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1.
Complementary and alternative medicine therapies for uremic pruritus - A systematic review of randomized controlled trials.
Yeam, CT, Yo, TE, Tan, YLC, Liew, A, Seng, JJB
Complementary therapies in medicine. 2021;:102609
Abstract
INTRODUCTION Uremic pruritus (UP) is one of the most bothersome symptoms among chronic kidney disease (CKD) patients. The pathophysiology of UP remains elusive, resulting in limited treatment options. The inability of standard medical treatments to provide effective relief has piqued interest in complementary and alternative medicine (CAM). METHODOLOGY A systematic review of randomized controlled trials (RCTs) summarizing the efficacy and safety profile of CAM used for UP in CKD patients was performed. CAM interventions were classified using categories proposed by the National Center for Complementary and Integrative Health. The efficacy of each CAM was determined from changes in UP severity and all reported adverse effects were extracted. RESULTS Of 5242 articles screened, 34 RCTs were included, with 15 (44.1 %) studies having a sample size greater than 50. The studies considered 21 treatments including omega-3 fatty acid supplementation (n=5), acupuncture (n=5), topical capsaicin (n=4) and acupressure (n=3). Acupuncture, acupressure and topical capsaicin were shown to be effective in improving uremic pruritus. Interventions which include oral omega-3 fatty acid and zinc supplementation demonstrated mixed efficacy. Other therapies such as evening primrose oil, turmeric, vitamin B3, vitamin D and thermal therapy were not effective for treatment of UP. Common adverse effects reported with topical capsaicin included mild burning sensations (50.0-88.2 %) or erythema (6.7-22.7%) while that of acupuncture included soreness (7.5 %), bleeding (6.0-7.5%) and hematoma (1.9 %). CONCLUSIONS Acupuncture, acupressure and topical capsaicin have the largest body of evidence for efficacy in the treatment of UP. Larger and higher quality RCTs are required to examine the efficacy and safety of promising CAM.
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Cancer-Related Fatigue-Is There a Role for Complementary and Integrative Medicine?
David, A, Hausner, D, Frenkel, M
Current oncology reports. 2021;(12):145
Abstract
PURPOSE OF REVIEW This review aims to assess recent data on possible effective and safe complementary and integrative medicine (CIM) modalities that can be of help to patients affected by cancer that suffer from cancer-related fatigue (CRF). RECENT FINDINGS Cancer-related fatigue (CRF) is one of the most common, persistent, and challenging symptoms among cancer patients and survivors. Many world-leading cancer centers incorporate CIM into routine cancer care including integrating multiple approaches to address CRF. Approaches that are supported by clinical evidence on the use of CIM during and following conventional oncology treatments are being discussed in this review. The review suggests that some CIM modalities might have a potential role in alleviating cancer-related fatigue. These modalities include acupuncture, touch therapies, nutrition, nutritional supplements, stress reduction, homeopathy, and circadian rhythm management. Additional research is still needed to better support the process of integrating CIM into a routine approach to cancer-related fatigue.
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Foods from Mayan Communities of Yucatán as Nutritional Alternative for Diabetes Prevention.
Uuh Narvaez, JJ, Segura Campos, MR
Journal of medicinal food. 2020;(4):349-357
Abstract
The increase in the prevalence of diabetes has become a severe problem around the world; mainly affecting indigenous communities as the Mayan of Yucatán in Mexico. Because of the high rates of poverty and insufficient health services in this ethnic group, inexpensive and accessible treatments are necessary. Some plant foods grown in traditional Mayan agricultural systems have antidiabetic potential. Our objective was to present a review of plant foods with nutritional alternatives for diabetes prevention from traditional agricultural systems in Mayan communities of Yucatán. This review reports the hypoglycemic, antihyperglycemic, and antidiabetic activities of leaves, fruits, vegetables, grains and legumes, and tubercles grown in milpas and home gardens of Mayan communities. Some plant foods have antidiabetic effect in vitro, in vivo, and in clinical studies. Some plant foods grown in traditional Mayan agricultural systems have antidiabetic potential. The inclusion of these plant foods in the diet can serve in the treatment of diabetes.
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Western herbal medicines in the treatment of irritable bowel syndrome: A systematic review and meta-analysis.
Hawrelak, JA, Wohlmuth, H, Pattinson, M, Myers, SP, Goldenberg, JZ, Harnett, J, Cooley, K, Van De Venter, C, Reid, R, Whitten, DL
Complementary therapies in medicine. 2020;:102233
Abstract
OBJECTIVE To evaluate the efficacy of Western herbal medicines in the treatment of irritable bowel syndrome (IBS). DESIGN A computer-based search of MEDLINE, EMBASE, CINAHL, AMED, GreenFILE, Health Source: Nursing/Academic Edition, and the Cochrane Library was conducted. A hand-search of the bibliographies of relevant papers and previous meta-analyses and reviews was also undertaken. Trials were included in the review if they were double-blind and placebo-controlled investigating the effects of Western herbal medicines on IBS-related symptoms or quality of life. There were no language restrictions. Eligibility assessment and data extraction were performed by two independent researchers. For herbal medicines where there was more than 1 trial of similar design, data were synthesised using relative risk of symptoms improving using the random effects model. RESULTS Thirty-three trials were identified that met all eligibility criteria. Seventeen of these evaluated peppermint essential oil, fifteen other Western herbal medicines, and one trial evaluated peppermint oil in one arm and aniseed essential oil in the other arm. Eighteen different herbal preparations were evaluated in these trials. Data suggests that a number of Western herbal medicines may provide relief of IBS symptoms. Meta-analyses suggest that peppermint essential oil is both efficacious and well-tolerated in the short-term management of IBS. Aloe vera and asafoetida also demonstrated efficacy in reducing global IBS symptoms in meta-analyses. The herbal formulas STW 5, STW 5-II and Carmint, along with Ferula assa-foetida, Pimpenella anisum oil, the combination of Curcumin and Foeniculum vulgare oil, and the blend of Schinopsis lorentzii, Aesculus hippocastanum, and peppermint essential oil also demonstrated efficacy in rigorously-designed clinical trials. CONCLUSION A number of Western herbal medicines show promise in the treatment of IBS. With the exception of peppermint essential oil, Aloe vera, and asafoetida, however, none of the positive trials have been replicated. This lack of replication limits the capacity to make definitive statements of efficacy for these herbal medicines.
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Complementary Medicine and Natural Medications in Psychiatry: A Guide for the Consultation-Liaison Psychiatrist.
Berman, S, Mischoulon, D, Naidoo, U
Psychosomatics. 2020;(5):508-517
Abstract
BACKGROUND Complementary and Alternative Medicine (CAM) is commonly and increasingly used in America and worldwide and can include both pharmacologic (e.g., vitamins and supplements) and nonpharmacologic (e.g., yoga) interventions. These therapies may be of interest to patients who desire "natural" alternatives or complements to standard treatments. CAM may be used by patients, with or without supervision from a licensed medical professional, to treat psychiatric conditions. OBJECTIVE To provide an overview of more commonly used CAM interventions that have relevance to mental health care providers, particularly consultation-liaison psychiatrists, and to describe the indications, safety, and dosing of these treatments. METHODS We searched PubMed to identify articles that described the uses, safety, mechanisms, and recommendations for CAM therapies in relation to the treatment of psychiatric conditions. Articles most relevant to this review were included, with a preferential focus on meta-analyses and systematic reviews. RESULTS We summarized common CAM therapies that have shown efficacy for the treatment of psychiatric conditions. These therapies include natural medications, nutritional psychiatry, light therapy, yoga, and exercise. CONCLUSIONS Certain CAM interventions may be effective as monotherapies and/or as adjunctive treatments for psychiatric conditions. However, they may also have safety risks, contraindications, and/or interactions with medications. It is therefore important for physicians and other mental health care professionals to inquire about patient use of CAM and to understand the indications, safety, and dosing of these therapies.
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Benefits and harms of ginseng supplementation on liver function? A systematic review and meta-analysis.
Ghavami, A, Ziaei, R, Foshati, S, Hojati Kermani, MA, Zare, M, Amani, R
Complementary therapies in clinical practice. 2020;:101173
Abstract
OBJECTIVE Existing evidence on the possible effects of ginseng on liver function has not been fully established. Therefore, the present review was undertaken to evaluate the overall effects of ginseng supplementation on liver enzymes in adults. METHODS A systematic computerized literature search of PubMed, Scopus, Web of Science, Cochrane Library and Google scholar databases was conducted up to May 2019. All RCTs using ginseng supplements in adults were included in this systematic review and meta-analysis. RESULTS Overall, 14 randomized trials (with 20 arms) including 992 subjects were identified. Pooled analysis did not illustrate any significant changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and albumin (ALB) levels, however, it showed a minor significant increase in bilirubin (BIL) levels. Subgroup analysis by dosage and study population revealed significant increase of bilirubin after ginseng supplementation ≥3 g/day or in unhealthy individuals. CONCLUSION Ginseng appears to have neither hepatoprotective nor hepatotoxic effects in conventional doses and duration. It is noteworthy that this seems applicable only for individuals with healthy liver function. Further largescale studies are warranted to confirm present findings.
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Alternative and complementary therapies in osteoarthritis and cartilage repair.
Fuggle, NR, Cooper, C, Oreffo, ROC, Price, AJ, Kaux, JF, Maheu, E, Cutolo, M, Honvo, G, Conaghan, PG, Berenbaum, F, et al
Aging clinical and experimental research. 2020;(4):547-560
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Abstract
Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of 'alternative' therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.
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Complementary, alternative, integrative and dietary therapies for children with Crohn's disease - A systematic review.
Schwermer, M, Fetz, K, Längler, A, Ostermann, T, Zuzak, TJ
Complementary therapies in medicine. 2020;:102493
Abstract
Children with diagnosed inflammatory bowel diseases such as Crohn's disease are faced with the daunting prospect of living with a chronic disease. Besides psychological stress, children are suffering from therapy side-effects; in particular, corticosteroid therapies are problematic in the growth phase. This highlights that there is a need for less aggressive alternative therapies for children as well as adolescents living with such chronic conditions. Elemental diets are widely used and accepted therapy options. Several pediatric Crohn's disease patients also use complementary, alternative and integrative therapies to reduce or avoid drug therapies. To survey such therapy options and their efficiency and safety, we performed a systematic literature search and screened databases (Cochrane Library, EMBASE, OvidSP, PubMed, CAMbase, CAM-QUEST, Anthromedics) from their inception to December 2019. In total, seven of 1439 studies fulfilled search criteria. Six RCTs and one retrospective controlled trial investigating elemental diets (Flexical, Elemental 028), semi-elemental diets (Pregomin), polymeric diets (Modulen IBD), whole protein based formulas, and ω-3 fatty acid supplementation were found. Data indicated that diet therapies were equal to or more effective than corticosteroid therapies when used to treat Crohn's disease. Regrettably, we could not identify controlled studies investigating complementary, alternative and integrative medicine approaches. Our review provides an updated overview of controlled studies investigating dietary therapies used in the treatment of pediatric Crohn's disease, and demonstrates that the current study situation does not reflect the actual use of complementary, alternative and integrative therapies. Therefore, clinical trials are necessary to estimate risks and benefits of such therapies. The review indicated that enteral diets and ω-3 fatty acid supplementation may be an effective alternative to corticosteroid treatments for children with Chron's disease.
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Nonantibiotic treatments for urinary cystitis: an update.
Barea, BM, Veeratterapillay, R, Harding, C
Current opinion in urology. 2020;(6):845-852
Abstract
PURPOSE OF REVIEW Urinary tract infections (UTIs) are one of most common infections in everyday clinical practice. Given the increase in antimicrobial therapy resistance, there has been an increased interest in nonantibiotic treatment options for common infections. RECENT FINDINGS A review of the recent literature including on nonantibiotic options for management of UTIs, symptoms of cystitis and prevention of recurrent UTIs. SUMMARY The article provides an overview on alternative therapy to antibiotics in the treatment of cystitis and recurrent UTI prophylaxis, including alkalinization of urine, cranberry products, probiotics, NSAIDS, D-mannose, herbal medicine, methenamine hippurate, oral immunostimulants (immunotherapy), topical oestrogens, vitamins and acupuncture. The last few years of intense research has focused on an effort to find evidence to corroborate potentially efficacious non antibiotic treatments. However, alternative treatments for UTIs have not brought conclusive evidence that antibiotic usage can be replaced completely by nonantibiotic options. The reason for this is largely due to a lack of good-quality randomized controlled trials on this subject.
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Nontraditional (non-Western pharmaceutical) treatments for chronic kidney disease.
Gobe, GC, Wojcikowski, K
Clinical nephrology. 2020;(1):49-54
Abstract
Nontraditional, non-Western medicines, often called complementary and alternative medicines (CAM), for chronic kidney disease (CKD) patients are, potentially, a huge low-cost therapy resource for poorer populations in the world. Use of CAM, particularly from plant sources, is common in poorer communities, but the scientific basis for their use is still under-researched and under-published. This review presents information on the treatment of kidney disease with CAM, particularly CKD and its closely associated cardiovascular disease (CVD), which might benefit vulnerable populations. The challenges of developing CAM therapies for resource-limited environments are also discussed, particularly with reference to targeting oxidative stress, a known cause of progressive diseases such as CKD and CVD. Oxidative stress is a mechanism often targeted by CAM, with good scientific basis. Dietary supplementation with antioxidants is one approach to reducing CKD incidence or morbidity. Antioxidant supplementation in populations with sufficient dietary antioxidant intake often report little benefit. In comparison, poorer populations that may have restricted nutritional dietary antioxidant intake may benefit from supplementation with antioxidants. Also needing consideration are the recorded instances of nephrotoxicity from CAM therapies, particularly related to nephrotoxic plant extracts, extract-drug reactions, and toxicity from contaminants within the extracts. As long as the possible toxicity of plant-derived CAM is considered, we argue that populations having marked deficiency in, or poor access to, dietary antioxidants, or high exposure to environmental oxidants, may benefit from these nontraditional medicines.