Eicosapentaenoic acid versus placebo as adjunctive therapy in chronic migraine: A randomized controlled trial.

OBJECTIVE: This study was conducted to assess the efficacy of daily 2000 mg eicosapentaenoic acid (EPA) supplementation in individuals with chronic migraine. BACKGROUND: Chronic migraine is characterized by a minimum of 15 headache days/month, necessitating a focus on preventive treatment strategies. EPA, a polyunsaturated fatty acid recognized for its anti-inflammatory properties, is examined for its potential effectiveness in chronic migraine management. METHODS: A randomized, blinded, placebo-controlled trial of eligible participants with a confirmed diagnosis of chronic migraine were enrolled. The intervention group received 1000 mg of EPA twice daily for 8 weeks, while the control group received two placebo softgels. Symptoms were recorded at 4 and 8 weeks. The primary outcome was assessed using the Headache Impact Test-6 to evaluate changes in patients. Secondary outcomes encompassed migraine headache days, headache severity measured via a visual analog scale, and the number of consumed painkillers. Descriptive analyses were reported in mean (± standard deviation [SD]). RESULTS: A total of 60 patients were included in the study and finally, 56 patients completed the study according to the protocol, including 47 (84%) females. The data comparison at baseline did not show any significant difference between the two groups except in the number of patients using valproic acid as prophylaxis (21 patients in the EPA group, and 13 in the placebo group; p = 0.037). The results showed after 8 weeks, a mean (SD) difference of Headache Impact Test-6 in the EPA and placebo groups was -6.96 (3.34) and -4.43 (5.24), respectively (p = 0.084). Regarding migraine headache days, participants reported a mean (SD) -9.76 (4.15) and -4.60 (4.87) decline in days with headache, respectively (p < 0.001). The number of attacks per month after 8 weeks was 3.0 (95% confidence interval [CI] 2.0-4.0) and 4.0 (95% CI 3.0-6.0), respectively (p < 0.001). Regarding severity, there was no significant difference between the two groups (mean [SD] difference: -0.76 [1.13] and -0.73 [1.04], respectively; p = 0.906). In terms of adverse events, two patients in the EPA group reported intolerable nausea and vomiting, and one patient in the placebo group reported dizziness. CONCLUSIONS: This study's findings support the potential of a daily 2000 mg EPA as a prophylactic pharmacotherapy in chronic migraine management, specifically in mitigating migraine attacks, migraine headache days, and overall quality of life.

Comparison of the Effect of Intracarpal Injection of Ketorolac With Triamcinolone in Carpal Tunnel Syndrome: A Randomized Controlled Trial.

BACKGROUND: The most prevalent entrapment neuropathy is carpal tunnel syndrome (CTS). Although nonsteroidal antiinflammatory drugs (NSAIDs) are frequently prescribed for musculoskeletal disorders, oral NSAIDs do not provide any additional benefits for CTS. Nevertheless, the use of NSAID phonophoresis has shown significant improvement, possibly due to increased concentration in the target tissue. The effects of intracarpal injection of NSAIDs on CTS have not been studied. OBJECTIVE: We conducted a controlled trial to compare the efficacy of ketorolac and triamcinolone in treating CTS. METHODS: Mild to moderate CTS patients were randomly assigned to receive either a local injection of 30 mg ketorolac or 40 mg triamcinolone. Patients were evaluated using visual analog scale (VAS) for pain, severity, function, electrodiagnostic findings, patient satisfaction, and any complications at the injection site, at baseline and 12 weeks after the procedures. RESULTS: Fifty patients participated, and 43 completed the study. Both groups showed significant improvement in the VAS, severity, function, and electrodiagnostic scores at 3 months compared with the baseline. A comparison of the groups showed significant differences in VAS, severity, and function, with the improvement being significantly higher in the triamcinolone group. CONCLUSION AND RELEVANCE: The present study showed that injection of triamcinolone or ketorolac into the carpal tunnel relieved pain, increased function, and improved electrodiagnostic findings in patients with mild to moderate CTS. It also showed that triamcinolone was superior to ketorolac in terms of analgesic effect and resulted in greater improvement in symptom severity and function.

A randomized, double-blind placebo-controlled phase I clinical study on safety and efficacy of the G-Rup® syrup (a mixture of ginger extract and honey) in symptomatic treatment of knee osteoarthritis.

WHAT IS KNOWN AND OBJECTIVES: Present study evaluated the safety profile and efficacy of G-Rup® syrup (100 mg/ml ginger extract plus 150 mg/ml honey) in symptomatic treatment of knee osteoarthritis (OA). METHODS: Patients diagnosed with knee OA were randomly assigned (1:1) to receive either of a 30 ml twice daily regimen of G-Rup® syrup or placebo over a 12-week period. Primary endpoints of the study comprised of an improvement in the joint's stiffness, physical functioning and pain score, assessed by WOMAC questionnaire and the visual analog scale (VAS). Secondary objectives comprised of safety and tolerability of the syrup by patients. RESULTS AND DISCUSSION: The 30 ml twice-daily regimen of G-Rup® syrup was safe and well tolerated by patients. Moreover, in whole studied time points, treatment with G-Rup® syrup could significantly Power the VAS score (p < 0.001) whereas improving WOMAC total score (p < 0.001) and pain (p < 0.001), physical functioning (p < 0.001), and stiffness sub-scores (p = 0.006) compared to the placebo receiving group. WHAT IS NEW AND CONCLUSION: Based on obtained results, the G-Rup® syrup, composed of a combination of honey and ginger, may be a proper supplementary choice, along with routine therapeutic regimens, for improvement of symptomatic treatment of OA.

Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial.

BACKGROUND: Intra articular (IA) injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) are of the new methods in the management of hip osteoarthritis (OA). The aim of this study was to compare the effectiveness of IA injections of PRP, HA and their combination in patients with hip OA. HA and PRP are two IA interventions that can be used in OA in the preoperative stages. Due to the different mechanisms of action, these two are proposed to have a synergistic effect by combining. METHODS: This is a randomized clinical trial with three parallel groups. In this study, patients with grade 2 and 3 hip OA were included, and were randomly divided into three injection groups: PRP, HA and PRP + HA. In either group, two injections with 2 weeks' interval were performed into the hip joint under ultrasound guidance. Patients were assessed before the intervention, 2 months and 6 months after the second injection, using the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne questionnaires. RESULTS: One hundred five patients were enrolled randomly in HA, PRP and PRP + HA groups. All three groups showed significant improvement in WOMAC, VAS, and Lequesne at 2 months and 6 months compared with baseline. Comparison of the 3 groups demonstrated significant differences regarding WOMAC and Lequesne total scores and the activities of daily living (ADL) subscale of Lequesne (P = 0.041, 0.001 and 0.002, respectively), in which the observed improvement at 6th month was significantly higher in the PRP + HA and PRP groups compared to the HA group. CONCLUSION: Although all 3 interventions were associated with improvement of pain and function in patients with hip OA, the therapeutic effects of PRP and PRP + HA injections lasted longer (6 months), and the effects of these two interventions on patients' performance, disability, and ADL were superior to HA in the long run. Moreover, the addition of HA to PRP was not associated with a significant increase in the therapeutic results. TRIAL REGISTRATION: The study was registered at Iranian Registry of Clinical Trials (IRCT) website http://www.irct.ir/ , a WHO Primary Register setup, with the registration number of IRCT20130523013442N30 on 29/11/2019.

Subacromial Injections of Low- or High-Molecular-Weight Hyaluronate Versus Physical Therapy for Shoulder Tendinopathy: A Randomized Triple-Blind Controlled Trial.

OBJECTIVE: Shoulder tendinopathy is a prevalent and debilitating problem. We compared the effects of subacromial high- or low-molecular-weight hyaluronate injection with physical therapy (PT) in shoulder tendinopathy. DESIGN: A triple-blinded randomized controlled trial. SETTING: We conducted the trial in an outpatient clinic at a teaching hospital. PARTICIPANTS: In total, 79 patients with shoulder tendinopathy were randomly allocated to high- (n = 27) or low-molecular-weight (n = 28) hyaluronate or PT (n = 24) groups. INTERVENTIONS: We administered a 20-mg injection of high- or low-molecular-weight hyaluronate. For PT, we prescribed 10 sessions of physiotherapy and exercise. OUTCOME MEASURES: The primary outcome was shoulder pain and the secondary outcomes included Disability of the Arm Shoulder and Hand score, shoulder range of movement and QoL. We measured the outcomes at baseline, 1, and 3 months of treatment, and assessed shoulder pain at the sixth month postintervention. RESULTS: The interventions were all clinically beneficial in the management of tendinopathy for high- (n = 25) and low-molecular-weight (n = 24) hyaluronate and PT (n = 19) groups (all P < 0.05). However, between-group analyses indicated that hyaluronate preparations were more effective in controlling pain, decreasing disability, increasing range of motion, and improving the quality of life (all P < 0.05). The pain and subjective feeling of rigidity at the injection area ( P = 0.012) were less prominent for low-molecular-weight hyaluronate. CONCLUSION: High- or low-molecular-weight hyaluronate is more effective than PT in the treatment of shoulder tendinopathy. The clinical benefits of hyaluronate last for at least 3 months, and the pain alleviation sustains partially for 6 months. Shoulder injection of low-molecular-weight hyaluronate is more tolerable to the patient than high-molecular-weight hyaluronate.

Electrodiagnostic signs of carpal tunnel syndrome in ocular pseudoexfoliation syndrome.

PURPOSE: To assess the occurrence and severity of electrodiagnostic signs of carpal tunnel syndrome (ED-CTS) in patients with ocular pseudoexfoliation (PEX) and compare them with normal subjects. METHOD: A cross-sectional study with comparison group was designed and 60 patients with PEX were recruited from May 2019 to February 2021, and the findings were compared with 59 healthy subjects. All patients underwent complete ophthalmologic examination and nerve conduction velocity test at the median nerve was used to assess the occurrence and severity of ED-CTS in both hands. RESULTS: The mean age of participants was 59.8 ± 4.5 years. Occurrence of ED-CTS was 38.3% in PEX patients and 20.3% in control subjects (P = 0.025). There was also a significant difference in the severityand presence of asymptomatic CTS (P < 0.05). Adjusting other variables, including; age and sex, having severe ED-CTS showed a 3.07fold higher chance in the PEX group (P = 0.005). CONCLUSION: According to our finding, it seems there is a direct association between PEX and the occurrence, as well as severity of ED-CTS.

Assessing multiple sclerosis-related quality of life among Iranian patients using the MSQOL-54 tool: a cross-sectional study.

BACKGROUND: Multiple sclerosis (MS) is a chronic autoimmune disease and is one of the most costly medical conditions that imposed families with catastrophic health expenditures. There is an increasing trend in using alternative medicines including, dietary supplements, herbs, vitamins, and minerals. To date, the association between dietary as well as herbal supplements and QoL in MS patients is under researched; thus, this study aimed to assess the association between the self-reported supplement used and QoL between MS patients. METHODS: This cross-sectional study was conducted on patients with MS referring to Shahid Kazemi Pharmacy, based in the city of Tehran, Iran, as a national pharmacy providing specialized pharmaceutical products and pharmaceutical care to patients. The Multiple Sclerosis Quality of Life-54 (MSQoL-54) tools was performed to evaluate MS patients QoL. RESULTS: A total number of 382 patients with MS participated in this study. They include 89 (23.3%) men and 293 (76.7%) women, aged 40 ± 10.9 years old. The overall score of the MSQoL-54 questionnaire was 41.58 out of 100. Physical health composite (PHC) and mental health composite (MHC) were 69.60 and 62.99 from 100, respectively. This study revealed that 76.4% of patients used at least one vitamin daily; 92.4% of patients do not receive any herbal product. Vitamin D is the most widely used supplement, followed by calcium, while vitamin C is the least consumed. No correlation was observed regarding supplement use and overall QoL, PHC, or MHC. There were no significant differences between QoL's dimensions score in patients who used supplements. The results showed that increasing the number of supplements used did not relate to overall QoL, PHC, or MHC. In addition, there was not any correlation between the duration used of supplements and QoL's dimensions score in MS patients (p-value> 0.05). CONCLUSIONS: The dietary supplement appears to be popular among MS patients. The study results showed that the number of supplementations and their long-term use in patients with MS were not associated with higher QoL. Similarly, the herbal supplements have failed to improve QoL.

High- Versus Low-Molecular-Weight Hyaluronic Acid for the Treatment of Rotator Cuff Tendinopathy: A Triple-Blind Randomized Comparative Trial.

BACKGROUND: Shoulder pain most commonly originates from the tendon structures of the rotator cuff. OBJECTIVE: We compared the clinical effects of high- versus low-molecular-weight (LMW) hyaluronic acid for the management of rotator cuff tendinopathy. METHODS: We carried out a parallel, triple-blind, randomized comparative trial at a teaching hospital. In total, 56 patients aged 16 to 70 years with rotator cuff tendinopathy were randomly allocated to 2 groups. We administered a single shoulder injection of either 1 mL of 1% high- (>2000 kDa) or 1 mL of 1% LMW hyaluronate (500-700 kDa) to the corresponding groups. The primary outcome was the intensity of shoulder pain. The secondary outcomes were range of motion and disability of the shoulder, and quality of life. We performed the measurements at baseline and at 1, 4, and 12 weeks postintervention. The pain measurements were repeated at the sixth month postintervention. RESULTS: Comparisons of baseline versus 3 months showed that both interventions were beneficial in the management of the tendinopathy (all P values <0.05). However, between-group analyses did not indicate any clinically significant difference between the 2 medications. The pain, induration (P = 0.007), and inflammation at the site of the injection were less prominent for LMW hyaluronate. CONCLUSION AND RELEVANCE: Both medications are effective for the treatment of tendinopathy. The benefits last at least for 3 months, and pain alleviation lasts partially for 6 months. The shoulder injection of LMW hyaluronate is more tolerable to the patient. Therefore, we recommend LMW hyaluronate as the first choice for the management of rotator cuff tendinopathy.

Impact of educational intervention by community pharmacists on asthma clinical outcomes, quality of life and medication adherence: A systematic review and meta-analysis.

WHAT IS KNOWN AND OBJECTIVE: Community pharmacists can play an important role in controlling chronic diseases. This study aimed to evaluate the effects of pharmacists' educational interventions in the community pharmacy settings on asthma control and severity, quality of life (QOL) and medication adherence. METHODS: Databases PubMed, Scopus and Web of Science were searched for evidence regarding asthma severity and control, QOL, and medication adherence after pharmacists' interventions in community pharmacy settings. Twenty-one studies were eligible for qualitative and quantitative analysis. Indices and questionnaires were used in the studies, such as Asthma-related quality of life (IAQLQ), Asthma Control Test (ACT), Perceived Control of Asthma Questionnaire (PCAQ), inhaler technique (IT), Asthma Control Questionnaire (ACQ), 36-Item Short Form survey (SF-36) and peak expiratory flow rate (PEFR). The outcomes were extracted, pooled and analysed as percentages, means, standard deviations and errors, and 95% confidence intervals (CIs). RESULTS AND DISCUSSION: Community pharmacists in all studies educated and followed up the asthmatic patients, addressing the outcome measures. Pharmacists underwent training courses of at least a day. Standardized mean differences for the indices were pooled as follows: IAQLQ -0.241 (95% CI, -0.362 to -0.121), ACT 0.14 (95% CI, 0.02 to 0.27), PCAQ -0.15 (95% CI, -0.28 to 0.01), IT 0.79 (95% CI, 0.05 to 1.54), ACQ -0.50 (95% CI, -0.69 to -0.30), SF-36 0.39 (95% CI, 0.16 to 0.62), PEFR 0.13 (95% CI, 0.01 to 0.26) and asthma symptoms score -0.34 (95% CI, -0.49 to -0.18). WHAT IS NEW AND CONCLUSION: Pharmacists' educational interventions in community pharmacy settings could significantly improve asthma severity and control, QOL and medication adherence.

Atezolizumab and Bevacizumab Targeted-Therapy in Advanced Hepatocellular Carcinoma: A Systematic Review of Cost-effectiveness Analyses.

BACKGROUND: Atezolizumab (ATZ) plus bevacizumab (BVC) co-administration is one of the newest systemic interventions in advanced hepatocellular carcinoma (AHCC). This treatment approach is more costly and effective than other therapeutic interventions, significantly improving AHCC survival and health-related quality of life. AIM: This economic study aimed to systematically review all cost-effectiveness analyses of ATZ/BVC combination in AHCC. METHOD: A comprehensive search in scientific databases was performed using a highly sensitive syntax to find all related economic evaluations. The target population was AHCC patients. The intervention was ATZ/BVC, which was compared with sorafenib, nivolumab, and other anticancer strategies. We included studies that reported quality-adjusted life-years (QALYs) and/or life-years, costs, and incremental cost-effectiveness ratio (ICER), and finally, the characteristics of included studies were categorized. RESULTS: Out of 315 identified records, 12 cost-effectiveness analyses were eligible for inclusion in the systematic review. Treatment costs were significantly higher with ATZ/BVC in all studies (from 61,397 to 253,687 USD/patient compared to sorafenib and nivolumab, respectively). Incremental QALYs/patient varied from 0.35 to 0.86 compared to sintilimab/BVC and sorafenib. Although ICERs for drugs varied widely, all were united in the lack of cost-effectiveness of the ATZ/BVC. The willingness-to-pay threshold in all studies was lower than the ICER, which indicated a reluctance to pay for this treatment strategy by the health systems. CONCLUSION: The ATZ/BVC combination is an expensive targeted immunotherapy in AHCC. Significant discounts in ATZ and BVC prices are essential for this novel approach to be cost-effective and extensively used.

Potential of nutraceuticals in celiac disease.

Celiac Disease (CD) is the most common hereditarily-based food intolerance worldwide and a chronic inflammatory condition. The current standard treatment for CD involves strict observance and compliance with a gluten-free diet (GFD). However, maintaining a complete GFD poses challenges, necessitating the exploration of alternative therapeutic approaches. Nutraceuticals, bioactive products bridging nutrition and pharmaceuticals, have emerged as potential candidates to regulate pathways associated with CD and offer therapeutic benefits. Despite extensive research on nutraceuticals in various diseases, their role in CD has been relatively overlooked. This review proposes comprehensively assessing the potential of different nutraceuticals, including phytochemicals, fatty acids, vitamins, minerals, plant-based enzymes, and dietary amino acids, in managing CD. Nutraceuticals exhibit the ability to modulate crucial CD pathways, such as regulating gluten fragment accessibility and digestion, intestinal barrier function, downregulation of tissue transglutaminase (TG2), intestinal epithelial morphology, regulating innate and adaptive immune responses, inflammation, oxidative stress, and gut microbiota composition. However, further investigation is necessary to fully elucidate the underlying cellular and molecular mechanisms behind the therapeutic and prophylactic effects of nutraceuticals for CD. Emphasizing such research would contribute to future developments in CD therapies and interventions.

Awareness and practical evaluation of correct use of iron chelators; a study to track the ambiguities of thalassemia patients on their medications in Iran.

PURPOSE: This study aimed to evaluate the knowledge, attitude, and practice toward iron chelating agents (ICAs) in Iranian thalassemia major patients. METHODS: A total of 101 patients with thalassemia major were involved in this cross-sectional survey. A deep medication review was done, and participants' knowledge, attitude, and practice were evaluated by a validated instrument based on a 20-scoring system. RESULTS: Statistical analyses showed 52 patients (51.5%) had a poor knowledge level (scores < 10) about their medications, 37 (36.6%) had a moderate level (scores 10-15), and 12 (11.9%) had a satisfactory level (scores > 15). Seventy-seven (76.2%) patients have positive beliefs regarding the dependence of their current health status on taking iron chelators, and 63 (62.4%) believed that they would become very ill without taking medication. The results also showed that the mean practice score in patients who received deferoxamine was 5.81 ± 3.50; in the patients who received deferiprone and those who received deferasirox, the mean scores were 7.36 ± 5.15 and 14.94 ± 4.14. Also, the knowledge and practice level had a direct linear correlation based on the regression analyses (P < 0.001). CONCLUSION: In conclusion, results of the present research suggests that the patients' knowledge about the administration, adverse events, and necessity of ICAs was not satisfactory. Improving the knowledge of thalassemia patients toward their medicines through educational interventions is highly recommended to improve their practice level.

The effect of crocin on movement disorders and oxidative DNA damage in Parkinson's disease: Insights from a randomized controlled trial.

BACKGROUND: Parkinson's disease (PD), the second most prevalent neurological disorder in the elderly, manifests with distinctive movement disorders, including bradykinesia, resting tremor, and stiffness. With a progressive course, current treatment strategies primarily target symptomatic relief. Crocin is a chemical compound isolated from the dry stigma of Crocus sativus, and has demonstrated neuroprotective properties. OBJECTIVES: This study explores the impact of crocin on movement disorders and neuronal oxidative DNA damage in PD patients. METHOD: Conducted as a randomized, blinded, and controlled trial, this research focused on patients aged 30 to 80 with idiopathic PD. Using the second and third parts of the movement disorder society-unified PD rating scale (MDS-UPDRS), aspects of daily life activity and movement disorders were assessed before and after an 8-week intervention. Patients in the crocin groups received capsules containing 30 mg of crocin twice daily. Additionally, the 8-hydroxy-2-deoxydiguanosine (8-OHdG) to urinary creatinine ratio (8-OHdG/uCr) was measured to evaluate neuronal oxidative DNA damage. RESULTS: Out of the initially evaluated 164 patients, 30 were randomly assigned to each group, with 53 subjects completing the study. Within-group analysis revealed a significant improvement in the second and third parts of MDS-UPDRS after 8 weeks of crocin intervention (P < 0.05). However, the 8-OHdG/uCr did not show significant changes. The well-tolerated daily dose of 60 mg of crocin demonstrated minimal side effects. CONCLUSION: This study establishes the efficacy of crocin in enhancing daily life activities and mitigating movement disorders, suggesting its potential as a supplementary intervention alongside conventional PD medications.

Mitochondrial transplantation attenuates toxicity in rat renal proximal tubular cells caused by Favipiravir.

OBJECTIVES: Exogenous mitochondria transplantation or mitotherapy can be used to swap out unhealthy mitochondria for functioning ones. Treatment of mitochondrial diseases using this approach may be beneficial. METHODS: In this study, we looked at the effect of transplanting newly isolated mitochondria on the toxicity that favipiravir (FAV) causes in renal proximal tubular cells (RPTCs). In this study, parameters such as lactate dehydrogenase (LDH) leakiness, reactive oxygen species (ROSs) production, damage to the lysosome membrane, reduced glutathione (GSH) content, extracellular oxidized glutathione (GSSG) content, GSH/GSSG ratio, ATP level, mitochondrial membrane potential (MMP) collapse, Bcl-2 content, and caspase-3 activity were used to assess the protective effects of mitochondrial transplantation against FAV-induced mitochondrial toxicity. KEY FINDINGS: The statistical analysis showed that the cytotoxicity, ROS production, MMP collapse, lysosomal damage, GSSG levels, and caspase-3 activity brought on by FAV in RPTCs were reduced by transplanting the healthy mitochondria. In addition, it led to an increase in ATP level, GSH content, Bcl-2 content, and GSH/GSSG ratio in RPTCs. CONCLUSIONS: A recent study found that mitochondrial transplantation is a powerful therapeutic approach for treating nephrotoxicity brought on by xenobiotics.

Evaluating the effectiveness of probiotics in relieving constipation in Parkinson's disease: A systematic review and meta-analysis.

Objectives: The aim of this study was to evaluate the effects of probiotics on the treatment of constipation in patients with Parkinson's disease (PD) by analyzing data from published randomized clinical trials (RCTs). PD is a neurodegenerative disease characterized by clinical symptoms such as rigidity, bradykinesia, and resting tremor. Constipation is a common complaint reported by PD patients. Probiotics are often used to treat functional constipation. The potential mechanisms behind PD-related constipation include dysfunction of the enteric nervous system due to alpha-synuclein aggregation, dyssynergic contractions of the puborectalis muscle, and alterations of the gut microbiome. Method: To conduct this study, we searched Scopus, PubMed, and Google Scholar for published articles on PD, probiotics, and constipation. We selected RCTs from 944 studies, and ultimately included 3 RCTs in our meta-analysis. The frequency of bowel movements per week was the only index that could be summarized among the records. We extracted and analyzed the results as means and standard deviations. Result: We calculated a standardized mean difference (SMD) of 0.92 (95% CI, 0.65 to 1.19; I-squared = 57.0%; p < 0.001) to determine the treatment effect in terms of frequency of bowel movements per week in the RCTs. Conclusion: Our results show that probiotic intake has beneficial effects on constipation in PD patients. Further research, including multicenter studies, is needed to assess the long-term efficacy and safety of probiotic supplements in neurodegenerative diseases.

Knowledge about Prescribing Antibiotics as Prophylaxis in Patients with Open Globe Injury: A Survey in Iranian Ophthalmologists.

Objective: This study aimed to evaluate the Iranian ophthalmologists' knowledge of prescribing prophylactic antibiotics to patients with open globe injury (OGI) in Iran. Methods: In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists' knowledge about prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. The questionnaire included demographic information as well as ophthalmologists' knowledge levels. Cronbach's alpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0. Results: Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%) subspecialists with different orientations completed the questionnaires. The total knowledge score was 13.04±2.96. The following are the results of ophthalmologists' responses to questions regarding the cornea/scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eye surgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as their proper dosage (2.96±2.35). There was no significant relationship between some demographic information such as sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologists with less work experience had significantly higher levels of knowledge than those with more work experience. Conclusion: The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribing prophylactic antibiotics in OGI.

Comparing the efficacy of three methods of permethrin application in pediculosis capitis: A randomized clinical trial.

BACKGROUND: Pediculosis capitis, also known as head lice, is a common problem that affects individuals of different socio-economic backgrounds. Permethrin is generally considered the first-line treatment option for head lice. AIMS: The objective of this study was to evaluate and compare the therapeutic effects of three different methods of permethrin treatment for head lice. METHOD: A parallel, randomized clinical trial was conducted on 157 patients with head lice. The participants underwent eye examination and dry combing by a trained professional. The subjects were randomly divided into three groups and treated with one of the three methods of permethrin application: permethrin shampoo for 10 min, permethrin shampoo for 1 h, or permethrin cream for 10 min on a weekly basis for 3 weeks. RESULTS: Of the 157 participants, 154 completed the study. The group treated with permethrin shampoo for 1 h had the shortest average time for eradication of lice at 1.226 ± 0.422 weeks, which was significantly lower than the other two groups. Additionally, the 1-h permethrin shampoo group had the lowest time for scalp itching of 2.15 ± 0.632 weeks, which was significantly lower than the other two groups. Moreover, the rate of lice eradication in the first week was significantly higher in the 1-h permethrin shampoo group. CONCLUSION: The results of this study suggest that the use of 1% permethrin shampoo for 1 h is more effective in eradicating head lice within the first week of treatment and in relieving scalp itching during the second week.

Efficacy of Probiotics in Improving Motor Function and Alleviating Constipation in Parkinson's Disease: A Randomized Controlled Trial.

Background: Parkinson's disease (PD) is one of the common neurodegenerative diseases, and there has been an increasing interest in the potential role of intestinal dysbiosis in its pathogenesis and related gastrointestinal complications such as constipation. Objectives: This study aims to evaluate the effects of multi-strain probiotics on constipation and motor function in PD patients. Methods: This study was a blinded, randomized controlled trial (RCT) that involved 27 PD patients who were diagnosed with constipation according to the ROME IV criteria for functional constipation. The primary outcome measured before and after the intervention in both the placebo and probiotic groups was the frequency of defecation. Secondary outcomes evaluated were laxative use, sense of complete evacuation, Bristol Stool Scale for consistency, and Unified Parkinson's Disease Rating Scale (UPDRS) scale. The study lasted for eight weeks. Both groups also were educated about lifestyle modification. Results: Of 30 included patients (15 in each group), 13 were women, and 17 were men. Three patients dropped out of the study. Between-group analysis showed that the frequency of bowel movements significantly increased in the probiotic group 4 [3 - 5] in comparison with 2 [2 - 3] in placebo (P = 0.02). Stool consistency also improved in the probiotic group (P = 0.04). However, there were no significant differences in other outcomes. The within-group analysis showed improvement in stool consistency in both probiotics and placebo groups (P = 0.01 and P = 0.007, respectively), while stool frequency and sense of complete evacuation significantly improved only in the probiotic group (P < 0.05). Conclusions: This study demonstrated that multi-strain probiotics could improve frequency, consistency, and sense of complete evacuation in PD patients, while there was no significant effect on motor functions in 8 weeks. It is suggested that additional studies be conducted on longer-term effects.

Evaluating the Effect of Eicosapentaenoic Acid in Children With Atopic Dermatitis: A Randomized Triple-Blind Clinical Trial.

OBJECTIVE: To evaluate the effects of dietary eicosapentaenoic acid (EPA) in children with atopic dermatitis. METHODS: Forty-eight children with atopic dermatitis were randomly allocated to receive either 250 mg twice daily EPA (n = 24) or placebo (n = 24) for 4 weeks. The absolute improvement in the SCORing Atopic Dermatitis (SCORAD) index and the necessity to use topical corticosteroids was evaluated. RESULTS: Based on an intention-to-treat analysis, after 2 weeks the scores decreased to 30.50 ± 8.91 and 38.34 ± 10.52 in the EPA and placebo groups, respectively (p = 0.015). Per-protocol analysis showed a decrease in scores to 18.01 ± 10.63 in the EPA group and to 30.11 ± 9.58 in the placebo group (p = 0.001). After 2 weeks, corticosteroid was needed in 11 (50.0%) patients in the EPA group and 14 (58.3%) patients in the placebo group (p = 0.571), and after 4 weeks, it was needed in 7 (33.3%) patients in the EPA group and 14 (63.6%) patients in the placebo group, respectively (p = 0.047). CONCLUSIONS: Our results show significant favorable effects of EPA on the SCORAD scale and with regard to the necessity for corticosteroid readministration. Few adverse effects were reported in the 2 groups. We conclude that EPA supplementation is a well-tolerated and effective add-on strategy for reducing the severity of atopic dermatitis in children.

Case report: Bilateral simple Syndactyly in a toddler with maternal exposure to cabergoline.

Cabergoline is routinely prescribed in the management of prolactin excreting adenomas and is associated with low risk of congenital malformations and teratogenicity. Here, we reported the case of a bilateral simple syndactyly in a toddler with maternal exposure to cabergoline during the pregnancy. This association has not been previously described before.