In-vitro evaluation of Nigella sativa and Punica granatum effect on protoscolices of hydatid cysts

Avaliação in vitro do efeito de Nigella sativa e Punica granatum em protoescólices de cistos hidáticos

Abstract

Cystic echinococcosis (CE) are commonly found in the liver and lungs of affected hosts. The treatment approach is usually surgical, or giving drugs in conjunction before surgery to kill protoscolices, to avoid anaphylactic shock from leakage of hydatid fluid into the peritoneum and to decrease opportunities for recurrences. The present study was to evaluate the in vitro scolicidal efficacy of hydroalcoholic extract of Punica granatum peel and Nigella sativa, on the protoscolices of CE that collected from the lungs of infected camels. Different concentrations of extracts with different exposure times were used and a viability assay was applied to measure the scolicidal effect. N. sativa showed its highest scolicidal efficacy at 100 mg/mL and 10 mg/mL concentrations after 30 and 60 min. P. granatum peel extract showed its maximum scolicidal efficacy at 100 mg/mL concentration after 120 min. All experiments of the current study revealed that the extracts of both N. sativa and P. granatum had a scolicidal effects on the protoscolices of camel hydatid cysts. It could be concluded that N. sativa extract is more potent than P. granatum peel extract regarding scolicidal effect, but the efficacies of both extracts were of moderate significant correlation to exposure time and concentrations.

Keywords:
Hydatid cyst; Echinococcus granulosus; Nigella sativa; Punica granatum; protoscolex

Resumo

Os cistos hidáticos (equinococose cística, CE) são comumente encontrados no fígado e nos pulmões dos hospedeiros afetados. A abordagem do tratamento geralmente é cirúrgica, e algumas drogas são administradas em conjunto antes da cirurgia para matar protoscólices e evitar choque anafilático devido ao vazamento de fluido hidático no peritônio e diminuir as oportunidades de recorrência. O presente estudo foi avaliar a eficácia in-vitro do extrato hidroalcoólico de casca de Punica granatum e Nigella sativa, sobre os protoescólices de cistos hidáticos, que foram coletados dos pulmões de camelos infectados. Concentrações dos extratos com diferentes tempos de exposição foram utilizados e um ensaio de viabilidade foi aplicado para medir o efeito escolicida. A N. sativa apresentou sua maior eficácia escolicida nas concentrações de 100 mg/mL e 10 mg/mL após 30 e 60 min. O extrato de casca de P. granatum mostrou sua máxima eficácia escolicida na concentração de 100 mg/mL após 120 min. Todos os experimentos do presente estudo revelaram que os extratos de N. sativa e P. granatum tiveram efeito escolicida dependente da dose e do tempo nos protoescólices dos cistos hidáticos de camelo. Pode-se concluir que o extrato de N. sativa é mais potente que o extrato de casca de P. granatum em relação ao efeito escolicida, mas a eficácia de ambos os extratos foi de correlação significativa moderada com o tempo de exposição e as concentrações.

Palavras-chave:
Cistos hidáticos; Echinococcus granulosus; Nigella sativa; Punica granatum; protoescólices

Introduction

Hydatidosis is caused by ingestion of eggs of Echinococcus spp. It is considered to be one of the major zoonotic diseases affects both humans and herbivorous animals. Four different Echinococcus species; E. granulosus, E. multilocularis, E. vogeli, and E. oligarthrus are well known to cause human and animal Echinococcosis (Hydatidosis) with different forms known as cystic echinococcosis (CE), alveolar echinococcosis, polycystic echinococcosis and unicystic echinococcosis; respectively. Other Echinococcus species seem to be rare in people or domesticated animals, but may affect wildlife. Cystic echinococcosis, the most common form of the disease in people and domesticated animals, is caused by E. granulosus sensu lato (E. granulosus s. l.) (THOMPSON, 2017).

CE is found mainly in the liver and lungs, and sometimes in the kidneys, spleen, bones, brain and other organs (AMMANN & ECKERT, 1996). Commonly, surgical removal and chemotherapy are the basic means of the treatment. However, this treatment approach may give rise to hydatid fluid leakage into the abdominal cavity, which leads to the possibility of occurrences of intraperitoneal cysts and anaphylactic shock. Recently, several plant extracts, such as garlic and olive leaf extracts have been evaluated as scolicidal agents instead of using chemotherapy in conjunction with surgery (MOAZENI & NAZER, 2010; SADJJADI et al., 2008; ZIBAEI et al., 2012).

Nigella sativa seeds have wide therapeutic effects and have been reported to have significant effects against many helminth infections. Mostly, the therapeutic benefits of N. sativa are due to its richness in Thymoquinone (TQ), which is a major active constituent. In studies focusing on antiparasitic effects (ISSA, 2003), it has been found that different extracts of N. sativa, as well as TQ, have a potent anthelmintic action against Fasciola gigantica (ULLAH et al., 2017) and Schistosoma mansoni (SHENAWY et al., 2008). The results from in-vitro tests on N. sativa seeds against miracidia, cercariae and adult worms have shown that they have strong effects against all stages of the parasite and an inhibitory effect on egg-laying among adult female worms. The antiparasitic activity of N. sativa seeds was high against cestodes in children (AKHTAR & RIFFAT, 1991).

N. sativa oil has anthelmintic effect in the rats infected with Trichinella spiralis infection and increased the production of antibodies generated during life cycle of this parasite (ABU EL EZZ, 2005). Recently, some studies have proven potent effect of N. sativa extracts on the protoscolices of hydatid cysts (MAHMOUDVAND et al., 2014a,b).

Punica granatum L. commonly known as pomegranate, is a fruit-bearing deciduous shrub or small tree that is native to Asia and belongs to the family Punicaceae (QNAIS et al., 2007). Different parts of the plant, such as bark, leaves and peels, have medicinal significance. P. granatum is widely used in many countries as a source of therapeutic agents against a variety of pathogenic microbes (ARUN & SINGH, 2012). P. granatum peel extract (100 mg/kg) administered for 10 consecutive days was found to stimulate immune systems and enhance cellular immunity in rabbits (ROSS et al., 2001). The constituents of pomegranate include highly hydrolysable tannins (punicalins and punicalagins), ellagic acid (a component of ellagitannins) and gallic acid (a component of gallotannins) (REDDY et al., 2007).

P. granatum has anticestodal and antinematodal activity (ABDELAZIZ et al., 2018; AL-MEGRIN, 2016; AMELIA et al., 2017), antitrematodal activity against paramphistomes in sheep (VEERAKUMARI et al., 2014).

Therefore, the aims of the present study were to evaluate the scolicidal efficacy (i.e., the mortality rate of the protoscolices) of aqueous extract of P. granatum peel and N. sativa seed oil on the protoscolices of hydatid cysts, and to determine the exposure time and concentrations of the extracts providing scolicidal activity.

Materials and Methods

Ethical considerations

This study followed the institutional ethical and animal care guidelines. All methods were conducted in accordance with the Guide for the Care and Use of Laboratory Animals of Sohag University, Sadat City University and Kafrelsheikh University, Egypt.

Preparation of aqueous pomegranate extracts

Pomegranates were collected and identified as P. granatum L. by botanists of the Botany Department, Faculty of Science, Assiut University, based on taxonomy (HYAM & PANKHURST, 1995). Briefly, the aqueous extract of P. granatum was prepared as follows. The peel was cut into thin slices, dried and blended until smooth. Then, 25 g of this paste were added to 75 mL water and placed in an extraction bag. This was allowed to boil for 60 min and was then poured into a water bath, which was heated until the extract turned viscous. The extract was then put into an oven at 50-60 °C until dryness was reached. One gram of extract was dissolved in 1 mL of 100% dimethyl sulfoxide (DMSO), and the final concentration of each extract was adjusted to 1,000 mg/ml. Concentrations of 100, 10, and 1 mg/mL were made. The material was kindly donated by the Department of Botany, Faculty of Science, Assiut University (ABDELAZIZ et al., 2018).

Preparation of Nigella. sativa oil extract

N. sativa L. (Ranunculaceae) was identified based on taxonomy (HYAM & PANKHURST, 1995). Dried seeds were purchased from a local market. The seeds were crushed and cold-macerated in petroleum ether (40-60 °C) for three days. After evaporation of the petroleum ether, the extract was taken out and the oil was filtered. The final concentration of each extract was adjusted to 1,000 mg/mL and subsequently concentrations of 100, 10 and 1 mg/mL were made. The extracted oil was kept in screw-capped tubes in the dark at -20 °C until use (AHMAD et al., 2013; SALIH et al., 2009).

Controls used

Niclozamide® (Adwia Inc., Egypt) was used as a positive control at a concentration of 75 mg/mL, while DMSO was used as a negative control solution in a 1% (w/v) formulation (NAGULESWARAN et al., 2006; STETTLER et al., 2003).

Preparation of protoscolices

Sixty hydatid cysts were collected from the lungs of infected camels that had been slaughtered at Sohag abattoir, Egypt, and were transferred to the laboratory of the Department of Parasitology, Faculty of Veterinary Medicine, Sohag University. Aseptically, the protoscolices were aspirated by 20 mL syring (plastic, single use and sterile) from the cysts washed three times in PBS (pH 7.2). The pooled protoscolices were kept in a concentration of 5 × 10³ protoscolex/mL in a normal saline solution (0.9% NaCl solution), and the viability of these protoscolices was more than 90%. This solution was kept for further use (MAHMOUDVAND et al., 2014a; SADJJADI et al., 2008).

Viability assay

The viability of the protoscolices was ascertained through staining with eosin. A solution containing 0.1 mg of eosin staining powder was added to 100 ml water to form a 0.1% (w/v) concentration stock solution. The viability of the protoscolices was evaluated microscopically by adding 10 μl of eosin stock solution to 10 μL of protoscolices for 15 min. The protoscolices were considered dead if they became stained, and alive if they remained unstained (SADJJADI et al., 2008).

Effect of N. sativa and P. granatum Extracts on Protoscolices

Three concentrations (100, 10 and 1 mg/mL) of each extract were used for 30, 60 and 120 min. 0.5 ml of each concentration was placed in 2 ml tubes, to which 0.5 ml of hydatid sand containing 2500 washed protoscolices was added. The contents of the tubes were gently mixed. The tubes were then incubated at 37 °C for 30, 60 and 120 min. At the end of each incubation time, the upper phase was carefully removed and 0.5 mL of Eosin stain (0.1% w/v) was then added to the remaining settled protoscolices and gently mixed. The percentages of dead/alive protoscolices were determined microscopically by counting in a hemocytometer slide. All experiments were performed in triplicate (SADJJADI et al., 2008).

Statistical analysis

All data were analyzed using of SPSS-IBM (version 20). The protoscolicidal activity was expressed as Mean ± SD (Standard Deviation). Statistical analysis was performed by Two-way ANOVA to compare all groups. Student’s T tests (2 tailed) for paired samples and PAERSON test were used to analyze and determine the significance differences of correlation coefficients between mean values of the protoscolicidal efficacy of both extract in relation to concentrations and time exposure, P values of less than 0.05 were considered to be statistically significant.

Results

The scolicidal efficacy (mortality rate among hydatid cyst protoscolices) was recorded for both the extract and the controls at different concentration and different exposure times (Table 1). DMSO treated control did not influence the viability of the parasite during the experiment.

Table 1
Scolicidal effects^a of various concentrations of Nigella sativa oil, and Punica granatum extract at different exposure time on protoscolices of camel hydatid cysts.

Incubation (exposure) time		Mortality rate% (scolicidal efficacy) (Mean ± SD)
	Niclosamide	DMSO	Nigella sativa oil concentrations *				Punica granatum extract concentrations*
	(positive control)	(negative control)	100 mg/mL	10 mg/mL	1 mg/ml		100 mg/mL	10 mg/mL	1 mg/ml
30 min	98.8 ± 2.1	0.0	43.9 ± 0.5	35.9 ± 2.4	25.8 ± 0.2		49.3 ± 2.4	38.9 ± 1.4	19.9 ± 1.6
60 min	100 ± 0.0	4.2 ± 2.4	89.9 ± 2.1**	69.9 ± 3.3	45.8 ± 3.6		72.4 ± 1.7**	44.9 ± 3.4	22.3 ± 2.4
120 min	100 ± 0.0	7.6 ± 2.1	100 ± 0.0**	88.4 ± 2.1	49.9 ± 1.1		89.7 ± 0.04**	59.9 ± 2.2	29.2 ± 1.9

• All experiments were done in triplicates. SD = Standard Deviation. DMSO = dimethyl sulfoxide.
• ^*
  Concentrations (100 mg/mL, 10 mg/mL and 1 mg/mL) were prepared from the concentrated extract solutions of Nigella sativa and Punica granatum of 1000 mg/ml;
• ^**
  The values are statistically significant at P<0.05;
• ^a
  Efficacy indicates the mortality rate of the viable protoscolices due to application of different treatments.

In the present study, N. sativa oil showed greater potential scolicidal efficacy on the protoscolices of hydatid cysts than did P. granatum peel extracts, when the extracts were applied at a concentration of 100 mg/mL for an exposure time of 120 min. The maximum mortality rate among the protoscolices (100%) was observed in N. sativa oil at 100 mg/mL concentration after 120 min of exposure, while the maximum scolicidal effect of P. granatum peel extract was 89.7% at 100 mg/mL concentration after the same time of exposure.

Statistically, the relationship was not so strong to indicate the association between scolicidal efficacy and both concentration and exposure time (Tables 2) as the Pearson’s correlation coefficient was smaller than ± 0.5. The scolicidal efficacy of both extracts became higher after 60 and 120 min than after 30 min of incubation, and this difference was highly significant (P < 0.05). At the same, the mean efficacy was proportionally increased with the extract concentrations that were applied, given that as the concentration increased, the scolicidal efficacy also increased significantly (P > 0.01).

Table 2
Significant correlation between the concentration, and exposure time on the scolicidal efficacy^a of Nigella sativa oil, and Punica granatum extract on protoscolices of camel hydatid cyst.

	Nigella sativa extract		Punica granatum extract		N
	Correlation Coefficient	P value	Correlation Coefficient	P value
Efficacya & exposure	.398	.006*	.286	.036*	27
Efficacya & concentration	-.490-	.062*	-.298-	.022*	27

• ^*
  Correlation is significant at the 0.05 level (2-tailed);
• ^a
  Efficacy indicates the mortality rate of the viable protoscolices due to application of different treatments.
• N = number of samples 27 (represent for each extract: 3 replicates × 3 concentrations × 3 three exposure intervals).

Discussion

Surgery is currently the mostly successful and effective treatment approach for cases of hydatid cysts (BELGHITI et al., 1986; BRUNETTI et al., 2010; JUNGHANSS et al., 2008; PRASAD et al., 1991). Moreover, scolicidal drugs are injected into the hydatid concurrently with surgery preoperatively to kill the protoscolices and avoid occurrences of leakage of hydatid fluid into the peritoneum and fatal anaphylactic shock (BESIM et al., 1998). However, the absence of objective evidence about the efficacy and toxicity of these drugs may lead surgeons to miss out this procedure during the operation (CIFTCI et al., 2007; HOSSEINI et al., 2006; MOAZENI & LARKI, 2010).

Recently, several studies have been conducted with a view to finding natural scolicidal products in plant extracts that would provide lower toxicity than that of chemical drugs. In-vitro studies using different Allium sativum extracts showed effectiveness on hydatid cyst protoscolices and scolices (MOAZENI & LARKI, 2010; SADJJADI et al., 2008). Zibaei et al. (2012) tested the scolicidal effects of Olea europaea and Satureja khuzestanica extracts on the protoscolices of hydatid cysts. This information from previous studies has shown that N. sativa contains a large variety of substances that possess scolicidal activity. N. sativa was mentioned in several studies by Forouzanfar et al. (2014), in which its active constituent thymoquinone was investigated regarding its antimicrobial effects. Akhtar & Riffat (1985) screened the antiparasitic activity of N. sativa seeds in relation to cestode worms and stated that these seeds had high efficacy against adult cestode worms.

P. granatum has been widely evaluated in different countries as a source of therapeutic agents with anticestodal and antinematodal activity (ABDELAZIZ et al., 2018; AL-MEGRIN, 2016; AMELIA et al., 2017).

Recently, some studies have been conducted to investigate the efficacy of N. sativa extract against the protoscolices of hydatid cyst (MAHMOUDVAND et al., 2014a,b) where applied both methalonic and aqueous extracts of N. sativa at concentration of 50 mg/mL were lethal to all CE protoscolices after 10 and 30 min of incubation; respectively which agreed with our results.

The present study had confirmed the scolicidal efficacy of the oil of N. sativa seeds, and of the ethanolic extract of P. granatum peel at different concentrations with different exposure times, against the protoscolices of hydatid cysts from camels. The oil extract of N. sativa demonstrated greater efficiency than that of P. granatum, in that it killed all the protoscolices examined (100%) at a concentration of 100 mg/mL after 120 min of exposure, while P. granatum gave rise to a maximum death rate (89.66%) at 100 mg/mL after 120 min.

Statistically, there were of moderate significant correlations between efficacy and concentration and between efficacy and exposure time (Tables 1 and 2). Thus, all of the experiments of the current study revealed dose-dependent and time-dependent scolicidal effects from extracts of both N. sativa and P. granatum, on the protoscolices of camel hydatid cysts.

Conclusion

N. sativa had greater scolicidal effect against hydatid cysts than P. granatum, and the efficacies of both extracts were of moderate significant correlations to exposure time and concentrations. These extracts have a useful effect and may be useful for the PAIR (Puncture-Aspiration-Injection-Re-Aspiration) method for treatment of hydatid disease because of their rapid and highly scolicidal activity. However, further studies are needed to clarify the mechanism of action of these plant extracts. Moreover, in-vivo studies are mandatory for evaluating the toxic effects of these plant extracts, and to study the possible adverse effects on both humans and domestic animals.

References

• Abdelaziz ARA, AbouLaila MR, Aziz M, Omar MA, Sultan K. In vitro and in vivo anthelmintic activity of pumpkin seeds and pomegranate peels extracts against Ascaridia galli. Beni-Suef Univ J Basic Appl Sci 2018; 7(2): 231-234. http://dx.doi.org/10.1016/j.bjbas.2018.02.003
  » http://dx.doi.org/10.1016/j.bjbas.2018.02.003
• Abu El Ezz NM. Effect of Nigella sativa and Allium cepa oils on Trichinella spiralis in experimentally infected rats. J Egypt Soc Parasitol 2005; 35(2): 511-523. PMid:16083064.
• Ahmad A, Husain A, Mujeeb M, Khan SA, Najmi AK, Siddique NA, et al. A review on therapeutic potential of Nigella sativa: A miracle herb. Asian Pac J Trop Biomed 2013; 3(5): 337-352. http://dx.doi.org/10.1016/S2221-1691(13)60075-1 PMid:23646296.
  » http://dx.doi.org/10.1016/S2221-1691(13)60075-1
• Akhtar M, Riffat S. Efficacy of Punica granatum Linn. (Anar) fruit-rinds against naturally acquired nematodal and cestodal infections. J Pharm Pb Univ Lhr Pak 1985; 6: 17-24.
• Akhtar MS, Riffat S. Field trial of Saussurea lappa roots against nematodes and Nigella sativa seeds against cestodes in children. J Pak Med Assoc 1991; 41(8): 185-187. PMid:1942479.
• Al-Megrin WA. Efficacy of Pomegranate (Punica granatum) Peel Extract Against Hymenolepis nana in infections Mice. Biosci Biotechnol Res Asia 2016; 13(1): 103-108. http://dx.doi.org/10.13005/bbra/2010
  » http://dx.doi.org/10.13005/bbra/2010
• Amelia M, Jasaputra DK, Tjokropranoto R. Effects of Pomegranate Peel (Punica granatum L.) Extract as an Anthelmintic. J Med Health 2017; 1(5): 409-416. http://dx.doi.org/10.28932/jmh.v1i5.537
  » http://dx.doi.org/10.28932/jmh.v1i5.537
• Ammann RW, Eckert J. Cestodes: echinococcus. Gastroenterol Clin North Am 1996; 25(3): 655-689. http://dx.doi.org/10.1016/S0889-8553(05)70268-5 PMid:8863045.
  » http://dx.doi.org/10.1016/S0889-8553(05)70268-5
• Arun N, Singh D. Punica granatum: a review on pharmacological and therapeutic properties. Int J Pharmaceut Sci Res 2012; 3(5): 1240-1245.
• Belghiti J, Benhamou JP, Houry S, Grenier P, Huguier M, Fékété F. Caustic sclerosing cholangitis: a complication of the surgical treatment of hydatid disease of the liver. Arch Surg 1986; 121(10): 1162-1165. http://dx.doi.org/10.1001/archsurg.1986.01400100070014 PMid:3767649.
  » http://dx.doi.org/10.1001/archsurg.1986.01400100070014
• Besim H, Karayalçin K, Hamamci O, Güngör C, Korkmaz A. Scolicidal agents in hydatid cyst surgery. HPB Surg 1998; 10(6): 347-351. http://dx.doi.org/10.1155/1998/78170 PMid:9515230.
  » http://dx.doi.org/10.1155/1998/78170
• Brunetti E, Kern P, Vuitton DA, WHO-IWGE2. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114(1): 1-16. http://dx.doi.org/10.1016/j.actatropica.2009.11.001 PMid:19931502.
  » http://dx.doi.org/10.1016/j.actatropica.2009.11.001
• Ciftci IH, Esme H, Sahin DA, Solak O, Sezer M, Dilek ON. Effect of octenidine dihydrochloride on viability of protoscoleces in hepatic and pulmonary hydatid diseases. J Natl Med Assoc 2007; 99(6): 674-677. PMid:17595938.
• Forouzanfar F, Bazzaz BSF, Hosseinzadeh H. Black cumin (Nigella sativa) and its constituent (thymoquinone): a review on antimicrobial effects. Iran J Basic Med Sci 2014; 17(12): 929-938. PMid:25859296.
• Hosseini SV, Ghanbarzadeh K, Barzin Z, Sadjjadi SM, Tanideh N, Mehrabani D. In vitro protoscolicidal effects of hypertonic glucose on protoscolices of hydatid cyst. Korean J Parasitol 2006; 44(3): 239-242. http://dx.doi.org/10.3347/kjp.2006.44.3.239 PMid:16969062.
  » http://dx.doi.org/10.3347/kjp.2006.44.3.239
• Hyam R, Pankhurst R. Plants and their names: a concise dictionary Oxford: Oxford University Press. 1995.
• Issa R. Using Nigella sativa (Habbet El-Baraka) in treatment of some parasitic diseases. Egypt J Med Sci 2003; 24(1-2): 435-446.
• Junghanss T, Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008; 79(3): 301-311. http://dx.doi.org/10.4269/ajtmh.2008.79.301 PMid:18784219.
  » http://dx.doi.org/10.4269/ajtmh.2008.79.301
• Mahmoudvand H, Asadi A, Harandi MF, Sharififar F, Jahanbakhsh S, Dezaki ES. In vitro lethal effects of various extracts of Nigella sativa seed on hydatid cyst protoscoleces. Iran J Basic Med Sci 2014a; 17(12): 1001-1006. PMid:25859304.
• Mahmoudvand H, Dezaki ES, Kheirandish F, Ezatpour B, Jahanbakhsh S, Harandi MF. Scolicidal effects of black cumin seed (Nigella sativa) essential oil on hydatid cysts. Korean J Parasitol 2014b; 52(6): 653-659. http://dx.doi.org/10.3347/kjp.2014.52.6.653 PMid:25548417.
  » http://dx.doi.org/10.3347/kjp.2014.52.6.653
• Moazeni M, Larki S. In vitro effectiveness of acidic and alkline solutions on scolices of hydatid cyst. Parasitol Res 2010; 106(4): 853-856. http://dx.doi.org/10.1007/s00436-010-1723-3 PMid:20111875.
  » http://dx.doi.org/10.1007/s00436-010-1723-3
• Moazeni M, Nazer A. In vitro effectiveness of garlic (Allium sativum) extract on scolices of hydatid cyst. World J Surg 2010; 34(11): 2677-2681. http://dx.doi.org/10.1007/s00268-010-0718-7 PMid:20625727.
  » http://dx.doi.org/10.1007/s00268-010-0718-7
• Naguleswaran A, Spicher M, Vonlaufen N, Ortega-Mora LM, Torgerson P, Gottstein B, et al. In vitro metacestodicidal activities of genistein and other isoflavones against Echinococcus multilocularis and Echinococcus granulosus. Antimicrob Agents Chemother 2006; 50(11): 3770-3778. http://dx.doi.org/10.1128/AAC.00578-06 PMid:16954323.
  » http://dx.doi.org/10.1128/AAC.00578-06
• Prasad J, Bellamy P, Stubbs R. Instillation of scolicidal agents into hepatic hydatid cysts: can it any longer be justified? N Z Med J 1991; 104(917): 336-337. PMid:1876339.
• Qnais EY, Elokda AS, Abu Ghalyun YY, Abdulla FA. Antidiarrheal Activity of the Aqueous extract of Punica granatum (Pomegranate) peels. Pharm Biol 2007; 45(9): 715-720. http://dx.doi.org/10.1080/13880200701575304
  » http://dx.doi.org/10.1080/13880200701575304
• Reddy MK, Gupta SK, Jacob MR, Khan SI, Ferreira D. Antioxidant, antimalarial and antimicrobial activities of tannin-rich fractions, ellagitannins and phenolic acids from Punica granatum L. Planta Med 2007; 73(5): 461-467. http://dx.doi.org/10.1055/s-2007-967167 PMid:17566148.
  » http://dx.doi.org/10.1055/s-2007-967167
• Ross RG, Selvasubramanian S, Jayasundar S. Immunomodulatory activity of Punica granatum in rabbits—a preliminary study. J Ethnopharmacol 2001; 78(1): 85-87. http://dx.doi.org/10.1016/S0378-8741(01)00287-2 PMid:11585693.
  » http://dx.doi.org/10.1016/S0378-8741(01)00287-2
• Sadjjadi SM, Zoharizadeh MR, Panjeshahin MR. In vitro screening of different Allium sativum extracts on hydatid cysts protoscoleces. J Invest Surg 2008; 21(6): 318-322. http://dx.doi.org/10.1080/08941930802348261 PMid:19160141.
  » http://dx.doi.org/10.1080/08941930802348261
• Salih B, Sipahi T, Dönmez EO. Ancient nigella seeds from Boyalı Höyük in north-central Turkey. J Ethnopharmacol 2009; 124(3): 416-420. http://dx.doi.org/10.1016/j.jep.2009.05.039 PMid:19505557.
  » http://dx.doi.org/10.1016/j.jep.2009.05.039
• Shenawy E, Soliman MF, Reyad SI. The effect of antioxidant properties of aqueous garlic extract and Nigella sativa as anti-schistosomiasis agents in mice. Rev Inst Med Trop São Paulo 2008; 50(1): 29-36. http://dx.doi.org/10.1590/S0036-46652008000100007 PMid:18327484.
  » http://dx.doi.org/10.1590/S0036-46652008000100007
• Stettler M, Fink R, Walker M, Gottstein B, Geary TG, Rossignol JF, et al. In vitro parasiticidal effect of nitazoxanide against Echinococcus multilocularis metacestodes. Antimicrob Agents Chemother 2003; 47(2): 467-474. http://dx.doi.org/10.1128/AAC.47.2.467-474.2003 PMid:12543645.
  » http://dx.doi.org/10.1128/AAC.47.2.467-474.2003
• Thompson RCA. Biology and Systematics of Echinococcus. Adv Parasitol 2017; 95: 65-109. http://dx.doi.org/10.1016/bs.apar.2016.07.001 PMid:28131366.
  » http://dx.doi.org/10.1016/bs.apar.2016.07.001
• Ullah R, Rehman A, Zafeer MF, Rehman L, Khan YA, Khan MA, et al. Anthelmintic potential of thymoquinone and curcumin on Fasciola gigantica. PLoS One 2017; 12(2): e0171267. http://dx.doi.org/10.1371/journal.pone.0171267 PMid:28152102.
  » http://dx.doi.org/10.1371/journal.pone.0171267
• Veerakumari L, Lalhmingchhuanmawii K, Ashwini R. Effect of Punica granatum ethanol extract on the carbohydrate metabolism of Cotylophoron cotylophorum. Int J Biol Sci 2014; 1: 1-5.
• Zibaei M, Sarlak A, Delfan B, Ezatpour B, Azargoon A. Scolicidal effects of Olea europaea and Satureja khuzestanica extracts on protoscolices of hydatid cysts. Korean J Parasitol 2012; 50(1): 53-56. http://dx.doi.org/10.3347/kjp.2012.50.1.53 PMid:22451734.
  » http://dx.doi.org/10.3347/kjp.2012.50.1.53

Publication Dates

• Publication in this collection
  13 June 2019
• Date of issue
  Apr-Jun 2019

History

• Received
  30 Oct 2018
• Accepted
  18 Mar 2019