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PubMed2006

Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know.

BACKGROUND: Widespread use of herbal medications/supplements among the presurgical population may have a negative effect on perioperative patient care. Thus, the authors' goal was to identify the prevalence of such use in a cosmetic surgery patient population compared with use among the general public; to assess physician awareness of proper management of these herbal medications/supplements; and to review the literature to provide rational strategies for managing perioperative patients taking these remedies. METHODS: To assess patient (n = 100) and general public (n = 100) usage rates, open-ended lists of (1) the most common herbal medications/supplements and (2) homeopathic treatments were compiled. Board-certified plastic surgeons (n = 20) were then given the same list of herbs/supplements and surveyed on their awareness of these treatments and perioperative side effects. RESULTS: The usage rate for cosmetic versus public surveys for herbal medicines/supplements was 55 percent versus 24 percent (p < 0.001), with 35 percent versus 8 percent (p < 0.001) engaging in homeopathic practices, respectively. Cosmetic patients' top four herbal/supplements of usage were chondroitin (18 percent), ephedra (18 percent), echinacea (14 percent), and glucosamine (10 percent). The top four used by the general public were echinacea (8 percent), garlic (6 percent), ginseng (4 percent), and ginger (4 percent). The physician survey demonstrated awareness of 54 percent of the listed supplements/herbal medicines, 85 percent of which were not suggested to be discontinued preoperatively, with only ephedra achieving 100 percent physician discontinuation preoperatively. CONCLUSIONS: Herbal medicines and supplements displayed greater prevalence in the cosmetic surgery population than in the population at large. Furthermore, side effects and potential complications warrant addressing these remedies as pharmaceuticals rather than as safe and "natural." Thus, a descriptive "top-10" list with perioperative recommendations was compiled for the plastic surgeon.

Adult↗
PubMedDate not supplied

Using benefit harm tradeoffs to estimate sufficiently important difference: the case of the common cold.

CONTEXT: The term "sufficiently important difference" (SID) refers to the overall amount of benefit that people consider sufficient to justify the costs and risks of treatment. Little is known about patient preferences regarding benefits and harms of common cold treatments. OBJECTIVES: To develop methods to assess SID and to estimate SID for common cold. DESIGN: The authors conducted in-person and telephone interviews with people with colds, using benefit harm tradeoff methods. The hypothetical benefit of reduction in length of illness was traded off against best estimates of costs and risks. First, the authors briefly described costs, risks, and possible symptomatic benefits of 4 treatment scenarios, based on evidence regarding vitamin C, echinacea, zinc, and pleconaril, an antiviral. Hypothetical benefit (reduction of illness duration) was then varied until the cold sufferer indicated that the treatment was minimally desirable. PARTICIPANTS: Interviews were conducted in person with 149 community-recruited adult participants, once at the beginning of their colds, and then again within a few days after symptoms had resolved. Additionally, 162 adult callers with self-identified colds completed interviews via telephone. RESULTS: A total of 460 benefit harm tradeoff interviews (1840 treatment scenarios) estimated overall mean SID as 52.6 h (95% CI, 50.6 to 54.6). For the scenario based on vitamin C, mean SID was estimated as 26.1 h (95% CI, 23.2 to 29.3), with 142 of 460 (31%) saying they would take it regardless of duration benefit, and 22 of 460 (5%) saying they would not take it, regardless of duration benefit. For the echinacea-based scenario, mean SID was estimated at 36.8 h (33.4 to 40.2), with 105 (23%) favoring and 41 (9%) rejecting treatment, regardless of duration benefit. For the zinc lozenge-based scenario, mean SID was estimated as 64.8 h (61.0 to 67.9), with 42 (9%) favoring and 109 (24%) rejecting treatment. For the prescription antiviral-based scenario, mean SID was estimated as 82.6 h (78.7 to 86.7), with 29 (6%) favoring and 223 (48%) rejecting. Severity of illness at the time of interview did not appear to significantly influence responses. Possible side effects, treatment type (tablet v. lozenge v. liquid), monetary costs, and opportunity costs (e.g., getting to the doctor or pharmacy, dosing frequency) did appear to be important in influencing these preference patterns. CONCLUSIONS: Our study suggests that, on average, people want the duration of their colds to be reduced by between 26 and 65 h to justify potential harms of popular cold treatments. A prescription antiviral would require a greater benefit (83 h) to justify larger perceived risks.

Adult↗
PubMed2004

Herbal remedies in the United States: potential adverse interactions with anticancer agents.

PURPOSE: Interest in the use of herbal products has grown dramatically in the Western world. Recent estimates suggest an overall prevalence for herbal preparation use of 13% to 63% among cancer patients. With the narrow therapeutic range associated with most anticancer drugs, there is an increasing need for understanding possible adverse drug interactions in medical oncology. METHODS: In this article, a literature overview is provided of known or suspected interactions of the 15 best-selling herbs in the United States with conventional allopathic therapies for cancer. RESULTS: Herbs with the potential to significantly modulate the activity of drug-metabolizing enzymes (notably cytochrome p450 isozymes) and/or the drug transporter P-glycoprotein include garlic (Allium sativum), ginkgo (Ginkgo biloba), echinacea (Echinacea purpurea), ginseng (Panax ginseng), St John' s wort (Hypericum perforatum), and kava (Piper methysticum). All of these products participate in potential pharmacokinetic interactions with anticancer drugs. CONCLUSION: It is suggested that health care professionals and consumers should be aware of the potential for adverse interactions with these herbs, question their patients on their use of them, especially among patients whose disease is not responding to treatments as expected, and urge patients to avoid herbs that could confound their cancer care.

Antineoplastic Agents↗
PubMed2004

Comparison of natural product use between primary care and nephrology patients.

BACKGROUND: The use of natural products is increasing, but healthcare professionals may underestimate the use of these agents by patients. It is unknown whether natural product use differs between primary care and specialty clinic patients, such as those in a nephrology clinic. OBJECTIVE: To compare patterns of natural product use between primary care and nephrology clinic patients. METHODS: One thousand adult patients from each clinic were randomly mailed an anonymous questionnaire to determine current and past use of natural products. RESULTS: A total of 491 surveys were returned, for an overall response rate of 26% (25% primary care; 28% nephrology clinic). Current use of natural products was similar between the primary care and nephrology groups (34% vs 29%, respectively; p = NS). Primary care patients were more likely to have taken a natural product in the past (57% vs 45%; p < 0.05); Echinacea was the most common product taken by those patients (26%). Green tea was the most common natural product taken by nephrology clinic patients (18%). More primary care patients took Echinacea compared with nephrology clinic patients (26% vs 12%; p < 0.01). Adverse reactions led to discontinuation of the natural product in 7% of respondents. CONCLUSIONS: Active use of natural products was similar between the survey respondents. Documentation and monitoring of natural product use by healthcare professionals working with primary care and nephrology clinic patients are recommended.

Dietary Supplements↗
PubMed1999

Assessing the risks and benefits of herbal medicine: an overview of scientific evidence.

The use of herbal medicine is widespread and growing, with as many as 3 in 10 Americans using botanical remedies in a given year. Because many herbal medicines have significant pharmacological activity, and thus potential adverse effects and drug interactions, healthcare professionals must be familiar with this therapeutic modality. This article summarizes the history and current use of plant-based medicine and highlights the evidence of the risks and benefits associated with 6 plants: echinacea, garlic, ginger, ginkgo, St John's wort, and valerian. Therapies outside the medical mainstream tend to suffer from a dearth of research and critical evaluation. Critics and supporters alike note the conceptual and practical difficulties in studying many complementary and alternative therapies such as acupuncture, homeopathy, and meditation. Herbal medicine, however, lends itself well to standard evaluation methods. This article summarizes and evaluates evidence from randomized controlled trials and meta-analyses. We present the results of meta-analyses and subsequent randomized controlled trials for garlic and St John's wort; a comprehensive critical review and subsequent randomized controlled trials for ginkgo; and summaries of all identified randomized controlled trials for echinacea, ginger, and valerian.

Ericales↗
PubMed1985

[Effect of a plant immunostimulant on phagocytosis of erythrocytes by the reticulohistiocytary system of isolated perfused rat liver].

By the help of the isolated, perfused rat liver, the influence of an immune stimulant of plant origin (Esberitox N; composition: herb. thujae occid. rec., rad. baptisiae tinct., rad. echinaceae ang. et purp.) on the activity of Kupffer cells was tested. It was shown that the phagocytosis of erythrocytes was improved significantly by the single extracts and the combination of this. The extract of thuja occidentalis had the most prominent effect on the first phase of phagocytosis, whereas the extract of echinacea purpurea dominantly influenced the phagocytosis dependent metabolism.

Adjuvants, Immunologic↗
PubMed1994

An evaluation of 55 commercial plant extracts in the Ames mutagenicity test.

55 commercial phytopharmaceuticals (extracts and tinctures) from 44 plant species were evaluated for mutagenic potential in the Salmonella/mammalian microsome mutagenicity test (Ames assay), utilizing tester strains TA98 and TA100 of Salmonella typhimurium with and without S9 mix from induced rat liver microsomes. Weak activities were detected after exposure of the bacteria to Alchemillae tinctura, Centaurii extractum, Hippocastani extractum and Myrtilli extractum. Moderate effects were observed with Crataegi extractum, Echinaceae angustifoliae extractum, Hyperici tinctura, Rutae tinctura and Trifolii fibrini extractum and tinctura. Quercetin was detected by TLC in all extracts with mutagenic activity except in Echinaceae angustifoliae and Centaurii extractum. From this study and earlier results we suggest that quercetin is possibly the main mutagenic principle in the following phytopharmaceuticals: Alchemillae tinctura, Cratagei extractum, Hippocastani extractum, Hyperici tinctura, Myrtilli extractum, Trifolii fibrini extractum and Trifolii fibrini tinctura.

Animals↗
PubMed2004

Activation of autoimmunity following use of immunostimulatory herbal supplements.

BACKGROUND: Evidence for the scientific basis of purported therapeutic effects and adverse effects of herbal supplements continues to grow. Many herbal supplements are touted for their immunostimulatory properties, and both in vitro and in vivo experiments have supported this claim. Although this explains their beneficial effects in preventing or curtailing disease, to our knowledge, no immunostimulatory herbal supplements have been reported to exacerbate disorders of immune system overactivity. OBSERVATIONS: We describe 3 patients whose autoimmune disease onset and/or flares correlated with ingestion of herbal supplements with proven immunostimulatory effects. Echinacea and the alga Spirulina platensis are implicated in 2 patients' flares of pemphigus vulgaris, and a supplement containing the algae Spirulina platensis and Aphanizomenon flos-aquae was ingested by a third patient days before both onset and a severe flare of dermatomyositis. The third patient showed heterozygosity for a tumor necrosis factor alpha (TNF-alpha) promoter polymorphism (-308A), leading to increased production of TNF-alpha, which may have predisposed her to developing dermatomyositis. CONCLUSIONS: Immunostimulatory herbal supplements may exacerbate preexisting autoimmune disease or precipitate autoimmune disease in persons genetically predisposed to such disorders. Increased production of TNF-alpha may play a role, although more research is needed to clarify the mechanisms of such phenomena.

Autoimmune Diseases↗
PubMed2001

Herbal medicines and perioperative care.

CONTEXT: Widespread use of herbal medications among the presurgical population may have a negative impact on perioperative patient care. OBJECTIVES: To review the literature on commonly used herbal medications in the context of the perioperative period and provide rational strategies for managing their preoperative use. DATA SOURCES: The MEDLINE and Cochrane Collaboration databases were searched for articles published between January 1966 and December 2000 using the search terms herbal medicine, phytotherapy, and alternative medicine and the names of the 16 most commonly used herbal medications. Additional data sources were obtained from manual searches of recent journal articles and textbooks. STUDY SELECTION: We selected studies, case reports, and reviews addressing the safety and pharmacology of 8 commonly used herbal medications for which safety information pertinent to the perioperative period was available. DATA EXTRACTION: We extracted safety, pharmacodynamic, and pharmacokinetic information from the selected literature and reached consensus about any discrepancies. DATA SYNTHESIS: Echinacea, ephedra, garlic, ginkgo, ginseng, kava, St John's wort, and valerian are commonly used herbal medications that may pose a concern during the perioperative period. Complications can arise from these herbs' direct and pharmacodynamic or pharmacokinetic effects. Direct effects include bleeding from garlic, ginkgo, and ginseng; cardiovascular instability from ephedra; and hypoglycemia from ginseng. Pharmacodynamic herb-drug interactions include potentiation of the sedative effect of anesthetics by kava and valerian. Pharmacokinetic herb-drug interactions include increased metabolism of many drugs used in the perioperative period by St John's wort. CONCLUSIONS: During the preoperative evaluation, physicians should explicitly elicit and document a history of herbal medication use. Physicians should be familiar with the potential perioperative effects of the commonly used herbal medications to prevent, recognize, and treat potentially serious problems associated with their use and discontinuation.

Dietary Supplements↗
PubMed2005

The hepatoprotective action of ten herbal extracts in CCl4 intoxicated liver.

The effect of ten phytotherapeutic products on CCl(4) intoxicated liver in albino male Wistar rats was investigated. Biochemical parameters, including serum transaminase activity (GPT and GOT), histoenzymological measurements (lactate dehydrogenase, LDH; succinate dehydrogenase, SDH, cytochromoxidase, CyOx; Mg(2+)-dependent adenosine triphosphatase, ATP-ase) and histochemical (Sudan black) and histological examinations (haematoxylin-eosin staining) of the liver were investigated. Some positive effects such as the reduction of hepatocytolysis and steatosis, and a return to normal values of the activity of some enzymes in the following plants: Chrysanthemum balsamita, Echinacea pallida, Calendula officinalis and Corylus avelana were obtained.

Animals↗
PubMedDate not supplied

Open, multicenter study to evaluate the tolerability and efficacy of Echinaforce Forte tablets in athletes.

This open, multicenter study investigated the tolerability and efficacy of a new tablet formulation of Echinacea purpurea extract (Echinaforce Forte; A. Vogel, Bioforce AG, Roggwil, Switzerland) in 80 subjects actively involved in sports. Most investigators (97.5%) rated the treatment as having "very good" or "good" tolerability. About 75% of patients and investigators rated its efficacy during a common cold as "very good" or "good," and 71% of subjects were free of cold episodes. This study is the first to suggest that Echinaforce is effective in the prophylaxis, as well as the treatment, of the common cold in persons who actively participate in sports.

Adolescent↗
PubMed2004

Planting densities and bird and rodent absence affect size distributions of four dicots in synthetic tallgrass communities.

Variability in the size distributions of populations is usually studied in monocultures or in mixed plantings of two species. Variability of size distributions of populations in more complex communities has been neglected. The effects of seeding density (35 or 350 seeds/species/m2) and presence of small vertebrates on the variability of size distributions were studied for a total of 1,920 individuals of 4 species in replicated synthetic communities of 18 species in northern Illinois. End-of season height and above-ground biomass were measured for prairie perennials Dalea purpurea (purple prairie clover), Echinacea purpurea (purple coneflower), Desmanthus illinoensis (Illinois bundleflower) and Heliopsis helianthoides (early sunflower). Variability in biomass distribution of the four target species was twice as great at low than at high densities when small vertebrates were excluded. Our results suggest that inter- and intraspecific competition may affect all individuals more under high-density conditions, thereby reducing the variability in their biomass distributions within this community. This result, a consequence of plant-plant interaction, is obscured when small birds or mammals are present, presumably because either or both add variance that overwhelms the pattern.

Analysis of Variance↗
PubMed1985

Evidence from two classic irritation tests for an anti-inflammatory action of a natural extract, Echinacina B.

The roots of Echinacea angustifolia (fam. Compositae) were used to obtain an antiphlogistic, immunostimulating and skin repairing extract. On the basis of these potential actions, the extract is used in cosmetic preparations. The aim of this study was to evaluate the anti-inflammatory activity of the extract using different irritation tests. The irritation reaction was induced by application of 0.015 ml of 0.25% croton oil in water to the ears of mice. The raw extract (Echinacina B), topically applied, inhibited oedema both at the maximum (6 hr) and in the decreasing phase (18 hr), and this effect was directly proportional to the doses used. Echinacina B was found to be more potent than the positive control, benzidamine, a topical non-steroidal anti-inflammatory drug. In addition, the extract given iv 1 hr before injection of 0.05 ml of 1% carrageenan into the hind paws of rats inhibited oedema in the histaminic and in the later phases of the phlogistic process. These data show the qualitative value of irritation tests for studying the anti-inflammatory action of a natural plant extract.

Animals↗
PubMed2005

Lack of herbal supplement characterization in published randomized controlled trials.

PURPOSE: Herbal supplements in the United States and abroad have poor quality control and high content variability. We assessed the extent to which recently published randomized controlled trials of herbal supplements characterized and verified the content of the supplement under study. METHODS: We identified all MEDLINE-indexed English language randomized controlled trials evaluating single-herb preparations of echinacea, garlic, ginkgo, saw palmetto, or St. John's wort that were published between January 1, 2000, and February 9, 2004. From each article we extracted information characterizing the herbal supplement studied. RESULTS: Of 81 randomized controlled trials meeting inclusion criteria, 12 (15%) reported performing tests to quantify actual contents, and 3 (4%) provided adequate data to compare actual with expected content values of at least one chemical constituent. In those 3 studies, actual content varied between 80% and 113% of expected values. Studies of higher overall quality (Jadad score > or =3) performed testing somewhat less frequently (5/54; 9%) than those with lower Jadad scores (7/27; 26%) (P = .09). CONCLUSION: Documented characterization of herbal supplements in published randomized controlled trials is inadequate. Investigators may be unaware of the extent to which herbal quality-control issues may detract from the value of otherwise well-designed clinical trials. The scientific and clinical utility of future herbal randomized controlled trials would be enhanced if authors provided evidence that the herbal products studied were of high quality.

Drug Contamination↗
PubMed2006

[Anaesthetic preoperative assessment of chronic medications and herbal medicine use: a multicenter survey].

OBJECTIVE: This study was undertaken to quantify the use of chronic medication and herbal remedies in the presurgical population. STUDY DESIGN: Prospective multicenter survey. PATIENTS AND METHODS: Adult patients presenting for anaesthesia were directly asked if they were currently using chronic medication or herbal remedies. RESULTS: Among 1057 patients (age 54+/-17 yrs, woman 54%, ASA 2 [1-4], 74%) were taking one or more chronic medication. The most commonly used treatments were, in descending order angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers (15%), beta blockers (11%) and platelet inhibitors (10%). Also, 9% were taking one or more of the following herbal remedies known to interact with the perioperative period: valeriane, ginseng, ginkgo, St John's wort, echinacea and ephedra. Women and patients aged 40-70 yr were most likely to be taking a herbal product (p<0.001 and p<0.01 respectively). CONCLUSION: Chronic medication and herbal remedies are common in patients presenting for anaesthesia. Because of the potential interactions between anaesthetic drugs or techniques and such medication it is important for anaesthetists to be aware of their use.

Adrenergic beta-Antagonists↗
PubMed2005

Non-antibiotic treatments for upper-respiratory tract infections (common cold).

OBJECTIVES: To review the seven Cochrane reviews of non-antibiotic treatment for the common cold. METHODS: Each Cochrane review was read and summarized, and results presented as relative risks and, where possible, numbers needed to treat. RESULTS: The main theme that runs through these Cochrane reviews is the variable quality of the primary studies. In general, the reviewers are fairly cautious about the benefits of any of the treatments other than first-dose decongestants and antihistamine-decongestant combinations. For antihistamines alone, the reviewers were clear about the lack of efficacy except in the high-quality studies in which a global improvement in symptoms was noted. Some studies were statistically significant, but the Cochrane reviewers were guarded about how clinically significant they were. For Echinacea, problems were found with the quality of the studies and the wide range of different forms of this substance. Heated humidified air seemed to be effective in the UK and Israel, but not the USA, making definitive statements about efficacy difficult. Over-the-counter medication for cough seemed to have no documented benefit in children under the age of 5 years. Letosteine (a mucolytic) may be effective in children but is not available in the UK. Bisolvon (a mucolytic) was found to be effective for cough in only one study. For older children and adults, dextromethorphan may be effective (two out of three studies showed benefit), and guiafenesin (an expectorant) showed mixed benefit in two trials. Dexbrompheniramine (a sedating antihistamine)/pseudoephedrine (6 mg/120 mg twice daily for 1 week) was significantly more effective than placebo for severity of cough, whereas, in another study, loratadine (a non-sedating antihistamine)/pseudoephedrine (5 mg/120 mg twice daily for 4 days) did not show any difference between the study groups. Vitamin C may have a small role in preventing the common cold, with possibly a greater role in high-intensity physical activity and sub-arctic conditions. Zinc lozenges seemed to be effective, but the issue of unblinding due to taste was a methodological issue of concern to the reviewers. The benefits and harms are calculated as numbers needed to treat for one person to benefit (NNTB) and numbers needed to treat for one person to harm (NNTH), and were calculated by the author. CONCLUSION: Most non-antibiotic treatments for the common cold are probably not effective. The most promising are dextromethorphan, bisolvon and guiaphenesin for cough, antihistamine-decongestant combinations for a wide range of symptoms, nasal decongestants (at least for the first dose) and possibly zinc lozenges.

Adult↗
PubMed2006

Conjugating berberine to a multidrug efflux pump inhibitor creates an effective antimicrobial.

In bacteria, multidrug-resistance pumps (MDRs) confer resistance to chemically unrelated amphipathic toxins. A major challenge in developing efficacious antibiotics is identifying antimicrobial compounds that are not rapidly pumped out of bacterial cells. The plant antimicrobial berberine, the active component of the medicinal plants echinacea and golden seal, is a cation that is readily extruded by bacterial MDRs, thereby rendering it relatively ineffective as a therapeutic agent. However, inhibition of MDR efflux causes a substantial increase in berberine antimicrobial activity, suggesting that berberine and potentially many other compounds could be more efficacious if an effective MDR pump inhibitor could be identified. Here we show that covalently linking berberine to INF 55 , an inhibitor of Major Facilitator MDRs, results in a highly effective antimicrobial that readily accumulates in bacteria. The hybrid molecule showed good efficacy in a Caenorhabditis elegans model of enterococcal infection, curing worms of the pathogen.

Animals↗
PubMed2002

Evaluation of antioxidant activity of some natural polyphenolic compounds using the Briggs-Rauscher reaction method.

A new method based on the inhibitory effects of antioxidants on the oscillations of the hydrogen peroxide, acidic iodate, malonic acid, and Mn(II)-catalyzed system (known as the Briggs-Rauscher reaction), was used for the evaluation of antioxidative capacity. With this method, which works near the pH of the fluids in the stomach (pH approximately 2), a group of natural compounds present in fruits and vegetables or in medicinal plants assumed to have antioxidant capacity, was tested successfully. The aim of the present study is to evaluate the antioxidative properties of some active principles contained in vegetables and aromatic plants, namely, cynarin (from Cynara scolymus), rosmarinic acid (from Rosmarinus officinalis), echinacoside (from Echinacea species), puerarin (from Pueraria lobata), and oleuropein (from Olea europea). Also studied with the Briggs-Rauscher reaction method was the antioxidant activity of cyanidin 3-O-beta-glucopyranoside (from Citrus aurantium) in order to compare the results with those obtained by other methods. The conclusions on the dependency of the antioxidative activity on the pH of the testing system are given.

Antioxidants↗