Use of Topical Complementary and Alternative Medicines (CAM) in Diabetic Septic Foot Disease in Makkah Region, Western of Saudi Arabia, an Exploratory Study

Diabetes is a chronic condition that is significantly impacted daily by environment. At least one in five Saudis, suffer from diabetes. “Diabetes is a pandemic of unprecedented magnitude spiraling out of control” (Boulton). Saudi Arabia ranks the second highest in the Middle East, and is the seventh in the world for the prevalence of diabetes (WHO). Diabetes mellitus (DM) has been found to be related to high mortality, morbidity accompanied by poor general health and lower quality of life. Current Saudi diabetes patients’ behaviors, practices, and beliefs regarding foot health problems such as ulcers, are not well investigated. Diabetic patients frequently utilize natural remedies and Herbs for self-medication as a part of complementary and alternative Medicine. Aim of study: To explore the widespread use of the alternative remedies in the local communities of the Western Saudi Arabia, the drives behind using and to focus on the potential adverse effects following their usage. Method: A descriptive, cross-sectional study of 386 diabetic patients with feet problems in Makkah Region, West of Saudi Arabia during the period April - June 2023. Results: Out of the 531 participants, only 386 participants reported diabetic foot disorder (DFD). Most of the participant were above 65 years of age group (24.61 %). Male (52.08%) more than female (47.92%) in the research group. All of the participants had diabetic foot disorders at least once. The prevalence of complementary and alternative medicines (CAM) use among them was 67.88%, as solitary or in combination with hospital medicines. Honey headed the list followed by myrrh and black seeds. Acquaintances advice (59.54%) was the most reason for using the alternative medicine. 60.30% of Diabetic foot patient complained of adverse effects during CAM remedies use. Conclusion: Consumption of CAM remedies among diabetic patients for Diabetic Foot Disorder (DFD) is common. Honey headed the list followed by myrrh and black seeds. Additional wide-scale research is required to establish their actual efficacy, safety and potential adverse out-comes and to generalize the outcomes.

Complementary and alternative medicines in irritable bowel syndrome: An integrative view

Irritable bowel syndrome(IBS)is a common gastrointestinal disorder with a high incidence in the general population.The diagnosis of IBS is mainly based on exclusion of other intestinal conditions through the absence of inflammatory markers and specific antigens.The current pharmacological treatment approaches available focus on reducing symptom severity while often limiting quality of life because of significant side effects.This has led to an effectiveness gap for IBS patients that seek further relief to increase their quality of life.Complementary and alternative medicines(CAM)have been associated with a higher degree of symptom management and quality of life in IBS patients.Over the past decade,a number of important clinical trials have shown that specific herbal therapies(peppermint oil and Iberogast?),hypnotherapy,cognitive behavior therapy,acupuncture,and yoga present with improved treatment outcomes in IBS patients.We propose an integrative approach to treating the diverse symptoms of IBS by combining the benefits of and need for pharmacotherapy with known CAM therapies to provide IBS patients with the best treatment outcome achievable.Initial steps in this direction are already being considered with an increasing number of practitioners recommending CAM therapies to their patients if pharmacotherapy alone does not alleviate symptoms sufficiently.

Attitudes and understanding of complementary and alternative medicine in cancer care:An exploratory study of patients’perspectives in Karachi,Pakistan

Objective:To evaluate the prevalence and types of complementary and alternative medicine(CAM)modalities among patients with cancer in Karachi,Pakistan.Methods:This descriptive cross-sectional study was conducted from March 2021 to December 2021.Five hundred patients with cancer were invited to participate in the study.Electronic databases,namely,Google scholar,Publons,EMBASE,PubMed,Chinese National Knowledge Infrastructure Database,and ResearchGate was used for questionnaire designed.The self-administered survey included questions on demographic characteristics,education level,socio-economic conditions and information about CAM therapies,prevalence,effectiveness,and common CAM modalities.Statistical analysis was conducted using SPSS software version 22.Results:Out of the 500 invited patients,433(86.6%)successfully completed and returned the questionnaires.In contrast to patients who were with younger,highly educated,professionally active,higher income,and had advanced cancer,time since diagnosis,type of treatment,cancer types and family history are significantly associated with CAM use.The results showed that 59.8%of the participants were acquainted with complementary and/or alternative medicine and considered safe owing to its natural ingredients.The prevalence of CAM usage among cancer patients was 40.9%and the most widely used CAM modality was herbal medicine(27.7%)and dietary supplements(28.8%).Patients used CAM as a complementary therapy to improve the morphological parameter(28.2%),strengthen the immune system(6.8%),and to decrease the side effects of conventional treatment(18.1%).Most of the respondents get the information regarding CAM therapy from the electronic media(43.2%)and the family members(48%)rather than healthcare personnel.Conclusions:Participants used CAM modalities along with the conventional health care practices.Further multicentre studies should be conducted to provide information regarding the usage of CAM therapies and their eventual benefits in patients with cancer.

Unresolved conundrum of the role of physical activity in inflammatory bowel disease:What next?

There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.This,in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches.In this context,the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations.This paper also points out the possibility of using adjuvant complementary medicine such as yoga,whose effects have been documented in other diseases like irritable bowel syndrome.A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal,to see whether the extraintestinal symptoms are alleviated.

Drug-Drug Interactions in Patients with Breast Cancer

The research paper investigates the intricate landscape of drug-drug interactions (DDIs) within the context of breast cancer treatment, with a particular focus on the elderly population and the use of complementary and alternative medicine (CAM). The study underscores the heightened susceptibility of elderly patients to DDIs due to the prevalence of polypharmacy and the widespread utilization of CAM among breast cancer patients. The potential ramifications of DDIs, encompassing adverse drug events and diminished treatment efficacy, are elucidated. The paper accentuates the imperative for healthcare providers to comprehensively understand both conventional and CAM therapies, enabling them to provide patients with informed guidance regarding safe and efficacious treatment options, culminating in enhanced patient outcomes.

Thematic Trends in Complementary and Alternative Medicine Applied in Cancer-Related Symptoms

Purpose： The main goal of this study is to discover the scientific evolution of Cancer-Related Symptoms in Complementary and Alternative Medicine research area, analyzing the articles indexed in the Web of Science database from 1980 to 2013.Design/Methodology/Approach： A co-word science mapping analysis is performed under a longitudinal framework（1980 to 2013）. The documental corpus is divided into two subperiods,1980–2008 and 2009–2013. Thus, the performance and impact rates, and conceptual evolution of the research field are shown.Findings： According to the results, the co-word analysis allows us to identify 12 main thematic areas in this emerging research field： anxiety, survivors and palliative care,meditation, treatment, symptoms and cancer types, postmenopause, cancer pain, low back pain, herbal medicine, children, depression and insomnia, inflammation mediators, and lymphedema. The different research lines are identified according to the main thematic areas,centered fundamentally on anxiety and suffering prevention. The scientific community can use this information to identify where the interest is focused and make decisions in different ways.Research limitation： Several limitations can be addressed： 1） some of the Complementary and Alternative Medicine therapies may not have been included; 2） only the documents indexed in Web of Science are analyzed; and 3） the thematic areas detected could change if another dataset was considered.Practical implications： The results obtained in the present study could be considered as an evidence-based framework in which future studies could be built.Originality/value： Currently, there are no studies that show the thematic evolution of this research area.

Complementary and alternative medicine applications in cancer medicine

Besides conventional medicine,many patients with cancer seek complementary and alternative medicine(CAM)as an additional treatment option.Since the early 1970s,the use of CAM in cancer treatment has expanded worldwide.CAM,as a tempting option,was used by patients with cancer mainly due to easy accessibility.Patients with cancer used CAM to achieve better quality of life or to find a cure.As physicians are mainly unaware of CAM use by patients,doctor-patient communication about CAM use should be brought to a higher level.To identify circumstances in which CAM are preferred,further investigations are needed especially in biologically based therapies.Clinical-based evidence for mind-body therapies have been established,so this type of CAM can be recommended for patients with cancer during chemotherapy.Future studies are necessary to fill the gaps so that CAM users,as well as medical experts,are in position to clearly determine all the benefits and disadvantages of the mentioned therapy.

Personal and professional influences on practitioners’ attitudes to traditional and complementary approaches to health in the UK

Objective:To explore primary care practitioners’personal and professional beliefs about traditional and complementary approaches(TCA)to health and the influence of professional socialization in the UK.Methods:As part of a larger study on child TCA use in a multi ethnic community,semi-structured,one on one,face-to-face interviewswith 30 primary care practitioners(GPs,nurses and health visitors)explored experience,knowledge and attitudes regarding TCA.Framework analysiswas used.This paper explores the key emergent issues of personal and professional beliefs and professional socialization resulting from the qualitative data obtained during the interviews.Results:Personal factors(ethnicity and personal use)influence attitudes,but professional factors appear to dominate,including biomedical theory,evidence basedmedicine,safety and treatment choice.Curbing of personal views and experience may be due to caution and conformity from increasing regulatory power.Inter-and intra-professional group differences also emerged,likely due to variation in training,status and professional role.Conclusions:Practitioners need to understand patients’diverse health beliefs and practices and discuss TCAwith families,despite regulatory and organizational constraints,to fulfil their professional duty to patients,particularly regarding safety.Further research is needed to verify the professional socialization process and the influence of specific regulation on training.

Using simulation in complementary medicine education:an overview of clinical trials

Backgroundand Aim:Using simulation in learning medical interventions is a common practice.Simulation techniques provided a safe environment for trainees and students to acquire clinical skills and knowledge to practice in a real clinical environment.The aim of this review is to assess the use of health simulation in the field of complementary medicine education.Methods:Three medical databases were searched from inception to 15 November 2021.The inclusion criteria were clinical trials that used simulation in the field of complementary medicine training and in English language and the full text can be retrieved.Results:After searching,495 articles were retrieved,235 articles were excluded for duplication and 249 articles were excluded after screening of titles/abstracts and applying inclusion and exclusion criteria.Finally,11 articles were included in this review.These clinical trials had 719 participants and reported positive impact of using simulation in complementary medicine education.Conclusion:Simulation wasused for training of some complementary medicine therapies such as chiropractic,acupuncture,massage therapy,cupping therapy and osteopathy.Using simulation in complementary medicine education is recommended to ensure a safe environment for training.Conducting high quality clinical trials to evaluate the use of simulation in complementary medicine education is highly recommended.

Use of Complementary and Alternative Medicine in Siblings of Pediatric Cancer Patients in Germany.A Population-Based Survey

Use of complementary and alternative medicine (CAM) in children with cancer is common and probably increasing. However data concerning use of CAM in siblings of children with an oncologic disease are missing so far. We conducted a population-based survey over a one-year period with 233 participants. Of the 209 respondents (90% response rate) 20% reported CAM use from the time on when the sibling was diagnosed to have cancer, compared to a prevalence rate of 48% before cancer diagnosis. The most prevalent therapies were homeopathy, anthroposophic medicine and Bach flowers. The main reasons for use were to strengthen the immune system and to achieve physical stabilization. Socio-demographic factors associated with CAM use were higher parental education and higher family income. A majority of CAM users would recommend them. 66% of the users informed a physician about CAM use. No side effects were reported.Conclusions: There is a significant decrease in CAM use in siblings of pediatric cancer patients after ascertainment of cancer in the affected sibling. Being out of the focus seems to be the main reason for non-use. Nevertheless the 20% CAM users rate CAM as very effective and would recommend CAM use to other parents.

Usage of complementary and alternative medicine in older adults: prevalence, subtypes and associated factors;a cross-sectional observation

Background:The usage of complementary and alternative medicine(CAM)is common in many healthcare settings worldwide.However,the factors associated with CAM usage in older adults and its relation with mood and cognitive function is under-studied.We used a cross-sectional study to explore the 12-month prevalence of usage of CAM among older adults in Singapore and its associated factors including mental health status.Methods:Using a door-to-door census and questionnaire survey,community dwellers aged 60 or above were voluntarily recruited in the Singapore Longitudinal Aging Study.Demographic information,usage of CAM in past 12 months,life-style,cognitive and depressive status using Mini-Mental Status Examination and Geriatric Depression Scale were collated from each participant.Results:Out of 4985 participants,2692(54%)used some types of CAM.The most common type of CAM was herbal medicine,followed by Qigong and Acupuncture.The usage of CAM was higher in Chinese females and those with higher educational levels.Having a history of chronic diseases was associated with higher prevalence of CAM use.Usage of CAM was also correlated with higher physical and social activities.No correlation was observed between cognitive or depressive status and the use of CAM.Conclusion:These results show a high prevalence of CAM usage among older adults in Singapore,which should be considered by medical practitioners treating this age group.Additionally,despite higher prevalence of suffering from multiple chronic diseases,the lack of association of CAM usage with poorer performance in mood and cognitive assessments suggests a protective role against depression and cognitive decline for CAM practices.

Potential role of Lycium barbarum polysaccharides in glaucoma management:evidence from preclinical in vivo studies

In recent years,the pharmacological benefits of herbal extracts have been revisited for their potential neuroprotective effects in glaucoma.The polysaccharides extracted from the fruits of Lycium barbarum L.,or Lycium barbarum polysaccharides,exert their anti-aging effect through reducing oxidative stress,modulating the immune response,enhancing neuronal responses,and promoting cytoprotection.The therapeutic efficacy of Lycium barbarum polysaccharides in preserving retinal ganglion cells and their functions was demonstrated in a range of experimental models of optic neuropathies.These include the acute and chronic ocular hypertension models,the partial optic nerve transection model,and the ischemic-reperfusion injuries model.Based on these findings,Lycium barbarum polysaccharides appear to be a good candidate to be developed as a neuroprotective agent for treating multifactorial diseases.This review aims to present a comprehensive review on the latest preclinical evidence on the pre-and post-treatment benefits of Lycium barbarum polysaccharides in retinal ganglion cell neuroprotection.The possible mechanisms of Lycium barbarum polysaccharides mediating retinal ganglion cell neuroprotection will also be described.Moreover,the potential research gaps in the effective translation of Lycium barbarum polysaccharides treatment into clinical glaucoma management will be discussed.

Effects of oral Shilajit tablets on sexual function and sexual quality of life among reproductive-aged women: a triple-blind randomized clinical trial

Background:Shilajit is mentioned in the“Kama Sutra”as a potent enhancer of sexual desire.This study aimed to investigate the effects of oral Shilajit tablets on sexual function and sexual quality of life among women of reproductive age.Methods:Forty-eight reproductive-aged women participated in a placebo-controlled triple-blind clinical trial.The intervention group took oral Shilajit tablets(200 mg)twice daily for 60 days and the control group took the placebo.Data collection tools were Sexual Quality of Life-Female and Female Sexual Function Index.Data were collected before the intervention,30,60,and 90 days after the start of the study.Results:Forty-three women completed the study.The mean score of total sexual function in the intervention group was significantly higher than before the intervention(P<0.001).The mean score of sexual function was 28.93 after 90 days in the intervention group while it was 22.09 in the control group.This finding was observed in most domains of the sexual function index.The mean score of sexual quality of life increased after 60 days of intervention in both groups;however,the difference was not statistically significant(P=0.094).Conclusion:The study indicated that Shilajit,as a complementary therapy,may improve sexual function and most of its domains;while there was no effect on improving the quality of sexual life.

Chinese Medicine in the United States:Historical Development and Growth

Chinese medicine is growing rapidly in the United States both as a field of research and in the daily treatment of illnesses.The popularity of Chinese medicine,particularly acupuncture,as a healing mechanism demonstrates American people’s positive experience with Chinese medicine and their embracing it as an alternative to the mainstream Western biomedicine.Chinese medicine is an important part of the Alternative and Complementary Medicine or Integrated Medicine in the United States health system.It is increasingly used and covered by health insurance.Although Chinese medicine has been in the United States since colonial times,it was discriminated against by local authorities.However,things began to change in the 1970s when individual states gradually passed laws to legalize the practice of acupuncture as a healing mechanism.American public interest in Chinese medicine,particularly acupuncture,was aroused by the media’s report of the“magic”power of acupuncture during President Nixon’s visit to China.Non-Asians studied acupuncture in the following decades,which contributed to the establishment of acupuncture as a profession in the American health system.The history of Chinese medicine in the United States illustrates that Chinese and Asian immigrants promoted Chinese medicine in the communities,while Chinese American medical scientists who were trained in biomedicine played an important role in shaping the biomedical method of acupuncture research.This article investigates the changes of Chinese medicine in the United States,with a focus on acupuncture.Situating the discussion in a larger context of social and cultural changes,this study examines the contributions of Chinese immigrants and the popularity of acupuncture in the United States.It analyzes the development of acupuncture practice and research,the professional training in Chinese medicine,and American people’s interest in using Chinese medicine as a reliable healing mechanism to many health problems,including chronic pain,cancer,and drug addictions.

Health benefits of pendant from the viewpoint of Persian medicine

Background:Reviewing historical evidence in the various schools of traditional medicine shows that numerous methods have been used to maintain human good health and treatment of diseases.Persian medicine(PM)scholars have been employed different methods to prescribe medications,which can be classified into two main groups:internal uses,including oral,parenteral,and anal,and also external uses such as topical,transdermal,and applying pendants.In this study,we aim to introduce some of the therapeutic pendants.Methods:We reviewed the most famous PM textbooks and current evidence in relevant databases such as PubMed,Science Direct,Scopus,Google scholar and SID related to the topic.Results:In this study,about 100 traditional therapeutic substances were found and finally,thirty-two of them were represented.They were often stones,and some of them were other materials such as metals,gums,and herbs.According to the PM,the utilization of pendants,in addition to cosmetic purposes,has been considered to maintain the health and treatment of some diseases.Therapeutic pendants can be considered as a kind of external medication use in which therapeutic materials are hung on the body surface.The external use of pendants could have curative effects with their close contact to the body surface.Conclusion:Pendant therapy may probably be considered as a non-invasive and easy-to-use treatment with unnoticeable side effects that can be utilized along with other therapies.

Structure-based multi-ligand molecular modeling to predict the synergistic effects of limonin and obacunone from Simiao pill against nitric oxide synthase 3 associated with hyperuricemia

Hyperuricemia(HUA)mainly occurs because of purine metabolism disorders.We recently proposed that limonin from Simiao pill may have therapeutic effects on nitric oxide synthase 3(NOS3)that is related to HUA.Concurrently,our previous work employed a new method,structure-based multi-ligand molecular modeling,to identify potential agents from a herbal formula that may produce synergistic effects and may have the potential to develop combination drugs.Therefore,we employed multi-ligand modeling to seek compounds with potential synergistic effects with limonin against NOS3.We obtained 403 multi-ligand docking results between 403 compounds and the limonin-NOS3 complex(average affinity–8.297 kcal/mol).Then we selected the top 10 highest binding affinity compounds for virtual pharmacokinetic and toxicity screening and we found that only obacunone passed all filters.We further subjected obacunone,bound to limonin and NOS3,to molecular dynamics simulations.We found that the NOS3-limonin-obacunone complex was more stable than the NOS3-limonin complex,based on the root mean square deviation of backbone Cαatoms and root mean square fluctuation,which suggests that synergistic effects may exist between limonin and obacunone.Further cell and animal experimental research is required to verify our results.

Tai Ji Quan as antihypertensive lifestyle therapy:A systematic review and meta-analysis

Background:Professional health organizations are not currently recommending Tai Ji Quan alongside aerobic exercise to treat hypertension.We aimed to examine the efficacy of Tai Ji Quan as antihypertensive lifestyle therapy.Methods:Tai Ji Quan interventions published in English and Chinese were included when they involved healthy adults,reported pre-and postintervention blood pressure(BP),and had a non-exercise/non-diet control group.We systematically searched 11 electronic databases for studies published through July 31,2018,yielding 31 qualifying controlled trials.We(1)evaluated the risk of bias and methodological study quality,(2)performed meta-regression analyses following random-effects assumptions,and(3)generated additive models representing the largest possible clinically relevant BP reductions.Results:Participants(n=3223)were middle-aged(56.6±15.1 years of age,mean±SD)adults with prehypertension(systolic BP(SBP)=136.9±15.2 mmHg,diastolic BP(DBP)=83.4±8.7 mmHg).Tai Ji Quan was practiced 4.0±1.4 sessions/week for 54.0§10.6 min/session for 22.3±20.2 weeks.Overall,Tai Ji Quan elicited significant reductions in SBP(-11.3 mmHg,95%CI:-14.6 to-8.0;d+=-0.75)and DBP(-4.8 mmHg,95%CI:-6.4 to-3.1;d+=-0.53)vs.control(p<0.001).Controlling for publication bias among samples with hypertension,Tai Ji Quan trials published in English elicited SBP reductions of 10.4 mmHg and DBP reductions of 4.0 mmHg,which was half the magnitude of trials published in Chinese(SBP reductions of 18.6 mmHg and DBP reductions of 8.8 mmHg).Conclusion:Our results indicate that Tai Ji Quan is a viable antihypertensive lifestyle therapy that produces clinically meaningful BP reductions(i.e.,10.4 mmHg and 4.0 mmHg of SBP and DBP reductions,respectively)among individuals with hypertension.Such magnitude of BP reductions can lower the incidence of cardiovascular disease by up to 40%.

Gemcitabine and cisplatin combined with the Chinese herbal medicine compound Fuzhenggubenfang improve quality of life and progression-free survival in patients with advanced non-small cell lung cancer

Objective： To assess the role of chemotherapy combined with the compound Chinese herbal medicine,Fuzhenggubenfang （FZGBF）, for treating advanced non-small-cell lung cancer. Methods： A total of 84 eligible patientswere enrolled from October 2013 to July 2016. Patients were randomized to receive either chemotherapy alone as thecontrol group or chemotherapy combined with FZGBF as the experimental group. The primary endpoint of the study wasquality of life （QOL） and progression-free survival （PFS）. Secondary endpoints were tumor response rate, toxicity,dropout rate, and univariate and multivariate analyses of clinicopathologic factors for QOL and PFS. Results： There wasa significant improvement in QOL, including better overall health （P 〈 0.001）, physical function （P 〈 0.001）, rolefunction （P 〈 0.001）, emotional function （P 〈 0.001）, cognitive function （P 〈 0.001）, and social function （P = 0.031）.Less fatigue, nausea or vomiting, insomnia, appetite loss, constipation, and alopecia were noted （All P 〈 0.001） whenFZGBF was combined with chemotherapy in comparison to chemotherapy alone. The experimental group had a betterPFS compared with the control group （P = 0.032）. There was no significant difference in tumor response rate. FZGBFsignificantly reduced chemotherapy-induced anemia （P 〈 0.001）, neutropenia （P = 0.023）, nausea and vomiting （P 〈0.001）. The use of Chinese herbal compounds had only mild side effects. In this study, factors influencing QOL were theuse of the Chinese herbal compounds （P 〈 0.001）, performance status score （P = 0.027）, clinical staging of cancer （P =0.009）, and sex （P = 0.044）. Use of traditional Chinese medicine （P = 0.043） and the number of previous chemotherapysessions （P = 0.003） were the factors influencing PFS in this study. Conclusion： FZGBF could improve QOL,compliance to treatment, relieved chemotherapy-related toxicities of patients, and consequently improved PFS, which isa promising drug combination in complementary medicine for the treatment of advanced NSCLC.

Non-pharmacological management of pediatric functional abdominal pain disorders:Current evidence and future perspectives

Functional abdominal pain disorders(FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome Ⅲ, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.