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      Herbal medicines: Saudi population knowledge, attitude, and practice at a glance

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          Abstract

          Herbal medicines are widely used in many countries in preventing and treating health disorders. In this study, a multiregional cross-sectional survey, a random sample of 809 adults from Saudi Arabia and territories were used to explore the participants’ knowledge, attitude, and practice regarding the use of tradition medicines in Saudi society. Data were collected through direct simple observation, interviews, and structured questionnaires. Observations were made and interviews conducted in public places such as markets and popular schools. The questionnaire included data on sociodemographic such as age and gender and was drafted with optional questions and predefined answer. Data were collected from May 1 st to the end of July 2014. Most of the respondents were female (85%). Approximately 70% of participants were found to be highly knowledgeable about the use of herbal medicine. The study found that 88.4% of the respondents stated to have used herbal medicines and 84.3% were interested in traditional recipes. Most of the participants used it for therapeutic reason (88.7%), with a successful effectiveness of 61.2%. In addition, the study found that 48.2% of the participants were taking information from friends and 76% stated that they do not trust the published information in commercial channels. Statistical analysis showed an association between the perception and the demographic data, with an increase in the use of herbal medicines. Because of the increased use of herbal medicine in Saudi Arabia facilitated by perceptions and attitudes of the population, it is important to ensure standardization, stability, and quality control of the use of medicine in Saudi Arabia.

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          Herbal Medicines Use During Pregnancy: A Review from the Middle East.

          The prevalence of the herbal medicines use is on the rise across the world, especially amongst pregnant women. The scenario in the Middle Eastern region was reviewed to explore the prevalence, usage pattern, motivation, and attitude towards use of herbal medicine by pregnant women. Literature published up to December 2012 showed the prevalence of herbal medicine use varied between 22.3-82.3%, implying a rising trend in the utilization of herbal medicine during pregnancy. The most common herbs used were peppermint, ginger, thyme, chamomile, sage, aniseed, fenugreek, and green tea. The most common reasons for use included the treatment of gastrointestinal disorders and cold and flu symptoms. The majority of women used these products during their first trimester, and did not reveal this information to their physician. Most women were advised by family and friends to use herbal medicines and believed they were more effective and had fewer side effects than modern medicine especially during pregnancy. In conclusion, the use of herbal medicine is prevalent among pregnant women in the Middle Eastern region and healthcare providers need to seek information pertaining to their use.
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            Herbal hepatotoxicity in traditional and modern medicine: actual key issues and new encouraging steps

            Plants are natural producers of chemical substances, providing potential treatment of human ailments since ancient times. Some herbal chemicals in medicinal plants of traditional and modern medicine carry the risk of herb induced liver injury (HILI) with a severe or potentially lethal clinical course, and the requirement of a liver transplant. Discontinuation of herbal use is mandatory in time when HILI is first suspected as diagnosis. Although, herbal hepatotoxicity is of utmost clinical and regulatory importance, lack of a stringent causality assessment remains a major issue for patients with suspected HILI, while this problem is best overcome by the use of the hepatotoxicity specific CIOMS (Council for International Organizations of Medical Sciences) scale and the evaluation of unintentional reexposure test results. Sixty five different commonly used herbs, herbal drugs, and herbal supplements and 111 different herbs or herbal mixtures of the traditional Chinese medicine (TCM) are reported causative for liver disease, with levels of causality proof that appear rarely conclusive. Encouraging steps in the field of herbal hepatotoxicity focus on introducing analytical methods that identify cases of intrinsic hepatotoxicity caused by pyrrolizidine alkaloids, and on omics technologies, including genomics, proteomics, metabolomics, and assessing circulating micro-RNA in the serum of some patients with intrinsic hepatotoxicity. It remains to be established whether these new technologies can identify idiosyncratic HILI cases. To enhance its globalization, herbal medicine should universally be marketed as herbal drugs under strict regulatory surveillance in analogy to regulatory approved chemical drugs, proving a positive risk/benefit profile by enforcing evidence based clinical trials and excellent herbal drug quality.
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              Safety classification of herbal medicines used in pregnancy in a multinational study

              Background The use of herbal medicines for health prevention and ailments is an increasing trend worldwide. Women in pregnancy are no exception; the reported prevalence of herbal medicine use in pregnancy ranges from 1 to 60 %. Despite a common perception of safety, herbal medicines may have potent pharmacological actions, and historically, have been used for this reason. Methods A multinational, cross-sectional study on how women treat disease and pregnancy-related health ailments was conducted between October 2011 and February 2012 in Europe, North America, and Australia. This study’s primary aim was to evaluate and classify the herbal medicines used according to their safety in pregnancy and, secondly, to investigate risk factors associated with the use of contraindicated herbal medicines during pregnancy. Results In total, 29.3 % of the women (n = 2673) reported the use of herbal medicines in pregnancy; of which we were able to identify 126 specific herbal medicines used by 2379 women (89.0 %). Twenty seven out of 126 herbal medicines were classified as contraindicated in pregnancy, and were used by 476 women (20.0 %). Twenty-eight were classified as safe for use in pregnancy and used by the largest number of women (n = 1128, 47.4 %). The greatest number was classified as requiring caution in pregnancy; these sixty herbal medicines were used by 751 women (31.6 %). Maternal factors associated with the use of contraindicated herbal medicines in pregnancy were found to be working in the home, having a university education, not using folic acid, and consuming alcohol. Interestingly, the recommendation to take a contraindicated herbal medicine was three times more likely to be from a healthcare practitioner (HCP) than an informal source. Conclusion Based on the current literature the majority of women in this study used an herbal medicine that was classified as safe for use in pregnancy. Women who reported taking a contraindicated herb were more likely to have been recommended it use by an HCP rather than informal source(s), indicating an urgent need for more education among HCPs. The paucity of human studies on herbal medicines safety in pregnancy stands in stark contrast to the widespread use of these products among pregnant women. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1079-z) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                Journal of Family Medicine and Primary Care
                Medknow Publications & Media Pvt Ltd (India )
                2249-4863
                2278-7135
                Sep-Oct 2018
                : 7
                : 5
                : 865-875
                Affiliations
                [1 ] Medical Centre of Public Security Training City, Medical Services of Ministry of Interior, Riyadh, Saudi Arabia
                [2 ] Department of Family Medicine, King Abdullah University Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
                [3 ] Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
                [4 ] Department of Pharmacy, College of Pharmacy, University of Shaqra, Al Dawadmi, Saudi Arabia
                Author notes
                Address for correspondence: Dr. Munira Mohammed Al Akeel, Medical Centre of Public Security Training City, Medical Services of Ministry of Interior, Riyadh, Saudi Arabia. E-mail: malakil8@ 123456hotmail.com
                Article
                JFMPC-7-865
                10.4103/jfmpc.jfmpc_315_17
                6259532
                30598925
                ece05a03-e52c-448c-a6ea-41f580defdaa
                Copyright: © 2018 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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                Original Article

                health,herbal medicine,saudi,traditional medicine
                health, herbal medicine, saudi, traditional medicine

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