Historical roots of the stigma of epilepsy: A review of the classic Iranian literature.

BACKGROUND: The stigma toward epilepsy is a daily challenge for people with epilepsy (PWE) and can influence the well-being and prognosis of these individuals. However, the cultural origins of such stigma have sparsely been examined. In this study, we aimed to investigate the classic Persian literature to gain insight into the historical and cultural beliefs and opinions regarding epilepsy as a determinant in developing stigma towards PWE. METHODS: In this narrative review of the classic Persian literature, we investigated the opinions and beliefs regarding epilepsy and PWE. In February 2023, we searched https://ganjoor.net (an open-access database of Iranian literature) for the relevant literary materials (poem and prose) using the Persian translation of the terms epilepsy (Sar'e) and epileptic (Masroo'e). Two clinical researchers went through the results and extracted the related materials under the supervision of two experts in Persian literature. A bilingual academic translated the included literary materials from Persian to English. RESULTS: Our search yielded 57 literature materials by 31 poets and writers from the 4th to 14th Hijri centuries, roughly coinciding with the past Gregorian millennium (1000-2000 AC). We classified the literary concepts related to epilepsy stigma into five subgroups: (i) a simile for pain and suffering; (ii) an atonement for blasphemous beliefs or a disease caused by supernatural power; (iii) a sign of madness, insanity, and lack of wisdom; (iv) a celestial observation; and (v) a subject for jokes. CONCLUSIONS: Classic Persian literature considered epilepsy as a simile for suffering and a sign of insanity that is caused by blasphemous beliefs or celestial objects, with PWE classified as insane and unwise. While such depictions became less prevalent after the 14th century CE, they can give rise to misconceptions and negative stigma toward PWE and should be addressed in modern culture. Each society should critically investigate its socio-cultural origins of stigma and rectify such misbeliefs.

Recent advancements in nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma, review and update.

Despite the existence of numerous eye drops in the market, most of them are not sufficiently effective because of quick clearance and the barriers within the eye. To increase the delivery of the drugs to the eye, various new formulations have been explored in recent decades. These formulations aim to enhance drug retention and penetration, while enabling sustained drug release over extended periods. One such innovative approach is the utilization of contact lenses, which were originally designed for cosmetic purposes and vision correction. Contact lenses have appeared as a promising formulation for ocular drug delivery, as they can increase the bioavailability of drugs in the eye and diminish unwanted side effects. They are specifically appropriate for treating chronic eye conditions, making them an area of interest for researchers in the field of ophthalmology. This review outlines the promising potential of nanomaterial-laden contact lenses for diagnosis and treatment of glaucoma. It classifies therapeutic approaches based on nanomaterial type, summarizes diagnostic advances, discusses improvement of contact lenses properties, covers marketing perspectives, and acknowledges the challenges of these innovative contact lenses for glaucoma management.

Nutritional and health beneficial properties of saffron (Crocus sativus L): a comprehensive review.

Saffron (Crocus sativus L., family Iridaceae) is used traditionally for medicinal purpose in Chinese, Ayurvedic, Persian and Unani medicines. The bioactive constituents such as apocarotenoids, monoterpenoids, flavonoids, phenolic acids and phytosterols are widely investigated in experimental and clinical studies for a wide range of therapeutic effects, especially on the nervous system. Some of the active constituents of saffron have high bioavailability and bioaccessibility and ability to pass the blood-brain barrier. Multiple preclinical and clinical studies have supported neuroprotective, anxiolytic, antidepressant, learning and memory-enhancing effect of saffron and its bioactive constituents (safranal, crocin, and picrocrocin). Thus, this plant and its active compounds could be a beneficial medicinal food ingredient in the formation of drugs targeting nervous system disorders. This review focuses on phytochemistry, bioaccessibility, bioavailability, and bioactivity of phytochemicals in saffron. Furthermore, the therapeutic effect of saffron against different nervous system disorders has also been discussed in detail.

Efficacy of topical Citrullus colocynthis (bitter apple) extract oil in chemotherapy-induced peripheral neuropathy: A pilot double-blind randomized placebo-controlled clinical trial.

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common complications in patients with cancer. Citrullus colocynthis (bitter apple) has been used in traditional Persian medicine as an effective pain relief, especially for neuralgia. We designed a pilot clinical trial to evaluate the safety and efficacy of topical C. colocynthis oil in management of CIPN in breast cancer patients. Thirty-four cancer patients with CIPN were randomly enrolled in two arms of a randomized, double-blind, placebo-controlled clinical trial. The patients were treated by topical C. colocynthis oil or placebo, two times per day for 2 months. Functional Assessment of Cancer Therapy/Gynecologic Oncology Group (FACT/GOG)-Neurotoxicity (Ntx) score was set as the primary outcome measure. No significant improvement was observed in the total score of FACT/GOG-Ntx scale (2.40 ± 1.90 vs. 1.05 ± 1.36, p = .879) in drug and placebo groups, respectively. There was also no significant improvement in the mean scores of FACT/GOG-Ntx in the sensory, motor, hearing, and functional domains in the two study groups. According to the results of this preliminary study, topical C. colocynthis oil failed to improve the symptoms of CIPN compared with placebo.

Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo controlled clinical trial.

Our aim is to assess the effect of cinnamon powder capsules on insulin resistance, anthropometric measurements, glucose and lipid profiles, and androgens of women with polycystic ovarian syndrome (PCOS). Out of 80 women that were diagnosed as PCOS by Rotterdam Criteria, 66 were enrolled in this randomized double-blind placebo-controlled clinical trial. All of the PCOS women were taking medroxy progesterone acetate 10 mg/day for the last 10 days of their menstrual cycles. The cases were randomly allocated to 2 groups. The women in the first group were treated by cinnamon powder capsules 1.5 g/day in 3 divided doses for 12 weeks and the second group by similar placebo capsules. Anthropometric measurements, fasting blood sugar, fasting insulin, blood glucose 2 hr after taking 75 g oral glucose, HbA1c, testosterone, dehydroepiandrosterone sulphate, homeostatic model assessment for insulin resistance, triglyceride, and cholesterol (low-density lipoprotein, high-density lipoprotein, and total) before and after the intervention were evaluated and compared as outcome measures. Fasting insulin (p = .024) and homeostatic model assessment for insulin resistance (p = .014) were reduced after 12 weeks in the cinnamon group compared with the placebo. There was also a significant decrease in low-density lipoprotein in cinnamon group (p = .004) as compared with baseline that caused significant difference with placebo (p = .049). However, changes in other outcome measurements did not lead to statistically significant difference with placebo. The present results suggest that complementary supplementation of cinnamon significantly reduced fasting insulin and insulin resistance in women with PCOS.

Use of complementary and alternative medicine among paediatric patients with hepatogastrointestinal diseases.

BACKGROUND: The use of complementary and alternative medicine (CAM) is becoming increasingly popular in Middle Eastern countries; it is often used for paediatric medical conditions such as chronic gastrointestinal complaints and failure to thrive. It is also commonly used in patients with chronic hepatic conditions such as cirrhosis and in hepatic transplant patients. AIMS: This study aimed to evaluate the prevalence, types and associated factors of CAM use in children with hepatogastrointestinal disease in Shiraz, Islamic Republic of Iran. METHODS: In a cross-sectional study carried out during September 2013-January 2014, 238 parents of children attending a paediatric gastroenterology and hepatology clinic at Shiraz University of Medical Sciences received a self-administered questionnaire covering associated factors of complementary and alternative medicine use; 210 questionnaires were completed and returned. RESULTS: Complementary and alternative medicine was used by 103 patients (49%); 74 (71.8%) of these used herbal remedies. Older age of the child significantly increased CAM use. Those with previous positive experience of CAM (62.1% of users, 40.2% of non-users) and those who had received recommendation for CAM by health care providers (24.3% of users, 6.6% of non-users) were significantly more likely to use CAM. CONCLUSIONS: This survey demonstrated the high prevalence of CAM use (especially herbal remedies) in paediatric patients with hepatogastrointestinal diseases.

The Prophylactic Effect of Hydroalcoholic Extract of Zingiber Officinale (Ginger) on Ethanol-Induced Reproductive Toxicity in Male Rats.

BACKGROUND: Ginger is a natural dietary component with antioxidant and anti-carcinogenic properties. This study was conducted to evaluate the prophylactic effect of ginger extract on ethanol-induced reproductive toxicity in male rats by measuring the total homocysteine (tHcy), trace elements, antioxidant enzymes activity including glutathione peroxidase, superoxide dismutase (SOD) and catalase, and malondialdehyde (MDA). METHODS: Twenty-eight adult male Sprague-Dawley rats were randomly divided into four experimental groups and treated daily for 28 days as follows: control, control+ginger (1 g/kg of body weight (B.W)/day by gavage), test group (ethanol 4 g/kg of B.W/day by gavage), and treated group (ethanol+ginger). At the end of the experiment, all the rats were sacrificed and their testes were removed and used for the measurement of the above factors. RESULTS: The results in the test group indicated that ethanol decreased antioxidant enzymes activity and increased MDA and tHcy compared with the control groups (P<0.05). In the treated group, ginger extract improved antioxidant enzymes activity and reduced tHcy and MDA level compared with the test group (P<0.05). CONCLUSION: It can be concluded that ethanol causes oxidative stress in testis and ginger extract improves the trace elements, antioxidant enzymes activity, and decreases tHcy and MDA.

Efficacy of Tribulus Terrestris Extract on the Serum Glucose and Lipids of Women with Diabetes Mellitus.

BACKGROUND: Considering folkloric use of Tribulus terrestris (T. terrestris) in diabetes and proven anti-hyperglycemic and anti-hyperlipidemic effects of T. terrestris in animal studies, we aimed to evaluate the efficacy of the hydro alcoholic extract of T. terrestris on the serum glucose and lipid profile of women with diabetes mellitus. METHODS: Ninety-eight diabetic women were randomly allocated to receive the T. terrestris (1000 mg/day) or placebo for three months. The patients were evaluated in terms of the fasting blood glucose, 2-hour postprandial glucose, glycosylated hemoglobin and lipid profile. RESULTS: T. terrestris showed a significant blood glucose lowering effect in diabetic women compared to placebo (P<0.05). Also, the total cholesterol and low-density lipoprotein of the T. terrestris group was significantly reduced compared with placebo, while no significant effect was observed in the triglyceride and high-density lipoprotein levels. CONCLUSION: This study showed preliminary promising hypoglycemic effect of T. terrestris in diabetic women.

Rhus Coriaria L. (Sumac) in Patients with Hyperlipidemia; A Double Blind Randomized Clinical Trial.

BACKGROUND: Lipid lowering effect of sumac is investigated in multiple animal studies with promising results. However, its clinical efficacy is not investigated adequately. This study is aimed to evaluate the lipid lowering effect of sumac in patients with Hyperlipidemia in a double blind randomized controlled trial. METHODS: Eighty patients with Hyperlipidemia according to NCEP-ATP III criteria were randomly allocated to receive the Rhus Coriaria L. (1000 mg/day) or placebo for two months. The patients were evaluated in terms of the serum triglyceride, total LDL, and HDL cholesterol. Systolic and diastolic blood pressures along with serum biochemistry profile including fasting blood sugar, liver and kidney function tests and complete blood count were evaluated before the enrolment of patients and after the intervention. RESULTS: No significant difference was observed between the sumac and placebo groups in term of mean reductions in total and LDL cholesterol and triglyceride levels. A significant increase in mean serum HDL cholesterol level was observed in the sumac group (41.18±8.2 vs. 44.65±8.4, P=0.001) after 2 months of intervention. CONCLUSION: The study showed significant HDL cholesterol increasing effect of sumac supplementation in patients with Hyperlipidemia.

The Efficacy of Boswellia Serrata Gum Resin for Control of Lipid Profile and Blood Glucose in Diabetic Patients.

BACKGROUND: Regarding preclinical evidence for antidiabetic effects of Boswellia serrata, we evaluated anti-hyperglycemic and lipid-lowering effects of Boswellia serrate gum resin in type 2 diabetic patients in a double-blind randomized placebo-control trial. METHODS: Fifty-six diabetic patients were randomly allocated to two groups to receive 250 mg of the Boswellia serrate gum resin or placebo twice daily for 8 weeks, in addition to their routine antidiabetic treatments. Fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), insulin level, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride of serum were measured before and after the intervention. RESULTS: Although there was a considerable reduction after the intervention in FBS (P=0.04), HbA1c (P=0.02) and triglyceride (P=0.01) in the Boswellia serrate gum resin group, no significant difference was observed in all outcome measures between the two groups at the end of the study (FBS P=0.09, HbA1c P=0.20, total cholesterol P=0.31, LDL P=0.49, HDL P=0.10, triglyceride P=0.78 and insulin level P=0.86). CONCLUSION: The current study showed the 8 weeks complementary use of Boswellia serrate gum resin with a daily dose of 500 mg had no better glucose and lipid lowering effect than placebo in diabetic patients.

The Role of Syndrome Differentiation in the Clinical Efficacy of Punica Granatum on Patients with Ulcerative Colitis.

BACKGROUND: The present study investigated the difference between therapeutic responses of hot and cold temperament patients (based on traditional Persian medicine) with ulcerative colitis to pomegranate peel extract. METHODS: Seventy-eight patients with moderate ulcerative colitis based on Lichtiger Colitis Activity Index (LCAI) criteria were randomized to receive an aqueous extract of the Punica granatum peel (6 gram per day) or placebo for four weeks. They were assessed before and after the intervention in terms of symptoms by LCAI scoring system. The results were compared in two therapeutic groups based on the patient s' temperament (cold and hot) which were diagnosed based on a previously validated questionnaire. RESULTS: Therapeutic response was significantly higher in patients with hot temperament compared to patients with cold temperament in the P. granatum group (1.91±0.492 vs. -0.500±0.500, P=0.029). CONCLUSION: This study showed the importance of considering syndrome differentiation and temperament in interpreting the effect of P. granatum peel extract on ulcerative colitis.

Comparative analysis of risk factors for retinopathy of prematurity in single and multiple birth neonates.

AIM: To conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates. METHODS: In a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births. RESULTS: The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001). CONCLUSION: Multiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates.

Occlusion therapy for amblyopia, a historical report from 9th century Persian scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE).

INTRODUCTION: This study reevaluates the historical origins of occlusion therapy for amblyopia, focusing on the contributions of the 9th-century Islamic scholar, Ali ibn Sahl ibn Rabban al-Tabari (838-870 CE). METHODS: The investigation delved into al-Tabari's writings, particularly "Firdous al-Hikma," to extract insights into his approach to addressing reduced vision in one eye.Additionally, the study examined subsequent advancements in occlusion therapy by scholars such as Thabit ibn Qurrah and Rhazes, building upon al-Tabari'sfoundational work. RESULTS: Al-Tabari's reports contain significant insights into occlusion therapy for amblyopia, predating commonly attributed origins of the treatment. Within "Firdous al-Hikma," he outlines methods for addressing reduced vision, advocating for the covering of the healthier eye to promote the function of the weaker eye. These findings highlight the pioneering efforts of al-Tabari and his contemporaries in the Islamic civilization and challenge the conventional narrative surrounding the history of occlusion therapy. Subsequent advancements by scholars such as Thabit ibn Qurrah and Rhazes expanded upon al-Tabari's work, advocating for similar therapeutic approaches within the Islamic civilization. Their contributions further solidified the practice of occlusion therapy, laying the groundwork for its continued evolution and refinement in subsequent centuries. DISCUSSION: Al-Tabari's contributions to occlusion therapy underscore the rich heritage of scientific inquiry in theIslamic civilization during the medieval period. This historical perspective sheds light on the diverse contributions to medical knowledge and practice outside of Western contexts and emphasizes the importance of recognizing and honoring these contributions in the broader history of medicine.

Successful maintenance treatment of a patient with resistant hyperthyroidism with traditional Persian medicine recommendations: A case report and literature review.

INTRODUCTION: Hyperthyroidism is a common endocrinology condition that could affect several aspects of the patient's life. CASE PRESENTATION: We present a 27-year-old woman who was sent to the traditional Persian medicine (TPM) clinic with a diagnosis of uncontrolled chronic hyperthyroidism (lower levels of thyroid stimulating hormone (TSH) and higher levels of T3 and T4) and its complications, such as developing exophthalmos, palpitations, anxiety, sleep problems, hair loss, and dry skin. The patient was under treatment with prednisolone and methimazole for up to one year, but no acceptable improvement was achieved. The patient received a package of TPM recommendations, which included lifestyle modification, Melissa officinalis herbal tea, and Persian barley water. The patient was followed for one year. After two months of follow-up of the patient, the level of TSH increased, and the level of T3 and T4 decreased. In addition, the patient's symptoms, including exophthalmos, palpitation, anxiety, sleep disturbance, and dryness of the skin, were improved considerably. After three months of consumption of the TPM-based regime and prescription, the serum levels of TSH, T3, and T4, of the patient were in normal ranges. In a one-year follow-up of the patient, the patient's condition was stable and her thyroid function tests were normal. We hereby present the following case to be in line with the CAse REports (CARE) checklist. CONCLUSION: It appears that TPM lifestyle recommendations, Melissa officinalis herbal tea, and Persian barley water were effective in treating the patient with uncontrolled hyperthyroidism. We recommend further studies and clinical trial designs in this regard.

Potential therapeutic effects of green tea (Camellia sinensis) in eye diseases, a review.

This review aims to evaluate the therapeutic potential of green tea (GT), scientifically named Camellia sinensis, in treating eye diseases. We provide an overview of the ingredients and traditional use of Camellia sinensis, followed by a detailed discussion of its therapeutic uses in various eye diseases, including ocular surface diseases (allergic diseases, dry eye, pterygium, and infections), cataract, glaucoma, uveitis, retinal diseases, and optic nerve diseases. The pharmacologic activities related to ocular diseases, such as anti-vascular endothelial growth factor, aldose reductase inhibitor activity, anti-bacterial, anti-inflammatory, and antioxidant effects are also explored in this review. The dose and route of administration of GT in various studies are discussed. Safety issues related to the use of GT, such as the side effects associated with high doses and long-term use, are also addressed. The review highlights the potential of GT as a natural therapeutic agent for a variety of ocular diseases. Its various pharmacologic activities make it a promising treatment option. However, more well-designed studies are needed to determine the optimal dose and route of administration and to assess its long-term safety and efficacy. Overall, GT appears to be a promising adjunct therapy for various ocular diseases.

Complementary and alternative medicine use among cancer patients in Iran: A systematic review.

Background: Cancer patients frequently turn to complementary and alternative medicine (CAM) to mitigate the adverse effects of conventional cancer treatments, alleviate stress, manage comorbidities, and address the cancer itself. This systematic review aims to investigate descriptive studies conducted in Iran, focusing on the prevalence and methods of CAM use among cancer patients. Methods: A thorough search of PubMed, Scopus, Google Scholar, Web of Science, Magiran, and the Scientific Information Database (SID) was conducted in both English and Persian from inception to July 2023. Inclusion criteria targeted studies exploring the frequency and patterns of CAM utilization among Iranian patients across diverse cancer types. Results: A total of 604 articles were found in the preliminary search, and 14 were included in this review. Among the 3,990 participants in the included studies, a weighted average of 51.83% (range 4.6%-100%) had used at least one CAM method. The most commonly used CAM methods were prayer (41.8%), medicinal herbs (30.1%), traditional and folk treatments (27.2%), bloodletting (17.3%), and hydrotherapy (13%). Patients reported using CAM for various reasons, including their beliefs, desire to cure the disease, reduce stress, positive past experiences, and improve physical condition. On average, 39% of patients informed their physicians about their CAM use. Conclusion: The findings underscore the relatively prevalent adoption of CAM by Iranian cancer patients. Given the low rate of disclosure to physicians, there is a compelling need for healthcare system vigilance and monitoring to ensure comprehensive patient care.

Effect of low dose honey on the apoptosis and inflammation gene expression in corneal limbal stem cells and keratocytes and its efficacy as an ophthalmic formulation in the treatment of dry eye: in-vitro and clinical study.

Background: The use of honey as an eye treatment encounters challenges due to its high osmolarity, low pH, and difficulties in sterilization. This study addresses these issues by employing a low concentration of honey, focusing on both in-vitro experiments and clinical trials for treating dry eye disease in corneal cells. Methods: In the in-vitro experiment, we investigated the impact of a 1% honey-supplemented medium (HSM) on limbal stem cells (LSCs) and keratocytes using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay and real-time polymerase chain reaction (PCR) for BCL-2, BAX, and IL-1ß gene expression. Simultaneously, in the clinical trial, 80 participants were divided into two groups, receiving either a 1% w/v honey ophthalmic formulation or a placebo for 3 months. Study outcomes included subjective improvement in dry eye symptoms, tear break-up time (TBUT), and Schirmer's test results. Results: MTT results indicated that 1% HSM did not compromise the survival of corneal cells and significantly reduced the expression of the IL-1ß gene. Additionally, participants in the honey group demonstrated a higher rate of improvement in dry eye symptoms and a significant enhancement in TBUT values at the three-month follow-up. However, there was no significant difference between the study groups in terms of Schirmer's test values. No adverse events were observed or reported. Conclusion: In conclusion, 1% honey exhibits anti-inflammatory and anti-infective properties, proving effective in ameliorating dry eye symptoms and enhancing tear film stability in patients with dry eye disease.Clinical Trial Registration: https://irct.behdasht.gov.ir/trial/63800.

Evidence-based practice in traditional persian medicine (TPM): a stakeholder and social network analysis.

BACKGROUND: The utilization of complementary and alternative medicine (CAM) is experiencing a global surge, accompanied by the adoption of national CAM policies in numerous countries. Traditional Persian medicine (TPM) is highly used as CAM in Iran, and the ongoing scientific evaluation of its interventions and the implementation of evidence-based medicine (EBM) encounters various barriers. Therefore, comprehending the characteristics and interactions of stakeholders is pivotal in advancing EBM within TPM policies. In this study, we utilized both classical stakeholder analysis and social network analysis to identify key stakeholders and potential communication patterns, thereby promoting EBM in TPM policy-making. METHODS: A cross-sectional nationwide stakeholder analysis was conducted in 2023 using snowball sampling. The interviews were carried out using a customized version of the six building blocks of health. Data were collected through semi-structured interviews. Stakeholders were assessed based on five factors (power, interest, influence, position, and competency). The connections and structure of the network were analyzed using degree, betweenness, closeness centrality, and modularity index to detect clusters of smaller networks. RESULTS: Among twenty-three identified stakeholders, the Ministry of Health and Medical Education (MOHME) and the Public were the most powerful and influential. The Iranian Academy of Medical Sciences was the most competent stakeholder. Social network analysis revealed a low density of connections among stakeholders. Pharmaceutical companies were identified as key connectors in the network, while the Public, supreme governmental bodies, and guilds acted as gatekeepers or brokers. The MOHME and Maraji were found to be high-ranking stakeholders based on four different centrality measures. CONCLUSION: This study identifies powerful stakeholders in the network and emphasizes the need to engage uninterested yet significant stakeholders. Recommendations include improving competence through education, strengthening international relations, and fostering stronger relationships. Engaging key connectors and gatekeepers is essential for bridging gaps in the network.

The Effect of Ophthalmic and Systemic Formulations of Latilactobacillus sakei on Clinical and Immunological Outcomes of Patients With Dry Eye Disease: A Factorial, Randomized, Placebo-controlled, and Triple-masking Clinical Trial.

Dry eye disease (DED) is one of the most prevalent eye diseases. This study aimed to evaluate the efficacy and safety of Latilactobacillus sakei (L. sakei) either as an ophthalmic bacterial lysate (drops, no live organism) or as an oral probiotic (capsules) on immunological and clinical outcomes of patients with DED. This study was a randomized, placebo-controlled, triple-masking clinical trial with four parallel arms. Patients were randomly assigned in a 2x2 factorial design combining active vs placebo capsules and active vs placebo eye drops in a 1:1x1:1 ratio. The ophthalmic drops are approved for use in the European Union as a medical device (CE registration code 0425-MED-004235). A total of 40 patients were evaluated. DED signs and symptoms decreased significantly by using active drops compared to placebo, as measured by the Ocular Surface Disease Index (OSDI), Tear Break-up Time (TBUT), and Schirmer I tests (all p<0.0001). Conversely, neither active capsules nor their interaction effect with active drops achieved significance vs placebo. There was also a significant decrease in the tear levels of IL-6 (p=0.0007), TNFα (p<0.0001), and IFNγ (p<0.0001) in patients receiving active drops. Intake of both active products (drops and capsules) was well tolerated. Postbiotic ophthalmic formulation containing L. sakei lysate significantly improved the signs and symptoms of DED and suppressed ocular surface inflammatory response. Conversely, oral intake of L.sakei as a probiotic capsule had no effect in these patients (ClinicalTrials.gov: NCT04938908).

Prophylactic effect of chamomile on post-dural puncture headache in women undergoing elective cesarean section: A randomized, double blind, placebo-controlled clinical trial.

BACKGROUND: Post-dural puncture headache (PDPH) is a common complication after spinal anesthesia, affecting patient recovery. This study evaluated the prophylactic effect of topical chamomile ointment on PDPH in women undergoing elective cesarean section. METHODS: In a randomized, double-blind, placebo-controlled clinical trial 148 pregnant women were randomized into two parallel groups and received 3cc of the chamomile or the placebo ointment on the forehead of the participants 20 minutes before the start of spinal anesthesia, and then 2 and 4 hours after that. The primary outcomes were the incidence rate of headache, and its severity assessed by a numeric rating scale (NRS), while secondary outcomes included analgesic consumption, frequency of nausea/vomiting, and adverse events. RESULTS: Chamomile ointment exhibited significant preventive effects on PDPH incidence compared to placebo. The chamomile group demonstrated lower rates of PDPH at 6 hours (3.5% vs. 7.18%, p = 0.021) and 12 hours (7.6% vs. 20%, p = 0.028) after spinal anesthesia. Analgesic consumption, frequency of nausea/vomiting, and adverse events were comparable between the groups. CONCLUSION: Topical chamomile ointment demonstrated significant preventive effects on PDPH incidence compared to placebo. Chamomile ointment could be a promising adjunctive approach to prevent PDPH, enhancing patient comfort and potentially reducing the need for analgesics. Further investigation is needed to explore its mechanisms and broader applications.