Herbal medicines:physician's recommendation and clinical evaluation of St.John's Wort for depression

Why some physicians recommend herbal medicines while others do not is not well understood. We undertook a survey designed to identify factors, which predict recommendation of herbal medicines by physicians in Malaysia. About a third (206 out of 626) of the physicians working at the University of Malaya Medical Centre ' were interviewed face-to-face, using a structured questionnaire. Physicians were asked about their personal use of, recommendation of, perceived interest in and, usefulness and safety of herbal medicines. Using logistic regression modelling we identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of recommendation. St. John's wort is one of the most widely used herbal remedies. It is also probably the most widely evaluated herbal remedy with no fewer than 57 randomised controlled trials. Evidence from the depression trials suggests that St. John's wort is more effective than placebo while its comparative efficacy to conventional antidepressants is not well established. We updated previous meta-analyses of St. John's wort, described the characteristics of the included trials, applied methods of data imputation and transformation for incomplete trial data and examined sources of heterogeneity in the design and results of those trials. Thirty randomised controlled trials, which were heterogeneous in design, were identified. Our meta-analysis showed that St. John's wort was significantly more effective than placebo [pooled RR 1.90 (1.54-2.35)] and [Pooled WMD 4.09 (2.33 to 5.84)]. However, the remedy was similar to conventional antidepressant in its efficacy [Pooled RR I. 0 I (0.93 -1.10)] and [Pooled WMD 0.18 (- 0.66 to 1.02). Subgroup analyses of the placebo-controlled trials suggested that use of different diagnostic classifications at the inclusion stage led to different estimates of effect. Similarly a significant difference in the estimates of efficacy was observed when trials were categorised according to length of follow-up. Confounding between the variables, diagnostic classification and length of trial was shown by loglinear analysis. Despite extensive study, there is still no consensus on how effective St. lohn's wort is in depression. However, most experts would agree that it has some effect. Our meta-analysis highlights the problems associated with the clinical evaluation of herbal medicines when the active ingredients are poorly defined or unknown. The problem is compounded when the target disease (e.g. depression) is also difficult to define and different instruments are available to diagnose and evaluate it

Direct patient reporting of adverse drug reactions: An analysis of spontaneous reports submitted to Malaysian pharmacovigilance centre

Purpose: To evaluate patient adverse drug reaction (ADR) reports in terms of categories by System Organ Class (SOC), suspected products and seriousness.Methods: The national database was retrospectively searched from 2008 to 2015. ADR reports by patients were included but vaccine-related reports and reports by healthcare professionals were excluded. Eligible reports were analysed descriptively and Chi-square test was used to evaluate the association of various categorical variables with serious ADRs.Results: Of the total of 75,391 reports screened in the National ADR database for the study period, only 81 (0.11 %) were reports from patients, of which 32 (40 %) reports involved serious ADRs. The majority of reports was associated with unregistered products or unapproved cosmetics. Half of the reports involved traditional products while cosmetic products constituted another 10 % of the reports. The three main SOCs involved were skin and appendages disorders (26 %), body as a whole (25 %), and central and peripheral nervous system disorders (9 %). A total of 23 out of 47 products tested were adulterated with prescription drugs while 4 cosmetic products exceeded the permitted limit for hydroquinone or mercury. Two factors found to be significantly associated with serious ADRs were product registration status and presence of adulteration.Conclusion: The findings indicate that patient reporting of suspected ADRs has the potential to add valuable information to pharmacovigilance.Keywords: Adulterants, Patient reporting, Complementary and alternative medicines, Cosmetics, Pharmacovigilanc

Hypercalcaemia in patients with breast cancer: Patterns and treatment outcomes among in-patients in a Malaysian tertiary healthcare facility

Purpose: To assess the patterns of use of bisphosphonate therapies for hypercalcaemia in breast cancer patients, and their outcomes.Methods: A retrospective chart review study of breast cancer patients hospitalised between 2009 and 2014 at Penang Hospital, a public tertiary hospital in Malaysia was conducted. Patients with mild (total serum calcium = 10.5 - 11.9 mg/dl); moderate (12 - 12.9 mg/dl), and severe (≥13 mg/dl) hypercalcaemia at cancer diagnosis or during cancer treatment were included. Relevant data were extracted from medical records analyzed statistically.Results: From the records, 1,023 breast cancer patients were identified, 164 of which had hypercalcaemia at cancer diagnosis or during cancer treatment. About 25 % of the hypercalcaemic patients had advanced-stage cancer, while 20 % had severe hypercalcaemia. Regarding the pattern of bisphosphonate use, the results showed that more than half of the patients received pamidronate as first-line treatment; about a quarter were treated with zoledronic acid, while others received only normal saline. These treatments produced significant reductions in serum calcium levels relative to baseline values.Conclusion: Although zoledronic acid is considered as the treatment of choice for hypercalcemia of malignancy, the current study found that the first line treatment used for hypercalcemia is pamidronate, mainly because its cost is lower than that of zoledronic acid.Keywords: Pamidronate, Zoledronic acid, Bisphosphonates, Calcium level

Consumer Adverse Drug Reactions (ADRs) Reporting in Malaysia: A Retrospective Analysis of Spontaneous Reports from the National Pharmacovigilance Database from 2008 to 2015

Many countries are incorporating direct patient reporting of adverse drug reactions (ADRs) into their pharmacovigilance systems as patients provide a different insight into drug safety compared to healthcare professionals. In Malaysia, consumer reporting of ADRs and issues with product qualitiesbegan in 2007. The aim of this study was to examine consumer reports in terms of ADR categoriesby System Organ Class (SOC), suspected products and the seriousness of the ADRs

Electromagnetic therapy for treating venous leg ulcers (Review)

BackgroundLeg ulceration is a common, chronic, recurring condition. The estimated prevalence of leg ulcers in the UK population is 1.5 to 3 per 1000. Venous ulcers (also called stasis or varicose ulcers) comprise 80% to 85% of all leg ulcers. Electromagnetic therapy (EMT) is sometimes used as a treatment to assist the healing of chronic wounds such as venous leg ulcers.ObjectivesTo assess the effects of EMT on the healing of venous leg ulcers.Search methodsFor this fourth update, we searched The Cochrane Wounds Group Specialised Register (searched 30 January 2015); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 12).Selection criteriaRandomised controlled trials comparing EMT with sham-EMT or other treatments.Data collection and analysisStandard Cochrane Collaboration methods were employed. At least two review authors independently scrutinised search results and obtained full reports of potentially eligible studies for further assessment. We extracted and summarised details of eligible studies using a data extraction sheet, and made attempts to obtain missing data by contacting study authors. A second review author checked data extraction, and we resolved disagreements after discussion between review authors.Main resultsThree randomised controlled trials (RCTs) of low or unclear risk of bias, involving 94 people, were included in the original review; subsequent updates have identified no new trials. All the trials compared the use of EMT with sham-EMT. Meta-analysis of these trials was not possible due to heterogeneity. In the two trials that reported healing rates; one small trial (44 participants) reported that significantly more ulcers healed in the EMT group than the sham-EMT group however this result was not robust to different assumptions about the outcomes of participants who were lost to follow up. The second trial that reported numbers of ulcers healed found no significant difference in healing. The third trial was also small (31 participants) and reported significantly greater reductions in ulcer size in the EMT group however this result may have been influenced by differences in the prognostic profiles of the treatment groups.Authors' conclusionsIt is not clear whether electromagnetic therapy influences the rate of healing of venous leg ulcers. Further research would be needed to answer this question

A Systematic Review of the Efficacy of Centella asiatica for Improvement of the Signs and Symptoms of Chronic Venous Insufficiency

We aimed to assess the efficacy of Centella asiatica for improvement of the signs and symptoms of chronic venous insufficiency (CVI). We searched 13 electronic databases including the Cochrane Central Register of Controlled Trials for randomised controlled trials assessing the efficacy of Centella asiatica for CVI. Two review authors independently selected studies, assessed the risks of bias of included studies and extracted data. The treatment effects of similar studies were pooled whenever appropriate. Eight studies met the inclusion criteria. The pooling of data of similar studies showed that Centella asiatica significantly improved microcirculatory parameters such as transcutaneous partial pressure of CO 2 and O 2 , rate of ankle swelling and venoarteriolar response. Three out of the eight studies did not provide quantitative data. However, these studies reported that patients treated with Centella asiatica showed significant improvement in CVI signs such as leg heaviness, pain and oedema. Our results show that Centella asiatica may be beneficial for improving signs and symptoms of CVI but this conclusion needs to be interpreted with caution as most of the studies were characterised by inadequate reporting and thus had unclear risks of bias, which may threaten the validity of the conclusions

Herbal medicines: Physician's recommendation and clinical evaluation of St.John's Wort for depression

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

A Systematic Review of the Efficacy of Centella asiatica for Improvement of the Signs and Symptoms of Chronic Venous Insufficiency

We aimed to assess the efficacy of Centella asiatica for improvement of the signs and symptoms of chronic venous insufficiency (CVI). We searched 13 electronic databases including the Cochrane Central Register of Controlled Trials for randomised controlled trials assessing the efficacy of Centella asiatica for CVI. Two review authors independently selected studies, assessed the risks of bias of included studies and extracted data. The treatment effects of similar studies were pooled whenever appropriate. Eight studies met the inclusion criteria. The pooling of data of similar studies showed that Centella asiatica significantly improved microcirculatory parameters such as transcutaneous partial pressure of CO2 and O2, rate of ankle swelling and venoarteriolar response. Three out of the eight studies did not provide quantitative data. However, these studies reported that patients treated with Centella asiatica showed significant improvement in CVI signs such as leg heaviness, pain and oedema. Our results show that Centella asiatica may be beneficial for improving signs and symptoms of CVI but this conclusion needs to be interpreted with caution as most of the studies were characterised by inadequate reporting and thus had unclear risks of bias, which may threaten the validity of the conclusions

Review: The in vitro hippocampal slice technique as a tool for studying the central nervous system

The use of brain slice preparations has become increasingly popular among scientists of different disciplines in recent decades for the study of the mammalian central nervous system (CNS) in general and of synaptic phenomena in particular. The in vitro hippocampal slice may be the single most used preparation, among other slices of different parts of the brain areas. The use of brain slices in different experimental work offers certain advantages over the in vivo approaches to the study of the CNS; however, such preparations may have some limitations. This review describes the hippocampal slice technique, explores some of the different types of studies in which it was employed and points out the advantages and limitations of its use

The invitro hippocampal slice technique as a tool for studying the central nervous system

The use of brain slice preparations has become increasingly popular among scientists of different disciplines in recent decades for the study of the mammalian central nervous system (CNS) in general and of synaptic phenomena in particular. The in vitro hippocampal slice may be the single most used preparation, among other slices of different parts of the brain areas. The use of brain slices in different experimental work offers certain advantages over the in vivo approaches to the study of the CNS; however, such preparations may have some limitations. This review describes the hippocampal slice technique, explores some of the different types of studies in which it was employed and points out the advantages and limitations of its use