Safety and Efficacy of a Mobiderm Compression Bandage During Intensive Phase of Decongestive Therapy in Patients with Breast Cancer-Related Lymphedema: A Randomized Controlled Trial.

Background: Breast cancer-related lymphedema (BCRL) after primary therapy is a common condition, causing physical and psychological distress. Decongestive lymphedema therapy (DLT) using multi-layered compression bandages is an effective treatment. We conducted a randomized controlled trial evaluating the use of a specific mobilizing bandage (Mobiderm®) on lymphedema volume reduction during the intensive phase of DLT. Methods and Results: Fifty female BCRL patients were randomized to receive either conventional multi-layered bandages or mobilizing bandaging by using Mobiderm. Affected limb volume and excess volume were evaluated at baseline (D0) and after 15 days. The primary outcome was change in affected limb volume after adjustment for baseline. Symptom scores were evaluated by visual analogue scale (VAS); safety and tolerability were also assessed. Baseline characteristics were comparable. Affected limb volume reduction was observed in both study groups after 15 days: by 19.0% in the Mobiderm arm and 8.6% in controls (adjusted values). The between-group mean difference in adjusted volume reduction at day 15 was 256 mL (95% confidence interval [CI], 92.5 to 421.3 mL; p = 0.003) favoring Mobiderm. Reductions in excess volume of 57.3% (Mobiderm) and 25.1% (controls) were observed (adjusted values); with between-group mean difference in adjusted excess volume of 220.2 mL (95% CI, 69.3 to 371.3 mL; p = 0.006) favoring Mobiderm. Pain/heaviness VAS scores fell significantly in both groups, with mean reductions of 1.84 (Mobiderm) versus 0.83 (control; p = 0.001). Both regimens were well tolerated. Conclusion: The use of Mobiderm in multilayer compression bandaging shows benefit in lymphedema reduction and in alleviating functional symptoms/pain in patients with BRCL.

Medicinal plant diversity and use in the highlands of Dolakha district, Nepal.

This paper presents the ethnomedical uses of wild species among nine rural communities managing local forest resources in the Bonch Village Development Committee (VDC), Dolakha district, Nepal. Local communities possess knowledge of 113 medical remedies derived from 58 species belonging to 40 families to treat a wide range of ailments. A review of literature indicated that 56 medical remedies reported in this paper are new. Most medicines were prepared in the form of juice and were administered orally. Roots and leaves were the most frequently used plant parts. Local people were familiar mostly with the species dealing with common ailments particularly cough/cold, digestive problems, fever, headache, and skin infections. Complex ailments were treated by traditional healers. Haphazard harvesting and over-exploitation of commercial species were also reported. Sustainable harvesting methods and domestication of potential commercial species require attention in the local forest operational plans. The present study indicates that the area harbors a high diversity of medicinal plants. Despite gradual socio-cultural transformation, local communities still possess substantial knowledge of plants and their uses. The reliance on folk medicines for health care is associated with the lack of modern medicines and medication, poverty and the traditional belief of its effectiveness. Since there is a lack of phyto-therapeutic evidence for many of the species, we recommend that phytochemical and pharmacological studies be carried out in order to confirm the validity of properties attributed to these species: this is particularly relevant for species with market potential beyond the district. With setting up management plans for their extraction, these medicinal resources can provide for both subsistence needs and income. This, however, requires detail assessment of resource quantities, productivity potential, sustainable harvesting methods, domestication possibilities, market value of potentially promising species, and importantly, equitable benefit sharing regimes.