan and placebo groups respectively. CONCLUSION: The above data suggest that chitosan in the administered dosage, without dietary alterations, does not reduce body weight in overweight subjects. No serious adverse effects were reported.

Adolescent↗
PubMed1999

Artemether for severe malaria: a meta-analysis of randomized clinical trials.

The treatment of choice for severe malaria is quinine. However, a gradual progression of resistance to quinine has become a concern in parts of the world. Artemisinin-related compounds are a relatively new class of drugs. This meta-analysis assesses the evidence regarding the clinical effectiveness of artemether for severe malaria. Computerized literature searches identified all randomized clinical trials of artemether in comparison with quinine. Standardized data extraction was independently performed by both authors. Results of nine trials, entered in the meta-analysis, demonstrate the absence of a significant difference between artemether and quinine in terms of mortality rate (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.50-1.14). Statistical pooling of data from trials in Southeast Asia showed a trend toward enhanced reduction of mortality (OR, 0.38; 95% CI, 0.14-1.02). These data demonstrate the equality of artemether and quinine for severe malaria and indicate a trend toward greater effectiveness of artemether in regions where there is recognized quinine resistance.

Antimalarials↗
PubMed1998

The effectiveness of acupuncture in treating acute dental pain: a systematic review.

OBJECTIVE: Acupuncture is frequently advocated as an effective treatment of dental pain. The question whether or not it is effective for this indication remains controversial. The aim of this systematic review therefore was to assess the effectiveness of acupuncture in dental pain. DATA SOURCES: Four electronic databases were searched: Medline, Embase, CISCOM, and the Cochrane Library. Only controlled trials were included in this review. DATA EXTRACTION: Information was extracted from included studies and entered on standard forms independently by both authors. Methodological quality was assessed using the Jadad score. MAIN RESULTS: 16 such studies were located. The majority of these trials imply that acupuncture is effective in dental analgesia. However, important questions remain unanswered. CONCLUSION: It is concluded that acupuncture can alleviate dental pain and that future investigations should define the optimal acupuncture technique and its relative efficacy compared with conventional methods of analgesia.

Acupuncture Analgesia↗
PubMed1998

[How effective is spa treatment? A systematic review of randomized studies].

BACKGROUND AND OBJECTIVE: In the context of general financial constraints within many national health services spa treatment is being looked at ever more critically in various European countries. An important argument against spa treatment has been the supposed lack of evidence for its efficacy. This analysis was undertaken to gather firm data bearing on this problem. METHODS: Several data bases were searched systematically for randomized studies of spa treatment. Only those were included in which one patient cohort had received spa treatment, while the control cohort had been treated for the same ailment on an ambulant basis at home. Nonrandomized studies were excluded. RESULTS: Only three randomized studies were found in which two patient cohorts, one with and one without spa treatment, were compared (postsalpingitis, back pain and osteoarthritis, respectively). In all three the evidence indicated some additional benefit from spa treatment. CONCLUSIONS: The data are not sufficient to prove the benefit of spa treatment, nor are they adequate to disprove it. More evidence-based studies are necessary to arrive at rationally based decisions relating to the efficacy of spa treatment.

Back Pain↗
PubMed1998

[Yohimbine in therapy of erectile dysfunction].

The bark of the yohimbine tree has long been appreciated as an aphrodisiac. Recent studies have shown that yohimbine is effective in the symptomatic treatment of erectile dysfunction. It is superior to placebo and has fewer side effects compared with the invasive treatment of erectile dysfunction. The evidence for effectiveness seems less compelling for other oral drugs used in this condition. It can be concluded that yohimbine is an attractive option in the symptomatic treatment of erectile dysfunction.

Administration, Oral↗
PubMed1998

Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review.

OBJECTIVE: To assess the evidence for or against horse-chestnut seed extract (HCSE) as a symptomatic treatment of chronic venous insufficiency (CVI). DATA SOURCES: Computerized literature searches were performed in MEDLINE, EMBASE, BIOSIS, CISCOM, and the Cochrane Library (all from their respective institution to December 1996). The search terms were "horse chestnut," "Aesculus hippocastanum," "escin," and "Rosskastanie" (German for "horse chestnut"). There were no restrictions on the language of publication. STUDY SELECTION: Double-blind, randomized controlled trials of oral HCSE for patients with CVI were included. Identifiers were removed from all publications before assessment. DATA EXTRACTION: Data were extracted in a standardized, predefined manner. Trial outcomes and the methodological quality of each trial were independently assessed by the 2 reviewers. DATA SYNTHESIS: The superiority of HCSE is suggested by all placebo-controlled studies. The use of HCSE is associated with a decrease of the lower-leg volume and a reduction in leg circumference at the calf and ankle. Symptoms such as leg pain, pruritus, and a feeling of fatigue and tenseness are reduced. Five comparative trials against the reference medication indicate that HCSE and O-(beta-hydroxyethyl)-rutosides are equally effective. One trial suggests a therapeutic equivalence of HCSE and compression therapy. Adverse effects are usually mild and infrequent. CONCLUSIONS: These data imply that HCSE is superior to placebo and as effective as reference medications in alleviating the objective signs and subjective symptoms of CVI. Thus, HCSE represents a treatment option for CVI that is worth considering.

Chronic Disease↗
PubMed1998

Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials.

BACKGROUND: The efficacy of homeopathic remedies has remained controversial. The homeopathic remedy most frequently studied in placebo-controlled clinical trials is Arnica montana. OBJECTIVE: To systematically review the clinical efficacy of homeopathic arnica. MATERIALS AND METHODS: Computerized literature searches were performed to retrieve all placebo-controlled studies on the subject. The following databases were searched: MEDLINE, EMBASE, CISCOM, and the Cochrane Library. Data were extracted in a predefined, standardized fashion independently by both authors. There were no restrictions on the language of publications. RESULTS: Eight trials fulfilled all inclusion criteria. Most related to conditions associated with tissue trauma. Most of these studies were burdened with severe methodological flaws. On balance, they do not suggest that homeopathic arnica is more efficacious than placebo. CONCLUSION: The claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials.

Arnica↗
PubMed1998

Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials.

PURPOSE: Erectile dysfunction is a common problem, particularly in diabetics. It is associated with a considerable burden of suffering. No generally accepted drug treatment exists. We systematically reviewed and meta-analyzed all randomized, placebo controlled trials of yohimbine monotherapy for erectile dysfunction to determine its therapeutic efficacy. Our secondary aim was to evaluate the safety of yohimbine. MATERIALS AND METHODS: We used computerized literature searches and standardized data extraction to rate methodological quality in a meta-analysis using computer statistical software. RESULTS: Seven trials fit the predefined inclusion criteria. Overall methodological quality of these studies was satisfactory. The meta-analysis demonstrated that yohimbine is superior to placebo in the treatment of erectile dysfunction (odds ratio 3.85, 95% confidence interval 6.67 to 2.22). Serious adverse reactions were infrequent and reversible. CONCLUSIONS: The benefit of yohimbine medication for erectile dysfunction seems to outweigh its risks. Therefore, yohimbine is believed to be a reasonable therapeutic option for erectile dysfunction that should be considered as initial pharmacological intervention.

Adrenergic alpha-Antagonists↗
PubMed1998

Feverfew as a preventive treatment for migraine: a systematic review.

BACKGROUND: Feverfew is a popular herbal remedy advocated for the prevention of migraine. AIM: The aim of this systematic review was to look at the evidence for or against the clinical effectiveness of feverfew in migraine prevention. DATA SOURCES: Literature searches were performed using the following databases: Medline, Embase, Biosis, CISCOM, and the Cochrane Library (all from their inception to April 1998). STUDY SELECTION: Only randomized, placebo-controlled, double-blind trials were included. DATA EXTRACTION: All articles were read by two independent reviewers. Data were extracted in a predefined, standardized fashion. The methodological quality of all trials was evaluated using the Jadad score. MAIN RESULTS: Five trials met the inclusion/exclusion criteria. The majority favor feverfew over placebo. Yet important caveats exist. CONCLUSION: The clinical effectiveness of feverfew in the prevention of migraine has not been established beyond reasonable doubt.

Humans↗
PubMed1998

Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis.

OBJECTIVE: Peppermint oil is the major constituent of several over-the-counter remedies for symptoms of irritable bowel syndrome (IBS). As the etiology of IBS is not known and treatment is symptomatic, there is a ready market for such products. However, evidence to support their use is sparse. The aim of this study was to review the clinical trials of extracts of peppermint (Mentha X piperita L.) as a symptomatic treatment for IBS. METHODS: Computerized literature searches were performed to identify all randomized controlled trials of peppermint oil for IBS. Databases included Medline, Embase, Biosis, CISCOM, and the Cochrane Library. There were no restrictions on the language of publication. Data were extracted in a standardized, predefined fashion, independently by both authors. Five double blind, randomized, controlled trials were entered into a metaanalysis. RESULTS: Eight randomized, controlled trials were located. Collectively they indicate that peppermint oil could be efficacious for symptom relief in IBS. A metaanalysis of five placebo-controlled, double blind trials seems to support this notion. In view of the methodological flaws associated with most studies, no definitive judgment about efficacy can be given. CONCLUSION: The role of peppermint oil in the symptomatic treatment of IBS has so far not been established beyond reasonable doubt. Well designed and carefully executed studies are needed to clarify the issue.

Colonic Diseases, Functional↗
PubMed1997

Evidence-based PM&R?

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Evidence-Based Medicine↗