Open Access Systematic Review Article

The Effectiveness of Manual Therapy and Exercise Therapy in Treating Non-specific Neck Pain Patients

Abdurrahman A. Alfawaz, Sultan S. Alanazi, Abdullah M. Almoshari, Sultan A. Alzobaidi, Yaser H. Alamri, Sami S. Alshwaiman, Abdulrahman H. Alghamdi

Journal of Complementary and Alternative Medical Research, Page 1-32
DOI: 10.9734/JOCAMR/2018/40303

Background: Non-specific neck pain (NS-NP) is a common disabling condition. Pain, stiffness, tenderness and a restricted range of motion are the most common symptoms observed on the physical examination of an NS-NP patient. Manual therapy (MT) and exercise are treatments commonly used for this population. However, the effectiveness of those treatments in the short and long term is questionable.  

Objectives: This systematic review aims to evaluate the effect of MT and/or exercise therapy on the pain and disability caused by NS-NP and to find the best available evidence from the literature.

Study Design: A systematic review of the literature (narrative synthesis).

Search Strategy: An inclusive search of different electronic databases (MEDLINE, CINAHL, PEDro, Science Direct and CENTRAL) was conducted to find the most relevant randomised controlled trials (RCTs) to satisfy the inclusion criteria of the review. The reference lists of relevant studies were also searched to find yet more relevant studies.

Means of Analysis: The methodological quality of the RCTs included was assessed using the PEDro scale. All the included trials were analysed qualitatively (narrative synthesis). The assessment of the methodology of each trial was conducted by a single reviewer.  

Main Results: Twenty-five RCTs were eligible for inclusion in this review (13 trials for exercise therapy and 12 for MT). The total number of study participants was 3,422. The mean age of participants was 44. The mean sample size was 137. The methodological quality of the trials was high, except for two trials assessed as being of low quality (a score of 5 on the PEDro scale). This systematic review found strong evidence supporting the following interventions: strengthening exercises in the long term, and both HVLA thoracic manipulation and cervical mobilisation in the short term. Moderate evidence was found to support the following interventions: a combination of upper and middle thoracic manipulation and cervical mobilisation in the short term, a combination of cervical thrust manipulation and exercise in the intermediate term, neck stabilisation exercises in combination with physical therapy modalities in the intermediate term, and a combination of upper cervical and upper thoracic manipulation again in the short term.

Conclusion: Within the limitations of this systematic review, both MT and exercise therapy showed beneficial effects on NP pain and disability in the short term. However, the efficacy of MT on disability in the long term needs further investigation.


Open Access Original Research Article

Effect of Ethanolic Leaf Extract of Vernonia amygdalina (Bitter Leaf) Extract on some of the Haematological Parameters in Wistar Rats

C. P. R. Chike, B. Njoku, K. Green, P. I. Akpojotor, M. O. Onyebuenyi, Deebii Numbara

Journal of Complementary and Alternative Medical Research, Page 1-7
DOI: 10.9734/JOCAMR/2018/35690

This study investigated some haematological parameters of Wistar rats using Vernonia amygdalina extract. The dried leaves of the plant species were extracted and put in 80% Volume/volume butanol dehydrogenase (V/V; BDH) ethanol. Thirty (30) Wistar rats were divided into 3 groups of 10 rats each. Group I served as control and feed with normal food and water. Groups II & III were served as test groups and were administered with VA100 mg/kg and VA300 mg/kg, orally once daily for 28 days. Five (5) animals were sacrificed from each group on the 14th and 28th day. Blood samples were collected through cardiac puncture for analyzing hematological parameters. It was observed that (RBC, Hb, PCV, MCV, MCH and MCHC) showed non-significant (p>0.05) changes on the 14th day. However, these showed a dose – dependent significant (p<0.05) decrease on day 28. There was a dose – dependent significant increase (p<0.05) in WBC and Lymphocyte; while neutrophils count decreased significantly (p<0.05) with dose dependent manner. Serum platelet level decreased significantly (p<0.05) if the level of dose increases. These findings revealed that V. amygdalina may have a possible potential to inhibit erythropoietin release or action and may strengthen the immunity. The observed reduced level of neutrophil count may be one of the reasons for the benign ethnic neutropenia which is seen in Africans. However, the study helps to conclude the anti inflammatory and potential effects of bitter leaf. This particular study also depicts that, ethanolic leaf extract of V. amygdalinamay cause anaemia especially at prolonged exposure.


Open Access Original Research Article

Immune Modulating and Antiproliferative Potential of Withania somnifera Crude and Pre-purified Fractions on Selected Cancerous and Normal Cells

Peter Githaiga Mwitari, Ngule Chrispus Mutuku, Lucia Keter, Jeremiah Gathirwa, Francis Kimani, Peter Kirira, Sabina Wachira

Journal of Complementary and Alternative Medical Research, Page 1-11
DOI: 10.9734/JOCAMR/2018/40053

Background: Cancer is a major public health problem globally. The burden of cancer is greater in developing countries where the cost of treatment and management is way beyond the reach of many resource challenged individuals. Plants are a good source for anticancer agents. Withania somnifera has been widely used for its great pharmacological value. Previous studies have shown that W. somnifera has potential as an immune modulating agent by up-regulating the Interleukin-7 cytokine gene expression. Interleukin-7 cytokine (IL-7) is required for the development of the immune system. Studies have shown that exogenous IL-7 increases T cell and B cell numbers. Activation of CD4+ and CD8+T cells may be effective agents for the treatment of malignant tumors. The objective of this study was to confirm that Kenyan W. somnifera plant parts extracts have antiproliferative activity and ability to raise IL-7 levels.

Methodology: The MTT assay was used to evaluate the anti-proliferative potential of the extracts. The conventional drug 5-Flourouracil was used as the positive control. For IL-7 analysis, the plant extract with the best antiproliferative activity was used. The cells were recultured in T25 flask then treated with the extract at 50µg/ml for 48hrs. After which the RNA was extracted using Pure Link RNA mini kit (Thermoscientific USA). The extracted RNA was quantified and its quality assessed using a NanoDrop ND-2000 spectrophotometer. Reverse transcription and cDNA amplification was done by a single step reaction technique using Invitrogen Super Script IV Reverse Transcriptase and Thermo scientific real time SYBR green kits according to the manufacturer’s instructions. Quantitative real-time PCR was performed in a reaction volume of 25 μL under different condition and time. A total of 50 cycles using RT- PCR Quant studio V system were performed. The primers were the designed using Expasy and Jusbio after which the ct cycle was used to determine the expression levels of IL-7.

Results: The stem methanol-dichloromethane extracts on HCC (IC50-25.23±1.23), roots water extract on DU 145 (IC50-8.04±1.55), leaves methanol-dichloromethane extracts on 22RVI (IC50-2.21±0.577) had the lowest IC50 values signifying high activity. The methanolic-dichloromethane extract stem bark gave the highest selectivity index on HCC (breast cancer, SI-98.403) compared to the other extracts. The most inhibitive methanol-dichloromethane extracts against cancerous cells did not inhibit the growth of IEC6 (normal cells). However after 48hrs of exposure of the plant’s extract on IEC6 cells expression of IL-7 gene was upregulated 2 times for crude W. somnifera leaves organic extract and up to 5.37 times for the prepurified fraction. Our findings indicate that Kenyan W. somnifera extracts especially in the pre-purified form have potential to treat and manage cancer. Of great significance is the potency of the plants extracts more so the prepurified fraction to up-regulate IL-7 which is an anticancer cytokine important in proliferation and maturation of immune system cells. This cytokine has been implicated in improved cancer prognosis. The potency of the W. somnifera extracts and pre-purified fraction to induce up-regulation of this could infer its probable immune modulation pathway as a possible mechanism of action of the plant’s extracts.


Open Access Original Research Article

Phenolics from the Rhizomes of Kaempferia galanga L. and Their Antioxidant Activity

Fazhuang Yao, Xiaopei Zhu, Yihai Wang, Xiangjiu He

Journal of Complementary and Alternative Medical Research, Page 1-6
DOI: 10.9734/JOCAMR/2018/40630

Aims: This research aimed at exploring phenolics from the Kaempferia galanga L. and evaluating their antioxidant effect.

Research Design: Phenolics were isolated and identified from the rhizomes of Kaempferia galanga L. Their radical scavenging ability was assayed by using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay method.

Place and Duration of Study: Research was conducted at the School of Pharmacy, Guangdong Pharmaceutical University, between at October 2016 and December 2017.

Methodology: Phenolics were isolated and purified by silica gel, ODS middle pressure liquid chromatography (MPLC) and high-performance liquid chromatography (HPLC), identified utilizing 1D, 2D nuclear magnetic resonance (NMR) and mass spectrum (MS). The radical scavenging ability of the isolated compounds was investigated via DPPH method.

Results: Ten phenolics were isolated and identified from the rhizomes of Kaempferia galanga L. (1-10). All compounds exhibited different levels of antioxidant effects in radical scavenging. Among them, compound 2 exhibited pronounced inhibitory effects in DPPH radical scavenging assay.

Conclusion: In this study, ten phenolics were isolated from the rhizomes of sand ginger (Kaempferia galanga L.). DPPH radical scavenging was carried out to assess their antioxidant activity. The results indicated that some phenolics showed moderate antioxidant activity compared to those of ascorbic acid in DPPH. And these also demonstrated that phenolics may be partially responsible for the rhizomes of sand ginger’s antioxidant activity. The discovery of phenolics and their antioxidant bioactivities is beneficial for understanding the scientific basis of the effects of Kaempferia galanga L.


Open Access Original Research Article

Histo-Architectural and Biochemical Changes in Kolaviron Induced Sleep Deprivation in Male Wistar Rats

O. O. Victor, M. O. Ebeye, P. E. Ohwin, M. O. Odigie, J. C. Igweh

Journal of Complementary and Alternative Medical Research, Page 1-11
DOI: 10.9734/JOCAMR/2018/39878

Organisms survive by maintaining a dynamic equilibrium with their environment. Stress is a state of threat to this equilibrium, and adaptation to stress, or allostasis, confers a survival advantage. Sleep deprivation constitute a biological stress implicated in many homeostatic alterations including weight loss, reduction in thymic weight, increased adrenal weight, elevated corticosterone and ACTH levels. This study sought to investigate the effects of ‘kolaviron extract’ on the biochemistry and histo-architecture of selected visceral. Thirty (30) male Wistar rats were randomly assigned into five (5) groups of six (6) rats each [A=Control, B=Sleep Deprived (SD), C=Kolaviron Extract (KE), D=KE+SD, and E=KE+SD]. While groups D and E respectively received 100 mg/kg and 200 mg/kg of extract in sleep deprived state, group C was given 200 mg/kg of extract without sleep deprivation. Groups A and B were each administered 1 ml of the vehicle (1% tween 80 solution) in normal-sleep and sleep-deprived states respectively. Following a two-week period of administration of test substance for 14 days, animals were euthanized, weights measured (weekly while administration lasted) and blood samples collected for assay of biochemical stressors. Selected organs were also harvested for histological analysis. At p < .05, Analysis of variance test (ANOVA) returns that Kolaviron extract decreases oxidative stress resulting from sleep deprivation in brain (specifically the pituitary gland and hypothalamus) and testicular tissues. It is recommended that further studies be made to check the possible impact(s) of kolaviron on other parts of the brain, with electron microscopy to evaluate any ultra-structural changes in the anterior pituitary and hypothalamus.