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Ethnopharmacological relevance Type 2 diabetes is characterized by tissue resistance to the action of insulin, combined with a relative deficiency in insulin secretion. In Guatemala, type 2 diabetes results in significant mortality rates. The low incomes of the indigenous population results in the use of alternative therapies such as medicinal plants to treat the illness. We could not find any previous study related to the use of medicinal plants to treat diabetes in Guatemala. The aim of this work is to determine the most effective plant species used in traditional medicine to treat type 2 diabetes. Materials and methods We performed an ethnopharmacological field study among the Cakchiquels of Chimaltenango to select the most prominent plants used to treat the disease. Type 2 diabetic patients from their community health centers were interviewed using structured questionnaires. Two mathematical tools were used to identify potential plant species: the Disease Consensus Index and the Use Value. International databases, including SCOPUS, PubMed, and Google Scholar, were used to identify whether the plants with the highest scores were known to elicit hypoglycemic effects. Results After analyzing the data, we can propose the following plants as the most prominent among the Cakchiquels of Chimaltenango to treat type 2 diabetes: Hamelia patens Jacq., Neurolaena lobata (L.) R.Br.ex Cass., Solanum americanum Mill., Croton guatemalensis Lotsy, and Quercus peduncularis Nee. Conclusions The Cakchiquel patients interviewed did not understand type 2 diabetes; however, they associated the onset of their disease with a negative emotion, such as shock, sadness or anger. Despite changes in lifestyle, influences of advertising, the availability of innovative treatments and the use of oral hypoglycemic treatments provided by health facilities serving indigenous communities, the Cakchiquel continue to use medicinal plants as adjunctive treatment. While they are unaware whether the plants can cause additional harm, they consider their consumption beneficial because they feel better. There were 11 plants identified with UVs greater than 0.5 and high DCIs; from these 64% of the plants have been identified as having hypoglycemic effects; this finding supports the traditional selection by the Cakchiquels of medicinal plants to treat T2D.

Ethnopharmacological relevance Every year between 1.2 and 5.5 million people worldwide are victims of snakebites, with about 400,000 left permanently injured. In Central America an estimated 5500 snakebite cases are reported by health centres, but this is likely to be an underestimate due to unreported cases in rural regions. The aim of this study is to review the medicinal plants used traditionally to treat snakebites in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. Materials and methods A literature search was performed on published primary data on medicinal plants of Central America and those specifically pertaining to use against snakebites. Plant use reports for traditional snakebite remedies identified in primary sources were extracted and entered in a database, with data analysed in terms of the most frequent numbers of use reports. The scientific evidence that might support the local uses of the most frequently reported species was also examined. Results A total of 260 independent plant use reports were recorded in the 34 sources included in this review, encompassing 208 species used to treat snakebite in Central America. Only nine species were reported in at least three studies: Cissampelos pareira L., Piper amalago L., Aristolochia trilobata L., Sansevieria hyacinthoides (L.) Druce, Strychnos panamensis Seem., Dorstenia contrajerva L., Scoparia dulcis L., Hamelia patens Jacq., and Simaba cedron Planch. Genera with the highest number of species used to treat snakebite were Piper , Aristolochia , Hamelia , Ipomoea , Passiflora and Peperomia . The extent of the scientific evidence available to understand any pharmacological basis for their use against snakebites varied between different plant species. Conclusion At least 208 plant species are traditionally used to treat snakebite in Central America but there is a lack of clinical research to evaluate their efficacy and safety. Available pharmacological data suggest different plant species may target different symptoms of snakebites, such as pain or anxiety, although more studies are needed to further evaluate the scientific basis for their use.

Ethnopharmacological relevance Globally 387 million people currently have diabetes and it is projected that this condition will be the 7th leading cause of death worldwide by 2030. As of 2012, its total prevalence in Central America (8.5%) was greater than the prevalence in most Latin American countries and the population of this region widely use herbal medicine. The aim of this study is to review the medicinal plants used to treat diabetes and its sequelae in seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. Materials and methods We conducted a literature review and extracted from primary sources the plant use reports in traditional remedies that matched one of the following disease categories: diabetes mellitus, kidney disease, urinary problems, skin diseases and infections, cardiovascular disease, sexual dysfunctions, visual loss, and nerve damage. Use reports were entered in a database and data were analysed in terms of the highest number of use reports for diabetes management and for the different sequelae. We also examined the scientific evidence that might support the local uses of the most reported species. Results Out of 535 identified species used to manage diabetes and its sequelae, 104 species are used to manage diabetes and we found in vitro and in vivo preclinical experimental evidence of hypoglycaemic effect for 16 of the 20 species reported by at least two sources. However, only seven of these species are reported in more than 3 studies: Momordica charantia L., Neurolaena lobata (L.) R. Br. ex Cass., Tecoma stans (L.) Juss. ex Kunth, Persea americana Mill., Psidium guajava L., Anacardium occidentale L. and Hamelia patens Jacq. Several of the species that are used to manage diabetes in Central America are also used to treat conditions that may arise as its consequence such as kidney disease, urinary problems and skin conditions. Conclusion This review provides an overview of the medicinal plants used to manage diabetes and its sequelae in Central America and of the current scientific knowledge that might explain their traditional use. In Central America a large number of medicinal plants are used to treat this condition and its sequelae, although relatively few species are widely used across the region. For the species used to manage diabetes, there is variation in the availability and quality of pharmacological, chemical and clinical studies to explain traditional use.

Hexane, chloroform and methanol extracts of seven herbal drugs used in the folk medicine of Central America against skin disorders (Aristolochia trilobata leaves and bark, Bursera simaruba bark, Hamelia patens leaves, Piper amalago leaves, and Syngonium podophyllum leaves and bark) were evaluated for their topical anti-inflammatory activity against the Croton oil-induced ear oedema in mice. Most of the extracts induced a dose-dependent oedema reduction. The chloroform extract of almost all the drugs exhibited interesting activities with ID(50) values ranging between 108 and 498 micro g/cm(2), comparable to that of indomethacin (93 micro g/cm(2)). Therefore, the tested plants are promising sources of principles with high anti-inflammatory activity.

Hamelia patens Jacq. (Rubiaceae) has received little attention in the laboratory for its wound healing ability even though it is commonly used as a treatment for wounds throughout Central America. A double incision wound healing bioassay was carried out with a crude extract of Hamelia patens collected from El Salvador. Animals were divided into three groups. Group I (n = 14) had the left incision treated with 5% (w/w) Hamelia patens and the contralateral side with petroleum jelly (PJ). Group II (n = 14) had the left incision treated with 10% (w/w) ointment and the contralateral side with petroleum jelly. Group III (n = 10) had the left incision treated with petroleum jelly and the contralateral side left untreated. Breaking strength of the incisions was measured on day 7 and day 12. For Groups I and II, there was no significant difference between treatment and control incisions at day 7. On day 12, there was a significant difference between the treated and control incisions for Groups I and II. There was no significant difference between petroleum jelly and untreated incisions for Group III on day 7 and day 12. Hamelia patens does increase breaking strength of wounds significantly more than the control group. Further wound healing studies of this plant are warranted.