Use Of Herbal Products Research Articles

Self-treatment with herbal products for weight-loss among overweight and obese subjects from central Mexico

Ethnopharmacological relevanceMexico ranks second in the world for obesity prevalence. In Mexico, obese and overweight subjects commonly seek alternative treatments for weight-loss, including the use of herbal products. Aim of the studyThe main objective of this study was to evaluate the prevalence of self-medication with herbal products for weight-loss among overweight and obese subjects residing in four states (Guanajuato, San Luis Potosi, State of Mexico, and Mexico City) from central Mexico. In addition, the factors related to self-medication among patients were studied. Materials and methodsA total of 1404 overweight and obese subjects were interviewed. A chi-square test examined associations between socio-demographic and socio-economic information, and self-medication with herbal products for weight-loss. ResultsThe prevalence of self-medication was 42.9% among the participants who used herbal products for weight-loss. The female gender was the strongest factor (OR: 2.20 (1.75–2.77) associated with self-medication for weight-loss, followed by a low educational level (elementary and middle school) [OR: 1.80 (1.31–2.44)], and a middle-socioeconomic status [OR: 1.75 (1.21–2.52)]. The main herbal products used for weight-loss were based on: i) green tea, Camellia sinensis (12.7% of frequency), ii) aceitilla, Bidens odorata (6.6%), and iii) soybean, Glycine max (5.3%). In addition, 65% of the respondents considered herbal products ineffective for weight-loss after 6 months of use. ConclusionDue to the high incidence of overweight and obesity in Mexico, there is a high prevalence (42.9%) of self-medication using natural products for weight-loss, particularly in women from Central Mexico. This study indicates the important need to educate patients about the harmful effects of consuming these products.

Bezbednosni aspekti primene biljnih proizvoda koji sadrže jedinjenja sa potencijalnim rizikom

Certain herbal drugs and herbal drug preparations contain compounds with a potential risk of use, such as pyrrolyzidine alkaloids (in Comfrey root, Symphyti radix, Coltsfoot leaf, Farfarae folium, Butterbur root, Petasitidis rhizoma), coumarin (in the Cassia bark, Cassiae cortex, Melilot, Meliloti herba), estragole (in Basil, Basilici herba, bitter/sweet fennel, Foeniculi amari/dulcis fructus, Aniseed, Anisi fructus), thujone (in Sage leaf, Salviae officinalis folium, Wormwood, Absinthii herba) or asarone (in Sweet flag rhizome, Calami rhizoma). For these ingredients and herbal drugs/herbal drug preparations which contain them, there are acceptable, limited daily intakes as well as recommendations for duration of use. Since pharmacist plays a key role in advising patients on the use of herbal products, including those containing compounds with a potential risk, it is very important to know the characteristics and proper use of these herbal products.

Prevalence and Correlates of the Use of Complementary and Alternative Medicine in Adults Living in a Rural Area.

There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world; however, previous research performed in Turkey has not focused on CAM use in rural areas. The present study was aimed at determining CAM use among people aged 18 years or older living in Balikesir, a province in the western part of Turkey, and the correlates of CAM use. This cross-sectional study was conducted in Balikesir between January 2015 and April 2015. The sample group was reached with multistage cluster sampling method. The study included 410 people who agreed to participate. Data were collected with the questionnaire developed by the researchers from the households through face-to-face interviews. The data were analyzed using the descriptive statistics, chi-square test, and logistic regression analysis. Of the participants, 87.3% reported that they had used CAM in the past 12 months. While 39.4% of them preferred herbal products, 25.7% reported that they used CAM due to chronic pain. The results of the logistic regression model demonstrated that CAM use was 4.23 times higher in the age group of those 44 years of age and older, 7.32 times higher among the women, 11.11 times higher among those who had junior high school or lower education, 9.76 times higher among the employed participants and 15.12 times higher among those who had chronic diseases. The results of the study revealed that nearly 9 of every 10 participants used CAM methods and that the most commonly used method was the use of herbal products.

Assessment of Inflammatory Bowel Disease and its Herbal Cure: A Review

Inflammatory bowel diseases (IBD) termed as chronic inflammatory disorders of the gastrointestinal tract distinct by episodes of reversion and decline. The two identified subtypes of the disease, ulcerative colitis and Crohn's Disease which differ in forms of clinical presentation. Environmental factors, including infections, diet, lifestyle factors, medication use have contributed to alterations in the global prevalence of the disease. Although the exact pathogenesis of IBD remains unknown, part of the underlying mechanism is a deregulated host immune response to intestinal flora, in genetically vulnerable Beings. The incidence of IBD is persistently rising in other earlier low incidence areas, such as Asia and the developing world. The annual frequency of CD is highest in North America (20.2 per 100, 000, per person-years); whereas the annual occurrence of UC is highest in Europe (24.3 per 100, 000 per person-years) Environmental risk factors of IBD is smoking, air water pollution, vitamin D, dietary, NSAID, stress. The newly described Th17 cells are also involved in the gut inflammatory answer in IBD. To understand the pathogenesis of IBD alternative model has been used such as zebrafish, c. elegans, Drosophila. The novel treatment of IBD such as vedolizumab, Etrolizumab, agents targeting specific pathways in IBD, but unfortunately possess life-threatening adverse effect and globally increased cost. This review also focuses on the favourable results from the use of herbal products in the treatment of IBD.

Herbal medicaments in endodontics - Current guidelines for in vivo studies in India.

Elimination of bacteria from infected root canal systems is a challenging task. Various techniques have been described to reduce the number of bacteria within the root canal system, which include chemomechanical instrumentation, use of various irrigants to remove or dissolve organic and inorganic debris, and to destroy bacteria. The intracanal medicament plays a key role in the success of root canal treatment. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. Natural products are known to play an important role in human life. The use of herbal products as mouthwash has been tried and tested in the literature. However, the use of herbal intracanal medicament has been shown promising results when used under in vitro conditions, but in vivo studies are very scarce. This may be due to the limited supporting literature available to use it as intracanal medicament in patients due to the ethical concern. Hence, the purpose of this review is to highlight the current guidelines (laid by the drugs and cosmetics act as per the Gazette of India) regarding the use of herbal medicaments for the clinical trials in endodontics.

<i>Phyllanthus emblica Linn.</i> (Amla) - A Natural Gift to Humans: An Overview

Medicinal plants are the precious gift of nature which plays vital role in healthcare system of developing nation and potent source of medicament to heal various diseases in the world. It plays a vital role to preserve our health. Medicinal plants are believed to be much safer. These days, the use of herbal products has become the foremost option for human all over the world because of curing treatment without any side effect. Ayurveda, the oldest health system in the world, provokes the uses amla to treat a host of diseases and promote positive health. It is a well-known fact that all parts of amla are useful in the treatment of various diseases. Among all, the most important part is fruit. Amla fruit is the richest source of vitamin C. Chemical composition of the amla fruit contains more than 80% of water. It also contains protein, carbohydrates, fiber, amino acids and minerals such as calcium, phosphorus, iron, niacin, carotene, thiamine, riboflavin etc. The chemical constituents present in the plant include tannins, gallic acid, ellagic acid, emblicol, phyllembin, lupeol, essential oil, fixed oil etc. Amla fruit is widely used as diuretic, laxative, liver tonic, antipyretic, hair tonic, ulcer preventive and for common cold, fever as alone or in combination with other plants. Research reports on amla reveals its analgesic, anti-tussive, cardioprotective, cytoprotective, immunomodulatory, chemopreventive, antioxidant, memory enhancing, anticancer, antidiabetic and some others properties. In this article, we review the morphology, distribution, nutritional value, chemical constituents, medicinal uses of amla.

Stavovi i navike pacijenata o korišćenju biljnih lekova

Objective. The aim of study was to examine the factors associated with the use of herbal drugs among patients in Serbia, as well as to assess the attitudes and habits of patients toward the use of herbal drugs. Methods. The study was designed as an observational, cross-sectional study. The research was conducted during February 2018 in six community pharmacies across the municipalities of Despotovac and Ćuprija. Study population consisted of adult volunteers of both genders and over 18 years of age who had purchased drugs in one of the six pharmacies involved in the study. Participants filled out the semi-structured questionnaires which had been specifically designed for purposes of this research. The questionnaire consisted of two parts. The first part comprised five questions relating to socio-demographic characteristics of participants, while the second part of the questionnaire was composed of eight questions concerning the use of herbal products. The study data were analyzed by descriptive and analytical statistics by SPSS statistical program. Results. There were 190 participants in total. The average age of the study subjects was 47.83 ± 15.9 years (the youngest was 18, while the oldest was 87 years old). Some form of herbal product was used by 145 (76.3%) participants. The most common reasons for the use of herbal drugs were common cold (22.6%), improving the digestion (8.9%), stimulation of immune system (7.5%), dermatological problems (7.5%), cough (4.8 %) and rheumatic complaints (4.8%). The most frequently participants gained information on use of herbal drugs from pharmacists (26.9%), from sources provided by Internet (21.0%), from their physicians (11.8%) and from family members and friends (10.8%). Of the total number 67.7% of participants considered herbal drugs to be completely safe for use. Slightly more than half of the study subjects (52.7%) gave information on using the herbal drug to their physicians. The binary logistic regression analyses showed that herbal drugs were more commonly used by younger women, with a higher school or university degree who prefer to use herbal medicines compared to other drugs. Conclusion. The results of our study have shown that herbal drugs had been more commonly used by younger women, with a higher school degree or university degree, and who declared that they preferred to use herbal drugs in relation to other drugs.

The Use of Indigenous Medicine Among Women During Pregnancy and Labour in Rural Ghana

The increasing use of herbal medicine and related products in pregnancy has been noticed all over the world, however, the safety of these medicines becomes particularly important among pregnant women and children. In spite of the insufficient data to justify herbal use during pregnancy, exposure to herbal products in unspecified quantities among pregnant women is of great concern. This study assessed the determinants of herbal use (Kaligu-tim), a known local oxytocin and its impact on the maternal birth outcomes in a rural district in Ghana. Descriptive cross-sectional study design was used. It consisted of 339 women attending postnatal care and child welfare clinics across the district. Data collection was done using a structured questionnaire. The selection of respondents was done using a systematic sampling technique. The data were coded and entered into SPSS version 22.0 for analysis. From the study, 64.9% and 45.4% of respondents had used local oxytocin in their previous and current pregnancies respectively; 5.5% did so during the first trimester, 26.8% in the second trimester and 67.7% in the third trimester. The study found a significant relationship between the use of herbal medicine and health service-related challenges, maternal age, the gestational term at delivery, parity of the respondents and mothers’ ethnicity. Previous and current use of Kaligu-tim reduced birth weight by 26g and 34.3g respectively, though these were not statistically significant. However, the previous history of Kaligu-tim was significantly associated with perinatal asphyxia, postpartum haemorrhage, obstructed labour and foetal distress in their subsequent deliveries. It can be concluded that the use of this Kaligu-tim possesses a greater long term health challenge for mothers and their babies.

Actual considerations of post-tonsillectomy case management

Despite the large number of studies and clinical observations on timely analgesia in the postoperative period, there are no clearly formulated views on the nature of the pain syndrome, and there are no modern protocols for the treatment of pain after tonsillectomy. The purpose of the study was to identify the effect of a homeopathic monocomponent herbal product Arnica Montana C9 (BUARON) on the condition of patients undergoing tonsillectomy. The article presents a study that was conducted in patients with chronic decompensated tonsillitis who were admitted to the Department of Otorhinolaryngology, Pavlov First Saint Petersburg State Medical University for planned surgery. Entered the results of the study into the developed computer database on a personal computer using tables 'Microsoft Excel'. Carried out the analysis and statistical processing of the obtained data using the software package Statistica for Windows v.10.0, determined the parameters of descriptive statistics. In accordance with the results of statistical analysis, it was found that the use of a homeopathic monocomponent herbal product Arnica Montana C9 (BOIRON) in patients after tonsillectomy leads to a reduction in treatment time compared to traditional therapy. The use of Arnica Montana C9 (BOIRON) can reduce the severity of pain in patients after tonsillectomy.

Traditional Chinese medicinal herbs for the treatment of idiopathic chronic fatigue and chronic fatigue syndrome

Chronic fatigue is increasingly common. Conventional medical care is limited in treating chronic fatigue, leading some patients to use traditional Chinese medicine therapies, including herbal medicine. To assess the effectiveness of traditional Chinese medicine herbal products in treating idiopathic chronic fatigue and chronic fatigue syndrome. The following databases were searched for terms related to traditional Chinese medicine, chronic fatigue, and clinical trials: CCDAN Controlled Trials Register (July 2009), MEDLINE (1966-2008), EMBASE (1980-2008), AMED (1985-2008), CINAHL (1982-2008), PSYCHINFO (1985-2008), CENTRAL (Issue 2 2008), the Chalmers Research Group PedCAM Database (2004), VIP Information (1989-2008), CNKI (1976-2008), OCLC Proceedings First (1992-2008), Conference Papers Index (1982-2008), and Dissertation Abstracts (1980-2008). Reference lists of included studies and review articles were examined and experts in the field were contacted for knowledge of additional studies. Selection criteria included published or unpublished randomized controlled trials (RCTs) of participants diagnosed with idiopathic chronic fatigue or chronic fatigue syndrome comparing traditional Chinese medicinal herbs with placebo, conventional standard of care (SOC), or no treatment/wait lists. The outcome of interest was fatigue. 13 databases were searched for RCTs investigating TCM herbal products for the treatment of chronic fatigue. Over 2400 references were located. Studies were screened and assessed for inclusion criteria by two authors. No studies that met all inclusion criteria were identified. Although studies examining the use of TCM herbal products for chronic fatigue were located, methodologic limitations resulted in the exclusion of all studies. Of note, many of the studies labelled as RCTs and conducted in China did not utilize rigorous randomization procedures. Improvements in methodology in future studies is required for meaningful synthesis of data.

Comparative effect of turmeric (Curcuma longa) and durba (Cynodon dactylon) on the healing of surgical wounds in cattle (Bos indicus)

Herbal preparations are used traditionally in wound management to promote wound healing process. In Bangladesh, there are limited researches on the use of herbal products to assist healing process. Therefore, this experiment was carried out to exploit turmeric (Curcuma longa) and durba (Cynodon dactylon) pastes in the treatment of surgical wounds in cattle and to study their healing effect on wound sutured with horizontal mattress using nylon. A total of 36 surgical wounds were made in six cattle. Tincture benzoin was used as control group. Follow-up information was recorded from day 0 to day 21 postoperatively. Some morphological characters such as swelling area of wound, elevation of sutured line from the skin surface, width of sutured area and contraction length per week were recorded to determine the healing process of the wounds. Bacteriological and histopathological studies were also performed. All wounds were closely monitored to observe any complications such as swelling, wound dehiscence, suture abscess, local infection and exudation etc. Results showed that Tr. Benzoin seal caused marked tissue reaction in wounds in comparison to turmeric and durba paste. Turmeric paste showed splendid results in the healing of the wounds produced in cattle. Durba paste also has wound healing activity but less effective than that of turmeric. This study could help veterinarians to consider herbal products especially turmeric for healing of wounds with minimum complications. Dissemination of these findings among the farmers may prevent skin degradation caused by the postoperative complications of the wound and thus improve the health status of livestock.Asian J. Med. Biol. Res. June 2018, 4(2): 164-171

Factors Associated With the Concomitant Use of Cardiovascular Drugs and Dietary Herbal Products: A Cross-Sectional Study.

Dietary herbal products taken together with prescription medicines may have harmful effects. In this study, we evaluated the use of dietary herbal supplements and identified factors that predict the concomitant use of these supplements in patients taking drugs prescribed for chronic cardiovascular diseases. We performed a cross-sectional study with 343 patients with cardiovascular diseases. Data regarding the sociodemographic status, medical condition, number of prescription drugs, and use of herbal supplements were collected using a self-administered questionnaire. Regular use of dietary herbal supplements was reported by 82.5% of patients. The most commonly consumed herbal supplement was garlic (71.2%), followed by onion (67.1%), and walnut (63.6%). Consumption of herbal supplements was commonly observed in patients with hypertension (53.6%). Among the patients in the study, 21.3% patients reported consumption of herbal supplements to the physician. Results of multivariable analysis showed that body mass index (odds ratio [OR] = 0.890, 95% confidence interval [CI] = 0.826-0.960), heart failure (OR = 0.325, 95% CI = 0.142-0.742), coronary artery disease (OR = 0.162, 95% CI = 0.069-0.379), smoking (OR = 3.852, 95% CI = 1.194-12.433), hypertension (OR = 10.584, 95% CI = 4.648-24.103), and dysrhythmia (OR = 9.339, 95% CI = 2.035-42.853) were associated with the use of dietary herbal supplements. Our results showed that dietary herbal supplements were commonly used by patients with chronic cardiovascular diseases. Therefore, understanding the interactions between the herbal supplements and drugs is necessary for minimizing adverse reactions.

Aile hekimleri ve eczacıların bitkisel ürün kullanımına yaklaşımları: Trabzon i̇linde pilot çalışma

Aile hekimleri ve eczacıların bitkisel ürün kullanımına yaklaşımları: Trabzon i̇linde pilot çalışma

Assessment of the credibility of public websites about medicinal herbs

In recent decades, there has been a growing interest in the use of herbs and herbal medicinal products, both in developing and developed countries. While electronic medium has become a more and more important tool for presenting information about health-related issues, several studies demonstrated that the internet often contains inaccurate and/or misleading information. In our study we assessed 30 Hungarian websites and 2 cellphone applications intended for public use and evaluated the quality and credibility of the information presented about medicinal plants recommended. It was found that websites showed very diverse safety: most websites gave mixed information, that is, some medicinal herbs and their potential hazard were properly described, while others were not. There were, however, websites, which completely missed to give information about any potential hazard. As credibility of public websites can be in most cases questioned, it is strongly recommended for potential users to consult more than one source of information.

Aqueous terminalia arjuna extract induced differential protein expression in hypercholesterolemic rabbits: A proteomic based study

Aim: Atherosclerosis is the major cause of mortality worldwide. Much attention has been focused on the use of herbal products to cure this disease. Hence the present study was designed to evaluate cardio-protective effect of aqueous Terminalia arjuna extract (TAE) on different proteins in hypercholesterolemic rabbits using proteomic approach.

Herbal Products Use During Pregnancy in North of Iran

Objectives: The use of herbs which has been increasing worldwide, requires special considerations particularly in pregnant woman. The present study was conducted at Alzahra Teaching hospital (from March 2016 to August 2017) to explore the pattern of herbal use during pregnancy in Guilan province (North of Iran). Materials and Methods: Data were obtained from 836 eligible women, who were interviewed at postnatal ward, and were analyzed. Results: The results of the study showed that 19.6% of the women consumed herbs during pregnancy. The most commonly used herbs included mint, flixweld, and cinnamon; in addition, the most prevalent indications resulted from these herbs consumption were gastrointestinal complications and cold. The rate of herbal consumption in pregnancy was related to education (P=0.001) and resistance (P=0.008); however, no relation was found regarding age (P=0.203), employment (P=0.255), or gravity (P=0.935). Conclusions: Although the findings of this study were preferable to those of some other studies, due to the importance of the issue, it is vital that health care providers to be open to question the herbal use during pregnancy.

GC- MS, FTIR, UV Analysis and in vitro Antioxidant Activity of a Nigeria Poly Herbal Mixture: Pax Herbal Bitters

Objective: The use of herbal products by the majority is primarily based on the belief that herbal drugs are safe, without any side effects, accessible and available at minimal cost. However, there is need for quality assurance of the botanicals in these products in order to meet the demands of product quality and efficacy. In this study, we aimed at identifying the chemical compositions of Pax herbal bitters towards a better understanding of its pharmacological claims. Methods: Pax herbal bitters purchased from licensed pharmacies in Nigeria was extracted separately with n-Hexane, Dichloromethane (DCM) and methanol. DPPH radical scavenging activity, total phenolic and total flavonoid content analysis of the various extracts were carried out. Chemical analysis of the extracts was also done using GC-MS, FTIR and UV. Results: The DPPH radical scavenging antioxidant activity showed highest activity in the DCM extract with an IC50 of 0.0167 while the total phenolic and total flavonoid content expressed as galic acid equivalents were found to be 20.00±0.23 and 2.55±0.01 for the methanol extract respectively and 5.39+ 0.01 and 2.54+ 0.14 for the DCM extract. The GC-MS, FTIR, and UV-VIS results showed that the herbal preparation contained compounds which may offer great pharmacological values. Some of the identified compounds include Isoborneol (0.61%, antioxidant, neuroprotective), Terpinen-4-ol (4.54%, anti-inflammatory, anti-fungi), 2, 4-Ditertbutylphenol (4.61% antioxidant, antifungi), Caryophyllene (9.33%, anti-inflammatory, anticancer), Isospathulenol (2.14%, immune-inhibitory), shogaol (15.16%, anti-cough, memory enhancer) and p-Heptylacetophenone (9.435%, anti-allergic). Conclusion: This study provides chemical basis for some of the claimed pharmacological actions of Pax herbal bitters.

Concurrent use of prescription drugs and herbal medicinal products in patients with diseases of the musculoskeletal system and connective tissue

Objective The concurrent use of prescription drugs and herbal medicinal products (HMPs) for the management of various disease are increasing. Many HMPs have been used to treat the common health complaints involved the musculoskeletal system and connective tissue. Therefore, we analyzed the extent of concurrent use of prescription drugs and HMPs in patients with diseases of the musculoskeletal system and connective tissue. Methods This study was conducted using the National Health Insurance Service–National Sample Cohort (NHIS-NSC), which consists of representative anonymized data extracted from national health insurance records pertaining to about 1,000,000 subjects from 2002 to 2013. The insured HMPs were 56 kinds of single herbal extracts and 67 kinds of mixed herbal extracts in Republic of Korea. Continuous variables were summarised by the means (and SDs) and categorical variables were summarised by proportions (%). Univariate and multivariable Statistical significance was defined as P Results The diseases of the musculoskeletal system and connective tissue accounted for the top 10 ranking concurrent use of prescription drugs and HMPs. The most frequently co-prescribed drugs were Antipyretics (or Analgesics, or Anti-inflammatory) and Ojeok-san (Wuji-san in China, Goshaku-san in Japan). The concurrent use rate in the elderly over the age of 65 is higher than the sum of all under 64-years-old. Conclusions The concurrent use rate in diseases of the musculoskeletal system and connective tissue was high. Potential herb-drug interaction is a clinical concern, with older people at greater risk. Further studies on the benefit and risk of concurrent use are needed.

Histopathological alterations in mice under sub-acute treatment with Hintonia latiflora methanolic stem bark extract.

The indiscriminate use of herbal products is increasingly growing worldwide; nonetheless consumers are not warned about the potential health risks that these products may cause. Hintonia latiflora (Hl) is a tree native to the American continent belonging to the Rubiaceae family and its stem bark is empirically used mainly to treat diabetes and malaria; supplements containing Hl are sold in America and Europe without medical prescription, thus scientific information regarding its toxicity as a consequence of a regular consumption is needed. In the present study, the histopathological effect of 200 and 1000 mg/kg of HI methanolic stem bark extract (HlMeOHe) was evaluated in the small bowel, liver, pancreas, kidneys and brain of CD-1 male mice after oral sub-acute treatment for 28 days. No histopathological alterations were observed in the brain and small bowel of the treated animals; however, mice presented diarrhea from day 2 of treatment with both doses. No histological changes were observed in the tissues collected from the animals treated with 200 mg/kg, except for the liver that depicted periportal hepatitis. Animals treated with the higher dose showed in the liver sections hydropic degeneration, hepatitis and necrosis, kidney sections depicted tubular necrosis and in pancreas sections, hydropic degeneration of the pancreatic islets was observed. In conclusion, HlMeOHe damaged the liver with an oral dose of 200 mg/kg, and at 1000 mg/kg injured the kidneys and pancreas of the CD-1 male mice.

Prescription patterns and characteristics of users of Chinese herbal products in the US: Analysis of a teaching center prescription database

Ethnopharmacological relevanceWe know little about US use of Chinese herbal products (CHP). Aim of the study: To understand CHP users’ sociodemographic characteristics, CHP indications for use, and prescribing patterns in an acupuncture teaching center in the United States. Materials and methodsRetrospective chart review and descriptive statistics. ResultsCHP users were mostly female and white with at least a college education. The most common main complaint for CHP treatment was genitourinary system. Most of the CHP users were given thirteen different herbs per prescription, and the mean number of herbs per CHP prescription was twelve. The most common dosing frequency was twice a day (BID) and the most common duration of prescription was seven days. Dang Gui / Angelicae sinensis (Oliv.) Diels was the most frequently prescribed Chinese herb. ConclusionWe identified CHP users’ sociodemographic characteristics and CHP prescription patterns in a teaching center in the United States. Future studies will focus on safety and the adverse effect of CHP.