Principales fitoquímicos con potencial terapéutico en el tratamiento de la retinopatía diabética con fitofármacos / Major Phytochemicals with Therapeutic Potential in the Treatment of Diabetic Retinopathy

La diabetes mellitus tipo 2 representa uno de los principales problemas de salud pública a nivel mundial hoy en día. Entre las principales complicaciones generadas por esta enfermedad se encuentra la retinopatía diabética, la cual puede conducir a pérdida de la visión de manera permanente, por lo que investigaciones sobre tratamientos para esta patología van en aumento. Es por esto que tratamientos en base a químicos obtenidos de plantas medicinales están siendo ampliamente investigados debido a que podrían proveer una alternativa más segura, de menor costo y menor toxicidad que la medicina estándar para el tratamiento de esta patología ocular de alta incidencia mundial. El objetivo de este estudio fue identificar los principales fitoquímicos con potencial para ser usados como tratamiento de la retinopatía diabética. Para lograr este cometido se llevó a cabo una revisión de la literatura publicada entre el enero 2017 y de junio 2021 utilizando las bases de datos WOS, PubMed y Scopus en inglés y español, con el fin de recopilar evidencia científica actualizada sobre el uso y efectos de fitoquímicos en la retinopatía diabética. Diversas familias de fitoquímicos útiles fueron identificadas, entre estas las más comunes fueron las de origen fenólico, aunque menos comunes también se encontraron carotenoides, terpenos y preparaciones constituidas por varias especies de plantas y fitoquímicos. Sus mecanismos de acción también fueron identificados, siendo los más comunes la supresión de la neovascularización mediada por VEGF, la protección y restauración de la barrera hematorretinal, la reducción en la actividad de las especies reactivas del oxígeno y el efecto antiinflamatorio. Dada la evidencia respecto a la utilidad de los fitoquímicos para el tratamiento de la retinopatía diabética, mayores investigaciones deben ser realizadas(AU)

Type 2 diabetes mellitus represents one of the main public health problems worldwide today. Among the main complications generated by this disease is diabetic retinopathy, which can lead to permanent vision loss. For this reason, research on treatments for this pathology is increasing. This is why treatments based on chemicals obtained from medicinal plants are widely investigated as they could provide a safer, less costly and less toxic alternative to standard medicine for the treatment of this eye disease of high incidence worldwide. The aim of this study was to identify the main phytochemicals with potential to be used as treatment for diabetic retinopathy. In order to achieve this purpose, a review of the literature published between January 2017 and June 2021 was conducted using the WOS, PUBMED and Scopus databases in English and Spanish, in order to compile updated scientific evidence on the use and impact of phytochemicals in diabetic retinopathy. Several families of useful phytochemicals were identified. Among these, the most common were those of phenolic origin, although less common were also found carotenoids, terpenes and blends consisting of various plant species and phytochemicals. Their mechanisms of action were also identified, the most common being suppression of vascular endothelial growth factor-mediated neovascularization, protection and restoration of the blood-retinal barrier, reduction in reactive oxygen species activity and anti-inflammatory effect. Given the evidence regarding the usefulness of phytochemicals for the treatment of diabetic retinopathy, further research should be conducted(AU)

Aplicación de la Medicina Natural y Tradicional y dificultades para su uso en Estomatología / Uses of Natural and Traditional Medicine and difficulties for its application in dentistry

Introducción: en Cuba con la introducción de la Medicina Natural y Tradicional en Estomatología, se amplía el enfoque terapéutico para las afecciones bucomaxilofaciales. No obstante, en la actualidad se observan dificultades para su aplicación. Objetivos: describir algunos aspectos de la aplicación de la Medicina Natural y Tradicional por estomatólogos del municipio Playa e identificar las dificultades que perciben para su utilización. Métodos: se realizó un estudio descriptivo de corte transversal, de enero a mayo del año 2012, con la aplicación de un cuestionario elaborado al efecto a una muestra de 88 estomatólogos del municipio Playa, La Habana, Cuba. Las variables estudiadas fueron: años de graduado, especialidad, maestría, aplicación de la Medicina Natural y Tradicional en el tratamiento estomatológico, terapias aplicadas con mayor frecuencia, dificultades para su aplicación y recomendaciones para favorecer su utilización. Resultados: en la muestra, el 58,0 por ciento correspondió a profesionales con 1 a 20 años de graduados y el 60,2 por ciento a especialistas en Estomatología General Integral. El 97,7 por ciento refirió hacer uso de la Medicina Natural y Tradicional en el tratamiento estomatológico; la terapia más aplicada resultó ser la Fitoterapia (80,7 por ciento). El 62,5 por ciento refirió como dificultad, falta de conocimiento sobre estas terapias y el 35,2 por ciento recomendó realizar cursos sobre las mismas. Conclusiones: casi la totalidad de los encuestados refirieron aplicar la Medicina Natural y Tradicional en el tratamiento estomatológico. Las principales dificultades referidas para su aplicación fueron la falta de conocimiento sobre estas terapias y no disponer regularmente de los recursos necesarios en la consulta(AU)

Introduction: the incorporation of Natural and Traditional Medicine into dental practice has broadened the scope of therapies for oral and maxillofacial disorders. However, difficulties are still found for its application. Objectives: describe some aspects of the application of Natural and Traditional Medicine by dentists from the municipality of Playa and identify the difficulties perceived for its application. Methods: a descriptive cross-sectional study was conducted from January to May 2012 based on a dedicated questionnaire applied to 88 dentists from the municipality of Playa, Havana, Cuba. The variables studied were years after graduation, specialty, master's degree, application of Natural and Traditional Medicine in dental treatment, therapies most commonly used, difficulties for their application and recommendations to improve their use. Results: from the overall study sample, 58.0 percent were professionals with 1 to 20 years' experience after graduation, whereas 60.2 percent were General Comprehensive Dentistry specialists. 97.7 percent stated they made use of Natural and Traditional Medicine in dental treatment. The therapy most commonly employed was phytotherapy (80.7 percent). 62.5 percent said that insufficient knowledge about these therapies was a difficulty, and 35.2 percent recommended to implement courses about them. Conclusions: almost all surveyed dentists said they included Natural and Traditional Medicine in their dental practice. The main difficulties cited in its application were lack of knowledge about these therapies and non-availability of the resources required in dental consultation offices(AU)

Syndrome of inappropriate antidiuretic hormone secretion induced by the phytotherapy Harpagophytum procumbers: case report / Síndrome da secreção inapropriada do hormônio antidiurético induzida pelo fitoterápico Harpagophytum procumbers: relato de caso

Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the inability of antidiuretic hormone (ADH) suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.

Resumo Introdução: A síndrome da secreção inapropriada do hormônio antidiurético (SIADH) consiste na incapacidade de supressão do hormônio antidiurético (ADH), comprometendo os mecanismos de excreção da água e concentração urinária. Possui como manifestações a hiponatremia e seus sintomas, sobretudo neurológicos. Há variadas causas que desencadeiam tal distúrbio, a se destacarem: distúrbios do sistema nervoso central, neoplasias malignas e drogas, dentre outros. Relato de Caso: Paciente feminina, 65 anos, hipertensa, apresentando manifestações clínicas e laboratoriais correspondentes à hiponatremia. O fato ocorreu em duas ocasiões em vigência de medicação fitoterápica para tratamento de osteoartrite. Discussão: A hiponatremia relacionada às drogas pode ser provocada pelo efeito direto do medicamento ou por desencadear SIADH. As manifestações clínicas apresentadas poderiam ter sido atribuídas a um quadro psiquiátrico, o que poderia ter desfecho grave, caso não diagnosticada corretamente. A associação de um fitoterápico à SIADH pôde ser confirmada após novo episódio de hiponatremia relacionado à reintrodução do Harpagophytum procumbers. Nossa revisão da literatura não encontrou este fitoterápico associado à SIADH, até o momento. Conclusão: SIADH pode ser ocasionada por medicamento fitoterápico doravante descrita sua associação na literatura.

EFFECTS OF TOPICAL TREATMENT WITH EUPHORBIA TIRUCALLI LATEX ON THE SURVIVAL AND INTESTINAL ADHESIONS IN RATS WITH EXPERIMENTAL PERITONITIS / EFEITOS DO TRATAMENTO TÓPICO COM O LÁTEX DA EUPHORBIA TIRUCALLI NA SOBREVIDA E NAS ADERÊNCIAS INTESTINAIS DE RATOS COM PERITONITE EXPERIMENTAL

Background: The use of plants of the family Euphorbiaceae, particularly Euphorbia tirucalli (avelós) has been popularly widespread for treating a variety of diseases of infectious, tumoral, and inflammatory. Aim: To demonstrated antimicrobial and immunomodulatory effects of these extracts, evaluating the effect of a topical treatment with an aqueous solution of avelós latex on the survival and on intestinal adhesions in rats with experimental peritonitis. Methods: Peritonitis was induced in 24 Wistar rats, that were randomized into four groups of six as follows: (1) Control group (n=6), no treatment; (2) Antibiotic group (n=6), treatment with a single intramuscular dose of antibiotic Unasyn; (3) Saline group (n=6), the abdominal cavity was washed with 0.9% saline; and (4) E.tirucalli group (n=6), the abdominal cavity was washed with E. tirucalli at a concentration of 12 mg/ml. The animals that died were necropsied, and the time of death was recorded. The survivors were killed on postoperative day 11, and necropsy was subsequently performed for evaluation of the intestinal adhesions. Results: Significant differences were observed in the control and antibiotic groups (p<0.01) with respect to the survival hours when compared with the saline and E. tirucalli groups. There was no significant difference (p>0.05) in the survival of animals in the saline andE. tirucalli groups; however, one animal died in the saline group. Necropsy of the animals in the saline and E. tirucalligroups showed strong adhesions resistant to manipulation, between the intestinal loops and abdominal wall. The remaining groups did not show any adhesions. Conclusions: Topical treatment with E. tirucalli latex stimulated an increased formation of intestinal adhesions and prevented the death of all animals with peritonitis.

Racional: O uso de plantas da família Euphorbiaceae, principalmente a Euphorbia tirucalli (avelós), tem sido popularmente difundido para o tratamento de uma variedade de doenças de natureza infecciosa, tumoral e inflamatória. Objetivo: Avaliar o efeito do tratamento tópico com a solução aquosa do látex do avelós na sobrevida e nas aderências intestinas de ratos com peritonite experimental. Métodos: Foi induzido peritonite em 24 ratos Wistar e randomizados em quatro grupos de seis, assim distribuídos: 1) Controle - (n=6), nenhum tratamento; 2) Antibiótico - (n=6), tratamento com dose única intramuscular de antibiótico Unasyn (Pfizer - São Paulo); 3) Salina - (n=6), lavagem da cavidade abdominal com solução fisiológica 0,9%; 4) E.Tirucalli - (n=6), lavagem da cavidade abdominal com E. tirucalli na concentração de 12 mg/ml. Os animais que morreram foram submetidos à necropsia e o horário do óbito anotado. Os sobreviventes foram submetidos à eutanásia no 11odia de pós-operatório e, posteriormente, realizou-se a necropsia para avaliação da formação de aderências. Resultados: Os grupos controle e antibiótico obtiveram diferença significativa (p<0,01) com relação às horas de vida entre os grupos salina e E. tirucalli. Não houve diferença significativa (p>0,05) na sobrevida dos animais dos grupos salina e E. tirucalli, no entanto, houve um óbito no grupo salina. A necropsia dos animais dos grupos salina e E. tirucalli mostrou aderências firmes e resistentes à manipulação entre alças intestinais e parede abdominal. Os demais grupos não tiveram formação de aderências. Conclusão: O tratamento tópico com o látex da E. tirucalli estimulou maior formação de aderências intestinais e evitou o óbito de todos animais com peritonite até o período avaliado.

Hepatotoxicidad asociada a hierbas y productos nutricionales de origen botánico / Herbals and herbal nutritional products hepatotoxicity

Las hierbas y otros productos de origen botánico, han sido utilizados por siglos en diversas culturas con fines medicinales y dietéticos. Contrario a la creencia de ser productos naturales y seguros, su potencial hepatotóxico es reconocido en diversos estudios a nivel mundial, lo que constituye un problema de salud que amerita mayor atención. La prevalencia reportada de hepatotoxicidad asociada a productos botánicos es variable y depende de diversos factores como población estudiada, período y diseño del estudio. Se han reportado un total de 60 productos a base de hierbas con fines medicinales y dietéticos, que pueden causar lesión hepática; sin embargo, el mecanismo fisiopatológico no está completamente dilucidado. Su cuadro clínico y características histológicas, no difieren de la lesión hepática asociada a medicamentos y la mayoría de los pacientes tienen un patrón de lesión hepatocelular. El diagnóstico se hace por exclusión, representando un desafío clínico importante, por lo que resulta fundamental la sospecha clínica y el diagnóstico diferencial de otras patologías agudas y crónicas. De allí que las investigaciones futuras están orientadas a mejorar los métodos diagnóstico existentes e introducir nuevas tecnologías toxicológicas, genéticas e inmunológicas. El manejo es complejo y representa un reto para el especialista puesto que no existe antídoto; el manejo se basa en suspender el uso del producto y en el tratamiento sintomático que disminuya la progresión a la falla hepática aguda fulminante.

Herbs and other botanicals have been used in different cultures with medicinal and dietary purposes for centuries. Contrary to the belief of being natural and safe products, their hepatotoxic potential is recognized in several studies worldwide, and represent a health problem that deserves greater attention. The reported prevalence of hepatotoxicity associated with botanicals is variable and depends on various factors such as population, period and design of the study. There have been reports of a total of 60 products with herbal medicinal and dietary purposes, which may cause liver damage; however, the pathophysiological mechanisms involved are not fully elucidated. Their clinical and histological features, not unlike liver injury associated with drugs in most patients, have a pattern of hepatocellular injury. Diagnosis is by exclusion, and represents a clinical challenge. It is essential the clinical suspicion and the differential diagnosis with other acute and chronic conditions. Hence, future researches are aimed at improving existing diagnostic methods and introducing new toxicological, genetic and immunological technologies. Treatment is complex and presents a challenge for the specialist, as there are no antidotes. Management based on the discontinued use of the product and in the symptomatic treatment, decreases the progression to an acute fulminant hepatic failure.

Clinical Features of Drug-induced Liver Injury According to Etiology

Drug-induced liver injury (DILI) is an increasingly common cause of acute hepatitis. We examined clinical features and types of liver injury of 65 affected patients who underwent liver biopsy according DILI etiology. The major causes of DILI were the use of herbal medications (43.2%), prescribed medications (21.6%), and traditional therapeutic preparations and dietary supplements (35%). DILI from herbal medications, traditional therapeutic preparations, and dietary supplements was associated with higher elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than was DILI from prescription medications. The types of liver injury based on the R ratio were hepatocellular (67.7%), mixed (10.8%), and cholestatic (21.5%). Herbal medications and traditional therapeutic preparations were more commonly associated with hepatocellular liver injury than were prescription medications (P = 0.002). Herbal medications and traditional therapeutic preparations induce more hepatocellular DILI and increased elevations in AST and ALT than prescribed medications.

Use of Triticum aestivum in open wound healing: a clinical, pathological, and tensiometric assessment in the rabbit model / Uso de Triticum aestivum na cicatrização de feridas: um ensaio clínico, histopatológico e tensiométrico em coelhos

While Triticum sp. has been shown to act in wound healing, stimulating collagen synthesis by fibroblasts, the use of this plant extract has yet to be assessed in vivo, in commercially viable presentations. This study used rabbits and assessed, on days seven, 14, and 21, the presence or absence of granulation tissue and epithelialization, histopathological structures, and scar quality through the breaking and tension strength. Treatments, performed for 21 days, were aqueous extract of T. aestivum at a concentration of 2mg/mL (group I) and 10mg/mL (group II) and a nonionic cream (control group). We demonstrate that the formation of granulation tissue was not significantly different between treatments. In the analysis of epithelial tissue, wounds in group II differed from other treatments by day 7. On days 14 and 21 there was no significant clinical difference between groups. In the histopathological evaluation, scar quality and rupture strength did not differ between the groups in the studied period. In the tension strength evaluation, group I differed from the others, presenting a higher tension strength overall. The studied treatments did not differ regarding healing evolution of the skin wounds, but T. aestivum extract, at 2mg/mL, presents better results in the tension strength evaluation...

O extrato de trigo (Triticum sp.) vem sendo usado na cicatrização de feridas por estimular a síntese de fibroblastos, entretanto a sua aplicabilidade in vivo em apresentações comercialmente viáveis ainda tem de ser demonstrada. Neste estudo, avaliaram-se feridas cutâneas de coelhos tratadas com extrato aquoso de T. aestivum quanto à presença de tecido de granulação e epitelização, estruturas histológicas, qualidade cicatricial, além de ensaio tensiométrico. As feridas foram tratadas diariamente, por 21 dias, com diferentes concentrações do extrato (grupo I = 2mg/mL; grupo II = 10mg/mL) ou apenas o veículo (grupo controle = creme não iônico), e avaliadas nos dias sete, 14 e 21. A formação de tecido de granulação não diferiu entre os tratamentos. A epitelização aconteceu em menor tempo em feridas do grupo II, mas aos 14 dias já não havia diferença neste parâmetro. Na avaliação histopatológica, a qualidade cicatricial e a força de ruptura não diferiram no período estudado, entretanto a resistência tensiométrica das feridas do grupo I foi maior que a dos demais tratamentos. Dessa forma, conclui-se que, mesmo não havendo diferença na evolução cicatricial de feridas tratadas ou não com extrato aquoso de T. aestivum, o uso desse composto, a 2mg/mL, resultou em tecidos cicatriciais mais resistentes à tração...

Hepatotoxicidade induzida por Hypericum perforatum com possível associação a copaíba (Copaifera langsdorffii Desf): relato de caso / Hypericum perforatum-induced hepatotoxicity with possible association with copaiba (Copaifera langsdorffii Desf):case report

Relatamos um caso de dano hepático em paciente idosa após uso de produtos naturais à base de Hypericum perforatum e copaíba (Copaifera langsdorffii Desf). A hepatotoxicidade do Hypericum perforatum é conhecida por relatos, mas a respeito da copaíba, largamente usada como anti-inflamatório, há apenas dados experimentais na literatura nacional. Essa apresentação visou chamar a atenção para possível efeito tóxico dessa associação, bem como para a recuperação clínica da paciente após interrupção de seu uso. Há uma tendência de suspeitar sobre a ação de medicamentos para justificar a lesão hepática aguda não viral, em razão do grande número de fármacos responsáveis por hepatotoxicidade. A literatura tem publicado experimentos e relatos clínicos em que produtos fitoterápicos, inclusive Hypericum perforatum, são o agente causador dessa agressão, considerados inócuos e utilizados livremente. É preciso lembrar que reações adversas ocorrem também com essas substâncias, merecendo sua investigação na obtenção da anamnese, pela possibilidade de promoverem quadros graves de falência hepática.

We report a case of liver damage in an elderly patient after the use of herbal products of Hypericum perforatum and copaiba (Copaifera langsdorffii Desf). Hepatotoxicity related to Hypericum perforatum is anecdotally known, but for copaiba, widely used as anti-inflammatory, there is just experimental data in the national literature. This report aimed to draw attention to the possible toxic effects of this association as well as to the clinical recovery of the patient after discontinuing their use. There is a tendency to suspect of the action of drugs to justify a non-viral acute liver injury, because of the large number of drugs responsible for hepatotoxicity. There are experiments and clinical reports in the literature describing some herbal products, including Hypericum perforatum, as the causative agents of this aggression, and are considered innocuous and used with no restrictions. We must remember that adverse reactions also occur with these substances; hence, they should be investigated when collecting the patient´s history, for leading to severe liver failure.

Pesquisa e atividades de extensão em fitoterapia desenvolvidas pela Rede FitoCerrado: uso racional de plantas medicinais e fitoterápicos por idosos em Uberlândia-MG / Research and extension activities in herbal medicine developed by Rede FitoCerrado: rational use of medicinal plants by the elderly in Uberlândia-MG

Este estudo objetivou realizar atividades de extensão em fitoterapia, a partir de um levantamento de dados sobre as plantas medicinais, fitoterápicos e medicamentos convencionais utilizados por 292 idosos frequentadores de um programa de Atividades Físicas e Recreativas para a Terceira Idade (AFRID), na cidade de Uberlândia-MG, utilizando como instrumento de investigação, um questionário semiestruturado. Dentre os entrevistados verificamos que 88% utilizavam medicamentos prescritos, principalmente para o controle da hipertensão. O uso de plantas medicinais foi relatado por 76,7% dos idosos, sendo as mais citadas: Cymbopogon citratus, Mentha sp., Rosmarinus officinalis, Plectranthus barbatus, Ocimum gratissimum, e Matricaria chamomilla. Dezesseis (5,5%) idosos utilizavam fitoterápicos, principalmente preparados a partir de extratos de Ginkgo biloba, Aesculus hippocastanum e Passiflora incarnata em associação com Crataegus oxyacantha e Salix alba. O uso concomitante de plantas medicinais e fitoterápicos com medicamentos convencionais foi relatado por 86,2% e 81,3% dos idosos, respectivamente. Após a análise dos dados percebemos a necessidade do desenvolvimento de ações educativas para informar e conscientizar os idosos sobre o uso da fitoterapia. Elaboramos uma caderneta e uma cartilha para promoção da difusão dessas informações e o aprimoramento do uso da fitoterapia entre os idosos e, dessa forma, alcançar os profissionais de saúde sobre os riscos e benefícios dessa terapêutica; contribuindo assim para o uso seguro e racional da fitoterapia.

This study aimed to carry out extension activities in herbal medicine from a survey of data on medicinal plants, herbal and conventional medicines used by 292 elderly people who attended a program of physical activity called Physical and Recreational Activities for the Elderly, in Uberlândia-MG, using a semi-structured questionnaire as means of investigation. Among the respondents 88% used prescription drugs, primarily for control of hypertension. The use of medicinal plants was reported by 76.7% of the elderly, being the most cited ones: Cymbopogon citratus, Mentha sp., Rosmarinus officinalis, Plectranthus barbatus, Ocimum gratissimum. and Matricaria chamomilla. Sixteen respondents (5,5%) used herbal medicines, especially those prepared from extracts of Ginkgo biloba, Aesculus hippocastanum, and Passiflora incarnata L. in association with Crataegus oxyacantha L. and Salix alba. The concomitant use of medicinal plants and herbal medicines with conventional drugs was reported by 86.2% and 81.3% of participants, respectively. After analyzing the data, we detected the need to develop educational activities to inform and educate seniors about the use of herbal medicine, encompassing the development a book and a primer for initial dissemination of this information, improving herbal medicine use among the elderly. This course of action would allow a greater knowledge of health professionals about the risks and benefits of this therapy, thereby contributing to the safe and rational use of herbal medicine.

Hepatic Sinusoidal Obstruction Syndrome Caused by Herbal Medicine: CT and MRI Features

OBJECTIVE: To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. MATERIALS AND METHODS: The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. RESULTS: Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). CONCLUSION: Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

SEGURIDAD del consumo de fitofármacos. Experiencia en FARMACOVIGILANCIA / SAFETY consumption of herbal medicines. Experience FARMACOVIGILANCIA

El documento que se presenta es una compilación estructurada por capítulos. En el primero se muestran los sustentos teóricos fundamentales acerca de la fitoterapia, como modalidad terapéutica de la medicina natural y tradicional; así como una serie de definiciones relacionadas con la fitoterapia, el consumo de fitofármacos y el desarrollo de la medicina natural y tradicional en Cuba. Un segundo capítulo en el que se abordan la seguridad y la farmacovigilancia de los fitofármacos. Por último, un tercer capítulo en el cual se exponen los principales resultados de investigaciones relacionadas con el tema en el contexto cubano. El incremento en los últimos años del uso de las diferentes modalidades de la Medicina Natural y Tradicional en el mundo, acentúa aún más la necesidad de crear y organizar sistemas de farmacovigilancia que pueden identificar, describir y cuantificar las reacciones adversas asociadas con su aplicación en la población. En consecuencia, los gobiernos deben apoyar más las investigaciones dirigidas a validar esta práctica, como recurso terapéutico eficaz y seguro. Este libro es el resultado del trabajo de un grupo de especialistas vinculados a la Escuela Nacional de Salud Pública, dirigido a aquellos interesados en la Medicina Natural y Bioenergética. Constituye un tributo a la profesionalidad, por la claridad y el rigor que los autores han sabido proyectar en el texto, en el cual se recogen experiencias y consideraciones de expertos dedicados a esta rama de la medicina.

Percepção de risco e conceitos sobre plantas medicinais, fitoterápicos emedicamentos alopáticos entre gestantes / Perceived risk and concepts about medicinal plants, herbal and allopathic medicines from the perspective of pregnant women / Percepción del riesgo y puntos de vista sobre las plantas medicinales,fitoterapias y medicinas alopáticas en mujeres embarazadas

O uso de plantas medicinais é parte do cotidiano da população brasileira,inclusive entre as gestantes, às quais o uso de medicamentos pode acarretar implicações tanto para a saúde materna como fetal. O objetivo deste estudo é analisar as percepções de risco relacionadas ao uso de fitoterápicos, plantas medicinais e medicamento alopático em gestantes, bem como apresentar os conceitos por elas definidos a respeito desses agentes terapêuticos. A pesquisa é de natureza qualitativa, sendo utilizada a análise de conteúdo. As definições sobre medicamento alopático e plantas medicinais, segundo as gestantes, estão associadas à natureza química do remédio, ao melhor efeito ou à experiência de uso delas com relação a esses agentes terapêuticos. Conclui-se que é imprescindível aprofundar o conceito da experiência subjetiva dos pacientes com a utilização de medicamentos, pois essa experiência influencia toda a forma como o sujeito se relaciona com os medicamentos.

The use of medicinal plants is part of everyday life of the Brazilian population,even among pregnant women, when the use of drugs may have implications for both maternaland fetal health. The approximation between the technical-scientific knowledge and the subjectivity of patients will break with the tradition of the biomedical model of health that is characterized by treating people equally, despite their disease, and without considering cultural differences.The objective of the study is to analyze the perceptions of risk related to use of herbal medicines, medicinal plants and allopathic medicine in pregnant women as well as to introduce the concepts defined by them with regards to these therapeutic agents.The research is qualitative using content analysis.The definitions of allopathic remedy and medicinal plants according to pregnant women are associated with the chemical nature of the remedy, the best effect or the experience of using them in relation to these therapeutic agents. It is concluded that it is essential to deepen the concept of the subjective experience of the patients with the use of medication, because this experience influences how the subject relates to medications.

El uso de plantas medicinales es parte de la vida cotidiana de la población brasileña, incluso entre las mujeres embarazadas, en las cuales, el uso de drogas puede traer consecuencias, tanto para la salud materna como la fetal. El objetivo de este estudio esanalizar las percepciones de riesgo relacionados con el uso de fitoterapias, plantas medicinales y medicinas alopáticas en mujeres embarazadas, así como presentar los conceptos definidos por ellas con respecto a estos agentes terapéuticos. La investigación es de enfoque cualitativo con la utilización del análisis de contenido. De acuerdo con la opinión de las mujeres, lãs definiciones sobre la medicina alopática y las plantas medicinales están asociados con la naturaleza química de la solución, al efecto delas mismas o a la experiencia de su uso em relación con estos agentes terapéuticos. Se concluye que es imprescindible profundizar el concepto de la experiencia subjetiva de los pacientes con el uso de la medicinas, ya que toda esta experiencia influye en la forma como la persona se relaciona con las mismas.

Fitoterapia, sus orígenes, características y situación en Chile / Origins and situation of phytotherapy in Chile

Phytotherapy is defined as the use of medicinal plants for therapeutic purposes and it uses a variety of complex vegetal structures. In public health, it is considered a type of alternative medicine, in which auto medication with herbs is common and there is a lack of quality assurance of herbal products. While the World Health Organization is proposing strategies to include complementary and alternative therapies as public health tools, in Chile this type of therapy is emerging. There is a lack of interest and underestimation of conventional medicine towards popular knowledge. At the present time, the Chilean Ministry of Health has recognized 103 plants aiming to promote the use of medicinal plants that are registered and certifed, according to the regulations of the National Control System of Pharmaceutical Products. Therefore, health care professionals should be educated about the association between pharmaceutical products and medicinal plants. Consultation systems about Phytotherapy should also be available, information should be provided about where to purchase safe herbal products and publicity about these products should be regulated.

The effect of eurycoma longifolia jack on spermatogenesis in estrogen-treated rats

Introduction: There is little data concerning the ability of Eurycoma longifolia Jack (EL) to reverse the inhibitory effects of estrogen on testosterone production and spermatogenesis. The aim of the present study was to determine the effect of EL on testicular histology and sperm count in estrogen-treated male rats. Methods: Adult male Sprague-Dawley rats weighing 200-250 g were divided into four groups of six rats each. Group A (control) was given solvent in the same manner as the treated groups were given EL. Group B was treated with EL (8 mg/kg body weight) orally. Group C was treated with estradiol (E2) (intramuscular dose of 500 ìg/kg body weight), and group D received a combined treatment of oral EL and intramuscular E2. After fourteen consecutive days of treatment, rats from all groups were sacrificed and subjected to spermatogenic and epididymal sperm cell counts. Results: The spermatogenic cell count in the E2-treated group was significantly decreased as compared to the control (p < 0.05) and EL+E2-treated groups (p < 0.05). A similar finding was found for the epididymal sperm count; the E2-treated group had a significant decrease in the count compared to the control (p < 0.05) and EL+E2-treated groups (p < 0.05). Rats that were treated with EL alone exhibited significantly higher sperm counts and sperm motility when compared to the control group (p < 0.05). Conclusions: EL extract acts as a potential agent for reversing the effects of estrogen by increasing spermatogenesis and sperm counts in rats after fourteen consecutive days of treatment.

Aloe-induced Toxic Hepatitis

Aloe has been widely used in phytomedicine. Phytomedicine describes aloe as a herb which has anti-inflammatory, anti-proliferative, anti-aging effects. In recent years several cases of aloe-induced hepatotoxicity were reported. But its pharmacokinetics and toxicity are poorly described in the literature. Here we report three cases with aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a 55-yr-old woman were admitted to the hospital for acute hepatitis. They had taken aloe preparation for months. Their clinical manifestation, laboratory findings and histologic findings met diagnostic criteria (RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. Aloe should be considered as a causative agent in hepatotoxicity.

Linden flower (Tilia spp.) as potential vehicle of Clostridium botulinum spores in the transmission of infant botulism / El té de tilo como vehículo potencial de esporas de Clostridium botulinum en la transmisión del botulismo infantil

Infant botulism is an intestinal toxemia caused principally by Clostridium botulinum. Since the infection occurs in the intestinal tract, numerous food products have been investigated for the presence of C. botulinum and its neurotoxins. In many countries, people use linden flower (Tilia spp) tea as a household remedy and give it to infants as a sedative. Therefore, to help provide a clear picture of this disease transmission, we investigated the presence of botulinum spores in linden flowers. In this study, we analyzed 100 samples of unwrapped linden flowers and 100 samples of linden flowers in tea bags to determine the prevalence and spore-load of C. botulinum. Results were analyzed by the Fisher test. We detected a prevalence of 3% of botulinum spores in the unwrapped linden flowers analyzed and a spore load of 30 spores per 100 grams. None of the industrialized linden flowers analyzed were contaminated with botulinum spores. C. botulinum type A was identified in two samples and type B in one sample. Linden flowers must be considered a potential vehicle of C. botulinum, and the ingestion of linden flower tea can represent a risk factor for infant botulism.

El botulismo del lactante es una toxiinfección causada, principalmente, por Clostridium botulinum. Debido a que esta infección ocurre en el tracto intestinal, la presencia de esta bacteria y sus neurotoxinas ha sido investigada en numerosos alimentos. En muchos países se utiliza el té de tilo (Tilia spp.) como sedante natural, el que se administra incluso a los lactantes. A fin de contribuir al esclarecimiento de la transmisión de esta enfermedad, se investigó la prevalencia y la carga de esporas botulínicas en esta hierba. Se analizaron 100 muestras de tilo comercializado a granel y 100 muestras de tilo industralizado en “saquitos”. Los resultados de prevalencia fueron analizados por el test de Fisher y la carga de esporas por la técnica del número más probable. Se halló una prevalencia de esporas de C. botulinum del 3% en el tilo comercializado a granel, con una carga de 30 esporas/100 g de hierba. En tanto, ninguna de las muestras en saquitos acusó la presencia del patógeno. Se identificaron tres cepas de C. botulinum, dos tipo A y una tipo B. En virtud de estos resultados, el tilo podría considerarse un potencial vehículo de esporas de C. botulinum y la administración de sus infusiones a menores y lactantes, un riesgo para la transmisión de la enfermedad.

Comportamiento de las reacciones adversas reportadas por productos naturales: Matanzas 2003-2008 / Behavior of adverse reactions caused by natural products: Matanzas 2003-2008

El uso de medicamentos naturales es fundamental dentro del procedimiento médico-farmacológico de la sociedad actual. Nuestro objetivo es evaluar el comportamiento del reporte de reacciones adversas a medicamentos naturales en la provincia Matanzas durante el período 2003-2008. Se realizó un estudio longitudinal, retrospectivo, observacional. Se consideró como elegible para el estudio el universo conformado por el conjunto de los reportes de sospecha de reacciones adversas a fitofármacos recogidos durante el período referido. Hubo un predominio en la frecuencia de aparición de las reacciones adversas a los medicamentos derivados de Ajo ( Allium sativum L. ), Eucalipto ( Eucalyptus sp. div. ) y Naranja Agria ( Citrus aurantium L. ), siendo estas reacciones de tipo leves y moderadas con afectación fundamental del sistema digestivo y la piel. Se reportaron reacciones adversas con el empleo de productos naturales en el período estudiado, siendo más frecuentes las reacciones clasificadas como moderadas según su gravedad y como probables según su relación de causalidad, con una mayor afectación del sistema digestivo y piel.

The usage of natural medicines is essential in the medico-pharmacological treatment nowadays. Our objective was evaluating behavior of the adverse reactions reports to natural medicines at the province of Matanzas during the period between 2003 and 2008. We carried out a longitudinal, retrospective, observational study. We considered as eligible to this study a universe formed by all the reports of suspected adverse reactions to phytomedicines recorded during the referred period. There was predominance in the frequency of adverse reactions to medicines prepared with Garlic ( Allium sativum L. ), Eucalyptus ( Eucalyptus sp. div. ) and Sour Orange ( Citrus aurantium L.); being these reactions light or moderated, and affecting mainly digestive system and skin. There were reported adverse reactions with the usage of natural products in the studied period, being more frequent the reactions classified as light according to their seriousness, and as probable according to the causality relation, highly affecting the digestive system and skin.

Medicina popular: benefícios e malefícios das plantas medicinais / Medicina popular: benefícios y malefícios de las plantas medicinales / Popular medicine: benefits and drawbacks of medicinal plants

Estudo descritivo objetivando verificar se os herbolários oferecem as informações corretas para a utilização das plantas medicinais; se orientam os clientes acerca das possíveis intoxicações ou interação com os alopáticos; e se utilizam critérios para a comercialização dos fitoterápicos. Utilizou-se um questionário contendo questões abertas e fechadas envolvendo aspectos da atuação dos herbolários com os fitoterápicos. Os herbolários conhecem a maioria das plantas medicinais, entretanto, há lacunas acerca da indicação correta desses produtos, dos efeitos colaterais e toxicidade. Os herbolários carecem conhecer melhor os princípios ativos das ervas, as indicações terapêuticas, orientar os usuários acerca das possíveis interações farmacológicas ou intoxicações medicamentosas e a respeito da limpeza, armazenamento, tempo de vida útil e contra-indicações do produto.

Descriptive study which aims to verify if the herbalist offer the information correct for the use of the medicinal plants; if they give for the customers concerning the possible poisonings or interaction with the allopathic guide and also if there is a criteria for the commercialization of the phytotherapics. A questionnaire was used containing open and closed questions involving aspects of the performance of the herbalists with the phytotherapics. The herbalists know the majority of the medicinal plants, however, there are some gaps concerning the correct indication of these products, of the collateral effect and toxicities. The herbalist lack to better know the principles of the grass, the therapeutically indications active, to guide the users concerning the possible pharmacological interactions or medicaments poisonings and regarding the cleanness, storage, time of useful life and contraindications of the product.

Estudio descriptivo con los objetivos de verificar se los herbolarios ofrecen las informaciones correctas para la utilización de las plantas medicinales; se orientan los clientes acerca de las posibles intoxicaciones o interaciones con los alopáticos y se utilizan critérios para la comercialización de los fitoterápicos. Se utilizó una encuesta conteniendo preguntas subjetivas y también objetivas tratando de aspectos de la actuación de los herbolarios con los fitoterápicos. Los herbolarios conocen la mayoría de las plantas medicinales, por lo tanto, hay huecos acerca de la indicación correcta de esos productos, de los efectos colaterales y de la toxicidad. Esos profesionales carecen conocer mejor los princípios activos de las hierbas, las indicaciones terapeuticas, orientar los usuários sobre las posibles interacciones farmacológicas o intoxicaciones medicamentosas y a respeto de puntos como limpieza, armazenamiento, tiempo de vida útil y contra-indicaciones del producto.

Reacciones adversas a medicamentos herbarios y otras formas de medicina natural y tradicional en Cuba durante 2001-2004 / Adverse reactions to herbal drugs and other forms of natural and traditional medicine in Cuba from 2001 to 2004

Caracterizar las notificaciones de sospechas de reacciones adversas a medicamentos herbarios y otros procedimientos de la medicina tradicional y natural durante el transcurso de 4 años en Cuba. Se realizó un estudio descriptivo y retrospectivo de farmacovigilancia mediante la notificación espontánea de reacciones adversas, se revisaron y clasificaron las notificaciones correspondientes a los años 2001 y 2004. Los reportes de sospechas de reacciones adversas a estas técnicas de medicina tradicional fueron menores que 5 por ciento del total de reportes recibidos; incluye además medicamentos, productos biológicos, vacunas, medios de contraste y otros. Se encontró como el grupo de edad de mayor incidencia el de 16 a 49 años y el sexo el femenino. El mayor porcentaje correspondió a los fitofármacos (57,8 por ciento), en todo el período de tiempo, seguido por la acupuntura y técnicas afines (37 por ciento). La valoración de causalidad se comportó con el mayor porcentaje de efectos adversos clasificados como probables, siguiendo el comportamiento de las sospechas de reacciones adversas nacional y la severidad mostró que fueron más notificadas las reacciones leves (alrededor de 70 por ciento), seguidas por las moderadas y no hubo ningún efecto adverso mortal. El estudio de los productos de medicina natural es aún insuficiente y es difícil realizar una valoración de causalidad ante una sospecha de reacción adversa, sin embargo, es muy útil que se reporte lo más mínimo que observe el paciente o el profesional sanitario.

To characterize the notifications of suspicions of adverse reactions to herbal drugs and other procedures of traditional and natural medicine during these 4 years in Cuba. A descriptive and retrospective study of pharmacovigilance was undertaken by the spontaneous notification of adverse reactions. The notifications corresponding to 2001 and 2004 were reviewed and classified. The reports of suspicions of adverse reactions to these techniques of traditional medicine were under 5 percent of the total of reports received, which also included drugs, biological products, vaccines, contrast media and others. The age group 16-49 showed the highest incidence and the females prevailed. The greatest percentage corresponded to the phytodrugs (57.8 percent) in the whole period, followed by acupuncture and related techniques (37 percent). In the causality assessment the highest percentage of adverse effects was classified as probable. According to the national behaviour of the suspicions of adverse reactions and severity, the mild reactions were the most notified (around 70 percent), followed by the moderate. There was no mortal adverse effect. The study of the natural medicine products is still insufficient, and it is difficult to make an evaluation of causality before a suspicion of adverse reaction. However, it is very useful to report the most minimum reaction detected by the patient or the health professional.