World Health Organization Monograph Research Articles

Monograph on the Use of Herbs to Address Metabolic Syndrome

IntroductionMetabolic syndrome is a collection of symptoms that have become an issue on a global scale. While allopathic medicine can address the downstream symptoms, the metabolic pathways that are the root cause of the syndrome can be managed using herbs. MethodsCriteria for the syndrome were set by the World Health Organization. Suggested herbs are taken from World Health Organization monographs, the British Pharmacopoeia, the United States Pharmacopoeia and the National Formulary, the Ayurvedic Pharmacopoeia, the Pharmacopoeia of the People's Republic of China, and the Japanese Pharmacopoeia. Herbs are cross-referenced with the primary literature when possible. Dietary recommendations and supplements are mentioned tangentially; however, they are not the intended focus of this monograph. ResultsHyperglycemia is considered a principal component and driver of metabolic syndrome. Insulin resistance, glycolysis, and insulin production can all be affected by herbs. Lipid metabolism occurs primarily in the liver; liver function can be enhanced using herbs. Inflammation caused by a hyperglycemic state can also be managed using herbs and reduced the progression of associated diseases. Since glycolysis and energy production occur in the mitochondria, supporting mitochondrial health with herbs is critical to positively affecting metabolic syndrome. ConclusionsBy using herbs to manage hyperglycemia, inflammation, liver congestion, and mitochondrial health, metabolic syndrome can be slowed, stopped, or even reversed.

Andrographis paniculata Dosage Forms and Advances in Nanoparticulate Delivery Systems: An Overview.

Andrographis paniculata is a well-known Asian medicinal plant with a major phytoconstituent of diterpene lactones, such as andrographolide, 14-deoxyandrographolide, and neoandrographolide. A World Health Organization (WHO) monograph on selected medicinal plants showed that A. paniculata extracts and its major diterpene lactones have promising anti-inflammatory, antidiabetic, antimalarial, anticancer, antifungal, antibacterial, antioxidant, and hypoglycemic activities. However, these active phytochemicals have poor water solubility and bioavailability when delivered in a conventional dosage form. These biological barriers can be mitigated if the extract or isolated compound are delivered as nanoparticles. This review discusses existing studies and marketed products of A. paniculata in solid, liquid, semi-solid, and gaseous dosage forms, either as an extract or isolated pure compounds, as well as their deficits in reaching maximum bioavailability. The pharmaceutics and pharmacological activity of A. paniculata as a nano-delivery system are also discussed.

Characterization and Comparison Analysis of WHO Monographs on Selected Medicinal Plants and ISO Standards of Chinese Materia Medica.

Medicinal plants or Chinese materia medica (CMM) are now attracting worldwide attention as they have increasingly prominent advantages over chemical drugs in disease treatment and healthcare. Since the 1990s, World Health Organization (WHO) and International Organization for Standardization established the Technical Committee of Traditional Chinese Medicine (ISO/TC 249) have carried out the development of quality standards on medicinal plants or CMMs respectively, and a considerable number of monographs and international standards have been published. Since the two international organizations adhere to different principles, the standards they develop naturally have different emphasis. Driven by market demand and international trade, ISO mainly takes quality, efficacy and safety into consideration when developing standards, while WHO pays more attention to clinical practice, quality control and medication guidance. Up to now, there is a lack of comparative analysis on the records, background, principles, basic content, and main requirements of quality standards on medicinal plants or CMMs respectively published by WHO and ISO. Therefore, based on international standards of CMM developed by ISO/TC 249 platform and WHO Monographs on Selected Medicinal Plants, this paper systematically compares the purposes, selected principles, standard-developing process, basic content, and main quality requirements to summarize their similarities and differences, and find their merits, aiming to serve as a reference to the development of international standards for CMMs that helps them go global.

A Case of Unclassified Malignant Pleomorphic Tumor of the Gingiva

Unclassified/undifferentiated sarcomas are defined by the 2013 World Health Organization monograph as a heterogeneous group of sarcomas without evidence of a specific line of differentiation. Notably, malignant soft tissue tumors of the head and neck are extremely rare. We report a rare case of an unclassified malignant pleomorphic tumor of the gingiva.

Ethnobotanical Study of Cultivated Plants in Kaišiadorys District, Lithuania: Possible Trends for New Herbal Based Medicines.

Background Despite the growing body of ethnobotanical studies in Europe, publications are scarce in Lithuania. Ethnobotanical study in Kaišiadorys district is one of the few from this field done in Lithuania. Lithuania is divided into five ethnographic regions, and Kaišiadorys district is an area which borders with the three of them (Aukštaitija, Dzūkija, and Suvalkija), which determines the ethnographic distinctiveness of the area. The aim of this study was to determine the occurrence of cultivated medicinal plants, their families and pharmaceutical forms used in Kaišiadorys district, Lithuania, and to assess the conformity of medicinal plant materials used by respondents with the recommendations for medicinal plant materials in the World Health Organization monographs. MethodsThe field work was conducted in periods of time from July 2016 to October 2017. During this ethnobotanical research, 30 people were interviewed, 25 of whom agreed to communicate. The average age of respondents was 65 years. Information was collected using semistructured and structured interviews. The obtained information was recorded indicating ethnic names of plants, their preparation techniques, parts used, modes of administration, and application for therapeutic purposes. Results Respondents mentioned 71 species of cultivated medicinal plants from 38 families, used for therapeutic purposes and indicated which parts of the plant they use, how they prepare them, indications for use, and ways of administration. The most commonly cited families were Asteraceae (20.5%), Lamiaceae (13.9%), and Apiaceae (12.8%); most popular plants, cited more than 20 times, were Tilia cordata L., Matricaria recutita L., Calendula officinalis L., Carum carvi L., and Artemisia absinthium L. The frequently used plant parts were flowers (mentioned 35.8%), leaves (16.3%), roots and tubers (16.1%), herb (14.8%), and seeds (7.0%). Diseases most frequently treated were digestive (21.5% of citations), respiratory (21.3 % of citations), mental and behavioral (11.0%) disorders, certain infections and parasitic diseases (10.1%), and diseases of genitourinary system (9.1%). Conclusions Only 19 of the cultivated medicinal plant species mentioned by interviewed persons are described in the World Health Organization monographs. This means that the remaining 52 species are used without the World Health Organization approved medical indications, based solely on the folk medicine knowledge and experience. This study showed that the folk use of plants is strongly rooted in daily practice in the studied area.

Nowe surowce roślinne w Farmakopei Europejskiej. Cz. 2. Rozwar wielkokwiatowy (Platycodon grandiflorus) – źródło nowego surowca saponinowego

In the one of the last supplements to the European Pharmacopoeia (Supl. 9.4) figures several herbal medicinal raw materials, so far unknown and not used in official Central European phytotherapy. In the first part of planed article series, the therapeutic values of species from Bupleurum genus, which are a new saponin providing raw materials, were presented. The second part is devoted to the botanical, ecological and chemical characteristics of Platycodon grandiflorus (balloon flower). This species also provides the new saponin raw material – Platycodi radix. The major part of the article is concerned to the review of different therapeutic applications of that raw material confirmed by the scientific researches. In the article the well established use in the traditional chinese medicine was emphasized. Moreover, the attention was paid also on the fact, that for about 20 years, plant has had the World Health Organization (WHO) monograph. In addition, the importance of the plant in the food and cosmetic industry was pointed. The aim of the article is familiarization with the basic knowledge about this species in the pharmaceutical and medical environment.

Nowe surowce roślinne w Farmakopei Europejskiej. Część I. Gatunki rodzaju Bupleurum (przewiercień) – źródło nowego surowca saponinowego

One of the last supplements to the European Pharmacopoeia (Supl. 9.4) introduces several new herbal medicinal raw materials, so far unknown and not used in official Central European phytotherapy. The article describes plant species from Bupleurum genus providing new saponin raw material. The botanical and ecological characteristics as well as the current state of research on the chemistry of pharmacopoeial species from that genus were presented. The confirmed by scientific researches therapeutic applications of plant raw material – Bupleuri radix, were described particularly. Attention was paid to the position of that raw material in Traditional Chinese Medicine (TCM). It was emphasized that for about 20 years, it has had the World Health Organization (WHO) monograph. In addition, the importance of this plant in the food industry and its increasing status in the cosmetic industry were pointed. The aim of the article is the popularization of basic knowledge about pharmacopoeial species from Bupleurum genus in the Polish pharmaceutical, medical and phytotherapeutical environment.

Addiction Lives: Ingeborg Rossow.

Addiction Lives: Ingeborg Rossow.

Retrospective Review of 95 Renal Cell Carcinomas Considering New Classification and Emerging Concepts

Introduction: Current classification of renal cell carcinoma (RCC) is outlined in the 2004 World Health Organization monograph. The diagnostic concepts continue advancing to keep up with the development of targeted therapies. In this study, we reviewed 95 cases diagnosed as RCC from 1998 to 2005. The study compared the new diagnoses with the original ones to determine …

How I treat mixed-phenotype acute leukemia

AbstractMixed-phenotype acute leukemia (MPAL) encompasses a heterogeneous group of rare leukemias in which assigning a single lineage of origin is not possible. A variety of different terms and classification systems have been used historically to describe this entity. MPAL is currently defined by a limited set of lineage-specific markers proposed in the 2008 World Health Organization monograph on classification of tumors of hematopoietic and lymphoid tissues. In adult patients, MPAL is characterized by relative therapeutic resistance that may be attributed in part to the high proportion of patients with adverse cytogenetic abnormalities. No prospective, controlled trials exist to guide therapy. The limited available data suggest that an “acute lymphoblastic leukemia–like” regimen followed by allogeneic stem-cell transplant may be advisable; addition of a tyrosine kinase inhibitor in patients with t(9;22) translocation is recommended. The role of immunophenotypic and genetic markers in guiding chemotherapy choice and postremission strategy, as well as the utility of targeted therapies in non–Ph-positive MPALs is unknown.

Patients with biopsy-proven nephrosclerosis and moderately impaired renal function have a higher risk for cardiovascular disease: 15 years' experience in a single, kidney disease center.

Nephrosclerosis progresses slowly to end-stage renal disease (ESRD) in only a small percentage of patients. However, because hypertension and nephrosclerosis are normally found simultaneously, nephrosclerosis is a risk factor for cardiovascular disease (CVD). In turn, the onset of CVD may progress to further renal impairment. To evaluate clinical outcomes and the association between nephrosclerosis and CVD in the long term. Prospective study We prospectively assessed 35 patients (male/female: 19/16) with nephrosclerosis aged >30 years at disease onset, attending the Kidney Disease Center, Saitama Medical University, in a single teaching hospital center between 1995 and 2014. Nephrosclerosis was diagnosed in accordance with the criteria outlined in the World Health Organization (WHO) monograph of renal diseases. All patients were followed by means of registries for 10 years to record subsequent events, if any. The primary study outcome was correlating the occurrence of CVD, defined as a composite of cardiovascular deaths, nonfatal and fatal myocardial infarction, and stroke, with the development of ESRD or death. The mean age of patients at the time of biopsy was 54.8 ± 12.7 years (range 33-72 years). Of these patients, seven were affected by nonfatal CVD and two died due to CVD. Only one patient developed ESRD during the follow-up period. Using Kaplan-Meier analysis, risk factors for the primary study outcome were estimated to include an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m(2), systolic blood pressure > 130 mmHg and proteinuria > 1 g/g creatinine. Univariate analysis was used for the assessment of the relative risk for the primary study endpoint of several covariates: age, systolic blood pressure, eGFR and proteinuria at time of renal biopsy. eGFR was found to be the strongest factor determining an event-free period [relative risk (RR) =1.931, p = 0.014]. Patients with nephrosclerosis are at high risk of CVD when they have moderately advanced renal impairment.

Mixed phenotype acute leukemia

Mixed phenotype acute leukemia

English

Herbal products have become increasingly popular throughout the world; one of the impediments in its acceptance is the lack of standard quality control profile. This research was conducted to standardize Roselle (Hibiscus sabdariffa) cultivated in Sudan. For this purpose, world health organization (WHO) monograph for medicinal plants was used to assess certain particulars of the plant including macro and microscopical characters, physical and chemical characteristics. Results obtained revealed that the macro and microscopical characters of H. sabdariffa were in accordance to those specified in WHO monographs. Results of purity tests were obtained as (16.3) water soluble extractive value (21.4%), 70% ethanol soluble extractive, (11.7%) the total ash, (3.8%) acid insoluble ash values and (8.5%) moisture content, respectively whereas value of foreign materials were calculated to be 2%. The heavy metal lead in the plant sample tested was found to be below the permissible limit (10 mg/kg) and the plant was found to be free from bacterial contamination. The high performance liquid chromatography (HPLC) analysis of H. sabdariffa revealed the presence of quercetin as a major phytoconstituent in a total content of 12.96%. It can be concluded that the obtained data of H. sabdariffa could be taken as guidelines in its quality assessment and will contribute positively to establish standards for the quality assessment of herbal products in Sudan. Key words: Standardization, herbal medicine, Hibiscus sabdariffa.

The myeloproliferative neoplasms including the eosinophilia-related myeloproliferations associated with tyrosine kinase mutations: changes and issues in classification and diagnosis criteria

The classification and diagnostic criteria of the myeloproliferative neoplasms have changed significantly in the 2008 World Health Organization monograph on the classification of hematologic malignancies. Many of the changes arose from the findings that the different malignancies are associated with abnormal cell signaling because of translocations or mutations in genes for protein tryosine kinases involved in the normal growth and regulation of hematopoietic cells. These include ABL1, PDGFRA, PDGFRB, FGFR1, JAK2, MPL, and KIT. The new classification attempts to reflect the related molecular pathogenesis of the different entities and incorporates the identification of the molecular defects into the diagnostic criteria for some of the individual diseases. Issues concerning the new classification are discussed, and the new diagnostic criteria are reviewed and commented upon.

World Health Organization Monographs on Selected Medicinal Plants

Focus on Alternative and Complementary TherapiesVolume 5, Issue 2 p. 159-159 World Health Organization Monographs on Selected Medicinal Plants E Ernst, E Ernst Exeter, UKSearch for more papers by this author E Ernst, E Ernst Exeter, UKSearch for more papers by this author First published: 14 June 2010 https://doi.org/10.1111/j.2042-7166.2000.tb02454.xCitations: 1Read the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume5, Issue2June 2000Pages 159-159 RelatedInformation

INCAP Studies of Nutrition and Infection

As soon as the Institute of Nutrition of Central America and Panama (INCAP) began to study the poor nutritional status and stunting of children in the rural villages of Central America, it was apparent that infections, particularly diarrheas, were also a serious problem. Studies of kwashiorkor indicated that infections precipitated kwashiorkor and anemia in children who were already malnourished. In the 1940s there was almost no suggestion in the literature of a relation between nutrition and infection. INCAP gradually identified the mechanisms by which any infection worsens nutritional status and demonstrated that infections were more severe and more often fatal in malnourished children and adults. These studies ultimately led to the 1968 World Health Organization (WHO) monograph "Interactions of nutrition and infection" and widespread recognition by public health workers of the importance of this relationship for morbidity and mortality in poorly nourished populations.

The Many Faces and Mimics of Papillary Thyroid Carcinoma

This article provides an overview of the 15 histologic variants of papillary thyroid carcinoma listed by the 2004 World Health Organization (WHO) monograph on endocrine tumors. The histologic features, differential diagnosis, and clinical course of each variant are discussed in some detail. The follicular variants (conventional and macrofollicular) constitute a morphologic challenge because the majority of these tumors are encapsulated and, also, because, in many tumors, not all neoplastic cells show the nuclear features considered to be diagnostic of papillary carcinoma. As a result, most of these tumors are missed even by experienced pathologists. Moreover, hyperplastic thyroid lesions, follicular adenomas, and Hashimoto's thyroiditis may contain cells with clear nuclei resembling those of papillary carcinoma. Papillary carcinomas composed entirely of hyperchromatic cells have been overlooked. The WHO monograph defines papillary carcinoma with focal spindle and giant cell carcinoma components but its clinical behavior is unknown. Papillary carcinoma with an insular pattern that does not show the artifactual separation of the cell nests has been misinterpreted as the solid variant of papillary carcinoma. Papillary microcarcinomas include not only the conventional type and the follicular variants but also the tall cell and columnar cell variants.

Echinacea angustifoliain Rhinovirus Infections

to the editor: The trial by Turner et al. (July 28 issue) 1 could have benefited from the inclusion of additional treatment groups with higher daily doses of echinacea. The dose equivalent of 900 mg of dried root derives from the German Commission E monograph for Echinacea pallida root, a different species from E. angustifolia. 2 E. angustifolia root is not officially approved and thus has no recommended dosage in Germany, owing to a lack of sufficient supporting data. The 1999 World Health Organization monograph on E. angustifolia root cites a 3-g daily dose, which is 330 percent of the dose used in this trial. 3 The 3-g daily dose is also recommended by the Canadian Natural Health Products Directorate. 4

Japan: Status of Cancer Pain and Palliative Care

Japan: Status of Cancer Pain and Palliative Care

Dietary supplement survey of pharmacists: personal and professional practices.

To survey pharmacists about personal/professional practices regarding dietary supplements, specifically personal use and recommendation patterns, reference usage, and desired computerized decision-support features. Anonymous, self-administered survey. National pharmacy association meeting. Practicing pharmacists who answered questions about dietary supplements. Acceptability of specific references, desired features in computerized decision support, frequency of personal use, and recommendations to patients, family, or friends. Seventy (70) pharmacists completed the survey. A majority (52.9%) reported taking dietary supplements including echinacea, zinc, and chromium picolinate. Fewer than half of pharmacists stated they have recommended a dietary supplement to a patient. Pharmacists stated that the top information sources were: published clinical trials, allopathic health care providers, alternative medicine practitioners, and word of mouth. The Internet was an important source for recommendations although not for personal use. The most highly accepted (>70%) print references included The Review of Natural Products and the World Health Organization Monographs on Selected Herbal Products. More than 90% rates the ability to view reference citations and computerized alerts on drug-dietary supplement interactions "very important" or "important". Interest was high in accessing computerized monographs. Pharmacists are self-educating about dietary supplements. Among pharmacists surveyed, there was some consensus as to which references were acceptable. There is a demand for dietary supplements information to be included in pharmacy computer systems, specifically to check for interactions against the patient's.drug profile. Although practitioners in Western and alternative medicine, as well as journal articles, are preferred information sources, the Internet and word of mouth are also important sources. Personal use of dietary supplements correlated with a twofold increase in the likelihood that a pharmacist would recommend a dietary supplement to a patient.