Search Results (420)

Diabetes mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia and represents a major global public health concern due to its rapidly increasing prevalence. Although current pharmacological therapies effectively achieve glycemic control, their long-term use is limited by adverse effects, high costs, patient compliance issues, and increasing interest in safer, multi-targeted therapeutic strategies. In this context, plant-derived bioactive compounds have gained attention as complementary or alternative approaches to metabolic disease management. Gymnema sylvestre (Retz.) R.Br. ex Sm (GS), traditionally known as “gurmar” (“sugar destroyer”), is one of the most extensively studied medicinal plants with significant antidiabetic potential. This review evaluates the antidiabetic effects of G. sylvestre, focusing on its phytochemical composition, molecular mechanisms, and impact on diabetes-related complications. Major bioactive constituents, including triterpenoid saponins (gymnemic acids), gurmarin-like peptides, flavonoids, and sterols, regulate glucose homeostasis, inhibit intestinal glucose absorption, preserve pancreatic β-cell function, stimulate insulin secretion, modulate lipid metabolism, and suppress inflammatory signaling pathways. Experimental and clinical evidence indicates that G. sylvestre modulates oxidative stress and inflammation associated with complications such as nephropathy, neuropathy, retinopathy, vascular dysfunction, and dyslipidemia. This review adopts a mechanism-oriented framework integrating phytochemical structure–molecular target–metabolic outcome relationships and discusses emerging strategies, including nanotechnology-based delivery systems, molecular docking, and multi-component phytotherapy. Overall, G. sylvestre represents a promising multi-target phytotherapeutic agent, highlighting directions for future mechanistic and clinical research. Full article

Dementia, and more specifically Alzheimer’s disease (AD), is a progressive neurodegenerative disorder that has become a growing health menace in the world with an escalation in incidence as well as enormous social and economic consequences. Existing pharmacological treatment including cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists are not very effective in reducing the symptoms and fail to prevent the disease process. The non-pharmacological treatment interventions such as diet, exercise and cognitive training have supportive effects and cannot be used as standalone treatments. Therapeutic gap has resulted in increased interest in complementary and alternative therapies, especially that of pleiotropic action of herbal medicines. Bacopa monnieri (BM) is an Ayurvedic herb that has historically been used to treat memory enhancement and now has both preclinical and clinical evidence supporting its ability to modulate neurotransmission, reduce oxidative stress and suppress neuroinflammation. However, such difficulties as low bioavailability, instability of the environmental factors, and variations in formulations restrict its clinical applicability. New technologies with a lot of potential such as microencapsulation technology can provide the solution to this problem by increasing stability, solubility, and targeted delivery of compounds that will increase treatment efficacy. This narrative review is a synthesis of the existing information on the pathogenesis of dementia, therapeutic approaches, and the effectiveness of BM as a complementary intervention. It points out links between traditional medicine and modern neuroscience, strengths and limitations of on-going evidence, gaps that need further research, such as long-term clinical trials, standardized formulations, and discovery of the role of BM in the gut–brain axis. BM is a prime example of how herbal medicines can be used as a complement to conventional treatment and play a role in multi-modal approaches aimed at reducing the cognitive impairment associated with dementia. Full article

Objectives: Recurrent vulvovaginal candidiasis (RVVC) is a difficult-to-treat infection, most likely due to the growth of Candida biofilms on the human vaginal epithelium. We assessed in vitro efficacy of conventional antifungals and complementary and alternative medicine (CAM) used in clinical settings, and sought for Candida biofilm-effective single or combination therapies. Methods: Standard broth microdilution assay and XTT (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) assay were used for antifungal and anti-biofilm efficacies of three conventional antifungals, and selected CAM including boric acid, povidone-iodine, and allicin (garlic extract), against Candida clinical isolates grown at neutral and acidic pHs respectively. Fractional inhibitory concentration (FIC) indices were assessed to evaluate interactions between fluconazole and different CAM. Viable count-based cell enumeration and confocal laser scanning microscopy (CLSM) were performed to confirm the efficacy of single or combination therapies against Candida biofilms. Results: All selected conventional antifungals and CAM showed efficacies against planktonic Candida cells. Acidic vaginal microenvironments provided agent-specific protection to Candida cells against conventional antifungals and the CAM. Synergistic or additive interactions were observed between fluconazole at serum achievable concentrations and povidone-iodide at topically achievable concentrations against all tested Candida strains. Most antifungal agents except caspofungin had very limited activities against Candida biofilms. Combining fluconazole at 8 mg/L with povidone-iodine at 2048 mg/L effectively killed Candida biofilms in an acidic vaginal microenvironment to a level that is comparable to that of caspofungin. Conclusions: We provided robust in vitro evidence supporting the combinational use of oral fluconazole and topical CAM povidone-iodine against Candida biofilms in managing RVVC. Full article

COVID-19 has spurred much interest in complementary and alternative agents for therapeutic purposes having antiviral and immunomodulatory effects. In these, natural products and bioactive compounds from plants have been at the center of attention due to their easy access, relatively low risk and long history of use in traditional medicine. This paper reviews in detail and critically assesses the scientific data that presently proposes the use of certain cannabinoids, cannabimimetic compounds and Artemisia species in the treatment and prevention of COVID-19. It gives an account of medicinal approaches to cannabinoids like cannabidiol (CBD), Δ9-tetrahydrocannabinol (THC) alongside other minor cannabinoids and synthetic and naturally-occurring cannabimimetics. The paper reports the potential of Artemisia annua and other species as treatments, especially focusing on their antiviral, anti-regulatory, anti-inflammatory and immunomodulating properties. It highlights the molecular interactions with SARS-CoV-2 targets as well as cytokine regulation and modulation of oxidative stress pathways, with special emphasis on these areas. The paper raises multiple issues like preclinical and clinical studies, safety aspects, regulatory hurdles and drawbacks related to the use of these natural compounds. After analyzing all the available data, the article entertains the idea of a cannabinoid–Artemisia combination as a supportive or adjunct therapy in COVID-19 treatment. It also points out that the clinical trials are insufficient concerning the establishment of effectiveness, determination of the appropriate dosage and assurance of the long-term safety of the treatment. Full article

Medicinal plants have attracted increasing scientific interest due to the diversity of bioactive compounds reported across different species. They may represent complementary sources of bioactive compounds alongside conventional antimicrobials, which may pose risks to animal health and compromise treatment efficacy. Considering the importance of alternative compounds, we aimed to evaluate the antimicrobial activity in vitro of medicinal plants Stryphnodendron adstringens (Mart.) Coville, known as barbatimão, Baccharis crispa Spreng, known as carqueja and Azadirachta indica, known as neem. S. adstringens (Mart.) Coville and B. crispa Spreng were used as extract and obtained from plants collected in the municipality of Bambuí, state of Minas Gerais, Brazil. A. indica was evaluated as extract and oil, and the crushed leaves and oil were purchased from a commercial company. Antimicrobial activity was determined by the minimum bactericidal concentration (MBC) test-against Staphylococcus aureus, Streptococcus agalactiae, Streptococcus uberis, Escherichia coli, and Salmonella spp., isolated from bovine mastitis. The bacteria were submitted to the MBC test at concentrations of 100, 50, 25, 12.5, 6.25, 3.12, 1.56, 0.78, 0.39, 0.19 and 0.09 mg/mL. The bacteria evaluated were sensitive to most plant extracts for at least one of the concentrations evaluated, except for Gram-negative bacteria, Escherichia coli, and Salmonella spp. There was no activity of B. crispa Spreng extract and A. indica against E. coli and neither of B. crispa Spreng extract against Salmonella spp. even at the highest concentration evaluated. S. adstringens (Mart.) Coville was considered the extract with the highest activity against the bacteria evaluated and S. uberis the most susceptible to antimicrobial action. The results indicate detectable antimicrobial activity of the evaluated extracts and oil, suggesting their potential relevance as complementary sources of bioactive compounds for further investigation, rather than as direct alternatives to conventional antibiotic therapies. Paper spray mass spectrometry (PS-MS) was employed as an exploratory phytochemical screening approach, and all metabolite assignments reported herein should be regarded as tentative or putative annotations under the analytical conditions used, consistent with MSI Level 3 confidence. Full article

The management of retinopathy of prematurity (ROP) has evolved alongside advances in neonatal medicine, shaped by both scientific progress and medico-legal influences. ROP-related medical malpractice lawsuits provide a unique perspective on how standards of care are defined and evaluated. This review comprises two complementary components: a narrative medico-historical review of ROP management and a structured descriptive comparison of judicial cases identified in publicly accessible legal databases in Japan. The aim was to clarify how evolving clinical practice, dissemination of knowledge, and institutional capacity have influenced judicial interpretations of the standard of care. The findings indicate that standards of care in ROP management have been determined not solely by established evidence but by a broader assessment of contemporaneous professional knowledge and clinical practice. A marked shift in judicial outcomes after the mid-1970s corresponded to the widespread adoption of systematic screening and photocoagulation therapy. These results suggest that medico-legal evaluation reflects system-level maturity in neonatal care. In the current era of anti-vascular endothelial growth factor therapy, litigation is likely to focus less on specific interventions and more on the appropriateness of clinical decision-making, consideration of alternatives, and adequacy of informed consent procedures. This review provides a medico-historical framework for improving patient safety, risk management, and quality of care in neonatal practice. Full article

With the growing interest in personalized medicine, alternative biological matrices to blood are increasingly explored as sources of diagnostic information. Saliva has emerged as a promising diagnostic matrix due to its non-invasive collection, suitability for home sampling, and minimal requirements for personnel training. Numerous studies have demonstrated the presence of metabolites in saliva that enable disease diagnosis and monitoring. However, the influence of pre-analytical and analytical factors on salivary metabolomics outcomes remains insufficiently characterized. In this study, we investigated factors potentially affecting the number and abundance of detected metabolites in untargeted salivary metabolomics using liquid chromatography coupled with mass spectrometry (LC–MS). The impact of chromatographic column type, extraction protocol, and saliva type (stimulated versus resting) was evaluated. Additionally, the effect of swab type on analyte recovery was assessed. The use of a synthetic swab for saliva collection yielded results most comparable to those obtained without swabs, for both resting and stimulated saliva samples, indicating minimal pre-analytical interference. The greatest metabolite coverage was obtained using ACN:MeOH (1:1, v/v), with a ZIC-HILIC column for polar metabolites and a C18 column for non-polar metabolite separation. These findings demonstrate that swab type, chromatographic column, extraction solvent, and saliva type critically shape metabolite coverage in untargeted salivary metabolomics. Importantly, the distinct metabolic profiles of resting and stimulated saliva suggest that these matrices may provide complementary clinical insights, underscoring the need for saliva type selection tailored to specific diagnostic and biomarker discovery objectives. Full article

Cancer ranks as one of the top causes of death worldwide, and the World Health Organisation (WHO) estimates an increase of up to 55% in cases over the next 15 years, reaching 300 million cases worldwide. Current approaches to the treatment of cancer, such as chemotherapy and radiation therapy, have been used with continuous significant advancements. However, these conventional methods have harmful side effects that can last a lifetime. Today, there is growing interest in developing alternative cancer therapies from natural products or complementary medicine. One of the natural sources that has shown promise as an anticancer agent is honey, which has long been applied as a complementary medicine, and its beneficial health effects on various diseases in both animal and human models have been widely studied. Malaysian honey, such as Tualang, pineapple, Gelam, Kelulut, and Acacia, possesses a rich composition of phytochemicals, including polyphenols and flavonoids, which are reported to have promising anticancer properties. Examples of the phytochemicals highlighted in this review are phenolic acid, syringic acid, salicylic acid, p-coumaric acid, gallic acid, benzoic acid, caffeic acid, chrysin and its derivatives, kaempferol, fisetin, catechin, apigenin, quercetin, acacetin, pinocembrin, pinobanksin, hesperetin, naringenin, vitexin, isoorientin, xanthohumol, and galangin. This review highlights the anticancer mechanisms and molecular pathways of the phytochemicals found in Malaysian honey, focusing on their antioxidant effects, induction of mitochondrial-mediated apoptosis, inhibition of angiogenesis and metastasis, and suppression of cancer cell proliferation. The findings of various studies published in the past five years are collated to understand their mechanisms of action. Full article

Thoracoabdominal aortic aneurysms (TAAAs) are uncommon and usually silent until rupture, causing a substantial burden to the health care system. Aneurysm growth and rupture prediction is mainly based on aneurysm diameter measurement by imaging modalities, meaning that the biology of aneurysm growth is not part of a potentially more adequate surveillance of aortic aneurysm patients. Alternatives or complementary options for aortic aneurysm surveillance are an ongoing, non-addressed open issue of vascular medicine. The application of different biomarkers has been discussed, yet so far, an adequate candidate for aortic aneurysm surveillance, if it comes to the thoracic or thoracoabdominal aorta, preferably without radiation exposure, has not been named. Elastin breakdown, as a component of aortic wall degeneration primarily driven by matrix metalloproteinases (MMPs), is a core element of aneurysm development. Desmosine is an elastin-specific cross-link increasingly studied as a circulating or urinary biomarker of compromised aortic wall integrity and disease activity. Accordingly, this review investigated whether plasma desmosine (pDES), a highly specific marker of elastin degradation, could be used as a non-invasive biomarker for detecting aortic aneurysms and assessing their risk profile. The existing literature of desmosine in fields of aortic pathologies in the acute and chronic setting will be assessed based on the current literature; furthermore, future perspectives of desmosine as a biomarker of aortic pathologies, such as aortic aneurysm dynamics, will be discussed. Full article

Preclinical imaging has recently been expanded through the use of ostrich embryos as an alternative in vivo model. In ovo experiments represent a promising substitute for conventional rodent-based animal testing. For artifact-free dynamic nuclear medicine imaging, reliable immobilization of embryos is essential. Although previous studies have demonstrated the feasibility of isoflurane anesthesia, the kinetics and uptake mechanisms of isoflurane in ostrich embryos remain insufficiently characterized. The aim of this study was to characterize gas exchange dynamics in ostrich eggs and to quantify isoflurane uptake using two complementary approaches: indirect consumption measurements in a closed system and direct quantification by serial blood sampling. Fourteen ostrich eggs, including seven fertilized and seven unfertilized specimens, were analyzed at developmental stages up to day 37 of incubation. Gas exchange was assessed in a sealed container using a clinical anesthesia gas monitoring system to measure oxygen consumption and carbon dioxide excretion. Isoflurane uptake was evaluated during exposure to concentrations of 2%, 4%, or 6%. In a separate experimental series, serial blood samples were collected during and after exposure to the same concentrations to determine systemic uptake. Fertilized embryos showed progressive increases in metabolic activity, with a maximal oxygen consumption and carbon dioxide excretion of 116 mL/h/kg and 93 mL/h/kg on day 37. Indirect measurements demonstrated isoflurane uptake rates of up to 1.1 mL/min at 6%, with proportionally lower values at 4% and 2%. Blood analyses confirmed systemic absorption, peak concentrations of 160 µg/mL, and detectable residual levels for up to 120 min after exposure. These findings refine in ovo imaging. Full article

Moyamoya disease (MMD) is a chronic, progressive cerebrovascular disorder characterized by steno-occlusive changes in the intracranial internal carotid arteries and the development of fragile collateral networks. Imaging plays a pivotal role in diagnosis, disease staging, and management, yet the expanding range of available imaging modalities has resulted in heterogeneous evidence that remains difficult to synthesize. This scoping review aimed to systematically map and critically appraise imaging-based diagnostic approaches used in MMD, summarizing their diagnostic performance, clinical utility, and limitations. A comprehensive literature search was conducted across major databases, and original studies evaluating imaging modalities in human MMD were included. Thirty-three studies published between 1995 and 2023 were analyzed, encompassing digital subtraction angiography, magnetic resonance imaging and angiography, perfusion and functional MRI, computed tomography-based techniques, nuclear medicine, ultrasound, neurophysiological methods, and emerging artificial intelligence applications. Digital subtraction angiography remains the diagnostic reference standard, particularly for disease confirmation and surgical planning. However, noninvasive modalities provide critical complementary information. Magnetic resonance-based techniques offer multiparametric assessment of vascular morphology, hemodynamics, vessel wall pathology, and parenchymal injury. Computed tomography angiography and perfusion imaging provide accessible alternatives with high sensitivity for vascular changes, while functional and neurophysiological methods contribute additional hemodynamic and regional assessments. Artificial intelligence applications show promising diagnostic performance but remain in early validation stages. The evidence base is limited by methodological heterogeneity, inconsistent reference standards, incomplete reporting of diagnostic accuracy metrics, and a scarcity of longitudinal and multimodal studies. Collectively, the findings support a multimodal imaging strategy in MMD, integrating structural and functional information to inform diagnosis and management. Future research should prioritize standardized protocols, longitudinal designs, and clinically validated imaging biomarkers to enable evidence-based diagnostic pathways. Full article

Infectious diseases continue to represent one of the most persistent challenges in human health and agricultural productivity. These diseases are caused by a wide range of pathogenic microorganisms, including bacteria, fungi, viruses, and parasites. Antimicrobial resistance, or AMR, is the gradual evolution of pathogenic microbes to evade the action of commonly used antimicrobial agents (antibiotics, antifungals, antivirals, and antiparasitics) and is a problem that continues to be exacerbated by the inappropriate use of antimicrobials across multiple global industries. AMR poses a major threat to our society, and without mitigation, will lead to devastating consequences with broad implications beyond human health. The search for alternative or complementary therapies to conventional antimicrobials is, therefore, of the utmost priority. In this review, we first outline the prevalence of AMR and the circumstances driving the proliferation of AMR, which is widely recognised as a One Health issue—through interconnected factors within human and veterinary medicine, agricultural practice, and the environment. We next summarise the various classes of pathogens, common antimicrobial agents, and the mechanisms which pathogens have evolved to evade antimicrobial action. Within this context, we discuss the therapeutic potential of bacteriophages, virophages, and mycoviruses against antimicrobial-resistant infections, and consider the future perspectives of virus-based formulations. Full article

In this narrative review, we address the prevention and therapy of iron deficiency anemia (IDA) with oral iron products in pediatric patients. Fortification of complementary foods with iron-containing micronutrient powders is the preferred method for the prevention of IDA in resource-limited settings. In developed countries, the prevention of sideropenia is through the consumption of iron-rich foods of animal origin. Regarding oral iron therapy, ferrous sulfate is the most widely used and cheapest product, but it is less well tolerated due to gastrointestinal side effects compared to complexes of ferric iron with polysaccharides, and complexes of iron with amino acids in casein, such as iron protein succinylate and iron acetyl aspartylate. These latter products are expensive and available only as single-dose vials with a fixed amount of elemental iron. Intermittent administration of ferrous sulfate, once or twice a week, is equally effective to daily therapy, with fewer side effects, and can be used in selected patients. Oral carbonyl iron has excellent bioavailability and the additional advantage of a high safety margin in cases of accidental overdose compared to iron salts, an important consideration given the potentially lethal consequences of iron overdose. Newer liposomal and sucrosomial iron products appear to have better intestinal tolerance and similar efficacy in the treatment of IDA, but limited pediatric data exist. In conclusion, all oral medicinal iron products are effective when prescribed for the treatment of IDA, if well-absorbed and taken consistently for 3 to 6 months. Physicians should be prepared to use alternative oral agents with better tolerance in case of gastrointestinal side effects. Full article

Recently, complementary and alternative medicine (CAM) has been actively employed for patients experiencing symptoms unresponsive to Western medical treatments like drug therapy. The natural compounds carotenoids and astaxanthin (AST) have demonstrated various beneficial biological actions for human health in several studies. Given their broad pharmacological activities and reduced toxicity, ASTs possess significant potential as resources for the development of natural analgesic drugs. Given recent studies showing that AST can modulate neuronal excitability, including nociceptive sensory transmission through voltage-gated Ca²⁺ channels and the n-methyl-D-aspartate (NMDA) glutamate receptor, and inhibit the cyclooxygenase-2 cascade, AST holds promise as a CAM, particularly as a therapeutic agent for nociceptive and pathological pain. Based on the in vivo research findings from our laboratory presented in this review, we have confirmed that carotenoid ASTs possess: (i) an intravenous anesthetic effect on both nociceptive and inflammatory pain comparable to existing analgesics such as ketamine; and (ii) an anti-inflammatory effect on chronic pain with an efficacy almost equivalent to that of the commonly used non-steroidal anti-inflammatory drug (NSAID) celecoxib. Therefore, these findings suggest that, as natural compounds, ASTs contribute to the relief of nociceptive and inflammatory pain, implying their potential for clinical application. Full article

Background/Objectives: Gastric ulcer is a prevalent global gastrointestinal disorder influenced by multiple factors, including excessive alcohol consumption, poor dietary habits, psychological stress, smoking, and the chronic use of non-steroidal anti-inflammatory drugs. Among these, alcohol plays a critical role in gastric mucosal injury by enhancing gastric acid secretion, triggering inflammatory responses, inducing oxidative stress, and promoting epithelial cell apoptosis while simultaneously depleting key protective mediators such as nitric oxide and prostaglandin E₂. Growing interest has focused on medicinal plants as promising sources of novel therapeutic agents for the management of peptic ulcer disease. Methods: This review summarizes commonly used medicinal plants documented in both Ayurvedic and modern medical systems that exhibit ulcer-healing potential. Experimental and preclinical studies indicate that various herbal drugs and plant extracts derived from different plant parts exert significant anti-ulcer effects through multiple mechanisms, including antioxidant activity, modulation of inflammatory pathways, enhancement of mucosal defense, and inhibition of gastric acid secretion. Results: The review further highlights the gastroprotective effects of these herbal remedies as demonstrated in established experimental ulcer models. Conclusions: Exploring plant-based therapies for gastric ulcers offers valuable insights into alternative and complementary treatment strategies. Continued research aimed at identifying bioactive compounds, elucidating their molecular mechanisms, and developing improved formulations may contribute to safer, more effective, and patient-friendly therapeutic options for peptic ulcer management. Full article