Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to qualitatively synthesize recent randomized controlled trials (RCTs) regarding the effect of topical application and oral intake of herbal products on the healing of diabetic foot ulcer (DFU). Also, we sought to pool the obtained findings in a meta-analysis using a random-effects model, if RCTs were relatively comparable and homogenous. A comprehensive search was performed on five electronic data sources from their inception through 23 January 2024. The RCTs, without restriction on the country of origin, were included if they compared the effect of administering standard treatments and/or placebo (i.e. control condition) to applying standard treatments and/or herbal products in topical or oral routes (i.e. experimental condition). Out of 1166 retrieved records, 28 RCTs were included. Studies used different poly and single herbal formulations. Based on the meta-analysis, administration of standard care plus daily dressing of the ulcer site with olive oil for 28 days significantly increased the total ulcer healing score (3 RCTs; weighted mean difference [WMD] = 89.30; p < 0.001), raised frequency of complete ulcer healing (2 RCTs; risk ratio [RR] = 12.44; p = 0.039) and declined ulcer degree (3 RCTs; WMD = -22.28; p = 0.002). Also, daily use of the bitter melon leaf extract in oral form for 28 days significantly increased the total ulcer healing score (2 RCTs; WMD = 0.40; p = 0.001). Additionally, based on qualitative synthesis, the adjuvant use of herbal agents seems an intriguing choice to manage DFU. Nonetheless, considering the undesirable methodological quality of most studies and the high heterogeneity in administered herbal formulations, more robust trials are required to build a solid conclusion regarding the use of herbal products for healing DFU.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis.

BACKGROUND: Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes. METHODS: Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software. RESULTS: Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials. CONCLUSION: More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care. TRIAL REGISTRATION: PROSPERO Registration No: CRD42023399626.

The Effects of Virtual Directed Painting Therapy on Anxiety, Depression, and Self-efficacy of Children with Type 1 Diabetes: A Randomized Controlled Clinical Trial.

Background: Diabetes-induced anxiety, depression, and decreased self-efficacy lead to poor adherence to treatment in diabetic children. Since painting therapy seems to be helpful to express their feelings, this study aimed to investigate the effects of virtual directed painting therapy on anxiety, depression, and self-efficacy in diabetic children. Methods: This randomized controlled trial was conducted on 40 children with type 1 diabetes aged 8-12 years who were referred to Imam Reza Clinic of Diabetes in Shiraz, from July to October 2020. Children were randomly selected and assigned to intervention and control groups, using block randomization. The intervention group received the routine care plus virtual painting therapy directed by WhatsApp (six 2-hour group sessions once a week for six weeks). Spence Children's Anxiety Scale, Maria Kovacs Children's Depression Inventory, and Diabetes Management Self-Efficacy Scale were completed before and after the intervention. Data were analyzed through SPSS 23, using Chi-square, Mann-Whitney U, and Wilcoxon tests. P value <0.05 was considered as significant. Results: After the intervention, the median (interquartile range) total scores for anxiety, depression, and self-efficacy in the intervention group were 48.50 (45.00-51.75), 7.00 (4.00-9.00), and 169.00 (154.00-178.00), and in the control group 55.00 (48.50-62.25), 13.00 (10.00-17.50), and 152.00, respectively (110.50-184.00). After the intervention, there was a significant difference between the groups regarding anxiety (P=0.02) and depression (P<0.001); however, the difference in self-efficacy was not significant (P=0.20). Conclusion: Painting therapy should be considered as a part of care programs in diabetes centers and other community settings to control anxiety and depression of diabetic children. Trial Registration Number: IRCT20200118046181N1.