Topical gabapentin 10% in the treatment of epidermolysis bullosa pruritus: A pilot, double-blind, split-site, randomized controlled trial.

Pruritus is a symptom that adversely affects the quality of life of patients with epidermolysis bullosa (EB). Although studies indicate the positive effect of gabapentin on some types of pruritus, its effect on pruritus due to EB remains unexplored. Hence, this study investigated the efficacy of topical gabapentin in treating EB pruritus. We piloted a 6-week, double-blind, split-site, randomized controlled trial on 14 patients with EB pruritus. In each patient, one pruritic lesion received topical gabapentin and the other a placebo. The items of the Leuven Itch Scale were evaluated before and after therapy; the lesions were photographed, and their appearance (i.e., erythema and excoriation severity, pruritic geometric area) was objectively assessed. Statistical analyses were made using SPSS v. 25. Quantitative data were reported as median (interquartile range) or mean ± standard deviation as appropriate. The median age of the 14 patients was 18 years (12-37), and the majority (64.3%) were male. A significant improvement was seen in the geometric area of the pruritic lesion in the intervention group (p = 0.005) but not in the control group (p = 0.054). Erythema severity, excoriation intensity, pruritus frequency and duration, and symptom-related distress significantly improved in both groups (p < 0.05 in all cases), but topical gabapentin failed to offer any statistical superiority relative to the placebo in the between-group analysis (p > 0.05). This study showed no significant difference between topical gabapentin and placebo in erythema severity, excoriation intensity, pruritus frequency and duration, and symptom-related distress among EB patients. However, the lesion area decreased only in the gabapentin group.

Psychometric Properties of a Persian Version of the SpREUK-P Questionnaire: An Instrument for Measuring the Importance and Frequency of Spiritual/Religious Practices in Iranian Patients with Chronic Gastrointestinal Diseases.

Attention to spiritual and religious issues is considered an important therapeutic method for patients with chronic disorders. This study aimed to assess the psychometric properties of a Persian version of the SpREUK-P questionnaire for evaluating spiritual and religious opinions among Iranian patients with chronic gastrointestinal diseases. This cross-sectional study was performed on 233 adult patients referring to the gastrointestinal clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, in 2017. The Persian version of the SpREUK-P questionnaire was prepared through the forward-backward translation method. The internal consistency of the questionnaire was evaluated by Cronbach's alpha coefficient. Furthermore, the construct validity of the instrument was assessed via exploratory factor analysis, while convergent and discriminant validity were investigated using Spearman correlation. Cultural adaptation, linguistic equivalency, and content validity of the Persian version of the SpREUK-P questionnaire were approved by a ten-member team of Shiraz University of Medical Sciences. Content validity indices were more than 0.8% across all items. Cronbach's alpha coefficients in terms of importance and practices were 0.81 and 0.71, respectively. Furthermore, the Persian version of the SpREUK-P showed excellent convergent validity and moderate to excellent discriminant validity. The results of exploratory factor analysis showed that all items were loaded properly on their own subscales, except for two items in the practice aspect and one item in the importance aspect. In conclusion, this study showed that the developed Persian SpREUK-P questionnaire is appropriate for assessing spiritual/religious opinions in Iranian patients with chronic diseases.

Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial.

BACKGROUND: Angiography is a highly effective invasive method for diagnosing coronary artery diseases but can lead to certain psychological problems such as stress, anxiety, and depression. This study aimed to compare the effects of education delivery through multimedia DVD content or text messaging in comparison with conventional printed pamphlets on the psychological parameters of patients scheduled for angiography. METHODS: This study was a randomized controlled clinical trial. We used the convenience sampling method to select 120 patients who met the inclusion criteria among individuals who were scheduled for elective coronary angiography. The patients were randomly divided into three groups through the block randomization method. The necessary educational tips for before, during, and after the angiography procedure were delivered to the patients in interventional group 1 (n = 40) and interventional group 2 (n = 40) through text messages and a multimedia DVD, respectively. The control group received routine hospital education through pamphlets besides the opportunity for verbal discussions with nurses. All educational content was delivered to the patients four days before the scheduled day of angiography. The DASS-21 questionnaire, consisting of the three domains of stress, anxiety, and depression, was used to collect the data. The questionnaire was administered at the time of delivering the educational content as the pretest evaluation and 30 min after the angiography procedure as the posttest evaluation. SPSS software, version 18, was used for statistical analysis. RESULTS: There was no significant difference among the three groups of patients in terms of pretest DASS-21 scores. Conversely, the mean posttest scores in all DASS-21 domains were significantly lower among the patients receiving education via the multimedia DVD or text messaging in comparison with the control group (P < 0.001). However, there were no statistically significant differences between the mean scores in all domains between the participants in the DVD and text messaging groups. CONCLUSION: It seems that both DVDs and text messaging are more effective than conventional pamphlets in controlling the anxiety, stress, and stress of patients scheduled for elective coronary artery angiography. Iranian Registry of Clinical Trials: IRCT registration number: IRCT2015030121283N1, Registration date: 2015-10-05, 1394/07/13.

Epidemiological factors in patients with dermatologic conditions referring to the clinic of traditional Persian Medicine: A cross-sectional study.

INTRODUCTION: Many patients with chronic diseases often use traditional medicine, as well as conventional medicine. The aim of this study was to evaluate the epidemiological factors of patients with dermatological conditions referring to traditional Persian Medicine (TPM) clinic. MATERIALS AND METHODS: In this cross-sectional study, we reviewed all the patients' medical documents, from March 2018 to March 2019, with dermatological conditions referred to the TPM clinic at Shiraz, Southern Iran. Then, the epidemiological factors of the patients were recorded in a researcher-made data collection form. SPSS software version 22 was used to analyse the data. RESULTS: Overall, 631 patients consisting of 151 (23.9%) males and 580 (76.1%) females were enrolled in the study. Most of the patients were aged from 31 to 40 years, 347 (55%) patients were married, and most of them were housewives. The frequency of patients in the spring was higher than in other seasons. Furthermore, most of the patients were university educated. Acne, eczema and hair loss were the three most complaints of the patients who were referred to the traditional medicine clinic. 301(47.7%) patients reported gastrointestinal problems as another complaint concomitant with their skin problems. CONCLUSION: It seems that women with skin problems, including acne, eczema, and hair loss, were more likely to refer to the TPM clinic. Therefore, the development of TPM clinics in the dermatology field as a scientific and academic approach can be effective in the treatment of patients with dermatological conditions accompanied by traditional medicine.

Evaluating prevalence of depression, anxiety and hopelessness in patients with Vitiligo on an Iranian population.

INTRODUCTION: Vitiligo is caused by partial or complete destruction of melanocytes in the affected skin area and influences the patient's quality of life. Besides physical involvement, vitiligo patients experience a high level of stress. Depression and Anxiety are common psychiatric disorders in vitiligo patients. AIM: This study, as the first study, evaluates hopelessness, anxiety, depression and general health of vitiligo patients in comparison with normal controls in an Iranian population. METHOD: Hundred patients with vitiligo and hundred healthy controls were examined. General health, depression, hopelessness and anxiety were evaluated based on general health questionnaire. Anxiety, depression and hopelessness levels were analyzed using Chi-Square, and the mean value of general health was evaluated through t-test. RESULTS: The results showed that anxiety and hopelessness levels were significantly higher in vitiligo patients than those who are in healthy controls. This significant difference refers to high levels of anxiety and hopelessness among women with vitiligo. It was also found that the single patients were more anxious, hopeless and depressive, while the married patients were only more anxious and hopeless than those who are in the control group, respectively. General health of patients was significantly worse than in healthy controls. The low level of general health in patients was related to poorer level of general health among women with vitiligo. CONCLUSION: It seems that women with vitiligo are more mentally stressed than men with vitiligo. Both singles and married vitiligo patients suffer from anxiety and hopelessness.

Applications of Ma'aljobon, a natural remedy from traditional Persian medicine, in dermatology: A journey from past to modernity.

Ma'aljobon, a handmade substance, is the liquid portion of coagulated milk after adding vinegar to the heated milk. In traditional Persian medicine (TPM) it has been known as a useful remedy for the treatment of some skin disorders. The aim of this study was to review the applications of Ma'aljobon for skin diseases according to the sages of TPM and modern medicine. Main TPM sources were reviewed with the keyword of "Ma'aljobon." Furthermore, electronic databases including Scopus, PubMed, SID, and Google Scholar were searched with the keyword "Whey protein" during 2000 to 2018. According to TPM sources, Ma'aljobon was used by Iranian sages as a safe and effective remedy to treat a wide range of skin diseases, such as pimples, and ulcers. Meantime, recent evidence has also shown the effectiveness of whey protein in treating some skin disorders such as atopic dermatitis. Gastrointestinal discomfort was the most adverse effect of Ma'aljobon mentioned in TPM sources. In conclusion, there were several applications for Ma'aljobon in treatment of dermatologic disease according to TPM, as well as modern medicine. These finding could be the basis of future clinical trials on the effects of Ma'aljobon in the treatment of skin problems.

Overview of herbal and traditional remedies in the treatment of cutaneous leishmaniasis based on Traditional Persian Medicine.

This study aims to describe the herbal and traditional remedies in the treatment of cutaneous leishmaniasis (CL) with an overview on related available evidence in modern medicine. This study is a review that focuses on the most important Traditional Persian Medicine (TPM) sources including Avicenna's Canon of Medicine, Jorjani's Zakhira-yi Kharazmshahi, and Aazam-Khan's Eksir-e-Aazam, as well as pertinent information from Embase, PubMed, Scopus, Scientific Information Database, and Google Scholar by using the keywords salak, rish-e-balkhi, cutaneous leishmaniasis, and leishmaniasis for selected remedies. Several oral and topical herbal remedies, such as Vitis vinifera L. (Unripe grapes), Berberis vulgaris L., Rheum ribes L., Santalum album L., Cinnamomum camphora (L.) J.Presl (Camphor), Brassica nigra (L.) K. Koch, Crocus sativus L., Juniperus excelsa M. Bieb, honey, and Alum root, were mentioned in TPM resources for the treatment of CL. Furthermore, cauterization, cupping, and leech therapy were considered for this purpose. In this review, some evidence-based studies will also be presented that have demonstrated the therapeutic properties of some of these products. In conclusion, the sages of TPM have recommended several systemic or topical medications, in addition to physical procedures, for treatment of CL, all of which could be a base for conducting further research on its efficacy.

Clinicopathological evaluation of patients with rippled pattern pigmentation of the skin: A single-center study.

The aim of the present study was to investigate the clinical association between rippled pattern pigmentation and the positivity of histopathological analysis for amyloid. A total of 50 patients (90% women) with rippled pattern pigmentation referring to Dermatology Clinic of Shahid Faghihi Hospital, Shiraz, Iran, in 2015 participated in this study. Two biopsies were performed for all the cases from the most frequently affected sites. The specimens were evaluated for amyloid deposits with hematoxylin-eosin (H&E), Congo red (CR), and crystal violet (CV) stains. The upper back was the most frequently affected area in the patients. Family history (28%), atopy (14%), pruritus as a common finding (86%), and history of friction (54%) were positive. The prevalence of disease was higher in patients with skin photo Type 3. Amyloid deposit was not detected in most patients by these stains. No statistically significant difference was found between the amyloid positive cases stained with H&E, CR, and CV (p-value > 0.05). Only the difference in positive results between biopsy number 2 and the total biopsy (1 and 2) was significant (p-value < .05). In conclusion, it seems that it is useful to increase the number of biopsies and other more sensitive staining methods to detect small focal amyloid deposits.

Efficacy of topical dimethyl sulfoxide (DMSO) 50% solution vs tretinoin 0.5% cream in treatment of patients with primary macular amyloidosis: A split-side single-blinded randomized clinical trial.

Primary localized cutaneous amyloidosis (PLCA) is a recalcitrant sporadic dermatological condition and most treatments have failed so far. We studied the efficacy of topical dimethyl sulfoxide (DMSO) 50% solution in comparison with tretinoin 0.5% cream in treatment of macular amyloidosis. In this split-side within-person single-blinded randomized clinical trial, 18 patients with bilateral macular amyloidosis received topical DMSO 50% solution and tretinoin 0.5% cream either on their right or the left side. The colorimetry, pruritus scoring, and photography were done. A significant pigmentation decline per each follow-up was observed in DMSO group compared to the tretinoin group (tretinoin: -1.31 vs DMSO: -7.34; difference in slopes: -6.03 [95% confidence interval: -12.06 to -0.01], PInteraction = .049). An insignificant diminution trend in pigmentation was observed for both treatments (Ptretinoin = .672, PDMSO = .092). Also, both treatments relived itchiness, but DMSO completely dispatched itchiness from the first follow-up (P = .003 for tretinoin and <.0001 for DMSO). In conclusion, our results showed DMSO and tretinoin cream have the positive effect on the both pigmentation and itchiness in PLCA. DMSO may be more beneficial than tretinoin, since DMSO was significantly better in reducing itchiness. More investigations are warranted to provide sufficient evidence.

Efficacy of oral supplementation of whey protein in patients with contact dermatitis: A pilot randomized double-blind placebo-controlled clinical trial.

Whey protein is a popular dietary product that has numerous health benefits such as immune modulation. In this study, we assessed efficacy of whey protein in management of patients with contact dermatitis (CD) through a double blind, randomized controlled clinical trial in Emam Reza clinic, Shiraz, Iran. Twenty-five patients in each group were randomly assigned to receive whey protein or placebo powder, 30 g in 200 mL warm water at fasting time for 4 weeks. Outcome measures were Dermatology Life Quality Index (DLQI) questionnaire and the Eczema Area and Severity Index (EASI) score. Furthermore, subjective total improvement (assessed by visual analogue scale) was set as the other primary outcome measure. A significant decrease was observed in the scores of EASI, DLQI, and subjective total improvement in the drug group after the intervention compared with the baseline. However, no changes were seen in the placebo group. Moreover, there was a significant reduction in the scores of EASI (P = .002) and subjective total improvement scores (P = .039) over the study period in the drug group compared with the placebo group. According to the results of this study, it seems that oral supplementation of whey protein could improve the symptoms of CD compared with placebo.

Sexual headache from view point of Avicenna and traditional Persian medicine.

One of the best remaining manuscripts is the "Canon of Medicine" fathered by Avicenna in the Islamic Golden Age [ninth to twelfth century AD]. Considering Avicenna's role in the development of medical science in the Islamic Golden Age, we reviewed Avicenna's point of view on sexual headache based on his famous book "Canon of Medicine". This historical review discusses the clinical approaches applied to diagnose, classify, and treat sexual headache-specifically herbal therapy-from the viewpoint of Avicenna and Traditional Persian Medicine. The accurate observations of Avicenna give a comprehensive classified etiology of the sexual headache. The efficacy of some medicinal herbs used by him for sexual headache treatments, such as the analgesic effect of lavender, chamomile, and jasmine has been proved by current medicine; however, the knowledge of medieval physicians should be scientifically investigated even further to extend new remedial options for sexual headache.

The Relationship between Body Mass Index and Temperament, Based on the Knowledge of Traditional Persian Medicine.

BACKGROUND: Temperament is one of the key concepts in traditional Persian medicine (TPM), which is the quality that will be obtained by the reaction between the four elements of water, earth, fire and air, and its property is different from the component property. According to TPM, temperament is influenced by many factors and the bulk of the body is one of these factors. In this study, we aimed at determining the relationship between person's temperament based on the knowledge of TPM and the body mass index (BMI). METHODS: This study is a cross-sectional study that examines the relationship between person's temperament and their BMI. For this purpose, 86 employees (20-40 years) of Shiraz Medical School were selected and their temperaments assessed using Dr. Mojahedi's temperament questionnaire and visitation by a TPM specialist. SPSS 18 was used for statistical analysis. RESULTS: In this study, 86 employees were evaluated including 18 (20.9%) male and 68 (79.1%) female. The mean age of the participants was 32.45±4.93 years old and the mean BMI was 23.75±2.94. Minimum and maximum BMI were related to people with temperament of cold and dry and cool temperament and more with the mean of 20.55±1.90 and 28.13±0.35, where the difference was statistically significant (P=0.0003). BMI in people with a temperament of hot and dry was significantly less than those with cool and wet temperament (P=0.01). CONCLUSION: Based on TPM, people with wet temperament are usually more obese and people with dry temperament are thinner. The results of this study confirm that obese people are cold and wet or have phlegmatic temperament whereas in comparison thin people are drier. This is in-line with the principles of TPM.

Efficacy of castor oil cream in treating infraorbital hyperpigmentation: An exploratory single-arm clinical trial.

INTRODUCTION: Infraorbital hyperpigmentation represents one of the most prevalent conditions in cosmetic dermatology. To treat this condition, many patients prefer natural remedies. This study explored the efficacy of topical castor oil cream in treating patients with infraorbital hyperpigmentation. METHODS: We conducted an exploratory single-arm clinical trial at the Shahid Faghihi Dermatology Clinic and Molecular Dermatology Research Center of Shiraz University of Medical Sciences, Shiraz, Iran, during 2021-2022. Using the convenience sampling method, we enrolled 25 patients with infraorbital hyperpigmentation. We instructed the patients to apply topical castor oil cream twice daily for 2 months. The darkness, melanin, and erythema levels were evaluated by VisioFace® 1000 D and SkinColorCatch® devices. We used a visual analog scale to assess skin laxity, wrinkles, and patient satisfaction. Data analysis was done with Stata version 14.2. RESULTS: The data of 22 patients with a mean age of 40.92 ± 7.33 years were analyzed. The VisioFace® scores decreased significantly by the end of the study [right eyes: mean difference (MD): -5.63 (95% CI: -7.12 to -4.15), p < 0.001; left eyes: MD: -5.91 (95% CI: -7.46 to -4.36), p < 0.001]. Moreover, castor oil cream significantly reduced the melanin level, wrinkles, and skin laxity in the infraorbital region (p < 0.05). CONCLUSIONS: Castor oil cream seems to be an effective alternative for treating infraorbital hyperpigmentation. Randomized clinical trials are needed to confirm our findings.

Efficacy of Dry Cupping versus Counselling with Mindfulness-based Cognitive Therapy Approach on Fertility Quality of Life and Conception Success in Infertile Women due to Polycystic Ovary Syndrome: A Pilot Randomized Clinical Trial.

Background: Physical and psychological interventions could affect the quality of life (QoL) of women with infertility. The purpose of this study was to compare the effectiveness of dry cupping and counselling with the mindfulness-based cognitive therapy (MBCT) approach on fertility QoL and conception success in infertile women due to polycystic ovary syndrome (PCOS). Methods: This was a two-arm pilot randomized clinical trial from first January 2021 to the end of November 2022. In this regard, 19 women with infertility who were referred to the health centers affiliated with Shiraz University of Medical Sciences and met the inclusion criteria were enrolled in the study. Participants were randomly divided into two groups (10 in the virtual MBCT group and 9 in the cupping group). All participants completed the fertility quality of life (FertiQol) tool before the intervention and three months after the end of the intervention. In addition, after the end of the intervention, a human chorionic gonadotropin test was performed monthly for three months, too. We used ANOVA/ANCOVA and its related effect sizes, including mean difference (MD) and standard mean difference (SMD: Hedges's g), and chi-square tests to compare the study group outcomes in Stata 14.2. P-values equal to or less than 0.10 were considered significant. Results: The intervention resulted in significant differences in the mean overall scores of FertiQol between the counseling and cupping groups (61.76±14.28 and 50.65±12.53, respectively) [P=0.091, MD=11.11 (90% CI: 0.33 to 21.89), SMD=1.07 (90% CI: 0.279 to 1.84)]. No significant difference was found in conception rates between the groups after the intervention. Conclusion: This pilot study found that MBCT improved the fertility QoL in PCOS-related infertility patients better than cupping therapy. Trial registration: IRCT201706110334452N1.

Efficacy of metformin vs. doxycycline in treating acne vulgaris: An assessor-blinded, add-on, randomized, controlled clinical trial.

INTRODUCTION: Insulin-like growth factor 1 (IGF-1) plays a role in the pathogenesis of acne vulgaris. Metformin can reduce IGF-1 levels and insulin resistance, so it may be useful in treating acne. OBJECTIVE: This study compared the efficacy of metformin and doxycycline in treating patients with acne vulgaris. METHODS: In this assessor-blind, add-on, randomized controlled clinical trial, we enrolled 40 patients with moderate acne vulgaris aged 15-40 and randomly divided them into two groups. For two months, the first group received doxycycline 100 mg capsules daily, and the second received metformin 500 mg tablets twice daily. The patients in both groups were adminitered to apply a fingertip (fourth finger) of 5% benzoyl peroxide gel (Pangel®) topically every night over the lesions, and to wash it off after 30 min. Patients were evaluated using the Global Acne Grading System (GAGS) score, Investigator Global Assessment for Acne (IGA) score, Cardiff Acne Disability Index (CADI), Total Acne Lesion Count (TLC), and the number of inflammatory and noninflammatory lesions. RESULTS: By the end of the study, the GAGS, IGA, CADI, and TLC scores and the number of inflammatory and noninflammatory lesions decreased significantly in both groups (p < 0.001), with no significant difference between the two groups (p > 0.05). CONCLUSION: This trial indicates equal efficacy of doxycycline and metformin in reducing acne vulgaris severity, with doxycycline performing better in reducing lesions of the inflammatory type. Confirmatory or equivalence clinical trials should be performed to confirm our results.

Psychometric properties of a Persian version of the Vulvovaginal Symptoms Questionnaire for measuring vulvovaginal symptoms in postmenopausal women.

OBJECTIVE: Vulvovaginal symptoms are common in postmenopausal women and can affect their quality of life and sexual function. Using a sample of postmenopausal Iranian women, we evaluated a Persian translation of the Vulvovaginal Symptoms Questionnaire (VSQ). METHODS: This study included 201 postmenopausal Iranian women referred to dermatology and gynecology clinics affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. We translated the VSQ to the Persian language using the forward-backward method. We examined the questionnaire's internal consistency using Cronbach α coefficient and evaluated its construct validity using exploratory and confirmatory factor analyses. RESULTS: A Cronbach α coefficient of 0.763 confirmed the overall internal consistency of the Persian VSQ. Exploratory factor analysis indicated that except for three items in the symptoms subscale, others had sufficient α coefficients, although some did not load on the expected subscales. Confirmatory factor analysis confirmed the appropriate allocation of all but two items to the expected subscales. An intraclass correlation coefficient of 0.89 confirmed the reliability of the questionnaire. CONCLUSIONS: Although some parts of the Persian VSQ were unsatisfactory, most were appropriate for assessing vulvovaginal symptoms in postmenopausal Iranian women. We recommend further cultural adaptations.

Psychometric properties of the Persian version of System for Evaluation of Teaching Qualities by students: A tool for assessing clinical tutors from students' viewpoint.

BACKGROUND: Effective clinical teaching is crucially important for patient care in future. Therefore, proper clinical training is essential to make physicians capable of delivering high-quality health care. MATERIALS AND METHODS: The present study was a cross-sectional research. After translating the questionnaire into Persian, it was distributed among medical students in the clinical years of medical education in teaching hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences in 2018. The System for Evaluation of Teaching Qualities (SETQ) has 25 questions in a 6-scale Likert scale that evaluates clinical tutors in five dimensions of teaching and learning environment, professional attitude toward students, transferring of goals, evaluation of students, feedback, and promoting self-directed learning. Instrument reliability was assessed by calculating the Cronbach's alpha coefficient, whereas questionnaire content validity was evaluated by relative content validity ratio (CVR) and content validity index (CVI). To evaluate the structural validity, an exploratory factor analysis was conducted. RESULTS: The SETQ was completed by 127 medical students. Cronbach's alpha coefficient of the total questionnaire was estimated as 0.908. The factor analysis showed that the questionnaire was composed of six factors, explaining 66.14% of the total variance. The CVI and CVR indices of the individual items were also acceptable. CONCLUSION: The findings of our study showed that the Persian version of SETQ questionnaire had the acceptable reliability and validity to be used in assessing clinical tutors in different hospitals in Iran.