New trends in the use of medicinal plants by Algerian diabetic patients, considerations of herb-drug interactions.

ETHNOPHARMACOLOGICAL RELEVANCE: Diabetes mellitus is a metabolic disorder, with a large prevalence in low- and middle-income countries. Numerous studies highlighted the use of medicinal plants for diabetes in Algeria. This use is influenced by cultural considerations. The industrialization of the country leads to the transformation of the trend of the utilization of plants, and the increase of polymedication. In this context, there is no information about the profile of diabetic patients using plants and the potential of herb-drug interactions. AIM OF THE STUDY: The objective was to evaluate the use of plants by diabetic patients and to search the drug interactions with the most cited species. MATERIALS AND METHODS: Descriptive and comparative studies were carried out among diabetic patients and traditional healers, in the west of Algeria, to inventory the plants used in diabetes. Bivariate and multivariate analysis by logistic regression were performed to evaluate the associated factors with the use, to determine the profile of users. Bibliometric research in PubMed, Google Scholar, Cochrane Library and ClinicalTirals was conducted to look for herb-drug interactions. RESULTS: Results show a decrease in the use of medicinal plants by diabetic patients, in comparison of previous findings, some of which have not been cited by traditional healers. The patients under oral anti-diabetic agents (ODA) have twice the risk to use plants in concomitant with drugs. Olea europea leaves and Trigonella feanum greacum seeds were the most cited herbals. Metformin was the most used drug. Several clinical trials revealed that the anti-diabetic plants had a synergistic effect with ODA, which can increase the hypoglycemia of diabetics. Non-important adverse reactions were noted. CONCLUSIONS: New trends of the use of medicinal plants by diabetic patients were noted, this is due to the diversification of information sources. Patients under ODA must be educated about the use and the risk of herb-drug interactions.

Highly focused anopheline breeding sites and malaria transmission in Dakar.

BACKGROUND: Urbanization has a great impact on the composition of the vector system and malaria transmission dynamics. In Dakar, some malaria cases are autochthonous but parasite rates and incidences of clinical malaria attacks have been recorded at low levels. Ecological heterogeneity of malaria transmission was investigated in Dakar, in order to characterize the Anopheles breeding sites in the city and to study the dynamics of larval density and adult aggressiveness in ten characteristically different urban areas. METHODS: Ten study areas were sampled in Dakar and Pikine. Mosquitoes were collected by human landing collection during four nights in each area (120 person-nights). The Plasmodium falciparum circumsporozoite (CSP) index was measured by ELISA and the entomological inoculation rates (EIR) were calculated. Open water collections in the study areas were monitored weekly for physico-chemical characterization and the presence of anopheline larvae. Adult mosquitoes and hatched larvae were identified morphologically and by molecular methods. RESULTS: In September-October 2007, 19,451 adult mosquitoes were caught among which, 1,101 were Anopheles gambiae s.l. The Human Biting Rate ranged from 0.1 bites per person per night in Yoff Village to 43.7 in Almadies. Seven out of 1,101 An. gambiae s.l. were found to be positive for P. falciparum (CSP index = 0.64%). EIR ranged from 0 infected bites per person per year in Yoff Village to 16.8 in Almadies. The An. gambiae complex population was composed of Anopheles arabiensis (94.8%) and Anopheles melas (5.2%). None of the An. melas were infected with P. falciparum. Of the 54 water collection sites monitored, 33 (61.1%) served as anopheline breeding sites on at least one observation. No An. melas was identified among the larval samples. Some physico-chemical characteristics of water bodies were associated with the presence/absence of anopheline larvae and with larval density. A very close parallel between larval and adult densities was found in six of the ten study areas. CONCLUSION: The results provide evidence of malaria transmission in downtown Dakar and its surrounding suburbs. Spatial heterogeneity of human biting rates was very marked and malaria transmission was highly focal. In Dakar, mean figures for transmission would not provide a comprehensive picture of the entomological situation; risk evaluation should therefore be undertaken on a small scale.