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Background: Prostatic diseases which include prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer are the benign or malignant disorders that affect the prostate. Phytotherapies have been adopted as the alternative treatment/ management option especially for BPH since the current modern methods of treatment presents a lot of adverse effects. Methodology: The literature was searched using different databases including Medline/PubMed, Cochrane library, Scopus, Proquest library, Embase, EBooks and Google Scholar for relevant records for a period from 1988 to 2018 to identify all the published articles of S. serrulata regarding treatment of prostatic diseases. The key search terms were Serenoa serrulata, S. repens, Saw palmetto, Prostate cancer treatment with Serenoa serrulata, treatment of Benign Prostatic Hyperplasia with Serenoa serrulata, phytochemicals of Serenoa serrulata, ethnobotanical uses of Serenoa serrulata, toxicity of Serenoa serrulata, pharmacological activities of Serenoa serrulata and also traditional management and treatment of prostatic diseases using Serenoa serrulata and also clinical trials on treatment of prostatic diseases with Serenoa serrulata. The retrieved articles were reviewed, synthesized and analyzed qualitatively. The reference list of the retrieved articles was also reviewed and synthesized. The original research articles which reported an investigation of S. serrulata of any study design, original published research articles, any time of publication and grey literature (conference papers, reported articles, academic thesis) were included. The articles whose full texts were not freely available by the time of search and those without clear information about methodology and study design were excluded. Results: This review reported that Serenoa serrulata belonging to the Arecaceae family commonly known as saw palmetto is used traditionally for treating prostatic disease conditions and other infertility conditions in both men and women. Phytochemical screening of hexanic and ethanolic extracts of S. serrulata comprised of free fatty acids and phytosterols which together contribute to their antiprostatic activities. These extracts of S. serrulata exhibited antiandrogenic, anti-inflammatory and anti-proliferative activities through inhibition of both isoenzymes 5α- reductase and inhibition of binding of dihydrotestosterone (DHT) to the cytosolic androgen receptors. This is a similar mechanism exhibited by finasteride and Tamsulosin both antiprostatic conventional drugs though the plant phytochemicals do not interfere with PSA secretion. S. serrulata has also been reported to be non-toxic in both non clinical and clinical trial studies. The medicinal plants reported by this review to be used in combination include; stinging nettle (Urtica dioca), Zingiber officinalis, Echinacea angustifolia and pumpkin (Cucurbita pepo). The antiprostatic conventional drugs reported include finasteride and Tamsulosin. Conclusion and Recommendation: The results showed that S. serrulata is effective in treating prostatic diseases. The potency and safety is improved when used in combination with Urtica dioca, Cucurbita pepo, Zingiber officinalis and Echinacea angustifolia as compared with anti-prostatic conventional drugs Finasteride and Tamsulosin alone. The plant combination has also been shown to have improvement in the quality of life and as well enhancing the synergy of Finasteride and Tamsulon and their adverse effects. Effective medicinal plant combinations should be formulated into products and integrated into the usual treatment for prostatic diseases.

The menace of current cases of parasite resistance to antimalarial drugs, non- availability and accessibility, and the high costs of pharmaceutical products contribute to the high rate of medicinal plants consumption in the treatment of malaria in Uganda. Different ethnobotanical surveys on medicinal plants with antimalarial properties have been conducted across different geographical regions in Uganda in order to identify and select the most commonly used antimalarial plants as candidates in the proposed national herbal pharmacopoeia. The available literature on the medicinal plants used against malaria in the western, central, eastern and northern geographical regions in Uganda was selected from reputable journals using various citation databases as guides. The commonly used antimalarial plants in the regions were searched using relevant journals on previously established ethno-botanical survey. They were then ranked in order of percentage frequency of appearance in the literature from surveys across the country. Fifteen medicinal plants were selected in this way from several antimalarial plants cited. Vernonia amygdalina and Azadirachta indica appeared most (100%), followed by Carica papaya, Mangifera indica and Hoslundia opposita with 80% appearance each across the 4 regions.The medicinal plants from this review were therefore ranked as the most used for treatment of malaria in Uganda and therefore, could be recommended for herbal pharmacopoeial standards development. Key words: Antimalarial, medicinal plants, antiplasmodial, herbal pharmacopoeial standards.

Background: Epilepsy has affected over sixty million people around the globe. Traditionally, communities have opted for complementary and alternative medicines (CAM) to help in the treatment of epilepsy which has worked for them and with minimal side effects. Methodology: A literature search was conducted from PubMed, Science Direct, Elsevier, Google Scholar, and many other sites that had studied on traditional approaches and medicinal plants which have been used commonly in west and east African communities and whose anticonvulsant or antiepileptic activities have been experimentally studied. Results: A total number of five traditional approaches for healing and nineteen medicinal plants were identified as the most commonly used by communities in west and east Africa, based on the literature which was available in ethnobotanical surveys and had experimental studies on anticonvulsant or antiepileptic conducted. Conclusion: In this study, twenty-four traditional approaches and medicinal plants were found in west and east Africa for the treatment of epilepsy. Further study on the phytoconstituents present in the medicinal plants should be carried out to isolate the active principles and to prove their pharmacological activities. Inclusion of the other well approved healing approaches and techniques recommended in epilepsy treatment in health settings.

Distress and pains among other gynecological challenges mothers go through during childbirth result in mortality. This has compelled people particularly in developing countries to use traditional medicine to induce birth due to lack of more effective alternatives. In Uganda, from time immemorial most child birth and pregnancy related problems have been solved using medicinal plants as a primary alternative to conventional drugs. Although research has been done to document and validate effectiveness of these plants, it is not compil ed for communication to the wider community. This study, therefore, reviewed the medicinal plants used in Uganda for easing childbirth. The study collated and documented medicinal plants used by Traditional Birth Attendants and Traditional Health Practitioners to induce labor and ease child birth in local communities in Uganda and show the gaps that need to be investigated. The available literature on medicinal plants used in Uganda for childbirth were selected from reputable journals using citation databases including Google Scholar, Institute for Scientific Information, PubMed, Scopus, Hinari, and Scientific Information Database among others. Asteraceae, Fabaceae, and Lamiaceae, respectively were the most cited for gynecological uses by various local communities in Uganda. The commonly reported species were Laggera alata Sch. Bip., Tagetes minuta L, Clitoria ternatea Linn and Ocimum lamiifolium Hochst ex Benth among others. Authors were also determined to ascertain scientific evidence against analgesic, anti-inflammatory, oxytocic and phytochemical properties of the selected plant species. Key words: Childbirth, medicinal plant, gynecology, Uganda.

Background: In sub-Saharan Africa, herbal medicine for cancer is dispensed by traditional medicine practitioners (TMPs) to a large extent, who may not have adequate knowledge about the disease and this has been found to contribute to the late presentation of cancer patients to clinics and hospitals leading to poor patient outcomes.Aim: This study will investigate the traditional medicine practitioner's concept of cancer, its care, herbal medicine use, and the patients' perceived benefits (clinical outcomes) in selected districts of Central Uganda.Methods: This study will use a convergent parallel mixed-method design. TMPs claiming to treat cancer, with at least 10 years of experience will be recruited and interviewed about their understanding of cancer as a disease (grounded theory design) and the herbs used in cancer treatment (ethnobotanical survey). We will also conduct a prospective observational study to obtain the data on the perceived clinical outcomes of using herbal medicine. Adult patients (>18years) with a medical diagnosis of cancer signposted by TMPs will be recruited and followed up at baseline, 3, and 6 months. Study outcomes will include a change in the quality of life score, cancer symptoms score, perceived benefits score, and adverse reactions. The researcher will analyze qualitative data using Open, axial, selective coding techniques. We will analyze the quantitative data using descriptive statistics and results presented in frequencies, percentages and measures of central tendency (mean) where applicable. Additional analyzes such as bivariate (paired t-test and one-way repeated measures ANOVA), and multivariate (linear mixed effects model) analysis for the repeated measures data shall be undertaken to analyze the prospective observational data. P- Values of Discussion: This study will aid researchers in further understanding the TMPs' conceptualization of cancer, how that links to the treatment dispensed to their patients, and ultimately the patient-perceived outcomes.

Ethnopharmacological relevance Momordica charantia Linnaeus (Cucurbitaceae) has been extensively used traditionally as food and herbal medicine for type 2 diabetes mellitus in Asia, Brazil, and east Africa. In vitro and in vivo studies suggest its glycemic control potential; however, clinical studies produced conflicting results. Aim of the study To evaluate the efficacy of M. charantia preparations in lowering elevated plasma glucose level in prediabetes and type 2 diabetes mellitus patients. Methods Electronic search of the Cochrane library, PubMed®, CINAHL, and SCOPUS databases was done from 1st January 1960–30th April 2018 without language restriction. Two independent reviewers extracted data and assessed risk of bias of articles. Revman var. 5.3 software was used for data synthesis in meta-analysis. Heterogeneity was assessed using Chi-square and I2 tests. Treatment effect was estimated using mean difference at follow up in outcome measures between M. charantia preparations and placebo or oral hypoglycemic agents control group. The protocol of this study has a registration number PROSPERO CRD42018083653. Results Ten studies of type 2 diabetes mellitus (n = 1045) were included in the meta-analysis. They had 4–16 weeks follow up and overall moderate to high risk of bias. Compared to placebo, M. charantia monoherbal formulation significantly reduces FPG, PPG and HBA1c with mean difference of − 0.72 mmol/L, (95% CI: −1.33, −0.12), I2 = 14%, − 1.43 mmol/L, (95% CI: −2.18, −0.67), I2 = 0, − 0.26%, (95% CI: -0.49, −0.03), I2 = 0 respectively. M. charantia also lowered FPG in prediabetes (mean difference −0.31 mmol/L, n = 52); the evidence was downgraded to low quality because the study had unclear risk of bias and inadequate sample size. No serious adverse effects were reported. Conclusion M. charantia adjunct preparations improved glycemic control in T2DM patients. However, this conclusion is based on low to very low quality evidences for the primary outcomes and sparse data for several safety outcomes, thus, warrant further research. Particularly needed are the researches that focus on standardizing M. charantia formulation and determine its efficacy and safety in clinical trials with adequate sample size, designed with random sequence generation, allocation concealment of intervention and blinding of both research personnel and participants.

Ethnopharmacological relevance Malaria remains a dire health challenge, particularly in sub-Saharan Africa. In Uganda, it is the most ordinary condition in hospital admission and outpatient care. The country's meager health services compel malaria patients to use herbal remedies such as Schkuhria pinnata (Lam.) Kuntze ex Thell (Asteraceae). Although in vivo studies tested the antimalarial activity of S. pinnata extracts, plant developmental stages and their effect at different doses remain unknown. Aim of the study This study aims to determine the effect of the plant developmental stage on the antimalarial activity of S. pinnata in mice and to document the acute oral toxicity profile. Methods Seeds of S. pinnata were grown, and aerial parts of each developmental stage were harvested. Extraction was done by maceration in 70% methanol. The antimalarial activity was evaluated using chloroquine-sensitive Plasmodium berghei on swiss albino mice, in a chemosuppressive test, at 150, 350, and 700 mg/kg, p.o. Standard drugs used were artemether-lumefantrine (0.57 + 3.43) mg/kg and chloroquine (10 mg/kg) as positive controls. Distilled water at 1 mL/100g was used as a negative control. The Lorke method was adopted to determine the acute toxicity of extracts. Results The flowering stage extract had a maximum suppression of parasitemia at 700 mg/kg (68.83 ± 4.49%). Extract at other developmental stages also significantly suppressed the parasitemia (in the ascending order) fruiting (50.71 ± 1.87%), budding (54.92 ± 7.56%), vegetative (55.39 ± 2.01%) compared to the negative control (24.7 ± 2.7%), p Conclusion Together, our findings revealed that the S. pinnata extracts at the flowering stage had superior antimalarial activity compared to other plant developmental stages. Extracts from all developmental stages have demonstrated a dose-dependent suppression of malarial parasites and increased survival time with an LD50 of 2157 mg/kg. Thus, for better antimalarial activity, local communities could consider harvesting S. pinnata at the flowering stage. Further studies are needed to isolate pure compounds from S. pinnata and determine their antimalarial activity.

Ethnopharmacological relevance The recognized challenges to access conventional antimalarial medicines could have contributed to the extensive use of Aristolochia bracteolata Lam. (Aristolochiaceae)to manage malaria in South Sudan traditionally. However, the use and acquired experiences are notwell documented. Aim of the study This study aimed to document the traditional use of A. bracteolata for malaria treatment and experiences among the local communities in Jubek State of South Sudan. Methods We performed a cross-sectional study in four counties in Jubek State and interviewed 396 community members, including traditional healers, using a semi-structured questionnaire. Four focused group discussions (FGDs) were also conducted using the interviewer guide. The inclusion criteria were; adults 18 years and older, men andwomen participants, at least one year residing in the study area before the study, and those with a history of medicinal plant use. Data were summarized and presented as proportions. Qualitative data were analyzed using a thematic content approach. The major themes that emerged were discussed. We applied the Pearson Chi-Square test at α = 0.05 to test the study's significant differences in responses. The statistical package for social sciences version 21 software was used for data analysis. Results Women accounted for 208 (52.5%) of participants, with the majority 321 (81.1%) were between 18 and 45 years. Interestingly, most 312 (78.8%) had formal education. Moreover, about 208 (52.5%) participants collect the plant in their vicinity, where leaves were the most commonly used part 277 (46.4%), followed by the roots, seeds, and stems at 245(41.0%), 71 (11.9%), and 4 (0.7%), respectively. Furthermore, about 63 (15.9%) of the participants experienced side effects, including early abortions, heartburns, sweating, and stomach discomforts. Conversely, a total of 387 (96.0%) reported getting cured of malaria. Generally, the quantity of medicine taken per day differs concerning parts of the plant, with leaves ranging from 1 to 10 pieces, roots at 0.4–1 g, and seeds at 0.1–0.5 g. The locals used these plant parts to prepare infusion and decoction traditional dosage forms for oral use. Conclusion The documented medicinal plant's therapeutic uses provided critical information on the traditional use of A. bracteolata by the community in Jubek state of South Sudan to treat malaria. Although most users reported getting cured of malaria, a notable proportion of them experienced side effects, including early-stage abortion and stomach discomforts. Thus, the use of A. bracteolata preparations, particularly in pregnant women, should be avoided. Finally, further studies are needed to devise a strategy to neutralize the toxic compounds and create community awareness on best practices to minimize side effects.

Background. Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories). Methods. Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity. Results. In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%). Conclusion. Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

Osteoarthritis remains a challenge in most parts of the world most particularly considering that one of the influencing factors, aging, cannot be avoided. Glucosamine and chondroitin have been used against the disorder for many years and have a huge market base in Europe and the United States where they are generally marketed as sulfates. Research shows that they are effective options against the disease at various levels, in vivo and clinical trials, but a better clinical position is required from more research as well as by using analogs of their chemical structures.

Cancers remain one of the leading causes of death in the world. However, known conventional cancer medicines remain scarce, expensive and out of reach to many patients. To provide an alternative for the expensive therapies, plants are proving to have potential to lead to the development of more drugs against cancers. In this work, we aimed at isolating possible pure compounds from Eichhornia crassipes roots and leaves, examining their prospects to be developed into oral drugs by looking at their chemical properties and also exploring their cytotoxic activities. A total of 12 isolates (A-L) were obtained and examination of their UV and mass profiles on LCMS and cytotoxicity on human cell lines. Compound C was the most active against MCF-7 cell lines (3.08 ± 0.06 µg/ml) and (3.92 ± 0.06 µg/ml) against HepG2. The standard drug, doxorubicin, had an IC50 value of 0.29 ± 0.05 µg/ml against MCF-7 and 0.33 ± 0.04 µg/ml against HepG2 cell lines. UV results from the LCMS chromatograms showed that some active isolates do not possess the chemistry suitable to be developed into oral drugs as they are while others that are not as potent possess very good drug-like chemistry. We therefore conclude that there is need for drug developers to consider chemical properties and medicinal chemistry prospects of active isolates/compounds through rational optimization in plant-based drug discovery. Eichhornia crassipes should be considered as a cheap source of potential drug hits against cancers.

Background: Achieving favorable HIV treatment outcomes is a major challenge, particularly due to non-adherence and consequent sub-therapeutic plasma antiretroviral drug levels. This is often complicated by the development of resistant strains due to mutations. Monitoring antiretroviral drug levels in the blood of patients enrolled on ART can reveal if levels are too high, enough, or too low. High levels may lead to dose-dependent side effects and sub-therapeutic levels could promote treatment failure and resistance. In Uganda, as part of routine HIV care, plasma antiretroviral drug level is estimated indirectly by clinic-based pill counts and patient self-reported adherence, which give no evidence of ingested medication. This study aimed at exploring steady-state nevirapine and efavirenz drug levels in HIV patients accessing ART at a rural referral hospital in South Western Uganda. Methods: This study was nested into a randomized clinical trial that evaluated the effect of Artemisia annua L. and Moringa oleifera on immunological response and viral load among persons living with HIV (PLHIV). In the parent study, 250 HIV-infected patients with continued immunologic suppression (CD4 count < 350cells/µL) despite a minimum of one-year on ART were enrolled. Out of 250 clinical trial participants, 95 were randomly selected for steady-state efavirenz and nevirapine plasma concentration sampling having taken the last at bedtime. Additionally, CD4 count, HIV load, liver, and renal function tests were determined. Participants were also interviewed for adherence, and factors that affect blood drug levels.Results: Of the 95 participants sampled, 67 (71%) and 28 (30%) were on efavirenz or nevirapine based ART respectively. The median viral load for participants on the efavirenz regimen was 490 copies/mL (IQR 116, 1900) while that for the participants on the nevirapine regimen was 500 copies/mL (IQR 137, 1270). The median plasma level for the participants on the nevirapine regimen (6.56 mg/L IQR 4.50, 9.80) was higher than that for the participants on the efavirenz regiment (2.54 mg/L IQR 1.47, 5.12). The prevalence of virologic failure among participants sampled on the efavirenz regimen was higher (37%) compared to that of the participants on the nevirapine regimen (21%). 30% of all plasma samples tested had sub-therapeutic levels of either efavirenz or nevirapine, including 2% in which no drugs were detected.Conclusion: Periodic therapeutic drug monitoring should be incorporated as one of the components in the monitoring of ART adherence to ensure adequate blood levels among adults accessing ART at MRRH, SW Uganda.

Type 2 diabetes mellitus is a chronic hyperglycemic condition due to progressively impaired glucose regulation. Momordica charantia L. could potentially improve hyperglycemia because its fruit extracts can alleviate insulin resistance, beta-cell dysfunction, and increase serum insulin level. We evaluated the effect of M. charantia L. in comparison with a vehicle on glycemic control in animal models of type 2 diabetes mellitus. MEDLINE, Web of Science, Scopus, and CINAHL databases were searched without language restriction through April 2019. About 66 studies involving 1861 animals that examined the effect of M. charantia L. on type 2 diabetes mellitus were included. Fruits and seed extracts reduced fasting plasma glucose (FPG) and glycosylated hemoglobin A1c in comparison to vehicle control: (42 studies, 815 animals; SMD, -6.86 [95% CI; -7.95, -5.77], 3 studies, 59 animals; SMD; -7.76 [95% CI; -12.50, -3.01]) respectively. Also, the extracts have hepato-renal protective effects at varying doses and duration of administration. Despite the observed significant glycemic control effect, poor methodological quality calls for future researches to focus on standardizing extract based on chemical markers and adopt measures to improve the quality of preclinical studies such as sample size calculation, randomization, and blinding.

Background Momordica charantia Linnaeus (Cucurbitaceae) has been used traditionally as a nutritious food and as a herbal medicine for type 2 diabetes mellitus. However, human studies that investigated its glycemic control have generated inconsistent findings. Therefore, this systematic review and meta-analysis is aimed at evaluating the safety and efficacy of M. charantia L. preparations in human studies that have investigated its role in glycemic control. Methods This protocol has been prepared according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The review will include randomized clinical trials and non-randomized clinical trials. The included studies will have assessed glycemic control of M. charantia preparations with placebo or standard oral anti-hyperglycemic agents in adult pre-diabetes and/or type 2 diabetes mellitus patients and have at least 4 weeks of follow-up. The primary outcomes of review are fasting blood glucose levels, glycosylated hemoglobin A1c, and post-prandial blood glucose level. Electronic database search for published literatures will be conducted without language restriction in EMBASE, MEDLINE/PubMed, the Cochrane Library, SCOPUS, Web of Sciences, and CINAHL databases. Search for gray literatures and references of the retrieved full-text articles will be conducted in Google, Google Scholar, OpenGrey, ProQuest dissertations & Theses, British Library EThos, and university digital library systems. Two independent reviewers will later evaluate full texts, extract data, and assess risk of bias of eligible articles. Publication biases will be assessed by testing asymmetry of funnel plot using Egger’s or Begg’s tests while heterogeneity will be assessed using Cochran Q test, P value, and I2. Revman software version 5.3 will be used for meta-analysis including subgroup and sensitivity analysis. Discussion This systematic review and meta-analysis will investigate both safety and efficacy of M. charantia preparations in type 2 diabetes mellitus. The review results will be published in a peer-reviewed journal. The results will bring better understanding of clinical outcomes in treatment of type 2 diabetes mellitus patients and highlight gaps for future research. Systematic review registration PROSPERO CRD42018083653. Electronic supplementary material The online version of this article (10.1186/s13643-018-0847-x) contains supplementary material, which is available to authorized users.

Human tuberculosis (TB) is amongst the oldest and deadliest human bacterial diseases that pose major health, social and economic burden at a global level. Current regimens for TB treatment are lengthy, expensive and ineffective to emerging drug resistant strains. Thus, there is an urgent need for identification and development of novel TB drugs and drug regimens with comprehensive and specific mechanisms of action. Many medicinal plants are traditionally used for TB treatment. While some of their phytochemical composition has been elucidated, their mechanisms of action are not well understood. Insufficient knowledge on Mycobacterium tuberculosis (M.tb) biology and the complex nature of its infection limit the effectiveness of current screening-based methods used for TB drug discovery. Nonetheless, application of metabolomics tools within the ‘omics’ approaches, could provide an alternative method of elucidating the mechanism of action of medicinal plants. Metabolomics aims at high throughput detection, quantification and identification of metabolites in biological samples. Changes in the concentration of specific metabolites in a biological sample indicate changes in the metabolic pathways. In this paper review and discuss novel methods that involve application of metabolomics to drug discovery and the understanding of mechanisms of action of medicinal plants with anti-TB activity. Current knowledge on TB infection, anti-TB drugs and mechanisms of action are also included. We further highlight metabolism of M. tuberculosis and the potential drug targets, as well as current approaches in the development of anti-TB drugs.

Hepatitis C Virus (HCV) infection represents a huge burden on healthcare systems worldwide. Vachellia nilotica (V. nilotica) is a widely used plant specie in folk medicine for viral diseases and in some communities for HCV infection. However, little is known regarding its role and possible mechanisms in the prevention and treatment of this viral infection. This review presents ethno-pharmacological, in vitro and in vivo shreds of evidence of the role and underlying mode of action of V. nilotica and its implication in treatment and complication management of HCV infection. PubMed, Library of Congress, SCOPUS, Science Direct and Google scholar databases were searched. Twenty-eight articles of which 15 were in vitro while remaining were in vivo studies were reviewed. V. nilotica's modes of antiviral activity are direct inactivation of HCV and inhibition of HCV NS3 protease. Its immuno-modulatory activity showed by immune cell proliferation and inhibition of immunosuppressive cytokine. V. nilotica's anticancer activity through inhibition of oxidative stress, inhibition of chromosomal aberrations and enhancement of antioxidant enzymes could be beneficial in treating HCV infection and delaying its progression to cancer. It can be inferred that V. nilotica could be a promising source of anti-hepatitis C virus drug leads with the ability to prevent its long-term sequelae while promoting immune competence. Further studies are needed to explore the applicability of the herb to clinical settings.

BackgroundMomordica charantiaL. (Cucurbitaceae) has been used to control hyperglycemia in people with type 2 diabetes mellitus in Asia, South America, and Africa for decades. However, a meta-analysis of clinical trials confirmed very low-quality evidence of its efficacy. To potentially increase the certainty of evidence, we evaluated the effect ofM. charantiaL. in comparison with vehicle on glycemic control in animal models of type 2 diabetes mellitus.MethodsReview authors searched in MEDLINE, Web of Science, Scopus, and CINAHL databases without language restriction through April 2019. Two authors independently evaluated full texts, assessed the risk of bias, and extracted data. We analyzed the influence of study design and evidence of publication bias.ResultsThe review included 66 studies involving 1861 animals. They had a follow up between 7 and 90 days. Majority 29 (43.9%) used Wistar albino rats, and 37 (56.1%) used male animals. Thirty-two (48%) used an aqueous extract of fresh fruits.M. charantiaL. reduced fasting plasma glucose (FPG) and glycosylated hemoglobin A1c in comparison to vehicle control (42 studies, 815 animals; SMD, −6.86 [95% CI; −7.95, −5.77], 3 studies, 59 animals; SMD; −7.76 [95%CI; −12.50, −3.01]) respectively. Magnitude of FPG was large in Wistar albino rat subgroup; SMD; −10.29, [95%CI; −12.55, −8.03]. Publication bias changed FPG to non-significant −2.46 SMD, [95%CI; - 5.10, 0.17]. We downgraded the evidence to moderate quality due to poor methodological quality, high risk of bias, unexplained heterogeneity, suspected publication bias, and lack of standardized dose.ConclusionM. charantiaL. lowers elevated plasma glucose level in type 2 diabetes mellitus animal models. Publication bias and poor methodological quality call for future researches to focus on standardizing dose with chemical markers and provide measures to improve preclinical type 2 diabetes mellitus studies.Systematic review registration CRD42019119181

Introduction Cinnamon has been used as a dietary component and in the management of diabetes mellitus. This study systematically reviewed and synthesized evidence on the efficacy of cinnamon for the treatment of type 2 diabetes mellitus (T2DM) and pre-diabetes patients. Methods Databases of Web of Sciences, the Cochrane library, PubMed, CINAHL and SCOPUS were searched. Stata version 13 (College Station, Texas 77845 USA) and RevMan var. 5.3 software were used for meta-analysis. Heterogeneity was assessed using Chi-square and I2 tests. Results Sixteen randomized controlled studies were included in the meta-analysis. Cinnamon significantly reduced fasting blood glucose (FBG) and homeostatic model assessment for insulin resistance (HOMA-IR) level compared to placebo with weighted mean difference (WMD) of −0.545 (95% CI: −0.910, −0.18) mmol/L, I2 = 83.6% and −0.714(−1.388, −0.04), I2 = 84.4% respectively. There was no significant change in weighted mean difference of glycosylated hemoglobin A1C (HbA1c) % and lipid profiles (mmol/L). Meta-regression did not show any factor significantly affecting the treatment response. Conclusion Cinnamon reduced FBG and HOMA-IR, level in T2DM and pre-diabetes patients compared to placebo. High heterogeneity observed among included studies warrants further clinical trials after standardization of cinnamon formulation.

Dioscorea bulbifera bulbils are used in the treatment of Piles, dysentery, syphilis, ulcers, cough, leprosy, diabetes, asthma, and cancer. It is a raw material for contraceptives, and it is one of the most consumed yam species especially in West Africa. Unfortunately, this plant is at the verge of extinction because of increased harvest for medicinal purpose. This review aims at providing up-to-date information about its photochemistry, clinical benefits, conservation status and best possible way on how this plant can be conserved for future use. Literature database search was employed, and the findings indicate that much as Dioscorea bulbifera is of diverse clinical and ethnomedicinal benefits, it’s vulnerable to extinction. In order to conserve Dioscorea bulbifera, there is a need to enlighten the local inhabitants on its clinical and commercial importance and uses. Also for the sustainable growth of the plant, the government and Non-governmental agencies have to distribute Dioscorea bulbils to the farmers for planting and also encourage its planting back into the wild. In addition, micropropagation of the D. bulbifera will be the perfect tool for re-establishing the plant in the natural habitat with more advantages of improving growth conditions of the plants.

Background: Occurrence of adverse drug reactions is a major global health problem mostly affecting older adults. Identifying the magnitude and predictors of adverse drug reactions is crucial to developing strategies to mitigate the burden of adverse drug reactions. This study’s objectives were to estimate and compare the prevalences of adverse drug reactions, to characterize them and to identify the predictors among hospitalized older adults. Methods: A comprehensive systematic literature search including both prevalence and risk factors of adverse drug reactions in hospitalized older adults was conducted using PubMed, Scopus and Google Scholar, involving all articles published in English. Descriptive statistics and comparison of means was performed using SPSS version 20.0 and metaprop command was performed in STATA version 13.0. Heterogeneity was assessed using I2 statistic. Results: A total of 18 studies, involving 80,695 participants with a median age of 77 years, were included in this study. The pooled prevalence of adverse drug reaction was 22% (95% confidence interval: 17%, 28%; I2 = 99.23%). Among high-income countries, the prevalence of adverse drug reactions was 29% (95% confidence interval: 16%, 42%) as compared to 19% (95% confidence interval: 14%–25%) in low and middle-income countries ( p value = 0.176). Of the 620 adverse drug reactions categorized, most were type A (89%), which are generally predictable and preventable. Two-thirds (795, 67%) of the adverse drug reactions were probable and most (1194, 69%) were mild or moderate. The majority (60%) of the categorized adverse drug reactions were preventable and less than one-third (31%) were severe. The most consistently reported predictors of adverse drug reactions in hospitalized older patients were medication-related factors, including polypharmacy and potentially inappropriate medications followed by disease-related factors—renal failure, complex comorbidity, heart failure and liver failure. Conclusion: Almost one-quarter of all hospitalized older adults experienced at least one adverse drug reaction during their hospital stay. The majority of the adverse drug reactions were preventable. Medication-related factors were the most consistently reported predictors of adverse drug reactions followed by disease-related factors.

Regimens of current drugs for tuberculosis are lengthy and are associated with many adverse effects. Currently, the emergence of different resistant strains has been observed. This urges a need for the discovery and development of novel drugs. The main sources of drug lead candidates are based on natural products. Zanthoxylum leprieurii, Lantana camara, and Cryptolepis Sanguinolenta are among the plants that have antimycobacterial activity. Recent technological methods, such as metabolomics, can rapidly detect and identify active compounds from medicinal plants. In this review, we aim to provide an overview and discussion of the antimycobacterial activity, phytochemical analysis and toxicity profile of these plants and their products as well as the potential of metabolomic fingerprinting of medicinal plants with a given activity on microbes, in the search for the potential drug hit molecules. The information for this review was extracted from databases such as Excerpta Medica Database, Google Scholar, Springer, and PubMed Central. Primary studies, using a combination of the keywords antimycobacterial medicinal plant, multidrug-resistant tuberculosis, phytochemistry, toxicity, Zanthoxylum leprieurii, Lantana camara, Cryptolepis sanguinolenta, and plant metabolomics/metabolic fingerprinting of plant extracts, have been considered. The above-mentioned plant species showed antimycobacterial activity against drug-resistant strains of M. tuberculosis. They may provide potential candidates for novel drugs against multidrug-resistant tuberculosis. However, extensive work is still needed. To our knowledge, there is no or limited literature that reports the metabolic fingerprints of these plants. The analysis of the metabolite fingerprints of medicinal plants with similar antimicrobial activity could be important to determine whether the activity results from common metabolites within different plant species. This review shows that these plants are potential candidates to provide drug hits against multidrug-resistant tuberculosis strains. Future studies of compound optimization, in vivo safety and efficacy, as well as of the specific mechanisms of action are however required.

Introduction:Phytolacca dodecandra L’Hér. is a native plant of sub-Saharan Africa and Madagascar which is traditionally used for various ailments. Concerned with the scope of the available evidence, we designed a scoping review to critically analyze scientific evidence on P dodecandra’s pharmacology, toxicity, and phytochemistry to validate its ethnomedical use.Methods:We searched without language restriction in MEDLINE, Google Scholar, Scopus, Embase, and Web of Science through December 2019. Both published and unpublished articles were assessed for relevance and reviewed.Results:Of 600 articles retrieved through database search, a total of 48 articles were finally included. The butanol extract of berries was more potent molluscicidal than aqueous extract. The berries had also miracidial, anthelmintic, antifungal activity, and antibacterial effect against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella spp. The methanol extracts of roots had an antifungal effect against Candida albicans, Cryptococcus neoformans, Microsporum gypseum, and Trichophyton mentagrophytes. Phytolacca dodecandra was toxic to aquatic invertebrate and fish. The fishes were up to 4 times more sensitive than snails. Saponins were the main phytoconstituent isolated from berries. Terpenoid and phenolic were abundant in leaves and bark extracts.Conclusions:Studies validated the traditional use of P dodecandra against snails, worms, and various bacterial and fungal infections. Limited phytochemical data call for future research to focus on isolation of compounds; test their toxicity and activity; and establish mechanism of action.