The Effects of Nano-curcumin Supplementation on Leptin and Adiponectin in Migraine Patients: A Double-blind Clinical Trial Study from Gene Expression to Clinical Symptoms.

BACKGROUND: Migraine is a disabling neurogenic disorder characterized by recurrent headache attacks. Adipokines act as inflammatory and pain mediators that contribute to migraine pathogenesis. Leptin and adiponectin levels change in migraine patients and are associated with headache attacks. Curcumin can exert modulatory and analgesic effects on adipokines through several mechanisms, from gene expression to suppressing pain. The aim of the present study was to evaluate the effects of nano-curcumin supplementation on leptin and adiponectin gene expression, their serum levels and migraine symptoms in patients with migraine. METHODS: Forty-four episodic migraine patients enrolled in this trial were divided into two groups as nano-curcumin (80 mg/day) and placebo group, over a two-month period. At the beginning and the end of the study, the mRNA expression of leptin and adiponectin from isolated PBMCs and their serum levels were measured using real-time PCR and ELISA method, respectively. The headache frequencies, severity and duration of pain were also recorded. RESULTS: The results of the present research showed that nano-curcumin can up-regulate adiponectin mRNA and increase its serum level significantly (P < 0.05). In the case of leptin, a reduction in gene expression and concentration was found in the nano-curcumin group but it was not statistically significant (P > 0.05). Nano-curcumin also significantly reduced the frequency, severity and duration of headaches (P < 0.05). CONCLUSION: These findings indicate that nano-curcumin supplement can be considered as a promising approach to migraine management and clinical symptoms improvement.

The Effect of Green Coffee Supplementation on Lipid Profile, Glycemic Indices, Inflammatory Biomarkers and Anthropometric Indices in Iranian Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial.

Polycystic ovary syndrome (PCOS) is a heterogeneous clinical syndrome. Recent studies examine different strategies to modulate its related complications. Chlorogenic acid, as a bioactive component of green coffee (GC), is known to have great health benefits. The present study aimed to determine the effect of GC on lipid profile, glycemic indices, and inflammatory biomarkers. Forty-four PCOS patients were enrolled in this randomized clinical trial of whom 34 have completed the study protocol. The intervention group (n = 17) received 400 mg of GC supplements, while the placebo group (n = 17) received the same amount of starch for six weeks. Then, glycemic indices, lipid profiles, and inflammatory parameters were measured. After the intervention period, no significant difference was shown in fasting blood sugar, insulin level, Homeostasis model assessment of insulin resistance index, low-density lipoprotein, high-density lipoprotein, Interleukin 6 or 10 between supplementation and placebo groups. However, cholesterol and triglyceride serum levels decreased significantly in the intervention group (p < 0.05). This research confirmed that GC supplements might improve some lipid profiles in women with PCOS. However, more detailed studies with larger sample sizes are required to prove the effectiveness of this supplement.

Comparison of the Effect of Intra-Articular, Periarticular, and Combined Injection of Analgesic on Pain Following Total Knee Arthroplasty: A Double-Blinded Randomized Clinical Trial.

The aim of this study was to compare the efficacy of 3 methods of intraoperative analgesic cocktail injection during total knee arthroplasty (TKA)-intra-articular (IA), periarticular (PA), and combined intra-articular and periarticular (IA+PA)-on controlling early postoperative pain. Methods: This was a prospective double-blinded parallel randomized clinical trial. A total of 153 patients scheduled for TKA were allocated to IA, PA, or IA+PA (51 patients each) by block randomization. The primary outcome was morphine consumption. Secondary outcomes were visual analogue scale (VAS) pain, knee flexion, straight leg raising, Knee Society Score (KSS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The morphine consumption was lowest in the PA group (median = 0, interquartile range [IQR] = 5) and highest in the IA group (median = 10, IQR = 5). The PA group had significantly lower VAS pain at rest than either IA (mean difference = -0.70; 95% confidence interval [CI] = -0.93 to -0.46; p < 0.001) or PA+IA (mean difference = -0.41; 95% CI = -0.65 to -0.18; p < 0.001). The PA group had also lower VAS pain during activity compared with IA (mean difference = -0.63; 95% CI = -0.85 to -0.40; p < 0.001) and IA+PA (mean difference = -0.38; 95% CI = -0.61 to -0.16; p < 0.001). The PA group had significantly greater active knee flexion compared with IA (mean difference = 9.68°; 95% CI = 5.50° to 13.86°; p < 0.001) and IA+PA (mean difference = 5.13°; 95% CI = 0.95° to 9.31°; p = 0.010). Passive knee flexion was greater for PA than IA (mean difference = 7.85°; 95% CI = 4.25° to 11.44°; p < 0.001). Other outcome variables were not significantly different among the 3 groups. The only complications were wound drainage (1 each in the IA and IA+PA groups) and deep venous thrombosis (1 in the IA group). Conclusions: PA was associated with less early postoperative pain and greater active knee flexion compared with the other 2 analgesic methods. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The effects of nano-curcumin supplementation on adipokines levels in obese and overweight patients with migraine: a double blind clinical trial study.

OBJECTIVE: The present study aimed to investigate the effects of nano-curcumin supplementation on adipokines levels and clinical signs in obese and overweight patients with migraine. RESULTS: Forty-four patients with episodic migraine participated in this clinical trial and were divided into two groups nano-curcumin (80 mg/day) and the control group over 2-month period. At the baseline and the end of the research, the serum levels of MCP-1, Resistin, and Visfatin were measured using the ELISA method. In addition, the headache attack frequencies, severity, and duration of pain were recorded. The results of the present study showed that nano-curcumin can significantly reduce MCP-1 serum levels in the nano-curcumin supplemented group (P = 0.015, size effect = 13.4%). In the case of resistin and visfatin, nano-curcumin supplementation exerted no statistically significant changes in serum levels (P > 0.05). Nano-curcumin also significantly reduced the attack frequencies, severity, and duration of headaches (P < 0.05). These findings indicate that targeting curcumin can be a promising approach to migraine management. However, further comprehensive human trials are needed to confirm these findings. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (IRCT) with ID number: IRCT20160626028637N2 on the date 2020-07-10.

Type 2 Diabetes Burden and Diabetes Distress: The Buffering Effect of Patient-centred Communication.

OBJECTIVES: Our aim in this study was to assess the moderating role of patient-centred communication as a source of social support in the relationship between burden of diabetes and diabetes distress. METHODS: Individuals with type 2 diabetes (N=1,267) completed validated tools of diabetes distress and multiple aspects of patient-centred communication. A path approach was used to evaluate the moderating role of patient-centred communication in the relationship between diabetes burden, as indicated by prescription of insulin and presence of complications, and distress. RESULTS: Lower Hurried Communication, higher Elicited Concerns/Responded, higher Explained Results/Medications, greater Patient-centred Decision-making and Compassionate/Respectful were significantly associated with lower distress after controlling for burden. Hurried Communication, Explained Results/Medications and Patient-centred Decision-making moderated the relation between insulin and diabetes distress. CONCLUSIONS: Our findings support the stress-buffering hypothesis of patient-centred communication and imply that aspects of patient-centred communication may protect against diabetes-related distress.

The Association Between Low Carbohydrate Diet and Resting Metabolic Rate in Overweight and Obese Women: A Cross-Sectional Study.

Resting metabolic rate (RMR) accounts for most daily energy expenditure. The low carbohydrate diet (LCD) attenuates decreases in RMR. This study aims to investigate the relationship between an LCD and RMR status among overweight and obese women. We enrolled 291 overweight and obese women in this cross-sectional study. Body mass index (BMI), fat mass, fat-free mass, visceral fat, and insulin level were assessed. RMR was measured using indirect calorimetry. LCD score (LCDS) was measured using a validated semi-quantitative food frequency questionnaire. Analysis of variance, independent sample t-test, and Multinomial logistic regression tests were used. Results showed no relationship between LCDS and deviation of normal RMR (DNR) even after adjust for confounders (increased [Inc.] RMR: odds ratio [OR], 0.97; 95% confidence interval [CI], 0.92-1.01; p = 0.20; decreased [Dec.] RMR: OR, 0.97; 95% CI, 0.94-1.00; p = 0.14). Some components of LCDS had no significant association with DNR, such as carbohydrate and Dec. RMR in adjusted model (OR, 1.62; 95% CI, 0.98-1.37; p = 0.08) and monounsaturated fatty acids and Dec. RMR in adjusted model (OR, 0.48; 95% CI, 0.21-1.10, p = 0.08). However, refined grains had a significant association with Inc. RMR in crude model (OR, 0.87; 95% CI, 0.77-0.99, p = 0.04). There is no association between LCDS and RMR status.

Patient-physician interpersonal processes of care at the time of diabetes treatment intensification and their links to patient outcomes.

OBJECTIVE: To investigate how patient-physician interpersonal processes of care are related to levels of diabetes-related distress, diabetes medication-taking behavior, and HbA1c during conversations with patients about intensifying medication. METHODS: We randomly recruited 1270 patients from diabetes specialty clinics in Tehran, Iran who were taking an additional oral diabetes medication or starting insulin during the prior 3 months. This interviewer-administered cross-sectional survey assessed multiple aspects of patient-physician interpersonal processes, diabetes-related distress, and diabetes medication-taking. Clinical history and HbA1c were collected from electronic medical records. Regression estimates and Structural Equation Modeling were used to test associations. RESULTS: Some communication scales indicated a significant relationship with total diabetes distress (P < 0.001). Diabetes medication-taking was associated with less diabetes distress (adjusted odds ratio [aOR]=0.45, P < 0.001), lower Hurried Communication (aOR=0.72, P = 0.013), higher Elicited Concerns (aOR=1.30, P = 0.012), and higher Explained Results (aOR=1.41, P < 0.001) scores. SEM analyses showed medication-taking behavior was associated with a 0.68 decrease in HbA1c. Hurried Communication and diabetes distress were directly associated with HbA1c. CONCLUSION: Aspects of patient-physician interpersonal processes at the time of intensifying diabetes treatment may be related to experiencing less distress, effective medication-taking, and improved HbA1c. PRACTICE IMPLICATIONS: The results are intended to inform communication strategies that physicians might incorporate into practice.

Physician preferences for working in deprived areas: a systematic review of discrete choice experiment.

Background: Physician shortages in rural areas is a universal concern, and most countries face this challenge. Many attributes influence the physician preferences about the choice of working location. The aim of this systematic review was to investigate which attributes were included in discrete choice experiment studies and which of them valued the most by physicians. Methods: The following databases were searched: PubMed, Embase, and Web of Science Core Collection. Further studies were retrieved from reference lists of included studies, and grey literature. Studies used discrete choice experiments methods to elicit preferences for working in the deprived area, focus on physicians or medical students, and published between 2000 and 2017 in the English language were included. Results: The literature search yielded 192 studies, of which 14 studies met inclusion criteria. The attributes and attribute levels were identified by literature review and qualitative research. The number of attributes varied from five to ten, and the most frequent number was six attributes. In most studies, maximum of sixteen different scenarios were given to the study samples. The "salary or income" attribute was the most important in fifty percent of the studies and the attributes related to "study and education" was at the next level. Conclusion: Financial attributes are not the only significant attributes considered by the physicians for deciding where to practice, but also the other non-financial attributes are important. It is suggested that based on the economic, social and cultural conditions of each country, a specific incentive package, including a set of financial and non-financial incentives, is developed to attract physicians to the deprived areas.

Health Professionals' Experience of Barriers in Empowering People with Spinal Cord Injury: a Qualitative Inquiry.

Introduction: Empowering an individual with spinal cord injury as far as possible is an experience with various social and cultural aspects. This study investigated health professionals' experiences of barriers in empowering individuals with spinal cord injuries. Methods: This was a qualitative inquiry with a conventional content analysis approach. A number of 11 healthcare professionals who were members of Iran Spinal Cord Injuries Research National Network or had been working in a related research center for at least three years participated in the study. A purposive sampling method was applied until reaching data saturation. The data were collected by semi-structured interviews. The collected data were managed with MAXQDA software version 13. Results: Three main themes as barriers in empowering people with spinal cord injury emerged: 1) Lack of patient-and-family-centered education, 2) Failure in providing sufficient healthcare services and 3) Inappropriate setting for using rehabilitation services. Conclusion: These finding can help policymakers to provide better social facilities and more support services for people with spinal cord injuries and their families. Further research is needed to investigate barriers to empowerment from the perspective of individuals with SCI and their families.

Health-related quality of life and medication adherence in elderly patients with epilepsy.

OBJECTIVE: Considering the high prevalence of epilepsy in the elderly and the importance of maximising their quality of life (QoL), this study aimed to investigate the relationship between medication adherence and QoL, and the mediating effects of medication adherence on the association between serum antiepileptic drug (AED) level and seizure severity with QoL in elderly epileptics. METHODS: In a longitudinal study, 766 elderly patients with epilepsy who were prescribed a minimum of one antiepileptic drug were selected by convenience sampling method. A Medication Adherence Report Scale (MARS-5) questionnaire was completed at the baseline. Seizure severity and QoL were assessed after six months using the Liverpool Seizure Severity Scale (LSSS) and the QoL in Epilepsy (QOLIE-31) questionnaires respectively. Serum level of AED was also measured at six-month follow-up. RESULTS: Medication adherence was significantly correlated with both seizure severity (ß = -0.33, p < 0.0001) and serum AED level (ß = 0.29, p < 0.0001) after adjusting for demographic and clinical characteristics. Neither QoL nor its sub-classes were correlated with seizure severity. In addition, a significant correlation was not observed between serum AED level and QoL. However, medication adherence was significantly correlated with QoL (ß = 0.30, p < 0.0001). The mediating effects of medication adherence on the association between serum AED level (Z = 3.39, p < 0.001) and seizure severity (Z = -3.47, p < 0.001) with QoL were supported by the Sobel test. CONCLUSION: This study demonstrates that medication adherence has a beneficial impact on QoL in elderly epileptics. Therefore, adherence to treatment should be monitored to improve their QoL.

HLA Class I and Class II Genes Distribution of the Iranian Sistanis.

BACKGROUND: The high polymorphism in the human leukocyte antigen (HLA) genes can be used as an identity of individuals to compare with other populations. This extreme polymorphism in the HLA system is accountable for the differences in alleles and haplotypes among ethnic groups, populations, and the inhabitants of many regions. OBJECTIVE: To define the frequency of HLA alleles and haplotypes among the Sistanis, Sistani/Zaboli population in Iran. METHODS: In this study, genotyping of class I (A, B, C) and class II HLA (DRB1, DQA1, DQB1) loci were determined in 90 unrelated Iraninan Sistani people and the results were compared with 474,892 HLA chromosomes from a diverse worldwide population. RESULTS: The highest frequently observed alleles in this study were A*02:01, B*35:01, C*12:03, C*06:02, DRB1*11, DQA1*05:05, and DQB1*03:01. Furthermore, the most frequent 3-locus haplotypes were A*02:01-B*50:01*C*06:02, DRB1*11-DQB1*03:01-DQA1*05:05, and A*02:01-B*50:01-DRB1*07. The most occurring 4-locus haplotypes were A*02:01-B*50:01-C*06:02-DRB1*07 and A*02:01-B*50:01-DRB1*07-DQB1*02:01. A*02:01-B*50:01-C*06:02-DRB1*07-DQB1*02:01 and A*02:01-B*50:01-C*06:02-DRB1*07-DQB1*02:01-DQA1*02:01 were determined to be the predominant 5- and 6-locus haplotypes, respectively. The heat maps and multiple correspondence analyses based on the frequency of HLA alleles showed that Sistanis share a common genetic inheritance with other Iranian ethnic groups such as the people from Yazd and Fars except some differences with Baluchis, Iranian Jews, Lurs of Kohgiluyeh/Buyerahmad, and Arabs of Fars, which may arise from the admixture of these groups or with foreign subgroups over centuries, and also a close relatedness with some European populations. CONCLUSION: These data could be useful for finding better donor matches for organ transplantation among Sistanis or other related Iranian ethnic groups, epidemiological studies of HLA-associated diseases, handling HLA genomics and mapping the migration pattern of different ethnic group.

Development of Persian version of the Spinal Cord Independence Measure III assessed by interview: a psychometric study.

STUDY DESIGN: Cross-sectional psychometric study. OBJECTIVES: To translate the Spinal Cord Independence Measure III (SCIM-III) into Persian, to evaluate it culturally and to analyze the validity and reliability of the Persian version of the SCIM-III (P-SCIM). SETTING: Brain and Spinal Injury Research Center (BASIR), Tehran, Iran. METHODS: The P-SCIM was developed by forward translation, back-translation, and cultural equivalence assessment procedure. The authors studied: (a) correlation of P-SCIM with the Functional Independence Measure (FIM™) for determining convergence validity, (b) P-SCIM scores in neurological categories for comparison and evaluating discriminative validity, (c) Inter-rater reliability of P-SCIM, (d) Cronbach's alpha for measuring internal consistency of P-SCIM-III. RESULTS: The validity of the scale was supported by a Pearson correlation coefficient of > 0.9 (p < 0.001) between FIM™ and P-SCIM. The Persian SCIM was found to be valid in discriminating different neurological categories. The Inter-rater reliability was concluded by Intraclass correlations of a coefficient > 0.9. Bland-Altman analysis demonstrated good agreement between our raters (mean difference: 0.7, limit of agreement: - 8.09-9.58). Also internal consistency of the scale was shown by Cronbach's alpha to be > 0.7 (0.86). CONCLUSION: P-SCIM-III is a valid and consistent tool for determining functionality in Persian speaking people with spinal cord injury.

The effect of the emotional intelligence education programme on quality of life in haemodialysis patients.

AIM: This study investigated the effect of the emotional intelligence education programme on quality of life of haemodialysis patients. BACKGROUND: Nurses need knowledge development regarding the impact of educational strategies on patients' quality of life suffering from chronic diseases. METHODS: A pragmatic quasi-randomized controlled trial was conducted with 47 haemodialysis patients attending a university hospital in an urban area of Iran. The patients were randomly assigned to intervention (n=23) and control (n=24) groups. A socio-demographic questionnaire, the Cyberia-Shrink Emotional Intelligence Questionnaire, and the Kidney Disease Quality of Life-Short Form were used to gather data. The intervention group attended an educational programme on emotional intelligence that consisted of six-group discussion sessions. To ensure the continuity of learning and to measure the subsequent expected behavioural changes, the patients filled out the data collection tools six and 12weeks after the completion of the education programme. RESULTS: The mean score of quality of life in the intervention group was 39.94±15.88 in pre-test, 44.87±16.04 six weeks and 52.47±16.07 at the 12weeks after the intervention (p=0.032). CONCLUSION: The consideration of emotional intelligence educational strategies by nurses requires its incorporation into pre-qualifying nursing degrees and professional development programmes. Nurse managers need to lead nurses for applying emotional intelligence in daily practice with the aim of providing an holistic patient care.

Human Leukocyte Antigen (HLA) Class I and II Polymorphism in Iranian Healthy Population from Yazd Province.

The major histocompatibility complex (MHC) genes are the most polymorphic loci in the human genome and have been widely studied in various populations and ethnic groups. Investigations into the HLA genes and proteins have been useful tool for anthropological, transplantation and disease association studies. The polymorphism of the HLA class I (A, B, C) and class II (DRB1, DQA1, DQB1) genes were investigated in 90 unrelated Iranian individuals from Yazd province located in the center of Iran using sequence-specific primers (PCR-SSP). Allele and haplotype frequencies, expected/observed heterozygosity, unbiased expected heterozygosity, number of effective alleles, deviations from Hardy-Weinberg (HW) equilibrium and genetic diversity were computed. A total of 23, 48, 23, 24, 13 and 16 alleles for HLA-A, -B,-C, -DRB1, -DQA and -DQB loci were determined, respectively in the population study. The most frequent allele identified in this study were A*02:01 (18.889%), HLA-B* 51:01 (12.778%), HLA-C* 12:03 (17.033%), HLA-DRB* 11 (24.4%), HLA-DQA* 05:05 (20.55%) and HLA-DQB*03:01 (22.8%).Furthermore, the most frequent 3-locus haplotypes were DRB*11-DQA*05:01-DQB*03:01 (21.1%), HLA-A*02:01- B *50:01- DRB*07:01 (4.9%) and A*26:01 -B* 38:01 -C*12:03(5%). The most 4-locus haplotype were A*11:01 -B* 52:01 -C*12:03 -DRB!*15(2.5%) and A*02:01 -B* 50:01 -DRB1*07:01 -DQB1*02:01(4.5%). The heterozygosity of the study population was confirmed the expected value and not deviated from Hardy-Weinberg equilibrium for all loci (p>0.05). Our study shows a close relatedness between Yazd population and other ethnic group of Iran despite some differences, which may be due to admixture of each one of these groups with each other or foreigner subpopulations during centuries. Moreover, the results of this study suggest that the Iranian population from Yazd province is in close vicinity with the Caucasians populations and far from the Korean and Japanese populations.

The multidrug resistance pumps are inhibited by silibinin and apoptosis induced in K562 and KCL22 leukemia cell lines.

Silibinin have been introduced for several years as a potent antioxidant in the field of nutraceuticals. Based on wide persuasive effects of this drug, we have decided to investigate the effects of silibinin on chronic myelogenous leukemia (CML) in vitro models, K562 and KCL22 cell lines. Lactate dehydrogenase (LDH) release, microculture tetrazolium test (MTT assay) and real-time PCR were employed to evaluate the effects of silibinin on cell cytotoxicity, cell proliferation and expression of various multidrug resistance genes in these cell lines, respectively. Our results have shown that presence of silibinin has inhibitory effects on cell proliferation of K562 and KCL22 cell lines. Also, our data indicated that silibinin, in a dose-dependent manner with applying no cytotoxic effects, inhibited cell proliferation and reduced mRNA expression levels of some transporter genes e.g. MDR1, MRP3, MRP2, MRP1, MRP5, MRP4, ABCG2, ABCB11, MRP6 and MRP7. The multifarious in vitro inhibitory effects of silibinin are in agreement with growing body of evidence that silibinin would be an efficient anticancer agent in order to be used in multi-target therapy to prevail the therapeutic hold backs against CML.

Translation, cultural adaptation assessment, and both validity and reliability testing of the Kidney Disease Quality of Life--Short Form version 1.3 for use with Iranian patients.

AIM: The aims of the study were to translate the Kidney Disease Quality of Life--Short Form version 1.3 (KDQOL-SF ver. 1.3) questionnaire into Iranian (Farsi), and to then assess it in terms of validity and reliability on Iranian patients. METHODS: The questionnaire was first translated into Farsi by two independent translators, and then subsequently translated back into English. After translation disparities had been reconciled, the final Iranian questionnaire was tested. An initial test-retest reliability evaluation was performed over a 10 day period on a sample of 20 patients recruited from a larger group (212 patients with end-stage renal disease on haemodialysis). Afterwards, reliability was estimated by internal consistency, and validity was assessed using known group comparisons and constructs for the patient group as a whole. Finally, the factor structure of the questionnaire was extracted by performing exploratory factor analysis. RESULTS: All of the scales in the questionnaire showed good test-retest reliability (i.e. intraclass correlations between test and retest scores were >0.7). All of the scales met the minimal criteria (0.7) for internal consistency and Cronbach's-α ranged 0.71-0.93. Furthermore, results from a discriminate validity evaluation showed that the questionnaire could be used to discriminate between subgroups of the patients. Finally, a principal component analysis of the disease-specific scales indicated that this part of the questionnaire could be summarized into an 11 factor structure that jointly accounted for 79.81% of the variance. CONCLUSION: The Iranian version of the KDQOL-SF questionnaire is both highly reliable and valid for use with Iranian patients on haemodialysis.