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PURPOSE: To investigate the role of non-pharmaceutical therapies on disease activity in rheumatoid arthritis through systematic review and meta-analysis. METHODS: A review of Pubmed, EMBASE, Web of Science, and the Cochrane Library was performed from inception until March 26, 2019. Only randomized controlled trials which assessed oral, non-pharmacological interventions (e.g. diets, vitamins, oils, herbal remedies, fatty acids, supplements, etc.) in adult patients with rheumatoid arthritis, that presented clinically-relevant outcomes (defined as pain, fatigue, disability, joint counts, and/or disease indices) were included in our meta-analysis. Data were analyzed as mean differences between active and placebo and forest plots were performed. Heterogeneity was evaluated using I-squared statistics while funnel plots and Cochrane's risk of bias assessment evaluated bias. RESULTS: 8170 articles were identified in the search and 51 were RCTs were included. The mean difference in DAS28 was significantly improved in experimental group treated with diet (-0.46 [-0.91, -0.02], p = 0.04), zinc sulfate, copper sulphate, selenium, potassium, lipoic acid, turmeric, pomegranate extract, chamomile, and cranberry extract supplements (-0.77 [-1.17, -0.38], p < 0.001), A, B6, C, D, E, and K vitamins (-0.52 [-0.74, -0.29], p < 0.001), and fatty acids (-0.19 [-0.36, -0.01], p = 0.03). Other clinical metrics such as SJC, TJC, HAQ, SDAI, ACR20, and self-reported pain were decreased in the treatment groups. There was significant reporting bias in the studies. CONCLUSION: Some non-pharmacological therapies may modestly improve some clinical outcomes in patients with rheumatoid arthritis. Many identified studies lacked full reporting. Further clinical trials that are well-designed, adequately powered, and sufficiently report ACR improvement criteria or EULAR response criteria outcomes are needed to confirm the efficacy of these therapies.

OBJECTIVES: The therapeutic use of nutrient-based 'nutraceuticals' and plant-based 'phytoceuticals' for the treatment of mental disorders is common; however, despite recent research progress, there have not been any updated global clinical guidelines since 2015. To address this, the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Disorders (CANMAT) convened an international taskforce involving 31 leading academics and clinicians from 15 countries, between 2019 and 2021. These guidelines are aimed at providing a definitive evidence-informed approach to assist clinicians in making decisions around the use of such agents for major psychiatric disorders. We also provide detail on safety and tolerability, and clinical advice regarding prescription (e.g. indications, dosage), in addition to consideration for use in specialised populations. METHODS: The methodology was based on the WFSBP guidelines development process. Evidence was assessed based on the WFSBP grading of evidence (and was modified to focus on Grade A level evidence - meta-analysis or two or more RCTs - due to the breadth of data available across all nutraceuticals and phytoceuticals across major psychiatric disorders). The taskforce assessed both the 'level of evidence' (LoE) (i.e. meta-analyses or RCTs) and the assessment of the direction of the evidence, to determine whether the intervention was 'Recommended' (+++), 'Provisionally Recommended' (++), 'Weakly Recommended' (+), 'Not Currently Recommended' (+/-), or 'Not Recommended' (-) for a particular condition. Due to the number of clinical trials now available in the field, we firstly examined the data from our two meta-reviews of meta-analyses (nutraceuticals conducted in 2019, and phytoceuticals in 2020). We then performed a search of additional relevant RCTs and reported on both these data as the primary drivers supporting our clinical recommendations. Lower levels of evidence, including isolated RCTs, open label studies, case studies, preclinical research, and interventions with only traditional or anecdotal use, were not assessed. RESULTS: Amongst nutraceuticals with Grade A evidence,

BACKGROUND: Dysmenorrhoea refers to painful menstrual cramps and is a common gynaecological complaint. Conventional treatments include non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs), which both reduce myometrial activity (contractions of the uterus). A suggested alternative approach is dietary supplements. We used the term 'dietary supplement' to include herbs or other botanical, vitamins, minerals, enzymes, and amino acids. We excluded traditional Chinese medicines. OBJECTIVES: To determine the efficacy and safety of dietary supplements for treating dysmenorrhoea. SEARCH METHODS: We searched sources including the Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO (all from inception to 23 March 2015), trial registries, and the reference lists of relevant articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of dietary supplements for moderate or severe primary or secondary dysmenorrhoea. We excluded studies of women with an intrauterine device. Eligible comparators were other dietary supplements, placebo, no treatment, or conventional analgesia. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, performed data extraction and assessed the risk of bias in the included trials. The primary outcomes were pain intensity and adverse effects. We used a fixed-effect model to calculate odds ratios (ORs) for dichotomous data, and mean differences (MDs) or standardised mean differences (SMDs) for continuous data, with 95% confidence intervals (CIs). We presented data that were unsuitable for analysis either descriptively or in additional tables. We assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS: We included 27 RCTs (3101 women). Most included studies were conducted amongst cohorts of students with primary dysmenorrhoea in their late teens or early twenties. Twenty-two studies were conducted in Iran and the rest were performed in other middle-income countries. Only one study address

Primary dysmenorrhea is one of the most common complaints among young women. This study aimed to evaluate the effects of chamomile and 1-theanine beverage intake on menstrual symptoms, pain intensity, mood, and sleep quality in young adult females with primary dysmenorrhea, using a two-phase continuous study design. In the first phase, a cross-sectional study was conducted to assess the prevalence of primary dysmenorrhea. In the second phase, participants were randomly assigned to either the intervention group (n = 15), which consumed chamomile and 1-theanine beverage (CTT), or the control group (n = 15), which consumed chamomile-flavored beverage (non-CTT). Beverages were consumed daily for five consecutive days, starting two days before the expected onset of menstruation and continuing through the first three days of menstruation. Compared to baseline values, consumption of CTT significantly reduced ( p < 0.001) visual analog scale and numerical rating scale values by 57.17% and 55.46%, respectively. Additionally, CTT intake led to significant reductions ( p < 0.05) in the severity of lower abdominal pain, loss of appetite, backpain, complexation, stomachache, body pain, depression, and irritability by 52.86%, 47.24%, 56.29%, 31.03%, 43.14%, 42.52%, 49.46%, 45.11%, respectively. CTT consumption also significantly decreased ( p < 0.05) daytime dysfunction by 31.97% compared to baseline. Meanwhile, non-CTT consumption significantly reduced ( p < 0.05) the severity of complexation, neuroticism, and confusion in the control group. The CTT beverage could be a potential alternative for managing primary dysmenorrhea. Further studies with longer durations are warranted to assess its potential long-term physiological effects.

OBJECTIVE: To investigate the effect of sertraline hydrochloride combined with compound chamomile lidocaine gel in the treatment of premature ejaculation (PE). METHODS: We selected 80 cases of PE treated in our hospital from June 2021 to May 2023 and equally randomized them into a control and an observation group, the former medicated with compound chamomile lidocaine gel while the latter with sertraline hydrochloride in addition, both for 6 weeks. We recorded and compared the intravaginal ejaculation latency time (IELT), the number of successful sexual intercourses per week, the Premature Ejaculation Diagnostic Tool (PEDT) scores, and the incidence of adverse reactions between the two groups of patients. RESULTS: After the treatment, the IELT was significantly longer (［5.39 ± 1.17］ vs ［2.49 ± 0.73］ min, P< 0.05), the weekly number of successful sexual intercourses remarkably higher (1.82 ± 0.45 vs 0.93 ± 0.19, P< 0.05) and the PEDT scores markedly lower (7.42 ± 2.04 vs 9.85 ± 2.36, P< 0.05) in the observation than in the control group, but no statistically significant differences were observed in the baseline PEDT scores or the incidence of adverse reactions between the two groups (P> 0.05). CONCLUSION: Sertraline hydrochloride combined with compound chamomile lidocaine gel is definitely effective in the treatment of PE, which can significantly improve the patients' quality of sexual life, with a high safety and low incidence of adverse reactions.

BACKGROUND: Diabetic neuropathy, a prevalent complication of diabetes mellitus, significantly impairs quality of life due to chronic pain and sensory deficits. Conventional pharmacotherapies, while effective, are often limited by systemic adverse effects. Chamomile (Matricaria chamomilla L.) oil, renowned for its anti-inflammatory, antioxidant, and analgesic properties, presents a promising topical alternative for mitigating neuropathic symptoms. OBJECTIVE: This study aimed to evaluate the efficacy of topical chamomile oil in improving neuropathy indices among patients with controlled diabetes, as measured by validated clinical tools. METHODS: A randomized, double-blind, placebo-controlled trial was conducted involving 72 participants with diabetic neuropathy. Participants were allocated to either the intervention group (chamomile oil) or the control group (placebo), with both groups continuing standard gabapentin therapy. Neuropathy outcomes were assessed using Neurothesiometer scores, the Michigan Neuropathy Screening Instrument (MNSI), and the DN4 questionnaire at baseline and post-intervention. ANCOVA was employed to analyze intergroup differences, adjusting for baseline covariates. RESULTS: The chamomile oil group exhibited statistically significant improvements in neuropathy indices compared to the placebo group (p < 0.05). Post-intervention, reductions in Neurothesiometer scores (mean difference: -1.14 ± 0.42), MNSI (-1.89 ± 0.31), and DN4 (-1.97 ± 0.28) were observed in the intervention group, with no comparable changes in controls. ANCOVA confirmed the robustness of these findings (F = 6.72, p = 0.012). CONCLUSION: Topical chamomile oil significantly alleviates neuropathic symptoms in diabetic patients, offering a safe and adjunctive therapeutic option. Its mechanism may involve modulation of oxidative stress and inflammatory pathways, warranting further investigation into long-term benefits and molecular targets. TRIAL REGISTRATION: This trial was registered at the Iranian Registry of Clinical Trials (IRCT), registration number IRCT20240611062090N1. The full protocol is available at www.irct.ir.

This study investigates the effects of topical solution of Scrophularia Striata in the healing process of peristomal skin wounds in patients attending the Stoma. One hundred participants from June 2023 to September 2023 were selected using convenience sampling and randomly assigned to two groups (experimental and control) in blocks using software. The experimental group was instructed to apply the topical solution of Scrophularia Striata once daily, saturating the ulcer area completely using an applicator on the peristomal skin, repeating this process every day for 14 consecutive days. The control group received the usual Stoma Center instructions (using chamomile ointment). The study compared the impact of topical solution of Scrophularia Striata on Ostomy Skin Tool to assess ulcer-healing progress between the two groups. The analysis revealed that on the 21 days post-intervention. The wound ulcer improvement in the experimental group was significantly greater than in the control group (p < 0.001). The results of the study indicate that the topical solution of Scrophularia Striata has been effective and more efficient in improving peristomal skin wounds compared to other routine treatments in these patients. Considering the impact of this solution on peristomal skin ulcer healing, its use is recommended. © 2025 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.

OBJECTIVE: Menopausal symptoms can significantly impact women's quality of life. Herbal interventions like Matricaria chamomilla (chamomile) have been suggested as potential remedies. However, their efficacy and safety remain underexplored. METHODS: This triple-blind clinical trial enrolled 80 postmenopausal women meeting specific criteria. Inclusion criteria included participants in early or late perimenopause, defined by a symptom score >15, FSH levels >40, or 2 years since menopause, with no significant comorbidities. Participants were randomly assigned to intervention and placebo groups. In a triple-blind clinical trial with 80 postmenopausal women (aged 47-62) from Babol City Health Center, participants were randomly assigned to receive either chamomile (100 mg capsules with 1.2% apigenin, four times daily) or a placebo over 12 weeks. Symptoms of menopause were assessed using the Australian Menopause Association's Scorecard Symptom Questionnaire. Over 12 weeks, they received either chamomile or placebo capsules, with side effect assessments every 4 weeks. RESULTS: Notable differences were found between the intervention and control groups in the overall scores on the symptom scorecard from baseline to 12 weeks' postintervention (-10.36; 95% confidence interval [CI], -13.84 to -6.92; P < 0.001). Specific subscores also improved in the intervention group: vasomotor (-2.25; 95% CI, -3.09 to -1.42; P < 0.001), psychological (-3.74; 95% CI, -5.29 to -2.20; P < 0.001), locomotor (-2.70; 95% CI, -3.63 to -1.77; P < 0.001), and urological (-1.89; 95% CI, -2.77 to -1.00; P < 0.001). Both groups showed significant changes in total symptom scores over time ( P < 0.001). Two participants experienced side effects, including mouth sores, skin spots, and itching, in the chamomile group, which led to their dropping out of the study. CONCLUSIONS: Chamomile intervention shows promise in alleviating menopausal symptoms, but its use warrants caution due to associated side effects. Further research is necessary to optimize dosage and mitigate adverse reactions for safer and more effective management of menopausal symptoms.

Background: Lymphedema is one of the disturbing complications after breast cancer treatment that may affect the quality of life (QoL) of breast cancer survivors (BCSs). Methods: In this double-blind randomized clinical trial, 63 patients with breast cancer-related lymphedema (BCRL) were included in the study. Group A received standard complete decongestive therapy (CDT), group B received CDT with olive oil, and group C received CDT with chamomile and olive oil. Lymphedema volume and range of motion (RoM) were measured at the beginning of the study and at sessions 7, 14, and 21. Patients' QoL was measured using the Short Form 36 questionnaire at baseline, at the end of the trial, and 1 month after the trial. For statistical analysis, SPSS software with a significance level of p < 0.05 was used. Results: The mean age of patients was 55.4 ± 10.1 years. Although the volume of lymphedema was reduced and RoM was increased in all groups, there was no significant difference between the three groups. However, the change in volume and RoM was more evident in group C. Moreover, the effect of interventions on health-related QoL dimensions in all groups was not statistically significant. However, in some dimensions, the score did not decrease in group B during follow-up. Conclusions: Chamomile and olive oils are tolerable for BCSs with BCRL; however, adding this intervention to CDT seems to have no superiority to CDT alone.

ObjectiveInsomnia is characterized by difficulty falling asleep, staying sleep, or both. Aromatherapy is a commonly used complementary and alternative medicine practice by persons with insomnia. Previous studies have shown that use of chamomile oil during massage therapy improves the quality of sleep (QoS). However, to our knowledge, no randomized controlled trials have examined the effects of chamomile oil inhalation on the treatment of insomnia. The present study evaluated the effect of chamomile oil inhalation on QoS and insomnia severity in persons with insomnia.MethodsA total of 80 participants ages 18-35 with insomnia were randomly assigned to aromatherapy group (AG; n = 40) or a control group (CG; n = 40). Those in the AG group received chamomile oil inhalation, while those in the CG group engaged in their normal routine for 10 minutes a day, daily for 15 days. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were administered before and after the intervention.ResultsWithin-group analysis showed a significant reduction both in PSQI and ISI scores among those in the AG (P < 0.001 for both scores), whereas the CG reported a significant reduction in PSQI score (P = 0.033) and no significant changes in ISI score (P = 0.068). The between-group analysis after the intervention demonstrated a significant reduction in PSQI and ISI scores in the AG group (P < 0.001 for both) compared to the CG group. No participant in either group reported adverse events during or after the study.ConclusionFifteen days of chamomile oil inhalation before bedtime reduced insomnia severity and enhanced the quality of sleep for young adults suffering from insomnia. Further studies are needed to replicate the results of this study using an active control group.

PURPOSE: To compare a liposomal gel with and without chamomile extract for the prevention of radiation dermatitis in breast cancer patients undergoing radiotherapy. METHODS: This study was a double-blind randomized clinical trial. A total of 100 participants undergoing radiotherapy for breast cancer were recruited. The primary outcome was the occurrence of dry desquamation. Cumulative dose of ionizing radiation at the first occurrence of dry desquamation, occurrence of erythema, moist desquamation, global radiation dermatitis, and any signs and symptoms self-reported by participants were secondary outcomes. RESULTS: Dry desquamation occurred in 6.0% of the participants using chamomile liposomal gel and 12.2% of those using liposomal gel (p = 0.32). The mean cumulative dose of ionizing radiation for the first occurrence of dry desquamation was 45.1 Gy in the chamomile liposomal gel group and 43.7 Gy in the liposomal gel group. There were no differences between the two gels in the occurrence of erythema, dry desquamation, moist desquamation, and radiation dermatitis compared to liposomal gel. There was a lower proportion of reported symptoms in the chamomile liposomal gel group compared to liposomal gel group in the first 3 weeks of radiation, especially for itching (p = 0.05). CONCLUSION: No statistically significant differences between the two gels were found in radiation dermatitis occurrence and dose at first occurrence. Comparing to the literature, it seems that both interventions may be effective, which might explain the lack of statistical difference between the groups. © 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

BACKGROUND AND PURPOSE: It was aimed to investigate the effects of massage with or without aromatherapy given to patients after colorectal cancer surgery on symptom management in the first three postoperative days. MATERIALS AND METHODS: This study was carried out with a pretest-posttest randomized controlled design. The study included the aromatherapy massage group (AG; n = 30), the classical massage group (MG; n = 30), and one control group (CG; n = 30). A blend of sweet almond oil, lavender, chamomile, and ginger oil was used in AG. Massage was applied to the foot area, and 20 min of classical massage was performed. Before the pretest, the participants were blinded by not informing them about their group allocations. The analyses were carried out using parametric methods. RESULTS: Postoperative pain varied significantly over time in all three groups (AG: p = 0.007; η2 = 0.150/MG: p = 0.008; η2 = 0.559/CG: p = 0.017; η2 = 0.132). Anxiety was found to differ between CG and AG and between CG and MG (p < 0.05). In all three groups, nausea-vomiting scores significantly decreased over time (AG: p = 0.002; η2 = 0.211/MG: p = 0.004; η2 = 0.164/CG: p = 0.021; η2 = 0.125). Sleep quality was significantly higher in the massage groups than in the control group only on the second postoperative day (p = 0.011). CONCLUSION: Aromatherapy massage had no significant effect on pain, fatigue, nausea, or vomiting compared to MG and CG, and sleep quality was higher in the massage groups compared to CG only on the second postoperative day. On the first three postoperative days, the post-intervention anxiety levels of AG and MG were lower than those of CG. CLINICALTRIALS: GOV.ID: NCT04810299.

BACKGROUND AND PURPOSE: Head and neck cancer patients frequently develop radiation dermatitis (RD) during radiotherapy. We compared liposomal gel with and without chamomile extract for the prevention and management of RD in head and neck cancer patients undergoing radiotherapy. MATERIALS AND METHODS: Sixty participants undergoing radiotherapy for the first time for head and neck cancer were recruited in a double-blind randomized clinical trial. Primary outcomes were the occurrence of dry desquamation and the cumulative dose of ionizing radiation at the first occurrence of dry desquamation. Secondary outcomes were the occurrence of erythema, moist desquamation, global RD, and participant self-reported symptoms. RESULTS: Dry desquamation occurred in 76.9 % (95 % CI: 57.9, 89.0) of participants in the chamomile liposomal gel group and in 88.9 % (95 % CI: 71.9, 96.1) in the liposomal gel group (p = 0.43). The median cumulative dose of ionizing radiation when dry desquamation occurred was 48.0 Gy in the chamomile liposomal gel group and 40.0 Gy in the liposomal gel group. Fewer symptoms were reported in the chamomile liposomal gel group. CONCLUSION: No statistically significant differences in outcomes were found between the two groups, though the chamomile liposomal gel group presented with lower grades of RD than the liposomal gel group. In addition, when compared to the literature on other topical interventions to manage RD, our results show that chamomile liposomal gel has potential for better management and prevention of RD in this population, which should be further tested. This study provides crucial information to design future studies. Clinical Trials Registration (REBEC): RBR-92cts3.

BACKGROUND: This short communication presents an analytical approach to evaluate the synergistic anticonvulsant effects of an herbal combination containing hydroalcoholic extracts of Origanum vulgare (oregano), Matricaria chamomilla (chamomile), and Lavandula angustifolia (lavender). OBJECTIVE: The study aimed to apply linear dose-response modeling to seizure score data to predict the expected outcomes of combination therapy and quantify synergy by comparing predicted and observed effects. METHODS: The herbal extracts were obtained through maceration with 70% ethanol. The animal study was performed using 2 different doses of each herb, involving 36 rats in 6 groups. Building on previous in vivo findings, the study utilized linear dose-response modeling to analyze the effects of the combination therapy on seizure scores and to determine the synergistic performance at combination doses of 17mg/kg, 34mg/kg, and 68mg/kg. RESULTS: The results highlighted the synergistic performance of the herbal combination, particularly at the dose of 34mg/kg, demonstrating the pharmacodynamic advantages of combination therapy and confirming the enhanced antiseizure effect of the herbal combination. CONCLUSIONS: This study confirms the synergistic anticonvulsant effects of the herbal combination and demonstrates its potential as a new supplementary treatment for seizures via a non-invasive intranasal administration method.

This study aims to evaluate the anticancer properties of chamomile nano-emulsion (Cha-NE) and α-lactalbumin (α-LA) coated Cha-NE (LA-Cha-NE) against breast tumor through both in vitro and in vivo investigations. Both Cha-NE and LA-Cha-NE exhibited typical semi-spherical forms under Transmission electron microscope (TEM), and displayed surface charges of 46.75 and 28.45 mV with average sizes of 87.46 and 112.75 nm, respectively. In a safe manner, Cha-NE and LA-Cha-NE showed higher selectivity against breast cancer (MDA-MB-231 and MCF7) cells than normal (HSF) cells. Reductions in serum contents of IL1β, TNF-α, IL-4, IL-6, IL-10, ASAT, ALAT, creatinine, urea, triglycerides, and cholesterol, as well as an the administration of LA-Cha-NE, breast tumor incidence dramatically reduced. Thus, improvement in survival rates leads to successful prevention of mammary tumorigenesis as proved by the histopathological and immunohistochemistry findings. However, there was an increase in mammary GSH, GPx, CAT, and SOD activity. Both in vitro and in vivo investigations showed that LA-Cha-NE had a beneficial therapeutic effect, exhibiting more significantly regulated apoptosis and elevated expression of genes that regulate the cell cycle. Thus, this study demonstrated that the chemo-preventive property of LA-Cha-NE may offer a brand-new alternative therapy to cure breast cancer by re-establishing the compromised oxidative stress response, enhancing the immune response, reducing inflammation process, and fortifying the apoptosis pathway. © 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

BACKGROUND The use of herbal medicines (HMs) is increasing, which raises concerns of herb-drug interactions (HDIs). This questionnaire-based study aimed to evaluate knowledge of HMs and HDIs in 147 undergraduate nursing students in Riyadh, Saudi Arabia, between March 2022 to June 2022. MATERIAL AND METHODS An online cross-sectional study was conducted among 147 nursing undergraduates at King Saud University, Riyadh, Saudi Arabia from March 2022 to June 2022, using a self-administered 24-item questionnaire. The convenience sampling method was used to evaluate the knowledge of HMs and interactions of anticoagulants, anti-inflammatory drugs, antibiotics, and antiplatelet drugs with herbs like ginkgo biloba, St. John's wort, garlic, ginger, green tea, and chamomile tea. RESULTS The findings of this study reported that 74.8% of the undergraduates used HMs. With regard to HDIs, 20.4% of nursing undergraduates identified the interaction between gingko biloba and drugs like ibuprofen and warfarin, while 13.6% identified interactions between drugs like warfarin with green tea, ginger, and chamomile tea. Regarding general knowledge, 59% of the students (n=84) reported good knowledge of HMs. Previous history of HM use significantly affected the mean HM knowledge score (t=4.635; P=0.0001). CONCLUSIONS To summarize, Saudi nursing students showed a lack of understanding and knowledge of HDIs. Ability to identify specific HDIs, like ginkgo biloba interactions with warfarin and ibuprofen, and warfarin interactions with green tea and ginger, was limited. There is a need to introduce HM and HDI courses in the academic curriculum.

BACKGROUND: The concurrent usage of herbal medicines with conventional therapies is an important concern in cancer treatment which can lead to unexpected consequences like herb-drug interactions. This study aimed to determine the prevalence of potential herb-drug interactions and to predict factors associated with herb-drug interactions for cancer patients. METHODS: This cross-sectional study was conducted among a convenience sample of 315 cancer patients referring to the oncology clinics of Kerman city in 2018. Data were collected via comprehensive face-to-face interviews and medical chart reviews. A drug interaction checker was used to determine herb-drug interactions. The information of patients was compared based on herb-drug interactions using bivariable logistic regression models, and predictors were determined by the multivariable logistic regression model. All analyses were performed by Stata software version 16. RESULTS: Of 262 patients (83.2% of the patients) who used herbal medicines, 209 patients [79.8% (95% Confidence Intervals (CI): 75.2 - 85.1)] had potential herb-drug interactions. Chamomile was the most popular herbal medicine (n = 163, 78.0%), and minor and moderate herb-drug interactions were caused by green tea (n = 34, 16.3%) and peppermint (n = 78, 37.5%). The number of chemotherapeutic agents (OR: 1.92, 95% CI: 1.43-2.58; P-value < 0.0001) and the experienced of pain during chemotherapy courses (OR = 2.22, 95%CI:1.00-4.94; P-value = 0.04) were some of the predictors of herb-drug interactions among cancer patients. CONCLUSION: Herbal medicine use during chemotherapy was found prevalent among cancer patients; of them, the experience of potential herb-drug interactions was highly frequent. Oncologists and clinical pharmacologists are recommended to take into account challenges associated with herb-drug interactions in their routine practices, particularly during chemotherapy among these patients. © 2023. The Author(s).

AIMS: To present an updated overview on the safety of concurrent use of food, herbal or dietary supplement and warfarin. METHODS: A systematic literature review was performed on 5 databases from inception up to 31 December 2019. These interactions were classified depending on the likelihood of interaction and supporting evidences. RESULTS: A total of 149 articles describing 78 herbs, food or dietary supplements were reported to interact with warfarin. These reports described potentiation with 45 (57.7%) herbs, food or dietary supplements while 23 (29.5%) reported inhibition and 10 (12.8%) reported limited impact on warfarin pharmacokinetics and pharmacodynamics. Twenty unique herb and dietary supplements also reported to result in minor bleeding events, such as purpura and gum bleeding as well as major events such as intracranial bleeding that led to death. CONCLUSION: While most food, herbs and supplements can be safely taken in moderation, healthcare professionals should be aware of the increased risk of bleeding when taking several food and herbs. These include Chinese wolfberry, chamomile tea, cannabis, cranberry, chitosan, green tea, Ginkgo biloba, ginger, spinach, St. John's Wort, sushi and smoking tobacco. Patients should be counselled to continue to seek advice from their healthcare professionals when starting any new herbs, food or supplement. © 2020 The British Pharmacological Society.

BACKGROUND: Pregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The aim of this study was to assess the potential for herb-drug interactions (HDIs) in pregnant women and to explore possible herb-drug interactions and their potential clinical significance. METHODS: A cross-sectional survey of women during early pregnancy or immediately postpartum in North-East Scotland. Outcome measures included; Prescription medicines use excluding vitamins and potential HDIs assessed using Natural Medicines Comprehensive Database. RESULTS: The survey was completed by 889 respondents (73% response rate). 45.3% (403) reported the use of at least one prescription medicine, excluding vitamins. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1-12). A total of 91 different prescription medicines were reported by respondents using HNPs. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1-12). Thirty-four herb-drug interactions were identified in 23 (12.7%) women with the potential to increase the risk of postpartum haemorrhage, alter maternal haemodynamics, and enhance maternal/fetal CNS depression. Almost all were rated as moderate (93.9%), one as a potentially major (ginger and nifedipine) and only one minor (ondansetron and chamomile). CONCLUSION: Almost half of pregnant women in this study were prescribed medicines excluding vitamins and minerals and almost half of these used HNPs. Potential moderate to severe HDIs were identified in an eighth of the study cohort. Healthcare professionals should be aware that the concurrent use of HNPs and prescription medicines during pregnancy is common and carries potential risks.

BACKGROUND: Today considerable number of drugs are produced from plants. Several plants with antibacterial and healing applications are used in medicine such as Roman chamomile (Chamaemelum nobile L.). Wound infection is one of the most prevalent infections among infectious diseases around the world. Due to appearance of drug resistance, researchers are now paying attention to medicinal plants. Therefore, this study was designed to investigate the antimicrobial and wound healing properties of C. nobile against Pseudomonas aeruginosa using in vivo conditions. METHODS: Ethanolic extract of C. nobile was provided using standard method. The 5% C. nobile ointment was prepared by dissolving lyophilized extract in eucerin. Forty five male rats were obtained from Ilam university. After anesthetization and wound creation, wounds were infected by P. aeruginosa. The rats were divided into three groups, group I was treated with C. nobile ointment, group II was treated with tetracycline ointment and the third group was treated with base gel as control group. RESULTS: Antibacterial and wound healing activities of C. nobile ointment were more than tetracycline ointment significantly. Our results indicated that extract of C. nobile had effective antibacterial activity and accelerated the progression of wound healing. CONCLUSION: Our study indicated that antibacterial and wound healing activities of C. nobile ointment were notable. C. nobile therapy in combination with antibiotics can also be useful because medicinal plants contents operate in synergy with antibiotics. These results revealed the value of plant extracts to control antibiotic resistant bacteria in wound infections.

Apigenin, a natural flavone, is widely distributed in plants such as celery, parsley and chamomile. It is present principally as glycosylated in nature. Higher intake of apigenin could reduce the risk of chronic diseases. It has gained particular interest in recent years as a beneficial, health-promoting agent with low intrinsic toxicity. Areas covered: This review summarizes and the absorption, distribution, metabolism and excretion (ADME) properties of apigenin, and drug-drug interaction of apigenin. Expert opinion: Since apigenin is a bioactive plant flavone and is widely distributed in common food, its consumption through the diet is recommended. Apigenin-enriched drugs are better for some chronic diseases, but may affect animal and human health if present in the daily diet. Dietary or therapeutic apigenin has value as a good cellular regulator in cancer, especially cancers of the gastrointestinal tract. Due to apigenin's limitations on absorption and bioavailability, novel carriers would need to be developed to enhance the oral bioavailability of apigenin. Further research about its ADME properties and drug-drug interactions are needed before apigenin can be brought to clinical trials.

Apigenin is a flavonoid found in parsley, onions, oranges, tea, chamomile, wheat, and sprouts. It has a variety of biological properties including anti-oxidant, anti-mutagenic, anti-carcinogenic, anti-inflammatory, anti-proliferative, and anti-spasmodic effects. Based on epidemiological and case-control studies, apigenin is regarded as a novel chemotherapeutic agent against various cancer types. However, little is known about the effects of apigenin on choriocarcinoma cells. Therefore, we investigated the anti-cancer effects of apigenin on choriocarcinoma cells (JAR and JEG3) in the present study. Apigenin reduced viability and migratory properties, increased apoptosis, and suppressed mitochondrial membrane potential in both the JAR and JEG3 cells. In addition, apigenin predominantly decreased phosphorylation of AKT, P70RSK, and S6 whereas the phosphorylation of ERK1/2 and P90RSK was increased by apigenin treatment of JAR and JEG3 cells in a dose-dependent manner. Moreover, treatment of JAR and JEG3 cells with both apigenin and pharmacological inhibitors of PI3K/AKT (LY294002) and ERK1/2 (U0126) revealed synergistic anti-proliferative effects. Collectively, these results indicated that the apigenin is an invaluable chemopreventive agent that inhibits progression and metastasis of choriocarcinoma cells through regulation of PI3K/AKT and ERK1/2 MAPK signal transduction mechanism. J. Cell. Physiol. 231: 2690-2699, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Chamomile (Matricaria chamomilla L., Asteraceae) is a medicinal plant widely used as remedy for pain and gastric disorders. The association of non-steroidal anti-inflammatory drugs (NSAIDs) with medicinal plant extracts may increase its antinociceptive activity, permit the use of lower doses and limit side effects. The aim was to isolate and identify the main chemical constituents of Matricaria chamomilla ethanolic extract (MCE) as well as to explore their activity as cyclooxygenase (COX) inhibitors in silico; besides, to examine the interaction between MCE and diclofenac on nociception in the formalin test by isobolographic analysis, and to determine the level of gastric injury in rats. Three terpenoids, α-bisabolol, bisabolol oxide A, and guaiazulene, were isolated and identified by (1)H NMR. Docking simulation predicted COX inhibitory activity for those terpenoids. Diclofenac, MCE, or their combinations produced an antinociceptive effect. The sole administration of diclofenac and the highest combined dose diclofenac-MCE produced significant a gastric damage, but that effect was not seen with MCE alone. An isobologram was constructed and the derived theoretical ED35 for the antinociceptive effect was significantly different from the experimental ED35; hence, the interaction between diclofenac and MCE that mediates the antinociceptive effect is synergist. The MCE contains three major terpenoids with plausible COX inhibitory activity in silico, but α-bisabolol showed the highest affinity. Data suggest that the diclofenac-MCE combination can interact at the systemic level in a synergic manner and may have therapeutic advantages for the clinical treatment of inflammatory pain.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) places a significant burden on the patient. Herbal agents are the most commonly complementary therapies used among the public. This study was done to determine the effect of ginger and chamomile capsules on nausea and vomiting in cases undergoing chemotherapy for breast cancer (BC). MATERIALS AND METHODS: In a randomized, double-blind and clinical trial study, 65 women with BC undergoing chemotherapy were referred to Breast Cancer Research Center, Tehran, Iran, between May 2013 to June 2014. Regimen for ginger group for 5 days before and 5 days after chemotherapy was: 2 times a day and 500 mg capsules of powdered ginger root in addition to a routine antiemetic regimen consisting of dexamethasone, metoclopramide and aprepitant (DMA) capsules. Chamomile group similarly was: 2 times a day and 500 mg capsules of Matricaria chamomilla extract in addition to a routine antiemetic regimen consisting of DMA capsules. Control group, routine antiemetic regimen consisting of DMA capsules. RESULTS: There were no significant differences between the ginger, chamomile and control groups regarding age. Drugs used for chemotherapy were identical and duration of disease was also matched (1-4 months). Ginger and chamomile were both significantly effective for reducing the frequency of vomiting, there being no significant difference between the ginger and chamomile groups. Moreover, unlike the chamomile, ginger significantly influenced the frequency of nausea. CONCLUSIONS: According to the findings of this study, it should be declared that taking ginger capsules (1 g/day) might relieve CINV safely. Nurses dealing directly with cancer patients should be responsible for providing educational programs for patients and their families about how to deal with their drug regimens and associated side effects.

This study investigated the effects of aromatherapy massage on the anxiety and self-esteem experienced by Korean elderly women. A quasi-experimental, control group, pretest-posttest design was used. The subjects comprised 36 elderly females: 16 in the experimental group and 20 in the control group. Aromatherapy massage using lavender, chamomile, rosemary, and lemon was given to the experimental group only. Each massage session lasted 20 min, and was performed 3 times per week for two 3-week periods with an intervening 1-week break. The intervention produced significant differences in the anxiety and self-esteem and no significant differences in blood pressure or pulse rate between the two groups. These results suggest that aromatherapy massage exerts positive effects on anxiety and self-esteem. However, more objective, clinical measures should be applied in a future study with a randomized placebo-controlled design.

PURPOSE: This study was designed to verify the effect of aromatherapy on a postpartum mother's perineal healing. METHOD: The research design was a clinical trial. The methods of aromatherapy were applied sitz bath or soap application using essential oils with Lavender, Myrrh, Neroli, Rose, Grapefruit, Mandarin, Orange, and Roman Chamomile. The subjects of this experiment were postpartum mothers who delivered vaginally with an episiotomy. They were allocated to one of three groups; the aroma-sitz bath group, aroma-soap application group or control group. To evaluate the effect of aromatherapy, the perineal healing status was measured using the REEDA scale and smears of episiotomy wound were obtained. The data were analyzed by repeated measures of ANOVA, ANCOVA, chi2-test, and multiple response analysis via SPSS program. RESULT: The REEDA scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed 'few'(5-10 bacteria per field) bacteria in the smears of episiotomy wound. The one bacteria was identified in the 50.8% of subjects in pretest and two bacteria in the 60.3% in posttest. Most frequently identified bacteria were Escherichia coli and Enterococcus faecalis. CONCLUSION: In conclusion, these findings indicate that postpartum aromatherapy for perineal care could be effective in healing the perineum perineal care could be effective in healing the perineum.

Pain perception is a multidimensional process encompassing sensory, affective, and cognitive components. In recent years, accumulating evidence suggests that olfactory stimulation can modulate pain perception through neurophysiological and emotional mechanisms. However, systematic understanding of how olfactory processing contributes to analgesia across different experimental and clinical contexts remains limited. This review aims to provide an integrative overview of current evidence regarding the role of olfactory pathways in pain modulation, summarizing findings from human and animal studies that investigated the analgesic potential of volatile compounds. A systematic literature search was conducted across PubMed, Web of Science, OVID, Cochrane Reviews, Embase, CNKI, and WanFang databases. A total of 4360 records were retrieved, screened for relevance, and refined to 147 studies, including 138 human-based and 9 animal-based investigations. Lavender, peppermint, chamomile, bergamot, and citrus-derived oils were most frequently associated with analgesic outcomes. Olfactory stimulation was found to modulate pain via central integrative circuits involving affective, autonomic, and sensory processing, engaging conserved pathways that support descending pain inhibition. Olfactory stimulation by specific flavor and fragrance compounds holds translational potential for non-pharmacological pain management. Nevertheless, methodological standardization and mechanistic validation are necessary to advance this emerging field. © 2026 Federation of American Societies for Experimental Biology.

BACKGROUND: Recurrent aphthous stomatitis (RAS) is a common oral mucosal condition affecting over 2.5 billion people worldwide. Although 0.1% triamcinolone acetonide is a standard treatment, its comparative efficacy remains uncertain. OBJECTIVE: To evaluate and compare systematically the efficacy of 0.1% triamcinolone acetonide with those of alternative therapies for RAS management. METHODS: A systematic review and meta-analysis were conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. From December 2024 to April 2025, PubMed and the Cochrane Central Register of Controlled Trials, Semantic Scholar, and ScienceDirect were searched for randomized controlled trials (RCTs) evaluating 0.1% triamcinolone acetonide in minor RAS treatment. Eligible studies reported the outcomes of pain reduction, ulcer size, or healing time. Risk of bias was assessed by using the Cochrane Risk of Bias Tool, and meta-analysis pooled estimates were calculated by employing a random effects model. RESULTS: Twenty-five RCTs involving 1474 participants were included. Thyme honey, sumac gel, and laser therapies were significantly more effective than 0.1% triamcinolone acetonide in reducing pain and ulcer size. CBD oil, hyaluronic acid, curcumin, amlexanox, and nanoformulated triamcinolone exhibited comparable efficacies as 0.1% triamcinolone acetonide. The outcomes under chamomile, acemannan, and doxycycline benzocaine gel treatments were less favorable than those under 0.1% triamcinolone acetonide treatment. Laser therapy, sumac gel, and Punica granatum extract significantly reduced healing time compared with 0.1% triamcinolone acetonide. The meta-analysis demonstrated that 0.1% triamcinolone acetonide was significantly more effective than thyme honey, Rhus coriaria gel, and nanobased triamcinolone in reducing ulcer size and shortened healing time compared with Salvizan and P. granatum gels. However, no significant effect was observed in pain reduction when 0.1% triamcinolone acetonide was compared with either other treatments or the placebo, and no significant difference in healing time was found when 0.1% triamcinolone aceton

Background: Oral mucositis (OM) is a frequent complication of anticancer therapy which arises from cytotoxic injury, having significant clinical implications. Nutritional and supplement-based interventions have been proposed as adjunctive strategies to improve outcomes. Objectives: This systematic review aimed to identify and synthesize evidence from randomized controlled trials (RCTs) evaluating nutritional or natural supplement interventions for prevention or management of OM in pediatric oncology. Methods: We conducted a systematic search (17 August 2025) of Scopus, PubMed/MEDLINE, and Google Scholar (1 January 2000-1 June 2025) following PRISMA guidelines and registered in PROSPERO (CRD420251134454). The review included randomized controlled trials in pediatric cancer patients (≤18 years; up to 25 years for follow-up) receiving chemo-/radiotherapy, assessing nutritional, dietary, or natural product interventions for oral mucositis prevention or treatment. Non-randomized, adult, non-English, non-peer-reviewed, or inaccessible studies were excluded. Outcomes included incidence, severity, duration of OM, and mucositis-associated pain. Risk of bias was assessed using the NIH Study Quality Assessment Tools and the Cochrane RoB 2 tool. Results were qualitatively summarized. Results: Of 5870 records identified, 20 RCTs met inclusion criteria resulting in 1430 total included patients. Interventions tested included systemic supplements (e.g., glutamine, zinc, and bovine colostrum), topically applied agents (e.g., honey, vitamin E, Aloe vera, and olive oil), and nutrient-containing rinses (e.g., chamomile, Caphosol, and Traumeel S). Honey-based interventions showed promising outcomes. Discussion: Study designs and sample sizes varied considerably, and outcome measures were heterogeneous. Challenges with blinding, variable compliance, and inconsistent reporting reduce confidence and precision in the findings. Conclusions: Evidence from pediatric RCTs remains limited but highlights nutritional and natural products as promising supportive care options for OM. Findings suggest potential for practical, low-cost adjuncts to established oral care protocols, warranting furthe

CONTEXT: Chamomile is a widely recognized medicinal herb, and it has been used for its various medicinal properties. Chamomile's widespread recognition and application in medicine highlights its significance in herbal therapeutic practices globally. OBJECTIVE: To explore chamomile as a low-risk antimicrobial and anti-inflammatory agent, utilizing clinical characteristics derived from the existing body of evidence from randomized clinical trials within the current literature. METHODS: We conducted a systematic review of randomized clinical trials using the search terms 'chamomile anti-inflammatory antimicrobial randomized clinical trials' and 'chamomile anti-inflammatory antimicrobial'. We sourced data from databases including PubMed, Google Scholar, Cochrane Library, and ClinicalTrials.gov. We then performed a meta-analysis using R to assess the efficacy of chamomile as an anti-inflammatory and an antimicrobial agent, and its impact on mucosal recovery in clinical settings. RESULTS: A total of 11 randomized clinical trials were identified. The mean difference, confidence intervals, and standard error from the extracted means and standard deviations for relevant outcomes were calculated. Statistical tests from the meta-analysis demonstrated that chamomile exhibited statistically significant reductions in mucositis severity and pain level, indicating the anti-inflammatory effects of chamomile. CONCLUSION: This study highlights chamomile's potential as a natural alternative for managing inflammation and microbial infections, offering a promising alternative to standard treatments. Our study suggests chamomile has the potential to act as a natural anti-inflammatory agent. A future study with a larger sample size may provide clinical evidence of this effect. Systematic review registration number (PROSPERO): CRD42024566615.