Uro Care

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10th Postgraduate Course December 7-8, 2007 at City De Luxe Restaurant

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  • Uro Care

    1. 1. Alternative Urological Drug Treatment For Urinary Stones
    2. 2. “ SAMBONG” ( Blumea balsamifera L. ) Releaf
    3. 3. SAMBONG ( Blumea balsamifera ) I. Folkloric Validation a. Used by most traditional healers for Cough, Colds, Fever, Headaches & Post-Partum bath b. 100% of healers reported the same side effect: DIURESIS Philippine Herbs
    4. 4. <ul><li>II. Scientific Validation </li></ul><ul><li>1. Biological Assay </li></ul><ul><li>i. LD 50% = 62gm/kg AAM </li></ul><ul><ul><ul><li> = 40 Kg Sambong powder single dose </li></ul></ul></ul><ul><ul><ul><li> = 80,000 tablets single dose </li></ul></ul></ul><ul><ul><ul><li>ii. ED 50% = 500mg/dose (HUMAN) </li></ul></ul></ul><ul><li>2. Toxicity Studies </li></ul><ul><li>Negative but with some incidence of hyperemic renal parenchyma </li></ul><ul><li>3. Mutagenecity, Clastogenecity </li></ul><ul><li>i.  Rec Assay, Ames Test, Host-Mediated Assay, Micronucleus Test </li></ul><ul><li>o  All negative results </li></ul><ul><li>  ii.  Exhibited anti-mutagenic potential vs. Tetracycline, Mitomycin D, </li></ul><ul><li> and Dimethylnitrosoamine </li></ul>Philippine Herbs
    5. 5. Chemical research Identification of volatile components in Sambong by GC-MS
    6. 6. Chemical research Identification of volatile components in sambong by GC-MS Flavanone-A
    7. 7. Summary: Phytochemical Analysis (>12 biochemicals) <ul><li>Terpenes </li></ul><ul><ul><li>Cineol, Limonene, Camphor, Borneol </li></ul></ul><ul><ul><li>Sesquiterpene (Drug for Toshida’s Sarcoma) </li></ul></ul><ul><ul><li>Monoterpenes </li></ul></ul><ul><ul><li>Triterpenes </li></ul></ul><ul><li>Alkaloids </li></ul><ul><li>Flavanoids </li></ul>
    8. 8. FIG 1. Diuretic Effect of Sambong (By NIRPROMP) 60% Average Increase in 24 hr. Urine Volume
    9. 9. FIG 2. Effect of Sambong on Blood Electrolytes (By NIRPROMP) *Changes not statistically significant Mean Serum Electrolyte Before Sambong After Sambong % Change * Sodium (mEq/L) 139.9 136.7 2.3% Potassium (mEq/L)   4.6 4.3 6.5% Chloride (mEq/L) 101.7 101.3 0.3%
    10. 10. Fig 3. Extended Open Phase 3 Clinical Trial: Effectivity of Sambong vs. Urolithiasis (By Jaime Purification, MD) * 89% Effectivity Rate vs. Urinary Tract Stones
    11. 11. Indications of Sambong (Re-Leaf) <ul><li>For Hypertension </li></ul><ul><ul><li>Replacement for synthetic diuretics </li></ul></ul><ul><li>For Urinary Stones </li></ul><ul><ul><li>In patients who are contraindicated as far as surgery and lithotripsy is concerned </li></ul></ul><ul><ul><li>In patients who fear or are perverse to the above-mentioned procedures </li></ul></ul><ul><ul><li>In patients who are economically-challenged </li></ul></ul><ul><ul><li>As prophylaxis </li></ul></ul>
    12. 12. Cost of Treatment <ul><li>Releaf Forte </li></ul><ul><ul><li>Cost per tablet (Forte)… P 6.60 </li></ul></ul><ul><ul><li>Dose TID……………….. P 19.80 </li></ul></ul><ul><ul><li>Duration – 1 month .……P 594.00 </li></ul></ul><ul><li>Follow-up Consultation </li></ul><ul><ul><li>Professional Fee ………..P1000.00 </li></ul></ul><ul><ul><li>2 Visits per month ………P2000.00 </li></ul></ul><ul><li>Diagnostics/Laboratory </li></ul><ul><ul><li>Fees ……………………...P1000.00 </li></ul></ul><ul><li>Grand Total………………………………….P3594 </li></ul>
    13. 14. Alternative Urological Drug Treatment For Benign Prostatic Hypertrophy
    14. 15. PROSTACTIVE ® Evidence-based v 1.7
    15. 16. ProstActive ® Chemical Research <ul><li>Concentrated (12:1) lipophilic extract </li></ul><ul><ul><li>Fruit of Saw Palmetto (Serenoa repens or Sabal serrulata) </li></ul></ul><ul><li>Purified liposterolic extract contains </li></ul><ul><ul><li>80-95% fatty acids and sterols </li></ul></ul><ul><ul><ul><li>Including beta-sitosterol </li></ul></ul></ul><ul><ul><li>Other constituents include esters, long-chain alcohols, and polysaccharides </li></ul></ul>
    16. 17. Indications: <ul><li>Early stages of Benign Prostatic Hyperplasia </li></ul><ul><li>Pre- and post-operative prostate treatment </li></ul><ul><li>Chronic Prostatitis </li></ul>
    17. 18. ProstActive Clinical Results
    18. 19. ProstActive Clinical Results
    19. 20. ProstActive Clinical Results
    20. 21. ProstActive Clinical Results
    21. 22. Dosage <ul><li>Prevention/Maintenance: one softgel per day </li></ul><ul><li>Therapeutic: one softgel 2X/day </li></ul><ul><ul><li>One softgel delivers 320 mg saw palmetto </li></ul></ul><ul><ul><ul><li>Study used 160 mg delivery unit 4X/day </li></ul></ul></ul><ul><li>Take with water at mealtime </li></ul><ul><ul><li>Increased absorption when taken with food </li></ul></ul><ul><li>Take continuously for maximum benefit </li></ul><ul><ul><li>Allow two to eight weeks for noticeable results </li></ul></ul><ul><ul><li>Fortschr Med 1995; 113:37-40 </li></ul></ul>
    22. 23. Precautions <ul><li>Very rare occurrence of acute urinary retention after initiating therapy for BPH </li></ul><ul><li>(Phytosterol supplementation should be avoided by pregnant women and nursing mothers) </li></ul>
    23. 24. Contraindications <ul><li>Phytosterol supplementation is contraindicated in those with the rare genetic disorders Sitosterolemia and Cerebrotendinotic Xanthomatosis </li></ul><ul><li>ProstActive is contraindicated in persons known to be allergic to Saw Palmetto </li></ul>
    24. 25. Adverse Reactions <ul><li>Generally well tolerated </li></ul><ul><li>Mild gastrointestinal reactions reported with phytosterol ingestion at > 1 g/day dosage including occasional indigestion, feeling of fullness, gas, diarrhea and constipation </li></ul>
    25. 26. Interactions <ul><li>Drugs </li></ul><ul><ul><li>None known to date </li></ul></ul><ul><ul><li>Phytosterol supplementation may be additive to the cholesterol-lowering effects of such cholesterol-lowering drugs as the statins. </li></ul></ul><ul><li>Nutritional Supplements & Food </li></ul><ul><ul><li>Some randomized trials have indicated that phytosterols, may lower serum levels of alpha- and beta-carotene, lycopene and vitamin E, probably by interfering with their absorption </li></ul></ul><ul><ul><li>Neither vitamin A nor vitamin D levels appear to be affected </li></ul></ul>
    26. 27. Laboratory Tests <ul><li>Several clinical studies have shown no effect on prostate-specific antigen (PSA) </li></ul><ul><ul><li>1 year ( Phytotherapy Res 1997;11:558-63) </li></ul></ul><ul><ul><li>6 months ( Urology 1998;51:1003-7) </li></ul></ul><ul><ul><li>6 months ( Prostate 1996;29:231-40) </li></ul></ul>
    27. 28. Advantage/Disadvantage <ul><li>A meta-analysis of 18 randomized, clinical trials involving extracts of S aw Palmetto in patients with BPH </li></ul><ul><ul><li>Study volunteers were significantly less likely to report erectile dysfunction when taking saw palmetto compared to finasteride (1.1% vs. 4.9%, p<0.001) </li></ul></ul><ul><ul><li>Slow Onset of Action </li></ul></ul>JAMA 1998;280:1604-9.
    28. 29. Thank You Very Much Eliseo T. Banaynal Jr., MD Medical Director for Natural and Semi-Synthetic Products Pascual Laboratories Inc.

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