Ex Vivo Antiplatelet and Thrombolytic Activity of Bioactive Fractions from the New-Fangled Stem Buds of Ficus religiosa L. with Simultaneous GC-MS Examination.

Different parts of Ficus religiosa are the common components of various traditional formulations for the treatment of several blood disorders. The new-fangled stem buds' powder was extracted with 80% ethanol and successively fractionated by chloroform and methanol. Chloroform and methanol fractions of Ficus religiosa (CFFR and MFFR) were tested for antiplatelet, antithrombotic, thrombolytic, and antioxidant activity in ex vivo mode. The MFFR was particularly investigated for GC-MS and toxicity. The antiplatelet activity of the CFFR, MFFR, and standard drug aspirin at 50 µg/mL was 54.32%, 86.61%, and 87.57%, and a significant delay in clot formation was noted. CFFR at different concentrations did not show a significant effect on the delay of clot formation, antiplatelet, and free radical scavenging activity. The most possible marker compounds for antiplatelet and antioxidant activity identified by GC-MS in the MFFR are salicylate derivatives aromatic compounds such as benzeneacetaldehyde (7), phenylmalonic acid (13), and Salicylic acid (14), as well as Benzamides derivatives such as carbobenzyloxy-dl-norvaline (17), 3-acetoxy-2(1H)-pyridone (16), and 3-benzylhexahydropyrrolo [1,2-a] pyrazine-1,4-dione (35). A toxicity study of MFFR did not show any physical indications of toxicity and mortality up to 1500 mg/kg body weight and nontoxic up to 1000 mg/kg, which is promising for the treatment of atherothrombotic diseases.

Composition, Antibacterial Efficacy, and Anticancer Activity of Essential Oil Extracted from Psidium guajava (L.) Leaves.

Essential oils (EO) are used as a natural remedy to treat various chronic diseases, although clinical evidence is lacking. In this context, we have endeavored to measure the percentage of chemical composition and biological efficacy of Psidium guajava (guava) leaf essential oil in treating oral infections and oral cancer. The essential oil obtained from hydrodistillation of P. guajava L. leaves was analyzed by gas chromatography−mass spectrometry (GC−MS). The activities of selected oral pathogens Candida albicans (C. albicans) and Streptococcus mutans (S. mutants) were studied in vitro and in silico. MTT assay was used to test for anticancer activity against human oral epidermal carcinoma (KB). GC−MS showed that the main components of PGLEO were limonene (38.01%) and ß-caryophyllene (27.98%). Minimum inhibitory concentrations (MICs) of 0.05−0.1% were demonstrated against C. albicans and S. mutans. Antimicrobial activity against C. albicans and S. mutans, as shown by molecular linkage analysis, revealed that the main metabolites, limonene and ß-caryophyllene, potentially inhibited the receptors of C. albicans and S. mutans. PGLEO showed significant (p < 0.001) anticancer activity (45.89%) at 200 µg/mL compared to doxorubicin (47.87%) with an IC50 value of 188.98 µg/mL. The outcomes of the present study suggest that PGLEO has promising antimicrobial and anticancer activities and could be a useful source for developing a natural therapeutic agent for oral infections and oral cancer.

Solubility Enhancement, Formulation Development, and Antibacterial Activity of Xanthan-Gum-Stabilized Colloidal Gold Nanogel of Hesperidin against Proteus vulgaris.

The objective of the study was to develop a transdermal nanoformulation of hesperidin (HSP) against Proteus vulgaris (P. vulgaris). Based on the low water solubility of HSP, we prepared HSP-enabled AuNPs stabilized with xanthan gum (XA), referred to as HSP@XA@AuNPs. The HSP@XA@AuNP formulation was evaluated for particle size (43.16 nm), PDI (0.565), zeta potential (-31.9 mV), and entrapment efficiency (56.7%). The HSP@XA@AuNPs gel was developed by incorporating selected formulation grades into a 1% Carbopol gel base and characterized by physical evaluation and rheological studies. The color of the HSP@XA@AuNP gel was light pink, and the texture was very smooth and non-greasy. The gel was shown to be odorless. A field emission scanning electron microscope (FESEM) was used to investigate the shape of HSP@XA@AuNPs further. The drug release was 73.08% for the HSP@XA@AuNPs and 86.26% for the HSP@XA@AuNPs gel in 500 min. The prepared gel showed antimicrobial activity against P. vulgaris with an MIC of 1.78 µg/mL. In conclusion, the HSP@XA@AuNPs gel could be an advanced modality for treating P. vulgaris.

Hepatoprotective activity of depsidone enriched Cladonia rangiferina extract against alcohol-induced hepatotoxicity targeting cytochrome P450 2E1 induced oxidative damage.

Alcoholic liver disease (ALD) is a broad-spectrum disorder, covering fatty liver, cirrhosis, alcoholic hepatitis and in extreme untreated condition hepatocellular carcinoma (HCC) may also develop. Cladonia rangiferina (CR) is a class of lichen having a broad spectrum of pharmacological activity. It is used like traditional natural sources in ancient times in India, China, Sri Lanka, etc. Folkloric record about CR has reported their use as an antimicrobial, antitumor, antioxidant, anti-inflammatory activities, etc. Hence, the present study was requested to ascertain the effect of the ethanolic extract of Cladonia rangiferina (CRE) on alcohol-induced hepatotoxicity. The animals were evaluated for the estimation of the liver in vivo biochemical antioxidant parameters. The liver tissues were further evaluated histopathologically and western blotting examination for localization of apoptotic gene expression that plays a pivotal role in hepatotoxicity. The results of this study reveal that CRE proves to be helpful in the treatment of alcohol-induced hepatotoxicity and oxidative stress. Results of different markers have shown that among all, CRE has demonstrated the best hepatoprotective activity. These observations say about the importance of the components of the extract. The ameliorative action of CRE in alcoholic liver damage may exist due to antioxidant, anti-inflammatory, and anti-apoptotic activities.

Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh.

Traditional practices constituting spiritual and religious (S/R) healing are an important component of the holistic healthcare model and are used in health, well-being, and treating a variety of diseases around the world. The main focus of this review is to summarize the Complementary and Alternative Medicine (CAM) studies that especially target S/R healing practices in Saudi Arabia (SA) and discuss the results in light of relevant international literature. From year 2013-2017, electronic searches of PubMed, OvidSP, Google Scholar, and two publishing housing Web sites (Sciencedomain.com and Dove Medical Press.com) were made using key words and Boolean operators and retrieved thousands of published papers from peer-reviewed journals. Two independent reviewers decided to include a total of 108 articles: 48 from SA and 60 from other international literature. The sociodemographic variables of the participants varied in local studies and were comparable with international data. The frequency and types of religious and spiritual practices reported in local and international zones varied in accordance with religious belief, gender, age, education, and prevalent chronic diseases. Most of professionals and practitioners showed fairly good knowledge and positive attitude toward spiritual and religious practices used in diverse clinical and non-clinical situations across the world. Furthermore, it was observed that in the international scenario, S/R researches using specific religious screening tools have been conducted on different aspects of clinical application including self-care, social cohesion, negative impact, and child development, whereas regional studies targeting varied participants mainly focused on the epidemiological trends of S/R therapies in Saudi Arabia. CAM practitioners and public tend to show great interest in prescribed and self-use of religious and spiritual therapies across the world because of multiple dynamic forces, including positive effects on health, sense of well-being and disease control, cost-effectiveness, easy access to services, and improvement in quality of life. Further studies are needed to assess the effectiveness of different types of religious and spiritual therapies and practices used in specific diseases, their role in promotion of health and well-being, and prevention of diseases nationwide and across the world. Besides integration of S/R into mainstream treatment modalities, medical education curriculum, continuous medical education, and training programs are needed for bridging the knowledge, attitude, and practice gaps concerning CAM in targeted population groups such as medical professionals, CAM practitioners, medical students, public and traditional healers, not only in SA but also around the world.

Posttraining Knowledge Retention among Licensed Cupping Providers in Saudi Arabia.

BACKGROUND: One of the licensing requirements for cupping providers in Saudi Arabia is to attend a compulsory training course that lasts 5 days for non-physicians and 4 days for physicians, irrespective of any previous experience in cupping therapy. The course is conducted by the National Center of Complementary and Alternative Medicine (NCCAM/MOH). As a part of course auditing, the current study aimed to evaluate knowledge retention among licensed cupping providers 1-3 years after passing the official cupping course. METHODS: Licensed cupping providers were invited to attend a continuing medical education activity. Sixty-two attended the continuing medical education activity. Before the event, participants were asked to answer 35 multiple-choice questions taken from the same data bank as the pretest and posttest of the course. The test scores were linked and compared with the pre- and posttest of the training course. RESULTS: A paired t test showed significant differences between the pre- and posttest knowledge scores (mean difference: 224.6 ± 86, p = 0.0001) and between the posttest and follow-up knowledge scores (mean difference: -115.26 ± 103.9, p = 0.0001). The follow-up score was still significantly higher than the pretest score, with a mean difference of 112 (95% CI: 83.66-140.34, p = 0.0001). There was no significant effect of category (physician vs. non-physician) on knowledge retention after controlling for the postcourse score. Gender, the total duration of experience, and total years of experience in cupping did not affect knowledge score retention between the physicians and the non-physicians. CONCLUSION: The official cupping training course of the NCCAM/MOH achieved reasonable knowledge retention. To achieve long-term knowledge retention, refresher training/courses and continuous professional development will be required.

The future of integrative health and medicine in Saudi Arabia.

Saudi Arabia is witnessing a healthcare transformation to face the challenges of the increased burden of noncommunicable diseases and to maintain the quality of healthcare services. However, in Saudi Arabia, where low back and neck pain, depressive disorders, migraine, diabetes, and anxiety disorders cause the most disability, a broader way of integrative health approach is needed to foster healthy lives and promote well-being for all ages. In the presence of the advanced modern medicine healthcare system in Saudi Arabia, the traditional medicine healing system is being used by a substantial proportion of Saudis but like a shadow healthcare system. This phenomenon of using two healthcare systems reflects a need for an integrative healthcare system. Integrative medicine or approach is about bringing traditional, complementary, and modern medicine in a harmonized system of healthcare which can give a high return and save cost. The rationale behind integrative medicine is to include the best practices of both conventional and complementary therapy, uniting these practices into an integrative approach. Pain management, care of cancer patients, and behavior change are among the leading areas of integration models that should be included in healthcare transformation in Saudi Arabia. Investment in behavior change and well-being outside the boundaries of the healthcare system in the Saudi 2030 vision will have more impact on health and wellness of the Saudi citizen in the face of the epidemics of the lifestyle diseases. Models of integrative medicine during the healthcare transformation can be developed, evaluated, and replicated.

Cupping therapy in Saudi Arabia: from control to integration.

Cupping therapy or Hijamah is a leading traditional practice after spiritual healings and herbal medicine in Saudi Arabia. Wet cupping is by far the most common type of cupping therapy. Hijamah in Saudi Arabia and other Muslim countries is a model of religious influences, interconnectivity, and cross-cultural influences between different civilizations. Accordingly, differentiating the cupping practiced in Saudi Arabia, and other Muslims societies from that practiced in other countries like China, by Korea only by the technique or cupping sites is an underestimation of the differences. In Saudi Arabia, the profile or characteristics of cupping therapy user is distinct from the profile of other traditional medicine users by being more educated, with higher job rank and not affected by nationality or gender. After an era of unregulated practice, cupping therapy is currently regulated and monitored by the National Center for Complementary and Alternative Medicine in the Ministry of Health (NCCAM/MOH) of Saudi Arabia. Regulations and licensing include practitioners, practice place, and cupping equipment. After regulation, cupping is mainly offered by the private sector and paid directly by the client as insurance does not cover it. In the private sector, licensed cupping service is usually provided as a parallel and not an integrated service. However, there are few models of integrated cupping clinic in universities, academic institutions, and governmental hospitals. Further health system research is needed to develop more models of integrated cupping service pending for the healthcare transformation which is going on in Saudi Arabia.

A Descriptive Review of the Prevalence and Usage of Traditional and Complementary Medicine among Saudi Diabetic Patients.

Diabetes mellitus represents a major burden in Saudi Arabia where seven million (20% of population) are living with diabetes. This article reviews the literature on usage of traditional and complementary medicine (T&CM) therapies among Saudi diabetic patients, focusing in particular on identifying the prevalence as well as discussing their safety and efficacy. Three databases (PubMed, Cochrane, and ScienceDirect) were searched prior to December 10, 2017, for articles published in peer-reviewed journals that reported primary data on the use of traditional and complementary medicine therapies among diabetic patients in Saudi Arabia. Six studies were selected according to the inclusion/exclusion criteria. In conclusion, the prevalence of use of T&CM therapies among diabetics in Saudi Arabia was 32.18%. This review identified that the most used T&CM therapy among diabetics was herbal treatment. The most used herbs were fenugreek, black seeds, neem, myrrh, helteet, harmel, and aloes. There is insufficient or little evidence to support the efficacy of the most identified herbs and therapies. This review is raising the safety concerns about the used herbs and complementary therapies which were commonly used without any medical consultation.

A brief illustration of the official national standards for the safe use of cupping therapy (Hijama) in Saudi Arabia.

Cupping therapy (Hijama in Arabic) is a popular traditional treatment especially in Asia, the Middle East and Central Europe. Traditionally, cupping therapy has been one of the most used practices in Saudi Arabia. Standardization of the practice of cupping therapy is a very important step to eliminate or reduce any adverse events related to cupping. This article gives a brief illustration and highlights the important points of the first accredited Saudi Arabian standards for the safe use of cupping equipment and its applications.

A Quality Model to Select Patients in Cupping Therapy Clinics: A New Tool for Ensuring Safety in Clinical Practice.

Cupping therapy is a popular treatment in various countries and regions, including Saudi Arabia. Cupping therapy is regulated in Saudi Arabia by the National Center for Complementary and Alternative Medicine, Ministry of Health. The authors recommend that this quality model to select patients in cupping clinics - version 1 (QMSPCC-1)-be used routinely as part of clinical practice and quality management in cupping clinics. The aim of the quality model is to ensure the safety of patients and to introduce and facilitate quality and auditing processes in cupping therapy clinics. Clinical evaluation of this tool is recommended. Continued development, reevaluation and reassessment of this tool are important.

Cupping Therapy: An Overview from a Modern Medicine Perspective.

Cupping therapy is an ancient traditional and complementary medicine practice. Recently, there is growing evidence of its potential benefits in the treatment of pain-related diseases. This article gives an overview of cupping therapy practice. Furthermore, this article suggests a new classification of cupping therapy sets, a new classification of cupping therapy adverse events, and an updated classification of cupping therapy types.

An assessment of the impact of herb-drug combinations used by cancer patients.

BACKGROUND: Herb/Dietary Supplements (HDS) are the most popular Complementary and Alternative Medicine (CAM) modality used by cancer patients and the only type which involves the ingestion of substances which may interfere with the efficacy and safety of conventional medicines. This study aimed to assess the level of use of HDS in cancer patients undergoing treatment in the UK, and their perceptions of their effects, using 127 case histories of patients who were taking HDS. Previous studies have evaluated the risks of interactions between HDS and conventional drugs on the basis on numbers of patient using HDSs, so our study aimed to further this exploration by examining the actual drug combinations taken by individual patients and their potential safety. METHOD: Three hundred seventy-five cancer patients attending oncology departments and centres of palliative care at the Oxford University Hospitals Trust (OUH), Duchess of Kent House, Sobell House, and Nettlebed Hospice participated in a self-administered questionnaire survey about their HDS use with their prescribed medicines. The classification system of Stockley's Herbal Medicine's Interactions was adopted to assess the potential risk of herb-drug interactions for these patients. RESULTS: 127/375 (34 %; 95 % CI 29, 39) consumed HDS, amounting to 101 different products. Most combinations were assessed as 'no interaction', 22 combinations were categorised as 'doubt about outcomes of use', 6 combinations as 'Potentially hazardous outcome', one combination as an interaction with 'Significant hazard', and one combination as an interaction of "Life-threatening outcome". Most patients did not report any adverse events. CONCLUSION: Most of the patients sampled were not exposed to any significant risk of harm from interactions with conventional medicines, but it is not possible as yet to conclude that risks in general are over-estimated. The incidence of HDS use was also less than anticipated, and significantly less than reported in other areas, illustrating the problems when extrapolating results from one region (the UK), in one setting (NHS oncology) in where patterns of supplement use may be very different to those elsewhere.

Cancer patients at risk of herb/food supplement-drug interactions: a systematic review.

Herbal medicines and dietary supplements are commonly taken by patients with cancer, leading to concern over interactions with conventional medicines. A literature search was carried out to identify published studies exploring supplement use by patients with a cancer diagnosis. A total of 818 articles were retrieved using the key words, but only 41 are judged to be relevant based on title. Following the review of the abstracts, ten papers were considered to be potentially relevant, but of these, only two met the selection criteria, and three additional papers were identified from published reviews. Of 806 patients surveyed, 433 (53.7%) were reported to be taking combinations of supplements and drugs, and 167 incidents of risk were identified, affecting 60 patients (13.9%). The interactions identified were mainly theoretical and not supported by clinical data. No studies reported any adverse events associated with these combinations; most did not record the actual drug combinations taken, and the risk potential of some supplements appears to have been over-estimated. More effort should be made to investigate supplement use in this vulnerable patient group, based on sound evidence of plausible interaction, not only to avoid harm but also to provide reassurance where appropriate if the patient wishes to take a particular supplement.