Comorbidities affecting re-admission and survival in COVID-19: Application of joint frailty model.

BACKGROUND: One of the common concerns of healthcare systems is the potential for re-admission of COVID-19 patients. In addition to adding costs to the healthcare system, re-admissions also endanger patient safety. Recognizing the factors that influence re-admission, can help provide appropriate and optimal health care. The aim of this study was to assess comorbidities that affect re-admission and survival in COVID-19 patients using a joint frailty model. METHODS: This historical cohort study was done using data of patients with COVID-19 who were re-hospitalized more than twice in a referral hospital in North of Iran. We used the joint frailty model to investigate prognostic factors of survival and recurrence, simultaneously using R version 3.5.1 (library "frailtypack"). P-values less than 0.05 were considered as statistically significant. RESULTS: A total of 112 patients with mean (SD) age of 63.76 (14.58) years old were recruited into the study. Forty-eight (42.9%) patients died in which 53.83% of them were re-admitted for a second time. Using adjusted joint model, the hazard of re-admission increased with cancer (Hazard ratio (HR) = 1.92) and hyperlipidemia (HR = 1.22). Furthermore, the hazard of death increased with hyperlipidemia (HR = 4.05) followed by age (HR = 1.76) and cancer (HR = 1.64). It Also decreased with lung disease (HR = 0.11), hypothyroidism (HR = 0.32), and hypertension (HR = 0.97). CONCLUSION: Considering the correlation between re-admission and mortality in the joint frailty model, malignancy and hyperlipidemia increased the risk of both re-admission and mortality. Moreover, lung disease probably due to the use of corticosteroids, was a protective factor against both mortality and re-admission.

Development and validation of self-report Mizaj identification questionnaire Based on Persian Medicine for the elders (age over 60).

Background: Introduction: Mizaj is the basis of attention to individual differences in Persian Medicine (PM). Regarding the importance of Mizaj for health preservation and treating diseases, it is necessary to achieve a standard tool for Mizaj identification. The purpose of this study was to design a standard self-reporting Mizaj identification questionnaire for elders. Methods: In this exploratory sequential study, criteria of Mizaj identification were extracted by reviewing PM literatures and interview with PM experts and elders. The primary questionnaire was designed and its validity and reliability were assessed, using weighted Kappa statistics, Pearson correlation coefficient (PCC) assessment, receiver operating characteristic (ROC) curve and determining the specificity and sensitivity of cut-off points. Results: Among the 101 items in the primary questionnaire, 73 items had acceptable reliability. The final 20-item questionnaire was obtained after the criterion validity and PCC assessment. The sensitivity and specificity of this questionnaire were 83% and 88% for warmness, 49% and 80% for moderate in warmness-coldness, 72% and 91% for coldness, 57% and 78% for wetness, 30% and 79% for moderate in wetness-dryness, and 81% and 67% for dryness, respectively. Conclusion: The standard Mizaj identification is recommended as a supplementary diagnostic tool for clinicians and researchers in PM. Also, the people with age over 60 can use it to identify their own Mizaj and then, choose the suitable PM or Unani medicine lifestyle recommendations based on their Mizaj.

The weight of Mizaj (temperament) indices in Persian Medicine: A Delphi study.

Background: Mizaj is an individualized viewpoint in Persian Medicine (PM) that is used for the prevetion of diseases and also treatment. Evaluating Mizaj in the two domains of hotness-coldness, and wetness-dryness, 10 criteria have been introduced, most of them are qualitative. To achieve valid and reliable questionnaires, the weight of these criteria must be determined in assessing the Mizaj. Methods: In a cross-sectional study with Delphi method, 10 indices were extracted from PM references and sent to PM experts via e-mail. They were asked to score the weight of each index in determining the Mizaj from 0 to 10. The scores ranked and comparing previous preliminary studies, criteria of major and minor were proposed. Results: Out of 147 invited PM experts, 122 completed the tables. Based on scores, physical functions, physique, and responsiveness of organs obtained the highest scores in the field of hotness-coldness. In wetness-dryness muscle/fat mass and sleep/wakefulness received the highest scores from the viewpoint of experts. Conclusion: Physical functions, physique (Anthropometry), responsiveness of organs and psychic function can be used as major criteria in Mizaj assessment methods in the hotness-coldness field. In the field of wetness-dryness, muscle/fat mass, sleep/wakefulness, tactile condition and physique (anthropometry) can be considered as major criteria.

The effect of oral use of concentrated pomegranate juice by mothers on hyperbilirubinemia in neonates under phototherapy: A randomized clinical trial.

Background: Hyperbilirubinemia is a common problem in neonates that causes hospitalization. The aim of this study was to investigate the effects of concentrated pomegranate juice (CPJ) consumption by breastfeeding mothers on neonatal hyperbilirubinemia. Materials and Methods: In this open-labeled, add-on, randomized clinical trial, 86 breastfeeding mothers and their neonates were allocated into two groups. In the control group, neonates received phototherapy. Besides neonates' phototherapy in the intervention group, their mothers received CPJ (1 tablespoon [15 g] three times a day) up to discharge. The bilirubin level was the primary outcome. The duration of phototherapy, the duration of hospital stay, and the need for exchange transfusions were secondary outcomes. Results: CPJ reduced the bilirubin level of hospitalized neonates within 48 h after consumption (P = 0.048, standard mean difference = 0.648). It also resulted in reduced duration of hospital stay and faster discharge of the neonates. Furthermore, in 48 h after discharge, bilirubin was significantly lower in the CPJ group (P = 0.003, partial eta squared = 0.123). Conclusion: Compared to the control group, consumption of CPJ by lactating mothers whose infants underwent phototherapy resulted in lower bilirubin levels, shorter hospital stay, and faster discharge.

Assessment of the Diagnostic Methods of Mizaj in Persian Medicine: A Systematic Review.

The concept of mizaj corresponds to the idea of personalized medicine and is the main diagnostic principle of Persian medicine (PM). This study aims to investigate diagnostic tools for the detection of mizaj in PM. In this systematic review of articles published before September 2022, articles were searched for in the Web of Science, PubMed, Scopus, Google Scholar, SID databases, and gray literature. The titles of the articles were screened by researchers and relevant articles were selected. Abstracts were reviewed by two reviewers to select final articles. Subsequently, the articles found were critically evaluated by two reviewers according to the CEBM method. Finally, article data were extracted. Of the 1812 articles found, 54 were included in the final evaluation. Of these, 47 articles were related to the diagnosis of whole body mizaj (WBM). WBM was diagnosed in 37 studies using questionnaires and 10 using expert panels. In addition, six articles examined the mizaj of organs. Only four of these questionnaires were found with reported reliability and validity. There were two questionnaires for assessing WBM, but neither had sufficient reliability and validity. Questionnaires that assess organs had weak designs and lacked sufficient reliability and validity.

Rhazes's methodology in the science of toxicology.

INTRODUCTION: Toxicology has been one of the most important topics throughout the history of medicine. Persian medicine (PM) textbooks such as Al-Hawi fi Al-Tib of Rhazes (Razi) can be a useful source for novel information about toxicology and thus we aimed to elucidate Rhazes's methodology in toxicology based on this textbook. METHODS: This research is a historical descriptive study. Data were obtained from the book Al-Hawi fi Al-Tib using keywords of poison, poisoning, and relevant terminologies in ArabicAQ1, Persian, and English and also from appropriate literature in PubMed, Scopus, Web of Science, Scientific Information Database (SID), Magiran, and IranDoc. RESULTS: After introducing the types of common poisons in his era, Rhazes categorized them into three main categories of plants, animals, and minerals, which cause human poisoning orally or via stings and bites. To identify the poison and make a diagnosis of the corresponding toxidrome, he conducted a thorough physical examination of the patient, carefully observing signs and symptoms, and then treated the poisoning using pharmaceutical and non-pharmaceutical modalities. In the book Al-Hawi fi Al-Tib, Rhazes has provided comprehensive information about the types of poisons, their effects on the human body, the signs and symptoms of poisonings, and relevant diagnostic and therapeutic methods. DISCUSSION: Rhazes had a great contributing role to the science of toxicology. We suggest future research on an in-depth analysis of other PM references for toxicology knowledge and how they may foster the science of toxicology.

Mizaj assessment and data analysis methods in Amirkola health and aging project (AHAP cohort).

Background: One of the principles of Persian medicine (PM) is the individualized approach that is presented with the concept of Mizaj. In this viewpoint, on the whole body, Mizaj is determined for every person based on 10 criteria, which is a result of the Mizaj of the main organs, including the brain, liver, and heart. There is no standard diagnostic tool for Mizaj assessment yet. The purpose of this study is to explain the method of Mizaj assessment and data analysis in the elderly in one of the biggest health and aging projects in Iran. The second phase of the Amirkola health and aging project (AHAP) evaluated more than 1,700 clinical and laboratory examinations of 2135 elderly people. Methods: In this study, a novel Mizaj assessment method in two phases is presented. In the first phase, 1541 elderly were assessed by a PM expert and typical diagnoses (the high confidence of expert's proficiency) were determined. At the second phase, an expert panel including 5 PM experts evaluated the cases. The data of the elderly whose Mizaj agreed in the expert panel was used to assess its correlation with Mizaj. Also, the Mizaj of the main organs of these cases was evaluated this way. Conclusion: In the lack of valid and reliable questionnaires to assess the personalized viewpoint of PM, a new expert-based method has been introduced that can be used in similar studies. The result of the Mizaj assessment in this way will be used to obtain objective values for the Mizaj assessment.

Effect of Cassia fistula L. aqueous extract in maternal reproductive outcome, some serum indices and fetal anomaly frequency in rat.

Background: Cassia fistula was used traditionally as laxative in pregnant women. Nevertheless, its fetal and maternal effects in pregnancy have not been studied yet. Methods: Oral (Lethal Dose, 50%) LD50 was determined in mice. In addition, a control group, pregnant rats in other 5 experimental groups (n=12) received orally C. fistula aqueous extract (500, 1000 and 2000 mg/kg), tween80 (10%) and distilled water during pregnancy up to the delivery (21-23 days). Some serum indices were evaluated in maternal blood samples after delivery. Histopathologic and histomorphometric evaluations were performed on the selected slices of newborn rats. Results: Anthraquinone content of the aqueous extract was 0.34% w/w. Oral LD50 was obtained more than 5000mg/kg. No abortions and newborn anomalies were observed in groups. The height and weight of the offspring were significantly reduced by the administration of 500, and 2000 mg/kg of extract compared to control. There was no significant change in maternal blood urea and creatinine. Higher concentration (2000mg/kg) led to ALT elevation. ALS levels decreased dose-dependency in treatment groups comparing to control. Histopathological findings showed significant lung vascular congestion, and hypertrophy of heart in group tween80, and significant hepatic parenchymal inflammation in tween80 and 2000mg/kg and 1000mg/kg groups. In all tissues of all groups, malpighian body area and bowman's capsule space significantly increased compared to the control group. Conclusion: It seems C. fistula extract is safe in pregnancy. Because of confounding role of tween80 in histopathological finding, more research is necessary.

The effect of Cassia fistula L. syrup in geriatrics constipation in comparison with the lactulose: A randomized clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Cassia fistula is widely used in traditional Persian Medicine as a mild laxative. The rate of chronic constipation increases above the age of 60. AIM OF THE STUDY: This study aimed to investigate the effect of Cassia fistula syrup (CFS) on geriatric constipation. MATERIALS AND METHODS: This clinical trial study was performed on 70 aged patients who were referred to the clinic of gastroenterology of Rouhani Hospital, Babol, North of Iran. Patients were randomly divided into two groups of CFS or Lactulose with a dose of 30 ccs/day. Patients were visited two weeks after entering the study to evaluate the frequency of defecation, feeling of incomplete emptying after defecation, manual maneuver, consistency of stool, and also the quality of life. RESULTS: The frequency of defecation per week varied from 1.82 ± 1.16 to 8.36 ± 3.44 in the CFS group after 2 weeks of intervention that was significantly more than the Lactulose that changed from 2.16 ± 1.46 to 5.66 ± 2.96 (P-value = 0.023, partial eta square = 0.079, NNT = 4). The quality of life, the percent of straining, lumpy or hard stool, pain during defecation, and the consistency of stool based on VAS were significantly better in the CFS group. The sensation of incomplete defecation, anorectal obstruction, and manual maneuvering were not different significantly between groups. CONCLUSION: CFS can be more effective than Lactulose on geriatric constipation.

The prevalence of complementary and alternative medicine use in the general population of Babol, North of Iran, 2018.

BACKGROUND: Complementary and Alternative Medicine (CAM) have recently become more popular and accepted worldwide. One principal step to identify the status and organize strategies of CAM is evaluating the manner and the prevalence of its usage among people. This study aimed to investigate the prevalence of CAM modalities usage by the people of Babol, a central city in the North of Iran, in 2018. METHODS: Using the original International CAM Questionnaire (I-CAM-Q), a questionnaire was redesigned in Persian (Farsi) with some changes such as adding special modalities in Iran and its validity and reliability were assessed. Six hundred households were evaluated using a cluster sampling method in 2018 spring by 12 trained interviewers. RESULTS: Finally, 1770 questionnaires were correctly completed. A total of 110 participants (6.21% of the completed questionnaires) had visited CAM therapists in the last year, 109 persons (6.15%) had received prescriptions from physicians and paramedics to use CAM, and a total of 1032 people (58.30%) used herbs and herbal medicines in the last 12 months. Also, 1265 individuals (71.46%) had used CAM throughout their lives. The most popular methods were herbal medicine (65.76%), Persian Medicine (13.78%), water therapy (10.45%) and music therapy (8.36%). The use of CAM was more popular among women. CONCLUSIONS: The general use of CAM in Babol was similar to other studies, but there were fewer visits by CAM therapists and less frequent adoption of common methods including homeopathy, acupuncture, and energy therapy. It was found that CAM was mostly used for non-serious diseases such as cold and transient gastrointestinal disorders, a pattern that is different from other studies in this field.

A Comparison of the Effect of Topical Preparation of Sambucus ebulus L. and Hydrocortisone on Hand Eczema: A Double-Blind Randomized Controlled Trial.

Objectives: Corticosteroids as the main treatment of hand eczema can cause major side effects. This study compared the effect of topical preparation of Sambucus ebulus L. leaves and hydrocortisone on the severity of hand eczema. Design: Ninety-four patients with hand eczema aging 18-60 years were recruited in two groups (S. ebulus vs. hydrocortisone). Interventions: The patients used topical medications twice a day and were followed for 4 weeks. The observations were made at the first visit, and also second and fourth weeks of the study. Outcome measures: The primary outcomes were changes in the severity of hand eczema (hand eczema severity index [HECSI]) and life quality (dermatology life quality index [DLQI]). Secondary outcomes were the rate of healing and the severity of itching. Results: Thirty-eight patients in hydrocortisone and 43 in S. ebulus fulfilled all phases of the follow-up. In both groups, the HECSI, itching scores decreased over time without any significant difference between the groups (p = 0.49, 0.57, respectively). The DLQI scores were significantly better in the S. ebulus group (p = 0.02) after 4 weeks of medication. There was no significant difference between the healing rates of the two groups (p = 0.33). Conclusions: Topical use of S. ebulus can be as effective as that of hydrocortisone when it comes to reducing the severity of hand eczema.

Individualizing the dosage of Methylphenidate in children with attention deficit hyperactivity disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood mental health disorders. Stimulant drugs as the most commonly used treatment and first-line therapy for ADHD have side effects. One of the newest approaches to select the best choices and optimize dosages of medications is personalized medicine. METHODS: This historical cohort study was carried out on the data taken from the period of 2008 to 2015. Eligible subjects were included in the study randomly. We used mixed-effects logistic regression models to personalize the dosage of Methylphenidate (MPH) in ADHD. The patients' heterogeneity was considered using subject-specific random effects, which are treated as the realizations of a stochastic process. To recommend a personalized dosage for a new patient, a two-step procedure was proposed. In the first step, we obtained estimates for population parameters. In the second step, the dosage of the drug for a new patient was updated at each follow-up. RESULTS: Of the 221 children enrolled in the study, 169 (76.5%) were male and 52 (23.5%) were females. The overall mean age at the beginning of the study is 82.5 (± 26.5) months. In multivariable mixed logit model, three variables (severity of ADHD, time duration receiving MPH, and dosage of MPH) had a significant relationship with improvement. Based on this model the personalized dosage of MPH was obtained. CONCLUSIONS: To determine the dosage of MPH for a new patient, the more the severity of baseline is, the more of an initial dose is required. To recommend the dose in the next times, first, the estimation of random coefficient should be updated. The optimum dose increased when the severity of ADHD increased. Also, the results show that the optimum dose of MPH as one proceeds through the period of treatment will decreased.

Nine Steps to Discover New Medicines from Traditional Sources: The Example of Persian Medicine.

Objectives: Developing a new medicine is a costly and time-consuming process. This study presents a novel method to collate a new materia medica from previously documented traditional Persian medicine (TPM) references. A well-documented materia medica will facilitate a quick and easy process to find traditional medicine for specific symptoms or diseases. Materials and methods: A nine-step algorithm is proposed to collate a new materia medica by searching and matching descriptions and references stated in various traditional Persian literature: (1) finding the equivalent of traditional description of symptoms or diseases; (2) determining the keywords to search in the references of TPM, including The Canon of Medicine (Book by Avicenna); (3) determining the best references of TPM for the aim of the study; (4) weighing up the references (a) based on the prominence of the author's prominence (b) determining whether the references are the author's own clinical findings or has citation from other scholars been used, (c) the popularity of the book that the references feature in, among other later scholars of TPM, the geographical and historical span across which the book has been distributed; (5) searching the references using keywords of symptoms or diseases; (6) finding the synonyms of terminologies in the various materia medicas and categorizing the findings; (7) revision (of references found) to ensure that nothing is neglected; (8) scoring the findings based on the defined criteria; (9) prioritization: sorting the materia medica based on the total scores. Some important economic, cultural or historical factors cannot be included in the main process of prioritization during the initial searching of the TPM materia medica. Therefore, it is necessary to take these factors into account after discovering the medicine and before using in practice to ascertain that they are a good match of a specific treatment, disease or symptom. Conclusion: A process to compile a new materia medica has been proposed which will enable the quick and easy selection of herbal treatments for various signs and symptoms of illnesses.

Hospital diet for COVID-19, an acute respiratory infectious disease: An evidence-based Protocol of a Clinical Trial.

BACKGROUND: COVID-19 caused a global pandemic problem. No confident management is introduced for it yet. This study aimed to propose a dietary protocol for hospitalized patients with the diagnosis of acute respiratory infectious disease caused by COVID-19 based on Persian Medicine. METHODS: This study was conducted in three phases. In the first phase, any diseases that could be matched with the clinical features of infection with COVID-19 were searched in selected PM references. In the second phase, medicinal herbs and foods that were available and could be used in the hospital diet were extracted and summarized. In the third phase, the new documentation of these pharmaceutical and food items was conducted. RESULTS: The signs and symptoms of infectious respiratory disease caused by COVID-19 can be categorized in the field of Zato al-rieh that can mainly be matched with pneumonia. Based on the described criteria, some nutrients and medicinal materia medica have been introduced for acute respiratory infection including Cydonia oblonga, Honey, Citrus sinensis, Malus domestica, Citrus medica, Crocus sativus, Raisin, Rosa Damas Cena, D.Carota, Camellia Sinensis, Anethum graveolens dhi, Punica granatum, Petroselinum Crispum, Coriandrum sativum, Urtica dioica, Allium sativum, Sesamum indicum. CONCLUSION: Most materia medica has documents in current articles including anti-cough suppressants, antiviral properties, anti-bacterial, anti-inflammatory, antioxidant, immunomodulatory etc. A protocol of hospital diet for patients with infectious respiratory syndrome caused by COVID-19 has been introduced in this manuscript.

Mizaj as an Index in Persian Traditional Medicine Index Could Associate with Sensitivity to the Radiation.

BACKGROUND: The sensitivity to the radiation among human population depends on various parameters. This variation could lead to dissimilar outcome of radiotherapy in similar situations. Mizaj is a well-known term in Persian medicine that present an individualized medicine viewpoint. All of the people will be categorized in cold, moderate, and warm Mizaj. In this study, we aimed to evaluate the possible association between Mizaj and radiosensitivity by comet assay. MATERIALS AND METHODS: Peripheral blood sample of 30 healthy volunteers (10 cold, 11 moderate and nine warm Mizaj) were taken and divided into two identical parts. The first part was exposed to 4 Gy x-rays, and the second part was regarded as the sham control. Then, DNA damages of samples were evaluated by the neutral comet assay. RESULTS: The results showed that the mean percentage of damaged cells, in all of the irradiated groups including A (warm), B (moderate) and C (cold) was significantly higher than the controls (P<0.001). Moreover, DNA damage rate in the irradiated warm Mizaj group was higher than both cold and moderate irradiated groups, but the difference between moderate and cold irradiated groups was not statistically significant. CONCLUSION: The results are indicating that warm Mizaj persons could be more radiosensitive than other groups, which their importance in radiotherapy individualization should be evaluated in more extensive studies.

The efficacy of a Persian herbal formulation on functional bloating: A double-blind randomized controlled trial.

BACKGROUND: Bloating is a common gastrointestinal complaint which is difficult to treat. OBJECTIVE: This study investigated the efficacy and compliance of a formulation called KAASER comprised of Trachyspermum ammi (L.) Sprague seed, Zingiber officinale Roscoe. rhizome and Piper nigrum L. berry in the treatment of functional bloating. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A total of 106 patients with functional bloating, between 20 and 50 years of age, participated in this double-blind randomized controlled trial. Patients were divided into 3 parallel groups that received 500 mg of placebo, dimethicone or KAASER, three times a day for 2 weeks. MAIN OUTCOME MEASURES: The frequency and severity of bloating were primary outcomes, while the frequencies of eructation, defecation, borborygmus and early satiation were secondary outcomes. All parameters were evaluated at the beginning (week 0), and also weeks 2, 4 and 10 of the study, through self-report checklists with a scoring system. RESULTS: Among the 84 patients who completed the study, the frequency and severity of bloating (P < 0.001), the frequencies of eructation, defecation and borborygmus (P = 0.03) were significantly improved in the group receiving KAASER (36 patients) compared with the dimethicone (35 patients) and placebo (35 patients) groups, during the 3 phases of follow-up. These significant differences persisted through the 2 and 8 weeks of follow-ups after cessation of medication (week 4 and 10). In early satiation, no significant differences were observed among the 3 groups. CONCLUSION: The results showed that KAASER can be effectively used to treat patients suffering from bloating. Bloating, eructation, defecation and borborygmus in the KAASER group remained significantly improved after 2 and 8 weeks of cessation of medication, making this mechanism an interesting area for further investigation. TRIAL REGISTRATION: Registration trial IRCT2015100324327N on Iranian Registry of Clinical Trials.

Effect of eryngo (Eryngium caucasicum Trautv) on primary dysmenorrhea: A randomized, double-blind, placebo-controlled study.

OBJECTIVE: This study strove to investigate the safety and effectiveness of Eryngo in the treatment of primary dysmenorrhea. MATERIALS AND METHODS: The researchers conducted a blinded, randomized, trial design on 169 women, 15-30 years of age, who had been diagnosed with primary dysmenorrhea at Babol University of Medical Sciences. Subjects were randomly assigned to receive 5 ml syrup of Eryngo, placebo, or Ibuprofen (200 mg) three times a day (15 ml/day), from one day prior to the onset of bleeding for five days. The degree of dysmenorrhea was reported by two measures; Visual analogue scale (VAS), as a primary outcome, and the assessment of dysmenorrhea severity (VMS), as a secondary outcome at 4 menstrual cycles: at pretreatment phase, at the first menstrual cycle, at the second menstrual cycle, and the third menstrual cycle without drug. RESULTS: The reduced peak-pain differed by the treatment length in women treated for two menstrual cycles: 4.2 (1.0) cm in the Eryngo group, 4.3 (0.0) cm in the Ibuprofen group, and 0.9 (0.1) cm in the placebo group (P < 0.0001). No serious side effects were reported in all groups under study. According to the results, minor side effects did not increase in the Eryngo group when compared with the placebo group. CONCLUSION: Eryngo relieved dysmenorrhea as effectively as Ibuprofen did. Thus, Eryngo could be regarded as a new herbal remedy for the treatment of dysmenorrhea. However, in order to prescribe Eryngo as herbal remedy, rigorous research studies are required to establish its efficacy by investigating its chemical, pharmacologic, and therapeutic properties.

Effect of Alpinia officinarum Hance rhizome extract on spermatogram factors in men with idiopathic infertility: A prospective double-blinded randomised clinical trial.

Despite scientific advances, many of the treatments in male infertility remained indeterminate. In recent years, the attention to herbal remedies as an effective treatment for male infertility is considerable. We designed this study to determine the effects of Alpinia officinarum on the results of semen analysis in men with idiopathic infertility. In this clinical trial, seventy-six participants with idiopathic infertility were included in the intervention (plant treatment: n = 31; placebo: n = 29). Participants were randomised to take capsules containing dried extract of A. officinarum rhizome or placebo on a daily (total daily dosage of 300 mg) basis for 3 months. After 12 weeks of intervention, the sperm count and total number of spermatozoa with normal morphology were increased in participants treated with A. officinarum extract compared with the placebo group. The mean sperm count was initially 52 × 106  ± 24 × 106 /ml which changed to 71 × 106  ± 23 × 106 /ml, after intervention (p = 0.043). Also, the mean percentage of spermatozoa with normal morphology was 14.34% ± 9.16% before the treatment which significantly increased to 19% ± 14.89% (p < 0.001). Alpinia officinarum, a traditional medicine remedy, can be effective in the improvement of sperm morphology and sperm count in idiopathic infertility without causing adverse effects.

Protective effects of cinnamon bark extract against ischemia-reperfusion injury and arrhythmias in rat.

Cinnamomum zeylanicum (cinnamon) is a plant with potent antioxidant activity and has been used in traditional medicine for improvement of heart function. The effects of cinnamon bark ethanolic extract were investigated against ischemia-induced arrhythmias and heart injury in an in vivo rat model of regional heart ischemia. The extract was also standardized, and its antioxidant activity was evaluated. Adult male Sprague-Dawley rats were subjected to 30 min of ischemia by occlusion of the left anterior descending coronary artery followed by 5 days of reperfusion. Thirty-two animals were randomized to receive daily oral administration of vehicle or C. zeylanicum bark extract (intragastric, 50, 100, or 200 mg/kg) 14 days before ischemia. C. zeylanicum was standardized through HPLC analysis. Administration of cinnamon bark extract significantly improved ischemia/reperfusion-induced myocardial injury as evidenced by reduction of the infarct size. Also, during the ischemic period, ventricular tachycardia and ventricular ectopic beats episodes decreased as compared with that of the control group. The extract stabilized the ST segment changes and QTc shortening, decreased R-wave amplitude, and increased heart rate during ischemia. The extract also caused significant elevations in serum superoxide dismutase and glutation proxidase activities as well as a significant decrease in serum cardiac troponin I, lactate dehydrogenase, and malondialdehyde levels, 5 days after reperfusion. In HPLC analysis, the amounts of Cinamic acid, Methyl eugenol, and Cinnamaldehyde were 8.99 ± 0.5, 13.02 ± 1.8, and 14.63 ± 1.1 mg/g, respectively. The results show that the ethanolic extract of cinnamon bark is able to protect the heart against ischemia-reperfusion injury probably due to its antioxidant properties. Hence, it might be beneficial in these patients and this remedy might be used for preparation of new drugs.

Herbs with Potential Nephrotoxic Effects According to the Traditional Persian Medicine: Review and Assessment of Scientific Evidence.

BACKGROUND: The increased use of herbal remedies particularly in patients with kidney diseases indicated the importance of studies, which focused on nephrotoxic plants. OBJECTIVE: The present study aimed to review and assess the kidney-damaging herbs mentioned in the Persian medicine [PM] books. METHOD: The main PM books were searched for nephrotoxic herbs and their relevant reformers traditionally proposed for preventing renal damage. PubMed, Scopus and Google Scholar were investigated for evaluation of the scientific evidence relating to the nephrotoxicity of herbs. RESULTS: A total of 64 plants with kidney damage potential and their reformer medicaments were recorded in 7 sources included in this review. Allium schoenoprasum and Marrubium vulgare were the most repeated and emphasized nephrotoxic plants in PM books, but there was no relevant scientific evidence. Despite the lack of clinical studies, some evidence was found for 38% of plants that were related to renal damage. The most repeated reformers for reducing the renal side effects mainly consisted of gum tragacanth, gum Arabic, mastic gum, anise, jujube and honey and some evidence was found for their nephroprotective activities. CONCLUSION: The present study reviewed and assessed the herbs with adverse renal effects in the main PM books. Some evidence was in line with the potential nephrotoxicity of plants and their .reformers. Despite the lack of clinical research for evaluation of their renal damage, the herbs may be focused in term of their nephrotoxicity; and there is a need for further studies on the scientific basis of their nephrotoxicity.