Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

Apitherapy and Gynaecology –To What Extent Can Methods from This Area Be Alternatives to Conventional Ones?

Summary

Background: Some holistic apitherapists claim that conventional medicine can be replaced by apitherapy. This claim has never been substantiated or falsified.

Methods/Design: Since holistic apitherapy is mainly promoted in books, we analyzed 135 books on apitherapy written in either German, English or French. We also compared the recommendations with findings from preclinical and clinical studies on the various bee products.

Results: A maximum of 6 topics were discussed in apitherapy books in relation to the top 20 gynaecological diagnoses. However, the mean was only 1.6 topics. We also found that the important topics like endometriosis, ovarian cysts, pelvic pain and vulvodynia were not discussed in any of books. Furthermore, we found that there was significant variation in the treatment recommendations for most of the top 20 gynaecological problems.

Conclusion: The claim that conventional medicine can be replaced by apitherapy is not supported by our analysis. The comparison between apitherapists’ recommendations and preclinical and clinical studies reveals that most recommendations are not supported by scientific evidence.

Keywords: Apitherapy; Gynaecology; Health claim; Bee product; Honey; Propolis; Royal jelly

Introduction

Obstetrics and gynaecology is the medical specialty that encompasses the two subspecialties related to pregnancy, childbirth, and the postpartum period (obstetrics) and the health of the female reproductive system – vagina, uterus, ovaries, and breasts (gynaecology). Additionally, there are various subspecialties. Examples are

• Maternal-fetal medicine – a subspecialty focusing on the medical and surgical management of high-risk pregnancies and surgery on the fetus.

• Reproductive endocrinology and infertility - a subspecialty dealing with the causes and treatment of infertility

• Gynaecological oncology - a subspecialty centering on the medical and surgical treatment of women with cancer of the reproductive organs

• Female pelvic medicine and reconstructive surgery - a subspecialty concentrating on the diagnosis and surgical treatment of women with urinary incontinence and prolapse of the pelvic organs

• Advanced laparoscopic surgery

• Family planning - a subspecialty with the emphasis on contraception and pregnancy termination (abortion)

• Pediatric and adolescent gynaecology

• Menopausal and geriatric gynaecology

A variety of evidence-based treatment options exist for these different diseases which are part of national and international standards and guidelines.

An increasing number of patients use complementary and alternative medicine (CAM), aside from this field of conventional medicine. The terms “alternative” and “complementary” are often used interchangeably. However, they refer to different concepts:

• “Complementary” use means a non-mainstream practice used together with conventional medicine,

• “Alternative” use means the use of a non-mainstream practice in place of conventional medicine. (https://www.nccih. nih.gov/health/complementary-alternative-or-integrativehealth- whats-in-a-name)

There is often no or not sufficient data to support the value of many CAM methods. Often, a placebo effect may improve symptoms or the spontaneous course of the disease or regression to mean may explain the effects observed and discussed by patients and proponents of these methods. In the field of oncology, it has been shown that prognosis is poorer with alternative medicine [1].

One CAM treatment concept is holistic apitherapy. It is defined as the use of substances produced by honeybees (such as venom, propolis, pollen or honey and others) to treat various medical conditions. Today, apitherapy is widely promoted by apitherapeutic societies all over the world and beekeepers (https://apitherapy. com/addresses/societies/; accessed April 2nd, 2020). Holistic apitherapy is largely promoted in apitherapeutic congresses and beekeeping congresses but especially in books. As has been shown in several analyses, the books on apitherapy do not comprise the scientific evidence but rather the personal beliefs of holistic apitherapists [2-6]. This is true for cancer, dysmenorrhea, menopausal problems, benign prostate, hyperplasia and allergic seasonal rhinitis [2-6]. However, the books on apitherapy are meant to be guidelines for apitherapists and other practitioners.

Apitherapists have also claimed that apitherapy can cure all or almost all diseases [7,8]; https://apitherapy.com/en/apitherapydata- base/apitherapy/diseases-that-can-be-treated-throughapitherapy/; accessed October 9th, 2020). These claims have not been validated yet. Since it is impossible to assess the entire field of medicine, we analyzed to what extent apitherapy could replace or complement treatments for problems in the field of gynaecology, excluding the surgical and oncological aspects.

Despite this, even a first glance conveys the impression that the recommendations alone for one specific medical problem are quite controversial. Thus, an interested reader might become even more confused after having read all the available information, realizing in the end that there is no generally accepted treatment for a certain disease. For example, in an analysis of 129 books on apitherapy, 29 different recommendations on what was thought to be best for the treatment of seasonal allergic rhinitis were found. This is all the more remarkable since the topic was only mentioned in 50 books [3].

Material and Methods

Based on data from the Central Institute for Statutory Health Care and various publications on the subject, we identified the diseases and symptoms most frequently dealt with in the gynaecological field.

Since the information on apitherapy can be found mainly in books, we identified 135 books on apitherapy using the search terms “apitherapy”, “apitherapie” and “apithérapie” as well as the names of various bee products on bookseller platforms and the JUST find system of the Justus-Liebig-University Gießen, Germany, which comprises 337 databases from the EBSCO Discovery Service. There was no pre-selection of the books except the restriction to the English, French and German languages.

Based on our search regarding the most eminent problems in the field, all the books were analyzed in detail for apitherapeutic recommendations regarding the following diseases (in alphabetical order):

1. Abnormal uterine bleeding, Menorrhagia (heavy periods)

2. Breast lumps, fibroids & common breast problems

3. Chlamydia

4. Condylomas, dysplasia / human-papilloma-virus-infections

5. Decreased libido (decreased sex drive)

6. Dysmenorrhea (painful periods)

7. Dyspareunia (painful intercourse)

8. Endometriosis

9. Gonorrhea and vaginitis

10. Incontinence

11. Infertility

12. Lichen sclerosis

13. Menopausal complaints

14. Osteoporosis

15. Ovarian cysts

16. Pelvic pain

17. Polycystic Ovarian Syndrome (PCOS)

18. Premenstrual syndrome (PMS)

19. Urinary tract infection

20. Vulvodynia

We excluded contraception because it cannot be recognized as a disease. At the same time, we analyzed the scientific evidence regarding the use of bee products for the above-named disease conditions using PubMed and JUST find (data search engine of the Justus-Liebig-University Gießen, Germany, which comprises 337 databases from the EBSCO Discovery Service).

The analyses of the contents of the books were documented in PSPP, a free statistical software application, intended as a free alternative for IBM SPSS Statistics. We used descriptive statistics.

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Iris Publishers_World Journal of Gynecology & Womens Health (WJGWH)

 Could Helicobacter Pylori Infection Be A Risk Factor for Hyperemesis Gravidarum

Summary

Background: Hyperemesis gravidarum may be severe enough to affect the patient physically and psychologically. Previous studies indicated a relationship between Helicobacter pylori and hyperemesis gravidarum. The aim of this study is to evaluate if Helicobacter pylori infection has a possible etiological role in hyperemesis gravidarum.

Methods: The study was a case control study which was conducted at the obstetrics and gynecology department, Al saidy hospitals Makka and included 120 patients pregnant between 7 and 16 weeks and presented with hyperemesis gravidarum. Patients underwent a stool analysis for detecting Helicobacter pylori antigen and according to the test results were included in either case group (antigen positive, 60 patients) or control group (antigen negative, 60 patients).

Results: The cases group showed ketonuria in 22 (36.7%) patients, protinuria in 34 (56.7%) patients and urinary tract infection in 26 (43.3%) patients. The control group showed ketonuria in 4 (6.67%) patients, protinuria in 18 (30%) patients and urinary tract infection in 8 (13.3%) patients and these differences were all significant statistically.

Conclusions: Helicobacter pylori infection possibly contributes to the etiology of hyperemesis gravidarum. Also, the severity of the disease seems strongly related to Helicobacter pylori infection.

Keywords: Hyperemesis gravidarum; Nausea; Vomiting; Morning thickness; Helicobacter pylori

Background

Nausea and vomiting during pregnancy are the most common conditions affecting pregnancy, occurring in about 80% of all pregnancies and commonly disappears by 16 to 18 weeks of gestation. Hyperemesis gravidarum is the most severe form of nausea and vomiting in pregnancy, it is accompanied by starvation, dehydration, acidosis, alkalosis from hydrochloric acid loss in the vomits, hypokalemia, weight loss and transient hepatic dysfunction [1]. Many hypotheses have been published to explain the etiology and pathophysiology of hyperemesis gravidarum including infections, gastrointestinal tract dysfunctions, endocrinal changes, anatomical, metabolic and immunological factors. However, no single theory is enough to give an adequate explanation for all the properties of hyperemesis gravidarum. Some studies done on patients with hyperemesis gravidarum indicated a relationship between Helicobacter pylori and hyperemesis gravidarum, in addition multiple gastrointestinal and extra digestive pathologies may be associated with Helicobacter pylori infection [2].

Helicobacter pylori is one of the most common bacteria affecting humans. It is a gram-negative helix-shaped microaerophilic bacterium transmitted by the oro oral or feco oral route. It is more prevalent in developing countries and young children. Types of diagnostic methods currently used include invasive and non- invasive methods for detection of Helicobacter pylori bacteria. The more widely accepted methods by the patients are the non-invasive methods, such as stool antigen detection, serum antibody detection and carbon labeled urea breath test. The investigation of choice for Helicobacter pylori in pregnancy is the stool antigen detection test [3].

The consequences of activated latent Helicobacter pylori could have an impact not only on the mother’s health (organ injury and nutritional deficiency), but also on her infant (malformations and inta-uterine growth restriction). Gastrointestinal manifestations during pregnancy, maternal anemia and fetal neural tube defect due to decreased iron and vitamin B12, are indications for investigation for Helicobacter pylori infection [4].

Most studies conducted on the correlation between pregnancy related disorders of gastrointestinal tract and Helicobacter pylori infection was cross sectional investigations in which the pregnant female was detected to be Helicobacter pylori positive during pregnancy or soon after delivery. However, there is no follow up study was conducted to explain the complete immune response against helicobacter pylori. One prospective study tested the presence of Helicobacter pylori infection before conception and showed that early pregnancy loss was associated with the presence of positive Helicobacter pylori before intra-cytoplasm sperm injection [5].

The aim of this study is to evaluate if Helicobacter pylori infection has a possible etiological role in hyperemesis gravidarum.

Methods

This study was a case control study which was conducted at the obstetrics and gynecology department, Al saidy hospitals Makka during the period from July 2017 to April 2019. The study was approved by the medical ethical committee and an informed verbal and written consent was obtained from all patients before inclusion.

The study included 120 pregnant women between 7- and 16-weeks gestational age with singleton pregnancy and presented with severe intractable vomiting more than 3 times per day and subjective weight loss as described by the patient and / or her relatives. The exclusion criteria were: 1) history of vomiting not related to pregnancy, 2) history of gastric troubles not related to pregnancy, 3) cases suspected to have acute condition which may be associated with vomiting e.g. appendicitis, intestinal obstruction, 4) multiple gestation, 5) associated disease e.g. hepatobiliary disorders, diabetes and 6) psychological disorders.

After consenting, patients underwent stool analysis for detecting HelicobacterpPylori antigen in stool (specific test) and according to the test results they were included in either the study group which included 60 patients with positive Helicobacter pylori antigen or the control group which included 60 patients with negative Helicobacter pylori antigen.

Then all patients underwent full history taking, thorough clinical examination and an ultrasound assessment to confirm dating, viability and placental formation. Laboratory investigations included: 1) Urinary sample to test for ketonuria, proteinuria and urinary tract infection. 2) Blood sample for routine laboratory investigations including complete blood picture to see (hemoglobin levels, total leukocytic count, platelet count), blood creatinine, aspartate transaminase (AST), alanine transaminase (ALT) and electrolytes (Na and K).

Sample size calculation

Sample size was calculated using G* power program and a sample size of 120 patients in both groups will achieve 90% power with 95% confidence interval for frequency of Helicobacter pylori of 88% in pregnant patients with HG as previously reported [6].

Statistical analysis

Data was collected throughout history, basic clinical examination, laboratory investigations and then it was coded, entered and analyzed using Microsoft Excel software. Data were then imported into Statistical Package for the Social Sciences (SPSS version 20.0) software for analysis. According to the type of data qualitative represent as number and percentage, quantitative continues group represent by mean ± SD, the following tests were used to test differences for significance; Differences between frequencies (qualitative variables) and percentages in groups were compared by Chi-square test. Differences between parametric quantitative independent groups by t test. P value was set at <0.05 for significant results &<0.001 for high significant result.

Results

This study included 120 pregnant females between 7- and 16-weeks gestational age presented with hyperemesis gravidarum who were equally divided into two groups according to presence of Helicobacter pylori antigen in stool. The age of the included patients ranged between 20-35 years and there was no statistically significant difference between both groups. The body mass index in the study group ranged from 21 to 29.1 with a mean value of 25.29±2.34 and in the control group it ranged from 21.1 to 29.8 with a mean value of 25.27±2.90 which was not significant. Gestational age in study group ranged from 7 to16 weeks with a mean value of 12.33±4.32 weeks while in the control group gestational age ranged from 7 to 15 weeks with a mean value of 12.07±4.05 weeks.

Thirty patients (50%) in the study group were rural residents compared to 24 patients (40%) in the control group and this difference was not significant (p>0.05). Table 1 shows comparison between the two studied groups regarding occupation and the difference between both groups was also not significant.

Routine laboratory investigations included hemoglobin levels, total leukocytic count, platelet count, blood creatinine, AST, ALT and serum electrolytes (Na and K) and the difference in these tests was not significant between the study and control groups.

Regarding urine analysis (Table 2), ketonuria was found in 22 (36.7%) patients in the study group compared to 8 (13.3%) patients in the control group which was significant (p = 0.037). proteinuria was found in 34 (56.7%) patients in the study group versus 18 (30%) patients in the control group which was also significant (p = 0.037). urinary tract infection was diagnosed in 26 (43.3%) patients in the study group compared to 8 (13.3%) patients among controls (p = 0.01).

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