Use of Complementary and Alternative Medicine among People with Type 2 Diabetes in Taiwan: A Cross-Sectional Survey

Research into CAM use by people with diabetes is limited. This study explored CAM use among patients who attend diabetic clinics for followup treatment. Special attention was paid to patients' changing patterns of CAM use before and after diagnosis with Type 2 diabetes, their experience of CAM use, and their management of CAM use with conventional medicines. A retrospective cross-sectional survey (n = 326) was undertaken in three census regions in Taiwan, including metropolitan, urban, and rural areas in 2006-7 (87.4% response rate). Participants reported extensive use of CAM with conventional medicines. The prevalence of CAM use was 22.7% before and 61.0% after diagnosis with Type 2 diabetes with nutritional supplements being the most commonly used CAM before and after diagnosis. However, the disclosure rate of CAM use to healthcare professionals remained low (24.6%), and lack of knowledge about CAM ingredients was common (63.4%). Awareness of the widespread use of CAM by people with Type 2 diabetes is crucial for healthcare professionals. The self-administration of both conventional medicines and CAM without disclosure of CAM use to healthcare professionals may result in ineffective diabetes management and adverse effects. CAM information needs to be incorporated into clinical practice and patient and professional education

Cytotoxic Effects of Bangladeshi Medicinal Plant Extracts

To investigate the cytotoxic effect of some Bangladeshi medicinal plant extracts, 16 Bangladeshi medicinal plants were successively extracted with n-hexane, dichloromethane, methanol and water. The methanolic and aqueous extracts were screened for cytotoxic activity against healthy mouse fibroblasts (NIH3T3) and three human cancer-cell lines (gastric: AGS; colon: HT-29; and breast: MDA-MB-435S) using the MTT assay. Two methanolic extracts (Hygrophila auriculata and Hibiscus tiliaceous) and one aqueous extract (Limnophila indica) showed no toxicity against healthy mouse fibroblasts, but selective cytotoxicity against breast cancer cells (IC50 1.1–1.6 mg mL−1). Seven methanolic extracts from L. indica, Clerodendron inerme, Cynometra ramiflora, Xylocarpus moluccensis, Argemone mexicana, Ammannia baccifera and Acrostichum aureum and four aqueous extracts from Hygrophila auriculata, Bruguiera gymnorrhiza, X. moluccensis and Aegiceras corniculatum showed low toxicity (IC50 > 2.5 mg mL−1) against mouse fibroblasts but selective cytotoxicity (IC50 0.2–2.3 mg mL−1) against different cancer cell lines. The methanolic extract of Blumea lacera showed the highest cytotoxicity (IC50 0.01–0.08 mg mL−1) against all tested cell lines among all extracts tested in this study. For some of the plants their traditional use as anticancer treatments correlates with the cytotoxic results, whereas for others so far unknown cytotoxic activities were identified

INSTRUCTIONAL DESIGN AND ASSESSMENT Integrating Complementary and Alternative Medicine Education Into the Pharmacy Curriculum

Objectives. To evaluate the effectiveness of an integrated approach to the teaching of evidence-based complementary and alternative medicine (CAM) in a pharmacy curriculum. Design. Evidence-based CAM education was integrated throughout the third, fourth, and fifth years of the pharmacy curriculum. Specifically, an introductory module focusing on CAM familiarization was added in the third year and integrated, evidence-based teaching related to CAM was incorporated into clinical topics through lectures and clinical case studies in the fourth and fifth years. Assessment. Students' self-assessed and actual CAM knowledge increased, as did their use of evidence-based CAM resources. However, only 30% of the fourth-year students felt they had learned enough about CAM. Students preferred having CAM teaching integrated into the curriculum beginning in the first year rather than waiting until later in their education. Conclusion. CAM education integrated over several years of study increases students' knowledge and application

Cytotoxic activity screening of Bangladeshi medicinal plant extracts

Abstract The cytotoxic activity of 23 crude methanol extracts from 19 Bangladeshi medicinal plants was investigated against healthy mouse fibroblasts (NIH3T3), healthy monkey kidney (VERO) and four human cancer cell lines (gastric, AGS; colon, HT-29; and breast, MCF-7 and MDA-MB-231) using MTT assay. High cytotoxicity across all cell lines tested was exhibited by Aegiceras corniculatum (fruit) and Hymenodictyon excelsum (bark) extracts (IC 50 values ranging from 0.0005 to 0.9980 and 0.08 to 0.44 mg/mL, respectively). Fourteen extracts from 11 plant species, namely Clitoria ternatea (flower and leaf), Dillenia indica (leaf), Diospyros peregrina (leaf), Dipterocarpus turbinatus (bark and leaf), Ecbolium viride (leaf), Glinus oppositifolius (whole plant), Gnaphalium luteoalbum (leaf), Jasminum sambac (leaf), Lannea coromandelica (bark and leaf), Mussaenda glabrata (leaf) and Saraca asoca (leaf), were also significantly cytotoxic (IC 50 \ 1.0 mg/mL) against at least one of the cancer cell lines tested. More selectively, Avicennia alba (leaf), C. ternatea (flower and leaf), Caesalpinia pulcherrima (leaf), E. viride (leaf) and G. oppositifolius (whole plant) showed cytotoxicity only against both of the breast cancer cell lines (MCF-7 and MDA-MB-231). In contrast, C. ternatea (flower and leaf) exhibited high cytotoxic activity against MDA-MB-231 (IC 50 values of 0.11 and 0.49 mg/mL, respectively), whereas E. viride and G. oppositifolius whole plant extracts exhibited high activity against MCF-7 cells (IC 50 values of 0.06 and 0.15 mg/mL, respectively). The cytotoxic activity test results for 9 of the plant species correlate with their traditional use as anticancer agents, thus making them interesting sources for further drug development

Medicinal Mushrooms

Since beginning of mankind nature is the most important source of medicines. Bioactive compounds produced by living organisms can be used directly as drugs or as lead compounds for drug development. Besides, the natural material can be used as crude drug for preparation of powder or extracts. Plants have traditionally been used as a source of most medical systems and as such herbal medicines constitute an important part of traditional and evidence-based medicine worldwide. In contrast though, the broad medicinal use of mushrooms was for a very long time restricted to Asian countries. Nowadays, the medicinal use of mushrooms, so called, medicinal mushrooms’, is increasing also in Western and other countries. This is underlined not only by growing sales of mushroom products but also by an increasing number of scientific papers and international conferences in this field. Medicinal mushrooms can be defined as macroscopic fungi, mostly higher Basidiomycetes, which are used in the form of extracts or powder for prevention, alleviation, or healing of diseases and/or for nutritional reasons. Presently medicinal mushrooms are mainly used as dietary supplements or functional food. Nevertheless they have the potential to become real drugs of traditional and/or evidence-based medicine. To explore this potential high quality products, preclinical and clinical trials according to the regulations, and legal authorization are necessary. The most important mushroom species are Ganoderma lucidum, Coriolus versicolor (L.:Fr.)Quél. (syn. Trametes versicolor [L.:Fr.]Pilát), Lentinula edodes (Berk.)Pegler, Agaricus brasiliensis Wasser et al., Cordyceps sinensis (Berk.)Sacc. (Ophiocordyceps sinensis (Berk.)Sung & al.), Grifola frondosa (Dicks.:Fr.)Gray, Hericium erinaceus (Bull.:Fr.)Pers. and some others. Due to the extended traditional use of these mushrooms extensive knowledge about in vitro activities and mode of action and effects in animal assays is available. Some information about several chemical constituents responsible for the pharmacological effects is also available. Needless to say more research on the pharmacology and chemistry of these and others, so far less explored mushrooms, is urgently needed. What’s also missing, however, are investigations about structure-activity-relationships and possible toxicological risks of these mushrooms and their products, clinical trials and suitable quality critera for mushroom products and established methods for its control. We received 13 research papers in this field which indicates that mushroom research is still very limited. However, this special issue includes 6 high-quality peer-reviewed papers demonstrating essential new findings about different pharmacological effects of several medicinal mushrooms and their components in vitro, in animal assays and in humans. Chan et al. and Kawai et al. showed that Amauroderma rugosum and Pleurotus eryngii have promising antiinflammatory properties. A. rugosum is used by indigenous communities in Malaysia, P. eryngii is consumed as fresh cultivated mushroom worldwide. Clitocybe nuda, also known as Lepista nuda, is an edible mushroom in Europe. It is known for its antioxidative and antimicrobial properties. The study by Shi et al. validated the antidiabetic and hypolipidemic effects of Clitocybe nuda in diabetic mice and gives detailed insight into its mode of action. Beta-glucans (MBGS) constitute one of the most important groups of bioactive compounds in mushrooms. They have been reported as anticancer agents mainly by strengthening immune activities. The papers of Chen et al. and Wu et al. focus on investigations of beta-glucans from Ganoderma lucidum, the famous Reishi or Ling Zhi mushroom. The beta-glucans isolated from solid culture of Ganoderma lucidum inhibit, in combination with radiation, tumor metastasis in Lewis lung carcinoma bearing mice (Chen at el.), whereas the oral administration of MBG, also obtained from mycelium of G. lucidum, modulates immune responses in an allergy murine model (Wu et al.). The study of Rossi et al. investigated the influence of a mixture of Ganoderma lucidum and Ophiocordyceps sinensis on the performance and stress resistance of cyclists by monitoring the testosterone/cortisol ratio in saliva, as well as oxidative stress. Although only a small number of participants were included in this study, the presented results confirm the potential clinical use of mushrooms in general and the protection of the athletes from overtraining syndrome in particular

Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice

BACKGROUND: Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products. METHODS: Pharmacy customers randomly selected from sixty large and small, metropolitan and rural pharmacies in three Australian states completed an anonymous, self administered questionnaire that had been pre-tested and validated. RESULTS: 1,121 customers participated (response rate 62%). 72% had used CMs within the previous 12 months, 61% used prescription medicines daily and 43% had used both concomitantly. Multivitamins, fish oils, vitamin C, glucosamine and probiotics were the five most popular CMs. 72% of people using CMs rated their products as 'very effective' or 'effective enough'. CMs were as frequently used by customers aged 60 years or older as younger customers (69% vs. 72%) although the pattern of use shifted with older age. Most customers (92%) thought pharmacists should provide safety information about CMs, 90% thought they should routinely check for interactions, 87% thought they should recommend effective CMs, 78% thought CMs should be recorded in customer's medication profile and 58% thought pharmacies stocking CMs should also employ a complementary medicine practitioner. Of those using CMs, 93% thought it important for pharmacists to be knowledgeable about CMs and 48% felt their pharmacist provides useful information about CMs. CONCLUSIONS: CMs are widely used by pharmacy customers of all ages who want pharmacists to be more involved in providing advice about these products

Efficacy of D-cycloserine augmented brief intensive cognitive-behavioural therapy for paediatric obsessive-compulsive disorder: A randomised clinical trial

Objective: To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes. Methods: Youth (n = 100, 7–17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions. Results: Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: −11.2 to −7.4, and estimate −10.7, 95% CI: −12.6 to −8.7), diagnostic severity (T1 to T2 estimate: −2.0, 95% CI: −2.4 to −1.5 and estimate −2.5, 95% CI: −3.0 to −2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1- and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs. Conclusions: DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample

Attitudes and perceptions of Australian pharmacy students towards Complementary and Alternative Medicine – a pilot study

<p>Abstract</p> <p>Background</p> <p>With the increased usage of CAM worldwide comes the demand for its integration into health professional education. However, the incorporation of CAM into health professional curricula is handled quite differently by different institutions and countries. Furthermore, the evaluation of CAM curricula is complicated because students' ability to learn about CAM may be influenced by factors such as student's prior knowledge and motivation, together with the perceptions and attitudes of clinical preceptors.</p> <p>The study aimed to describe the attitudes, perceptions and beliefs of second, third and fourth year pharmacy students towards complementary and alternative medicine (CAM) and to explore factors that might affect attitudes such as learning, preceptors and placements.</p> <p>Methods</p> <p>Pharmacy students from a University in South East Queensland, Australia participated in the study. The study consisted of a cross-sectional survey (n = 110) and semi-structured interviews (n = 9).</p> <p>Results</p> <p>The overall response rate for the survey was 75%, namely 50% (36/72) for second year, 77.3% (34/44) for third year and 97.6% (40/41) for fourth year students. Overall, 95.5% of pharmacy students believe that pharmacists should be able to advise patients about CAM and most (93.7%) have used CAM prior to course enrolment. Students' attitudes to CAM are influenced by the use of CAM by family, friends and self, CAM training, lecturers and to a lesser degree by preceptors. The majority of pharmacy students (89.2%) perceive education about CAM as a core and integral part of their professional degree and favour it over an additional postgraduate degree. However, they see a greater need for education in complementary medicines (such as herbal medicines, vitamins and minerals) than for education in complementary therapies (such as acupuncture, meditation and bio-magnetism). Knowledge and educational input rationalised rather than marginalised students' attitudes towards CAM.</p> <p>Conclusion</p> <p>Pharmacy students perceive education about CAM as a core and integral part of their professional degree. Students' attitudes towards CAM can be influenced by learning, lecturers, preceptors and practice experience. The content and focus of CAM education has to be further investigated and tailored to meet the professional needs of our future health professionals.</p

The prevalence and experience of Australian naturopaths and Western herbalists working within community pharmacies

<p>Abstract</p> <p>Background</p> <p>Naturopaths and Western herbal medicine (WHM) practitioners were surveyed to identify their extent, experience and roles within the community pharmacy setting and to explore their attitudes to integration of complementary medicine (CM) practitioners within the pharmacy setting.</p> <p>Method</p> <p>Practising naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations.</p> <p>Results</p> <p>479 practitioners participated. 24% of respondents (n = 111) reported they had worked in community pharmacy, three-quarters for less than 5 years. Whilst in this role 74% conducted specialist CMs sales, 62% short customer consultations, 52% long consultations in a private room and 51% staff education. This was generally described as a positive learning experience and many appreciated the opportunity to utilise their specialist knowledge in the service of both customers and pharmacy staff. 14% (n = 15) did not enjoy the experience of working in pharmacy at all and suggested pharmacist attitude largely influenced whether the experience was positive or not. Few practitioners were satisfied with the remuneration received. 44% of the total sample provided comment on the issue of integration into pharmacy, with the main concern being the perceived incommensurate paradigms of practice between pharmacy and naturopathy. Of the total sample, 38% reported that they would consider working as a practitioner in retail pharmacy in future.</p> <p>Conclusions</p> <p>The level of integration of CM into pharmacy is extending beyond the mere stocking of supplements. Naturopaths and Western Herbalists are becoming utilised in pharmacies</p

Die Trans-Sialidase von :i:Trypanosoma congolense:/i: - Isolierung, Charakterisierung und Molekularbiologie

:i:Trypanosoma congolense:/i: is the agent of Nagana, the trypanosomiasis in African ruminants. During its insect stage the parasite expresses an enzyme called trans-sialidase (TS), which enables the parasites to transfer sialic acids from the environment onto trypanosomal surface molecules and is believed to play an important role in maintaining the pathogenicity of the parasites. Thus far, only two TS proteins and their sequences have been characterised in detail, one from the American trypanosome :i:T. cruzi:/i: and one from the African trypanosome :i:T. b. brucei:/i:. :p:This study describes the purification and characterisation of two TS forms from the African trypanosome :i:T. congolense:/i:. The purification of the two TS forms using a combination of anion exchange chromatography, isoelectric focusing, gel filtration and, subsequently, antibody affinity chromatography resulted, in both cases, in the isolation of a 90 kDa monomer on SDS-PAGE which was identified as TS using micro-sequencing. Monoclonal antibody 7/23, which bound and partially inhibited TS activity, was found in both cases to bind to a 90 kDa protein. Both TS forms possessed sialidase and transfer activity, but markedly differed in their activity ratios. Interestingly, GARP, the surface glycoprotein, was co-purified with TS-form 1 suggesting an association between both proteins. :p: This study also describes the identification of two partial TS gene sequences from :i:T. congolense:/i: utilising a PCR-based approach. Both :i:T. congolense:/i: TS genes, TS1 and TS2, which share only 50 % identity with each other, show significant similarity with known viral, bacterial and trypanosomal sialidases and TS. In both partial sequences most of the critical active site residues common to other trypanosomal sialidases and TS are conserved. Moreover, a peptide sequence derived from the native, active TS from :i:T. congolense:/i: was found within the sequence of TS1