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1.  A survey of medicinal plants used by the Deb barma clan of the Tripura tribe of Moulvibazar district, Bangladesh 
Background
The number of tribes present within Bangladesh has been estimated to approximate one hundred and fifty. Information on traditional medicinal practices, particularly of the smaller tribes and their clans is lacking. It was the objective of the study to document the tribal medicinal practices of the Deb barma clan of the Tripura tribe, which clan can be found residing in Dolusora Tripura Palli of Moulvibazar district of Bangladesh. A further objective was to determine the extent of the community households who still prefer traditional treatment to other forms of treatment, particularly allopathic treatment.
Methods
Interviews of the tribal healer and the tribal community regarding their ethnomedicinal practices were carried out with the help of a semi-structured questionnaire and the guided field-walk method. All together 67 clan members were interviewed including the Headman, tribal healer, 19 Heads of households and 46 other adult members of the clan. Information on number of members of household, their age, gender, educational status, occupation of working household members and preferred mode of treatment was obtained through the semi-structured questionnaire. In the guided field-walk method, the healer took the interviewers on field-walks through areas from where he collected his medicinal plants, pointed out the plants, and described their uses.
Results
The clan had a total of 135 people distributed into 20 households and had only one traditional healer. Use of medicinal plants, wearing of amulets, and worship of the evil god ‘Bura debta’ constituted the traditional medicinal practices of the clan for treatment of diseases. The healer used a total of 44 medicinal plants distributed into 34 families for treatment of various ailments like pain, coughs, cold, gastrointestinal disorders, cuts and wounds, diabetes, malaria, heart disorders, and paralysis.
Conclusions
Available scientific reports validate the use of a number of plants by the traditional healer. A number of the plants used by the clan healer had reported similar uses in Ayurveda, but differ considerably in their therapeutic uses from that reported for other tribes in Bangladesh. The present survey also indicated that in recent years the Deb barma clan members are inclining more towards allopathic medicine.
doi:10.1186/1746-4269-10-19
PMCID: PMC3996145  PMID: 24502444
Indigenous knowledge; Allopathic medicine; Ethnomedicine; Bangladesh
2.  Survey and Scientific Evaluation of Medicinal Plants Used by the Pahan and Teli Tribal Communities of Natore District, Bangladesh 
The Pahans and the Telis are two of the smallest indigenous communities in Bangladesh. The Pahans, numbering about 14,000 people are widely scattered in several northern districts of the country, while the Telis are such a small community that nothing has been reported on their numbers and lifestyle. Both tribes are on the verge of disappearance. One each of the Pahan and the Teli community was located after much search in two adjoining villages of Natore district, Bangladesh. Since the tribes were found to still depend on their traditional medicinal practitioners for treatment of ailments, it was the objective of the present study to document their traditional usage of medicinal plants and to evaluate such plants against modern research-based pharmacological activity studies on these plants. Interviews were conducted of the practitioners of the Pahan and Teli community of Natore district with the help of a semi-structured questionnaire and using the guided field-walk method. Plant specimens as pointed out by the practitioners were collected and pressed on the field and identification completed at the Bangladesh National Herbarium. The Pahan tribal practitioners used 13 plants distributed into 9 families for treatment of 14 different ailments. The Teli tribal practitioner used 15 plants divided into 14 families for treatment of 17 different ailments. Eight out of the thirteen plants used by the Pahan tribal practitioner (61.5%) had reported relevant pharmacological activities in the scientific literature, while six out of the fifteen plants used by the Teli tribal practitioners (40%) had such relevant pharmacological activities in accordance with their usage. The medicinal plants used by the Pahans and Telis warrant further scientific studies toward discovery of lead compounds and efficacious drugs and the documentation and protection of the traditional medical knowledge held by these tribes.
PMCID: PMC3746669  PMID: 23983368
Asian medicine; CAM; ethnomedicine; alternative therapy
3.  Medicinal Plants Used for Treatment of Diabetes by the Marakh Sect of the Garo Tribe Living in Mymensingh District, Bangladesh 
Diabetes mellitus is an endocrinological disorder arising from insulin deficiency or due to ineffectiveness of the insulin produced by the body. This results in high blood glucose and with time, to neurological, cardiovascular, retinal and renal complications. It is a debilitating disease and affects the population of every country of the world. Around 200 million people of the world suffer from this disease and this figure is projected to rise to 300 million in the coming years. The disease cannot be cured with allopathic medicine as the drugs used do not restore normal glucose homeostasis and moreover have side-effects. On the other hand, traditional medicinal practitioners of various countries claim to cure diabetes or at least alleviate the major symptoms and progression of this disease through administration of medicinal plants. The Garos are an indigenous community of Bangladesh, who still follow their traditional medicinal practices. Their traditional medicinal formulations contain a number of plants, which they claim to be active antidiabetic agents. Since observation of indigenous practices have led to discovery of many modern drugs, it was the objective of the present study to conduct a survey among the Marakh sect of the Garos residing in Mymensingh district of Bangladesh to find out the medicinal plants that they use for treatment of diabetes. It was found that the tribal practitioners of the Marakh sect of the Garos use twelve medicinal plants for treatment of diabetes. These plants were Lannea coromandelica, Alstonia scholaris, Catharanthus roseus, Enhydra fluctuans, Terminalia chebula, Coccinia grandis, Momordica charantia, Cuscuta reflexa, Phyllanthus emblica, Syzygium aqueum, Drynaria quercifolia, and Clerodendrum viscosum. A review of the scientific literature demonstrated that almost all the plants used by the Garo tribal practitioners have reported antidiabetic and/or antioxidant properties and have enormous potential for possible development of new and efficacious antidiabetic drugs.
PMCID: PMC3746667  PMID: 23983370
Diabetes; CAM; ethnomedicine; Garo
4.  Medicinal Formulations of a Kanda Tribal Healer — A Tribe on the Verge of Disappearance in Bangladesh 
The Kanda tribe is one of the lesser known small tribes of Bangladesh with an estimated population of about 1700 people (according to them), and on the verge of extinction as a separate entity. To some extent, they have assimilated with the surrounding mainstream Bengali-speaking population, but they still maintain their cultural practices including traditional medicinal practices, for which they have their own tribal healers. Nothing at all has been documented thus far about their traditional medicinal practices and formulations, which are on the verge of disappearance. The Kanda tribe can be found only in scattered tea gardens of Sreemangal in Sylhet district of Bangladesh; dispersion of the tribe into small separated communities is also contributing to the fast losing of traditional medicinal practices. The objective of the present study was to conduct an ethnomedicinal survey among the traditional healers of the Kanda tribe (in fact, only one such healer was found after extensive searches). Information was collected from the healer with the help of a semi-structured questionnaire and the guided field-walk method. A total of 24 formulations were obtained from the healer containing 34 plants including two plants, which could not be identified. Besides medicinal plants, the Kanda healer also used the body hairs of the Asiatic black bear (Ursus thibetanus) and bats (Pteropus giganteus giganteus) in one of his formulation for treatment of fever with shivering. The ailments treated by the Kanda healer were fairly common ailments like cuts and wounds, skin diseases, helminthiasis, fever, respiratory problems (coughs, asthma), gastrointestinal disorders (stomach pain, constipation, diarrhea), burning sensations during urination, various types of pain (headache, body ache, toothache, ear ache), conjunctivitis, poisonous snake, insect or reptile bites, jaundice, and bone fractures. A number of important drugs in allopathic medicine like quinine, artemisinin, and morphine (to name only a few) have been discovered from observing indigenous medicinal practices. From that view point, the formulations used by the Kanda healer merit scientific studies for their potential in the discovery of cheap and effective new drugs. Scientific validation of the medicinal formulations of the Kanda healer can also be effective for treatment of ailments among this tribe, which does not have or does not want to have any contact with modern medicine.
PMCID: PMC3746568  PMID: 24146444
5.  Tribal Formulations for Treatment of Pain: A Study of the Bede Community Traditional Medicinal Practitioners of Porabari Village in Dhaka District, Bangladesh 
The Bedes form one of the largest tribal or indigenous communities in Bangladesh and are popularly known as the boat people or water gypsies because of their preference for living in boats. They travel almost throughout the whole year by boats on the numerous waterways of Bangladesh and earn their livelihood by selling sundry items, performing jugglery acts, catching snakes, and treating village people by the various riversides with their traditional medicinal formulations. Life is hard for the community, and both men and women toil day long. As a result of their strenuous lifestyle, they suffer from various types of pain, and have developed an assortment of formulations for treatment of pain in different parts of the body. Pain is the most common reason for physician consultation in all parts of the world including Bangladesh. Although a number of drugs are available to treat pain, including non-steroidal, steroidal, and narcotic drugs, such drugs usually have side-effects like causing bleeding in the stomach over prolonged use (as in the case of rheumatic pain), or can be addictive. Moreover, pain arising from causes like rheumatism has no proper treatment in allopathic medicine. It was the objective of the present study to document the formulations used by the Bede traditional practitioners for pain treatment, for they claim to have used these formulations over centuries with success. Surveys were conducted among a large Bede community, who reside in boats on the Bangshi River by Porabari village of Savar area in Dhaka district of Bangladesh. Interviews of 30 traditional practitioners were conducted with the help of a semi-structured questionnaire and the guided field-walk method. It was observed that the Bede practitioners used 53 formulations for treatment of various types of pain, the main ingredient of all formulations being medicinal plants. Out of the 53 formulations, 25 were for treatment of rheumatic pain, either exclusively, or along with other types of body pain. A total of 65 plants belonging to 39 families were used in the formulations. The Fabaceae family provided 7 plants followed by the Solanaceae family with 4 plants. 47 out of the 53 formulations were used topically, 5 formulations were orally administered, and 1 formulation had both topical and oral uses. 8 formulations for treatment of rheumatic pain contained Calotropis gigantea, suggesting that the plant has strong potential for further scientific studies leading to discovery of novel efficacious compounds for rheumatic pain treatment.
PMCID: PMC3746354  PMID: 24082322
6.  Ethnomedicinal plants used by the Nag clan of the Rai Ghatual tribe of Moulvibazar district, Bangladesh 
Ancient Science of Life  2013;32(4):217-221.
Context:
Medicinal practices of the tribes of Bangladesh remain largely un-documented.
Aims:
The aim of the present study was to conduct an ethnomedicinal survey and documentation among the Nag clan of the Rai Ghatual tribe of Bangladesh.
Settings and Design:
The survey was carried out among the Nag clan of the Rai Ghatual tribal community of Moulvibazar district. The clan, according to them, is the only Nag clan of the Rai Ghatual tribe in Bangladesh. The clan has three tribal healers, still continuing their traditional medicinal practices.
Materials and Methods:
Interviews of the healers were carried out with the help of a semi-structured questionnaire and the guided field-walk method.
Results:
The Nag clan healers were observed to use 28 different plant species distributed into 22 families for treatment of ailments such as fever, loss of appetite, male infertility, dysentery, lower abdominal pain during menstruation, jaundice, stomachache, burning sensations during urination, bodily pain and weak health.
Conclusions:
This is the first reported study of the traditional medicinal practices of Nag clan healers. Several of the plants can be validated in their uses on the basis of existing scientific literature. The medicinal plants used by the Nag healers warrant further scientific studies, for the plants are readily available and can form alternative medicinal sources instead of costlier biomedical drugs.
doi:10.4103/0257-7941.131975
PMCID: PMC4078472  PMID: 24991070
Bangladesh; ethnomedicine; Moulvibazar; Nag clan; Rai Ghatual
7.  Medicinal Plants Used by the Mandais - A Little Known Tribe of Bangladesh 
The Mandais are a little known tribe of Bangladesh inhabiting the north central regions, particularly Tangail district of Bangladesh. Their population has been estimated to be less than 10,000 people. Although the tribe has for the most part assimilated with the mainstream Bengali-speaking population, they to some extent still retain their original tribal customs, including their traditional medicinal practices. Since this practice is also on the verge of disappearance, the objective of the present study was to conduct an ethnomedicinal survey among Mandai tribal practitioners to document their use of medicinal plants for treatment of various ailments. Four traditional practitioners were found in the exclusive Mandai-inhabited village of Chokchokia in Tangail district. Information was collected from the practitioners with the help of a semi-structured questionnaire and guided field-walk method. It was observed that the four traditional practitioners used a total of 31 plants distributed into 23 families for treatment. The various ailments treated included diabetes, low semen density, jaundice, gastrointestinal tract disorders (stomach ache, indigestion, dysentery, and diarrhea), leucorrhea, pain (rheumatic pain, joint pain), skin disorders, respiratory tract disorders (coughs, mucus, and allergy), debility, fever, and helminthiasis. From the number of plants used (seven), it appeared that gastrointestinal tract disorders formed the most common ailment among the Mandai community, possibly brought about by the low income status of the people coupled with unhygienic conditions of living.
PMCID: PMC3746648  PMID: 23983389
Medicinal plants; CAM; ethnomedicine; Mandai
8.  Ethnomedicinal plants of the Bauri tribal community of Moulvibazar District, Bangladesh 
Ancient Science of Life  2013;32(3):144-149.
Context:
Bangladesh reportedly has more than 100 tribal communities; however, documentation of their medicinal practices is markedly absent.
Aim:
The aim of the present study was to conduct an ethnomedicinal survey among the little known Bauri tribe of Bangladesh, whose tribal medicinal practices are yet to be documented.
Settings and Design:
The survey was carried out among the Bauri tribal community of Purbo Tila village in Moulvibazar District. The community is believed to be the only Bauri community in the country and had four tribal healers who continue their traditional medicinal practices.
Materials and Methods:
Interviews of the healers were carried out with the help of a semi-structured questionnaire and the guided field-walk method where the healers took the interviewers on guided field-walks through areas from where they collected their medicinal plants. Here they identified the plants and described their uses.
Results:
The Bauri healers were observed to use 40 different plant species and one bird species for treatment of ailments such as fever, respiratory tract disorders, pain, gastrointestinal disorders, eye problems like cataract and conjunctivitis, jaundice, abscess, cardiovascular disorders, urinary problems, paralysis, dog bite, snake bite, helminthiasis, lesions on the tongue or lips and piles. Leaves were the major plant part used and constituted 38.3% of total uses followed by fruits at 14.9%.
Conclusions:
A review of the relevant scientific literature showed that a number of medicinal plants used by the Bauri healers possess pharmacological activities, which were in line with the traditional uses, thus validating their use by the Bauri tribe.
doi:10.4103/0257-7941.122997
PMCID: PMC3902534  PMID: 24501442
Bauri; ethnomedicine; Moulvibazar
9.  A Plant-Derived Morphinan as a Novel Lead Compound Active against Malaria Liver Stages  
PLoS Medicine  2006;3(12):e513.
Background
The global spread of multidrug–resistant malaria parasites has led to an urgent need for new chemotherapeutic agents. Drug discovery is primarily directed to the asexual blood stages, and few drugs that are effective against the obligatory liver stages, from which the pathogenic blood infection is initiated, have become available since primaquine was deployed in the 1950s.
Methods and Findings
Using bioassay-guided fractionation based on the parasite's hepatic stage, we have isolated a novel morphinan alkaloid, tazopsine, from a plant traditionally used against malaria in Madagascar. This compound and readily obtained semisynthetic derivatives were tested for inhibitory activity against liver stage development in vitro (P. falciparum and P. yoelii) and in vivo (P. yoelii). Tazopsine fully inhibited the development of P. yoelii (50% inhibitory concentration [IC50] 3.1 μM, therapeutic index [TI] 14) and P. falciparum (IC50 4.2 μM, TI 7) hepatic parasites in cultured primary hepatocytes, with inhibition being most pronounced during the early developmental stages. One derivative, N-cyclopentyl-tazopsine (NCP-tazopsine), with similar inhibitory activity was selected for its lower toxicity (IC50 3.3 μM, TI 46, and IC50 42.4 μM, TI 60, on P. yoelii and P. falciparum hepatic stages in vitro, respectively). Oral administration of NCP-tazopsine completely protected mice from a sporozoite challenge. Unlike the parent molecule, the derivative was uniquely active against Plasmodium hepatic stages.
Conclusions
A readily obtained semisynthetic derivative of a plant-derived compound, tazopsine, has been shown to be specifically active against the liver stage, but inactive against the blood forms of the malaria parasite. This unique specificity in an antimalarial drug severely restricts the pressure for the selection of drug resistance to a parasite stage limited both in numbers and duration, thus allowing researchers to envisage the incorporation of a true causal prophylactic in malaria control programs.
A derivative of a morphinan alkaloid, tazopsine, from a plant used against malaria in Madagascar, is active against the hepatic stages ofPlasmodium species.
Editors' Summary
Background.
The parasite that causes malaria has quickly developed resistance to many of the drugs that are commonly used to treat this disease. As a result, new drugs and drug combinations are needed. In some parts of the world where antimalarial drugs are failing due to resistance, or are not available to everyone, people often turn to traditional herbal remedies instead. These traditional plant remedies can be a useful starting point for development of new drugs, but the process of developing effective new drugs from plant remedies is long and complicated. An important initial step is to isolate and identify the active compounds from plants and then see how well these compounds perform against malaria parasites in laboratory tests. If the tests are successful, such compounds could then progress to experiments in animals and possibly eventually human trials. One plant used widely in Madagascar for treatment of malaria is Strychnopsis thouarsii; the traditional remedy consists of the plant stem bark boiled in water.
Why Was This Study Done?
The group of researchers doing this study wanted to discover candidates for new malaria drugs. They therefore wanted to find out which molecular compounds in the stem bark of S. thouarsii contained antimalarial activity, and what particular stage of the malaria parasite's life cycle these compounds had an effect on. The researchers suspected that the agents in this plant bark had some activity against the “liver stage” of malaria infection in humans. This is the first stage of infection, after a person has been bitten by a malaria-infected mosquito, and before blood cells are invaded by malaria parasites (which then causes the disease symptoms). Very few drugs currently in existence have an effect on the “liver stage” of infection, but activity at this stage would be tremendously useful because it could mean a drug is better for prevention of malaria than others in existence.
What Did the Researchers Do and Find?
First, the researchers wanted to take the traditional herbal remedy—of S. thouarsii bark boiled in water—and find out precisely which molecule in that remedy was responsible for the antimalarial activity. They therefore used a method called chromatography to progressively separate the herbal extract into its distinct components. At each stage of separation, the extract was checked for activity against malaria using a laboratory test. Inactive extracts were disregarded, and the active component then taken on to a further separation round. After many rounds of separation and testing, the researchers got down to a single, apparently new, molecule that was active against malaria in the laboratory test, and this molecule was named tazopsine (in the Malagasy language the word Tazo refers to malaria). In order to find out how effective the molecule was at killing malaria parasites, the researchers took human or mouse liver cells cultured in the laboratory, infected them with malaria parasites (either the malaria parasite that normally infects humans, or a related species that infects mice), and then added tazopsine at different concentrations. The compound completely killed the malaria parasites even at very low concentrations, and had activity against malaria infecting either liver cells or red blood cells. Tazopsine was then given to mice injected with a species of the malaria parasite. The compound protected most mice against malaria infection when it was used at a dosage level lower than the toxic dose. The researchers then tried making a series of different variants of tazopsine in the hope that some variants would be less toxic, but equally active as, the original compound. They found one variant, named NCP-tazopsine, that was much less toxic but just as active as tazopsine, but only against the malaria infecting liver cells.
What Do These Findings Mean?
In these experiments a new molecule, tazopsine, was discovered from a Malagasy plant, and it was found to be active against liver-stage malaria parasites, in laboratory experiments and in mice. This molecule or variants of it could in future become candidate antimalarial drugs in humans. However, much work would need to be done before testing could get to that stage. Different variants of molecules related to tazopsine would need to be tested to find one that has low toxicity, and these variants would need to be fully evaluated in animals to see how they are handled in the body before any trials could begin in humans.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030513
The World Health Organization publishes a minisite containing links to information about all aspects of malaria worldwide, including treatment, prevention, and current programmes for malaria control
Medicines for Malaria Venture is a collaboration between public and private organizations (including the pharmaceutical industry) that aims to fund and manage the development of new drugs for treatment and prevention of malaria
Wikipedia entries for drug discovery and drug development (note: Wikipedia is an internet encyclopedia that anyone can edit)
doi:10.1371/journal.pmed.0030513
PMCID: PMC1716192  PMID: 17194195
10.  Tribes in Karnataka: Status of health research 
The south Indian State of Karnataka, once part of several kingdoms and princely states of repute in the Deccan peninsula, is rich in its historic, cultural and anthropological heritage. The State is the home to 42,48,987 tribal people, of whom 50,870 belong to the primitive group. Although these people represent only 6.95 per cent of the population of the State, there are as many as 50 different tribes notified by the Government of India, living in Karnataka, of which 14 tribes including two primitive ones, are primarily natives of this State. Extreme poverty and neglect over generations have left them in poor state of health and nutrition. Unfortunately, despite efforts from the Government and non-Governmental organizations alike, literature that is available to assess the state of health of these tribes of the region remains scanty. It is however, interesting to note that most of these tribes who had been original natives of the forests of the Western Ghats have been privy to an enormous amount of knowledge about various medicinal plants and their use in traditional/folklore medicine and these practices have been the subject matter of various scientific studies. This article is an attempt to list and map the various tribes of the State of Karnataka and review the studies carried out on the health of these ethnic groups, and the information obtained about the traditional health practices from these people.
doi:10.4103/0971-5916.159586
PMCID: PMC4510769  PMID: 26139788
Ethnic people; health; Karnataka; scheduled tribe; traditional/herbal medicine; tribe
11.  Antimalarial plants of northeast India: An overview 
The need for an alternative drug for malaria initiated intensive efforts for developing new antimalarials from indigenous plants. The information from different tribal communities of northeast India along with research papers, including books, journals and documents of different universities and institutes of northeast India was collected for information on botanical therapies and plant species used for malaria. Sixty-eight plant species belonging to 33 families are used by the people of northeast India for the treatment of malaria. Six plant species, namely, Alstonia scholaris, Coptis teeta, Crotolaria occulta, Ocimum sanctum, Polygala persicariaefolia, Vitex peduncularis, have been reported by more than one worker from different parts of northeast India. The species reported to be used for the treatment of malaria were either found around the vicinity of their habitation or in the forest area of northeast India. The most frequently used plant parts were leaves (33%), roots (31%), and bark and whole plant (12%). The present study has compiled and enlisted the antimalarial plants of northeast India, which would help future workers to find out the suitable antimalarial plants by thorough study.
doi:10.4103/0975-9476.93940
PMCID: PMC3326788  PMID: 22529674
Alkaloids; malaria; medicinal plants; mosquito repellents; northeast India; traditional knowledge of medicine
12.  Ethnomedicinal plants used for the treatment of cuts and wounds by Kuruma tribes, Wayanadu districts of Kerala, India 
Objective
To study the ethnomedicinal uses by the Kuruma tribals for discovering new drugs to cure cuts and wounds so as to provid the data scientifically evaluated.
Methods
A survey was conducted during May 2008–September 2009 to collect information on medicinal plants used by the Kuruma tribes and queries were made on the various species of plants used regularly and occasionally to cure cuts and wounds.
Results
The present study includes information on 34 plant species belonging to 32 genera and 25 families used by Kuruma tribe of Wayanad district of Kerala for the treatment of cuts and wounds.
Conclusions
The present study of the knowledge on the folklore uses of the medicinal plants used by Kuruma tribes leads to effective utilization of herbal medicines in the future.
doi:10.12980/APJTB.4.2014B571
PMCID: PMC4025284  PMID: 25183135
Ethnomedicine; Kuruma tribe; Cuts; Wounds; Wayanad; Kerala
13.  Treatment with aquatic plants by a Bagdi tribal healer of Rajbari District, Bangladesh 
Ancient Science of Life  2013;33(1):22-26.
Context:
Tribal healers mainly use land plants in their medicinal formulations; use of aquatic plants has been scarcely reported.
Aims:
The aim of the present study was to conduct an ethnomedicinal survey working with a Bagdi tribal healer of Rajbari District, Bangladesh.
Settings and Design:
The survey was carried out working with a Bagdi healer, who lived alone in the wetlands of Rajbari District and used primarily aquatic plants for treatment.
Materials and Methods:
Interview of the healer was carried out with the help of a semi-structured questionnaire and the guided field-walk method.
Results:
The Bagdi healer was observed to use seven different aquatic plant species coming from five plant families for treatment of ailments such as hemorrhoids, tonsillitis, heart disorders, burning sensations and pain in hands or legs, blurred vision, debility, sexual weakness in males, chronic dysentery, infertility in women, constipation, chronic leucorrhea, blackness and foul odor of menstrual blood, hair loss, graying of hair and to keep the head cool. One plant was used to treat what the healer mentioned as “evil eye”, this refers to their belief in black-magic.
Conclusions:
This is the first reported instance of a Bagdi healer who primarily uses aquatic plants for treatment. Ethnomedicinal uses of a number of the plants used by the Bagdi healer have been reported for other places in India and Pakistan. Taken together, the various uses of the different plant species opens up scientific possibilities of new drug discoveries from the plants.
doi:10.4103/0257-7941.134562
PMCID: PMC4140017  PMID: 25161326
Aquatic plants; Bagdi; Bangladesh; ethnomedicine; Rajbari
14.  Medicinal Plants and Formulations Used by the Soren Clan of the Santal Tribe in Rajshahi District, Bangladesh for Treatment of Various Ailments 
The Santals form the largest tribal community in northern Bangladesh reside primarily in Rajshahi and Rangpur Divisions, where they live in the districts of Rajshahi, Rangpur, Thakurgaon, Dinajpur, and Panchagarh. Although they are fast losing their traditional medicinal practices, they still have their own medicinal practitioners who rely mostly on medicinal plants for treatment of a variety of ailments. The traditional medicinal practices vary quite extensively between the twelve clans of the Santals. The objective of the present study was to conduct an ethnomedicinal survey amongst the Soren clan of the Santal community residing in two villages of Tanor Santal Para in Rajshahi district to collect information on their use of medicinal plants. Interviews were conducted of the two existing Santal traditional medicinal practitioners of the Soren clan with the help of a semi-structured questionnaire and using the guided field-walk method. Plant specimens as pointed out by the practitioners were collected and pressed on the field and identification completed at the Bangladesh National Herbarium. Information on 53 medicinal plants distributed into 32 families was obtained in this survey. Ailments treated by these plants included skin disorders, respiratory tract disorders, gastro-intestinal disorders, sexual dysfunctions, sexually transmitted diseases, diabetes, helminthiasis, pain, urinary problems, filariasis, leprosy, tuberculosis, epilepsy, snake bite, enlarged heart, and paralysis. The medicinal plants used by the Santals merit further scientific studies for some of their formulations are used to treat diseases like diabetes, paralysis, enlarged heart, tuberculosis, and filariasis for which modern medicine has no known cure or medicines have developed resistant vectors.
PMCID: PMC3746673  PMID: 23983366
Asian medicine; CAM; ethnomedicine; alternative therapy
15.  Multiple Origins and Regional Dispersal of Resistant dhps in African Plasmodium falciparum Malaria 
PLoS Medicine  2009;6(4):e1000055.
Cally Roper and colleagues analyze the distribution of sulfadoxine resistance mutations and flanking microsatellite loci to trace the emergence and dispersal of drug-resistant Plasmodium falciparum malaria in Africa.
Background
Although the molecular basis of resistance to a number of common antimalarial drugs is well known, a geographic description of the emergence and dispersal of resistance mutations across Africa has not been attempted. To that end we have characterised the evolutionary origins of antifolate resistance mutations in the dihydropteroate synthase (dhps) gene and mapped their contemporary distribution.
Methods and Findings
We used microsatellite polymorphism flanking the dhps gene to determine which resistance alleles shared common ancestry and found five major lineages each of which had a unique geographical distribution. The extent to which allelic lineages were shared among 20 African Plasmodium falciparum populations revealed five major geographical groupings. Resistance lineages were common to all sites within these regions. The most marked differentiation was between east and west African P. falciparum, in which resistance alleles were not only of different ancestry but also carried different resistance mutations.
Conclusions
Resistant dhps has emerged independently in multiple sites in Africa during the past 10–20 years. Our data show the molecular basis of resistance differs between east and west Africa, which is likely to translate into differing antifolate sensitivity. We have also demonstrated that the dispersal patterns of resistance lineages give unique insights into recent parasite migration patterns.
Editors' Summary
Background
Plasmodium falciparum, a mosquito-borne parasite that causes malaria, kills nearly one million people every year, mostly in sub-Saharan Africa. People become infected with P. falciparum when they are bitten by a mosquito that has acquired the parasite in a blood meal taken from an infected person. P. falciparum malaria, which is characterized by recurring fevers and chills, anemia (loss of red blood cells), and damage to vital organs, can be fatal within hours of symptom onset if untreated. Until recently, treatment in Africa relied on chloroquine and sulfadoxine–pyrimethamine. Unfortunately, parasites resistant to both these antimalarial drugs is now widespread. Consequently, the World Health Organization currently recommends artemisinin combination therapy for the treatment of P. falciparum malaria in Africa and other places where drug-resistant malaria is common. In this therapy, artemisinin derivatives (new fast-acting antimalarial agents) are used in combination with another antimalarial to reduce the chances of P. falciparum becoming resistant to either drug.
Why Was This Study Done?
P. falciparum becomes resistant to antimalarial drugs by acquiring “resistance mutations,” genetic changes that prevent these drugs from killing the parasite. A mutation in the gene encoding a protein called the chloroquine resistance transporter causes resistance to chloroquine, a specific group of mutations in the dihydrofolate reductase gene causes resistance to pyrimethamine, and several mutations in dhps, the gene that encodes dihydropteroate synthase, are associated with resistance to sulfadoxine. Scientists have discovered that the mutations causing chloroquine and pyrimethamine resistance originated in Asia and spread into Africa (probably multiple times) in the late 1970s and mid-1980s, respectively. These Asian-derived mutations are now common throughout Africa and, consequently, it is not possible to determine how they spread across the continent. Information of this sort would, however, help experts design effective measures to control the spread of drug-resistant P. falciparum. Because the mutations in dhps that cause sulfadoxine resistance only began to emerge in the mid-1990s, they haven't spread evenly across Africa yet. In this study, therefore, the researchers use genetic methods to characterize the geographical origins and contemporary distribution of dhps resistance mutations in Africa.
What Did the Researchers Do and Find?
The researchers analyzed dhps mutations in P. falciparum DNA from blood samples collected from patients with malaria in various African countries and searched the scientific literature for other similar studies. Together, these data show that five major variant dhps sequences (three of which contain mutations that confer various degrees of resistance to sulphadoxine in laboratory tests) are currently present in Africa, each with a unique geographical distribution. In particular, the data show that P. falciparum parasites in east and west Africa carry different resistance mutations. Next, the researchers looked for microsatellite variants in the DNA flanking the dhps gene. Microsatellites are DNA regions that contain short, repeated sequences of nucleotides. Because the number of repeats can vary and because microsatellites are inherited together with nearby genes, the ancestry of various resistance mutations can be worked out by examining the microsatellites flanking different mutant dhps genes. This analysis revealed five regional clusters in which the same resistance lineage was present at all the sites examined within the region and also showed that the resistance mutations in east and west Africa have a different ancestry.
What Do These Findings Mean?
These findings show that sulfadoxine-resistant P. falciparum has recently emerged independently at multiple sites in Africa and that the molecular basis for sulfadoxine resistance is different in east and west Africa. This latter result may have clinical implications because it suggests that the effectiveness of sulfadoxine as an antimalarial drug may vary across the continent. Finally, although many more samples need to be analyzed to build a complete picture of the spread of antimalarial resistance across Africa, these findings suggest that economic and transport infrastructures may have played a role in governing recent parasite dispersal across this continent by affecting human migration. Thus, coordinated malaria control campaigns across socioeconomically linked areas in Africa may reduce the African malaria burden more effectively than campaigns that are confined to national territories.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000055.
This study is further discussed in a PLoS Medicine Perspective by Tim Anderson
The MedlinePlus encyclopedia contains a page on malaria (in English and Spanish)
Information is available from the World Health Organization on malaria (in several languages) and on drug-resistant malaria
The US Centers for Disease Control and Prevention provide information on malaria (in English and Spanish)
Information is available from the Roll Back Malaria Partnership on its approach to the global control of malaria, and on malaria control efforts in specific parts of the world
The WorldWide Antimalarial Resistance Network is creating an international database about antimalarial drug resistance
doi:10.1371/journal.pmed.1000055
PMCID: PMC2661256  PMID: 19365539
16.  Traditional Knowledge and Formulations of Medicinal Plants Used by the Traditional Medical Practitioners of Bangladesh to Treat Schizophrenia Like Psychosis 
Schizophrenia is a subtle disorder of brain development and plasticity; it affects the most basic human processes of perception, emotion, and judgment. In Bangladesh the traditional medical practitioners of rural and remote areas characterized the schizophrenia as an insanity or a mental problem due to possession by ghosts or evil spirits and they have used various plant species' to treat such symptoms. The aim of the present study was to conduct an ethnomedicinal plant survey and documentation of the formulations of different plant parts used by the traditional medical practitioners of Rangamati district of Bangladesh for the treatment of schizophrenia like psychosis. It was observed that the traditional medical practitioners used a total of 15 plant species to make 14 formulations. The plants were divided into 13 families, used for treatment of schizophrenia and accompanying symptoms like hallucination, depression, oversleeping or insomnia, deterioration of personal hygiene, forgetfulness, and fear due to evil spirits like genies or ghost. A search of the relevant scientific literatures showed that a number of plants used by the medicinal practitioners have been scientifically validated in their uses and traditional medicinal knowledge has been a means towards the discovery of many modern medicines. Moreover, the antipsychotic drug reserpine, isolated from the dried root of Rauvolfia serpentina species, revolutionized the treatment of schizophrenia. So it is very much possible that formulations of the practitioner, when examined scientifically in their entireties, can form discovery of lead compounds which can be used as safe and effective antipsychotic drug to treat schizophrenia.
doi:10.1155/2014/679810
PMCID: PMC4100298  PMID: 25101175
17.  Antimalarial natural products: a review 
Objective: Malaria is an infectious disease commonplace in tropical countries. For many years, major antimalarial drugs consisted of natural products, but since 1930s these drugs have been largely replaced with a series of synthetic drugs. This article tries to briefly indicate that some plants which previously were used to treat malaria, as a result of deficiencies of synthetic drugs, have revived into useful products once more. It also attempts to describe some tests which can be used to evaluate plant extracts for antimalarial activity.
Materials and Methods: By referring to some recent literatures, data were collected about plants used for the treatment of malaria, evaluation of plant extracts for antimalarial activity, modes of action of natural antimalarial agents, and recent research on antimalarial plants in Iran and other countries.
Results and Conclusion: There is an urgent need for the development of new treatments for malaria. Many countries have a vast precedence in the use of medicinal plants and the required knowledge spans many centuries. Although malaria is controlled in Iran, some researchers tend to study malaria and related subjects. In vitro biological tests for the detection of antimalarial activities in plant extracts are currently available. It is vital that the efficacy and safety of traditional medicines be validated and their active constituents be identified in order to establish reliable quality control measures.
PMCID: PMC4075661  PMID: 25050231
Antimalarial plants; Malaria; Natural Products
18.  Medicinal Plants Useful for Malaria Therapy in Okeigbo, Ondo State, Southwest Nigeria 
There is increasing resistance of malaria parasites to chloroquine, the cheapest and commonly used drug for malaria in Nigeria. Artemisin, a product from medicinal plant indigenous to China, based on active principle of Artemisia annua, has been introduced into the Nigerian market. However not much has been done to project antimalaria properties of indigenous medicinal plants. This study thus, has the main objective of presenting medicinal plants used for malaria therapy in Okeigbo, Ondo State, South west Nigeria. Focus group discussions and interview were held about plants often found useful for malaria therapy in the community. Fifty species (local names) including for example: Morinda lucida (Oruwo), Enantia chlorantha (Awopa), Alstonia boonei (Ahun), Azadirachta indica (Dongoyaro) and Khaya grandifoliola (Oganwo) plants were found to be in use for malaria therapy at Okeigbo, Southwest, Nigeria . The parts of plants used could either be the barks, roots, leaves or whole plants. The recipes also, could be a combination of various species of plants or plant parts. This study highlights potential sources for the development of new antimalarial drugs from indigenous medicinal plants found in Okeigbo, Nigeria.
PMCID: PMC2816451  PMID: 20162091
Malaria; Medicinal plants; antimalarial drugs; Okeigbo; Southwest Nigeria
19.  PA01.56. Malaria cure by Herbal / Ayurvedic Medicine in Central Indian tribal belt 
Ancient Science of Life  2012;32(Suppl 1):S106.
Malaria is one of the dreaded global killer diseases especially in the poor, forested, hilly, remote regions with little medical facilities. About 2 million malaria cases are estimated to occur in India annually as per the National malaria research institute study, but many more unreported cases also occur. Each leads to treatment cost of Rs. 1,000/ (one thousand) on average. This implies Rs. 2 billion drug market. Considering that the proposed local medicinal plants based drug will cut the treatment cost by at least 50% , the business potential with 100% replacement would be Rs. 1 billion at least. The formula is basically clinically found successful by Bombay Hospital scientists. The pharmaceutical companies do not invest in the market “at the bottom of the pyramid” due to thin margins/ loss risk. Thus, of the patented malaria medicine developed by National Research Development Council (NRDC) named “Ayush 64” (www.nrdcindia.com/pages/ayush64.htm), hardly any companies bought marketing rights or did many sales. There is huge market in N. E. India/ Africa/ S. America! Ayurveda has proven medicines to treat malaria viz. Mahasudarshan Churna, Tribhuvan kirti & Parijat vati, who treat “Visham jwara” its Ayurvedic indication. However, these are unknown, unavailable, costly & unused in the tribal areas so not popularized. Folk medicines reported, but rarely, to treat malaria include Neem, Kalmegh & Harsingar, where in a clinical study in Mumbai on 120 Malaria patients, 77% showed complete parasite eradication within 7 days of treatment with the leaf paste, and is also found safe. We also found it effective in our work in Balangir in 2011, besides also by the other NGOs in Orissa viz. Sambandh & FRLHT (www.iaim.edu.in), mainly as a prophylactic. About 30% of the family expenses today spent on Malaria treatment will be cut by about 50%, saving about Rs.2,500/ annually to spend on food, health & education. About 10% productivity will also grow, taking total benefit to Rs.4, 000/ annually, as each person per family spend lying on bed about 10 15 days in Malaria fever. This will be at a cost of just Rs. 500/ making the output: input ratio 1.5, than the total loss now! Also, local & common plants sources, simple technology ensure continued availability & low cost unlike Artemissin drug.
PMCID: PMC3800859
20.  The Activities of Current Antimalarial Drugs on the Life Cycle Stages of Plasmodium: A Comparative Study with Human and Rodent Parasites 
PLoS Medicine  2012;9(2):e1001169.
Michael Delves and colleagues compare the activity of 50 current and experimental antimalarials against liver, sexual blood, and mosquito stages of selected human and nonhuman parasite species, including Plasmodium falciparum, Plasmodium berghei, and Plasmodium yoelii.
Background
Malaria remains a disease of devastating global impact, killing more than 800,000 people every year—the vast majority being children under the age of 5. While effective therapies are available, if malaria is to be eradicated a broader range of small molecule therapeutics that are able to target the liver and the transmissible sexual stages are required. These new medicines are needed both to meet the challenge of malaria eradication and to circumvent resistance.
Methods and Findings
Little is known about the wider stage-specific activities of current antimalarials that were primarily designed to alleviate symptoms of malaria in the blood stage. To overcome this critical gap, we developed assays to measure activity of antimalarials against all life stages of malaria parasites, using a diverse set of human and nonhuman parasite species, including male gamete production (exflagellation) in Plasmodium falciparum, ookinete development in P. berghei, oocyst development in P. berghei and P. falciparum, and the liver stage of P. yoelii. We then compared 50 current and experimental antimalarials in these assays. We show that endoperoxides such as OZ439, a stable synthetic molecule currently in clinical phase IIa trials, are strong inhibitors of gametocyte maturation/gamete formation and impact sporogony; lumefantrine impairs development in the vector; and NPC-1161B, a new 8-aminoquinoline, inhibits sporogony.
Conclusions
These data enable objective comparisons of the strengths and weaknesses of each chemical class at targeting each stage of the lifecycle. Noting that the activities of many compounds lie within achievable blood concentrations, these results offer an invaluable guide to decisions regarding which drugs to combine in the next-generation of antimalarial drugs. This study might reveal the potential of life-cycle–wide analyses of drugs for other pathogens with complex life cycles.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Malaria is a life-threatening disease caused by the Plasmodium parasite, which is transmitted to people through the bites of infected mosquitoes. According to latest global estimates, about 250 million people are infected with malaria every year with roughly 800,000 deaths—most occurring among young children living in Africa. Malaria also causes severe morbidity in children, such as anemia, low birth weight, and neurological problems, which compromise the health and development of millions of children living in malaria endemic areas. In addition to strategies that scale up and roll out the prevention of malaria, such as country-wide programs to provide insecticide-treating bednets, in the goal to eradicate malaria, the global health community has refocused efforts on the treatment of malaria, including finding new compounds that target different stages of the parasite life cycle as it passes from vector to host and back.
The interruption of malaria transmission worldwide is one of the greatest challenges for the global health community. In January 2011, this journal published a series on The Malaria Eradication Research Agenda (malERA), which described a set of research and development priorities, identified key knowledge gaps and the necessary tools needed, and introduced a draft research and development agenda for the worldwide eradication of malaria.
Why Was This Study Done?
Most currently available antimalarial drugs primarily target the disease-causing parasites' stages in the human blood system. But to eradicate malaria, new drugs that block transmission of the parasite between the human host and the mosquito vector, and eliminate the various stages of the parasite during its cycle in the human body, are needed. In this laboratory study, the researchers compared the profiles of all available and experimental antimalarials and analyzed each drug for activity against each specific stage in the malaria parasite's life cycle to provide a reference set of methods and data, that might serve as a benchmark to help guide the malaria research community in assessing the potential of newly discovered antimalarials. Furthermore, this analysis could provide insights into which chemical drug classes might provide transmission-blocking capabilities—an essential component of malaria eradication.
What Did the Researchers Do and Find?
The researchers used novel laboratory techniques under standardized conditions to develop a series of novel assays to analyze the activities of 50 antimalarial compounds (current drugs and those under development) against three Plasmodium species encompassing every major cellular strategy of the malarial life cycle including drug resistant parasite strains. In their comparative analysis, the researchers undertook a chemical profiling approach to identify the drugs that block transmission from the host to the mosquito vector and additionally suppress transmission from the mosquito to the human host.
The researchers highlighted some encouraging results; for example, the potencies of some antimalarials against the asexual blood stage of cultivated P. falciparum and P. vivax isolates show a very good correlation, suggesting that most of the pathways inhibited by antimalarials in P. falciparum may also be valid targets in P. vivax. The researchers also have shown that approved drugs, such as pyronaridine and atovaquone, can target liver and sexual stages in addition to asexual blood stages. Furthermore, the researchers found promising results for new compounds currently in clinical trials, such as the endoperoxide OZ439, a stable synthetic molecule currently being studied in a phase IIa clinical trial, which seemed to be a strong inhibitor of gametocyte maturation and gamete formation. The new 8-aminoquinoline, NPC-1161B, also inhibited sporogony.
What Do These Findings Mean?
The results of this analysis provide a valuable guide to help researchers decide which drugs and compounds show most promise as potential future antimalarial drugs for blocking the transmission of malaria. This study could also help researchers make decisions about which molecules could be best combined to provide the next generation of drugs that will succeed artemisinin compound therapy and support the eradication of malaria. Furthermore, this comprehensive approach to drug discovery could be applied to test drugs against other pathogens with complex life cycles.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001169.
The malERA a research agenda for malaria eradication sponsored collection, published by PLoS in January 2011, comprises 12 Review articles that discuss agendas in malaria research and development
doi:10.1371/journal.pmed.1001169
PMCID: PMC3283556  PMID: 22363211
21.  Traditional use of medicinal plants by the Jaintia tribes in North Cachar Hills district of Assam, northeast India 
The study of ethnobotany relating to any tribe is in itself a very intricate or convoluted process. This paper documents the traditional knowledge of medicinal plants that are in use by the indigenous Jaintia tribes residing in few isolated pockets of northeast India. The present study was done through structured questionnaires in consultations with the tribal practitioners and has resulted in the documentation of 39 medicinal plant species belonging to 27 families and 35 genera. For curing diverse form of ailments, the use of aboveground plant parts was higher (76.59%) than the underground plant parts (23.41%). Of the aboveground plant parts, leaf was used in the majority of cases (23 species), followed by fruit (4). Different underground plant forms such as root, tuber, rhizome, bulb and pseudo-bulb were also found to be in use by the Jaintia tribe as a medicine. Altogether, 30 types of ailments have been reported to be cured by using these 39 medicinal plant species. The study thus underlines the potentials of the ethnobotanical research and the need for the documentation of traditional ecological knowledge pertaining to the medicinal plant utilization for the greater benefit of mankind.
doi:10.1186/1746-4269-2-33
PMCID: PMC1563446  PMID: 16899114
22.  Plants traditionally prescribed to treat tazo (malaria) in the eastern region of Madagascar 
Malaria Journal  2003;2:25.
Background
Malaria is known as tazo or tazomoka in local terminology in Madagascar. Within the context of traditional practice, malaria (and/or malaria symptoms) is commonly treated by decoctions or infusions from bitter plants. One possible approach to the identification of new antimalarial drug candidates is to search for compounds that cure or prevent malaria in plants empirically used to treat malaria. Thus, it is worth documenting the ethnobotanical data, and testing the antiplasmodial activity of the extractive from plants.
Methods
We interviewed traditional healers, known locally as ombiasy, at Andasibe in the eastern, rainy part of Madagascar. We recorded details of the preparation and use of plants for medicinal purposes. We extracted five alkaloids from Z. tsihanimposa stem bark, and tested them in vitro against Plasmodium falciparum FCM29.
Results
We found that traditional healers treat malaria with herbal remedies consisting of one to eight different plants. We identified and listed the medicinal plants commonly used to treat malaria. The plants used included a large number of species from different families. Zanthoxylum sp (Rutaceae) was frequently cited, and plants from this genus are also used to treat malaria in other parts of Madagascar. From the plant list, Zanthoxylum tsihanimposa, bitter plant endemic to Madagascar, was selected and examined. Five alkaloids were isolates from the stem bark of this plant, and tested in vitro against malaria parasite. The geometric mean IC50 values ranged from 98.4 to 332.1 micromolar. The quinoline alkaloid gamma-fagarine exhibited the strongest antiplasmodial activity.
Conclusions
The current use of plants for medicinal purposes reflects the attachment of the Malagasy people to their culture, and also a lack of access to modern medicine. The possible extrapolation of these in vitro findings, obtained with plant extracts, to the treatment of malaria and/or the signs evoking malaria is still unclear. If plants are to be used as sources of novel antimalarial compounds, we need to increase our knowledge of their empirical use to improve plant selection. In the hope of preserving useful resources, we should now gather and record ethnobotanical data in Madagascar, and should try to bridge the gaps between empirics and realism.
doi:10.1186/1475-2875-2-25
PMCID: PMC184444  PMID: 12921540
23.  Population Pharmacokinetics of Artesunate and Dihydroartemisinin following Intra-Rectal Dosing of Artesunate in Malaria Patients 
PLoS Medicine  2006;3(11):e444.
Background
Intra-rectal artesunate has been developed as a potentially life-saving treatment of severe malaria in rural village settings where administration of parenteral antimalarial drugs is not possible. We studied the population pharmacokinetics of intra-rectal artesunate and the relationship with parasitological responses in patients with moderately severe falciparum malaria.
Methods and Findings
Adults and children in Africa and Southeast Asia with moderately severe malaria were recruited in two Phase II studies (12 adults from Southeast Asia and 11 children from Africa) with intensive sampling protocols, and three Phase III studies (44 children from Southeast Asia, and 86 children and 26 adults from Africa) with sparse sampling. All patients received 10 mg/kg artesunate as a single intra-rectal dose of suppositories. Venous blood samples were taken during a period of 24 h following dosing. Plasma artesunate and dihydroartemisinin (DHA, the main biologically active metabolite) concentrations were measured by high-performance liquid chromatography with electrochemical detection. The pharmacokinetic properties of DHA were determined using nonlinear mixed-effects modelling. Artesunate is rapidly hydrolysed in vivo to DHA, and this contributes the majority of antimalarial activity. For DHA, a one-compartment model assuming complete conversion from artesunate and first-order appearance and elimination kinetics gave the best fit to the data. The mean population estimate of apparent clearance (CL/F) was 2.64 (l/kg/h) with 66% inter-individual variability. The apparent volume of distribution (V/F) was 2.75 (l/kg) with 96% inter-individual variability. The estimated DHA population mean elimination half-life was 43 min. Gender was associated with increased mean CL/F by 1.14 (95% CI: 0.36–1.92) (l/kg/h) for a male compared with a female, and weight was positively associated with V/F. Larger V/Fs were observed for the patients requiring early rescue treatment compared with the remainder, independent of any confounders. No associations between the parasitological responses and the posterior individual estimates of V/F, CL/F, and AUC0–6h were observed.
Conclusions
The pharmacokinetic properties of DHA were affected only by gender and body weight. Patients with the lowest area under the DHA concentration curve did not have slower parasite clearance, suggesting that rectal artesunate is well absorbed in most patients with moderately severe malaria. However, a number of modelling assumptions were required due to the large intra- and inter-individual variability of the DHA concentrations.
A study of the population pharmacokinetics of intra-rectal artesunate in patients with moderately severe falciparum malaria found the pharmacokinetic properties of dihydroartemisinin were affected only by gender and body weight.
Editors' Summary
Background.
More than 40% of the world's population is at risk of malaria, a tropical parasitic disease that is transmitted between people by infected mosquitoes. Malaria parasites cause a 'flu-like illness that includes chills, fevers, headaches, and sometimes nausea and vomiting. If untreated, people with malaria can rapidly become anemic—the parasite destroys their red blood cells—or can develop complications that damage the brain and other organs. Severe malaria can be fatal and must be treated quickly. It has become a matter of great concern that the parasite has developed resistance to most of the drugs used to treat or prevent malaria. In the past few years, artemisinin derivatives have been shown to be an effective new form of treatment. Artemisinin derivatives are effective, rapid-acting antimalarial drugs—wormwood, the plant source of artemisinin, is an ancient Chinese cure for malaria. Artesunate, a water-soluble derivative of artemisinin, can be given as tablets or as injections. However, people with severe malaria often cannot take oral medicines, and in rural settings in the developing world, artesunate injections are usually impracticable. Consequently, rectal artesunate suppositories have been developed to provide first-line treatment of severe malaria in these settings. This simple dosing method can “buy” patients valuable time during which they can be moved to a hospital for further treatment.
Why Was This Study Done?
When treating severe malaria, it is important that every patient absorbs the antimalarial drug rapidly and efficiently into their blood. If even a small proportion of patients malabsorb the drug, many people could die. How the body processes a drug is known as pharmacokinetics, and although some pharmacokinetic studies have investigated how the body processes artesunate given in rectal suppositories, relatively little is know about the population pharmacokinetics of artesunate given this way. That is, the patient characteristics that affect the processing of intra-rectal artesunate are not known, and it is unclear whether a small proportion of the population might fail to absorb the drug given via this route. In this study, the researchers have developed and tested a population pharmacokinetic model for artesunate given rectally to children and adults with moderately severe malaria.
What Did the Researchers Do and Find?
The researchers took serial blood samples from nearly 200 patients with moderately severe malaria in Africa and Southeast Asia for the first 24 hours after they received a rectal artesunate suppository. They measured the levels of artesunate and dihydroartemisinin (DHA; the body rapidly converts artesunate to DHA, which kills the malaria parasites) in these samples and used these data to build a pharmacokinetic model for how the body processes. Averaged out across the patients, they calculated, for example, that half of the drug present absorbed was eliminated within 43 minutes. To find out whether any patient characteristics affected the pharmacokinetics of intra-rectal artesunate, the researchers used their model to estimate the clearance of DHA from the body and the ability of DHA to spread through the body (so-called apparent volume of distribution) for the study patients. This analysis showed that only gender and weight affected DHA pharmacokinetics. Finally, the researchers showed that how well the parasite was cleared from the patients was not related to these pharmacokinetic parameters, although the need for earlier rescue treatment was associated with a larger volume of distribution for DHA. Importantly, the parasitological response was not affected by the estimated cumulative amount of DHA absorbed into the blood during the first six hours after treatment.
What Do These Findings Mean?
The data presented in this study indicate that individual patients processed artesunate very differently in terms of how they absorbed the drug and how it spread around the body. Even so, the maximal effects of artesunate on the malaria parasite were achieved rapidly in nearly all the patients. This and other pharmacokinetic findings must be interpreted with caution, warn the researchers, because their model included many assumptions to allow, for example, for the variability of DHA concentrations both within individual patients and between patients. Nevertheless, the findings provide important clues about which patient characteristics might cause early treatment failure, and indicate that artesunate is sufficiently well absorbed via the rectal route in most patients to make artesunate suppositories a promising first-line treatment for moderately severe malaria.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030444.
• World Health Organization links to general information on malaria plus specific information on rectal artesunate
• MedlinePlus encyclopedia entry on malaria
• US Centers for Disease Control and Prevention information on malaria for patients and professionals
• Wikipedia pages on malaria and artemisinin (note that Wikipedia is a free online encyclopedia that anyone can edit)
doi:10.1371/journal.pmed.0030444
PMCID: PMC1664603  PMID: 17132053
24.  Traditional healing practice and folk medicines used by Mishing community of North East India 
Assam and Arunachal Pradesh have very rich tradition of herbal medicines used in the treatment of various ailments. Tribal communities practice different types of traditional healing practices. Enough documentation is available on the healing practices in other tribal communities except Mishing community of Assam and foot hill of East Siang district of Arunachal Pradesh hence the attempt was made for the same. A survey on folk medicinal plants and folk healers of Mishing tribe was conducted in few places of Lakhimpur and Dhemaji district of Assam and East Siang district of Arunachal Pradesh, where this ethnic group is living since time immemorial. All information was collected based on interview and field studies with local healers within the community. The identification of medicinal plants collected with help of indigenous healers was done. Such medicines have been shown to have significant healing power, either in their natural state or as the source of new products processed by them. This study is mainly concentrated with plants used to cure diseases and to enquire about different healing systems. Detail note on the method of preparation of precise dose, the part/parts of plants used and method of application is given.
doi:10.4103/0975-9476.100171
PMCID: PMC3487237  PMID: 23125508
Ethno-medicines; ethnic groups; herbal practitioners
25.  Indigenous knowledge of medicinal plants used by Saperas community of Khetawas, Jhajjar District, Haryana, India 
Background
Plants have traditionally been used as a source of medicine in India by indigenous people of different ethnic groups inhabiting various terrains for the control of various ailments afflicting human and their domestic animals. The indigenous community of snake charmers belongs to the 'Nath' community in India have played important role of healers in treating snake bite victims. Snake charmers also sell herbal remedies for common ailments. In the present paper an attempt has been made to document on ethno botanical survey and traditional medicines used by snake charmers of village Khetawas located in district Jhajjar of Haryana, India as the little work has been made in the past to document the knowledge from this community.
Methods
Ethno botanical data and traditional uses of plants information was obtained by semi structured oral interviews from experienced rural folk, traditional herbal medicine practitioners of the 'Nath' community. A total of 42 selected inhabitants were interviewed, 41 were male and only one woman. The age of the healers was between 25 years and 75 years. The plant specimens were identified according to different references concerning the medicinal plants of Haryana and adjoining areas and further confirmation from Forest Research Institute, Dehradun.
Results
The present study revealed that the people of the snake charmer community used 57 medicinal plants species that belonged to 51 genera and 35 families for the treatment of various diseases. The study has brought to light that the main diseases treated by this community was snakebite in which 19 different types of medicinal plants belongs to 13 families were used. Significantly higher number of medicinal plants was claimed by men as compared to women. The highest numbers of medicinal plants for traditional uses utilized by this community were belonging to family Fabaceae.
Conclusion
This community carries a vast knowledge of medicinal plants but as snake charming is banned in India as part of efforts to protect India's steadily depleting wildlife, this knowledge is also rapidly disappearing in this community. Such type of ethno botanical studies will help in systematic documentation of ethno botanical knowledge and availing to the scientific world plant therapies used as antivenin by the Saperas community.
doi:10.1186/1746-4269-6-4
PMCID: PMC2826346  PMID: 20109179

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