Comparison of the effect of phenobarbital & levetiracetam in the treatment of neonatal abstinence syndrome (NAS) as adjuvant treatment in neonates admitted to the neonatal intensive care unit: a randomized clinical trial.

BACKGROUND: Infants who are born from mothers with substance use disorder might suffer from neonatal abstinence syndrome (NAS) and need treatment with medicines. One of these medicines is phenobarbital, which may cause side effects in long-term consumption. Alternative drugs can be used to reduce these side effects. This study seeks the comparison of the effects of phenobarbital & levetiracetam as adjuvant therapy in neonatal abstinence syndrome. METHODS: This randomized clinical trial was performed in one year from May 2021 until May 2022. The neonates who were born from mothers with substance use disorder and had neonatal abstinence syndrome in Afzalipoor Hospital of Kerman were studied. The treatment started with morphine initially and every four hours the infants were checked. The infants who were diagnosed with uncontrolled symptoms After obtaining informed consent from the parents were randomly divided into two groups and treated with secondary drugs, either phenobarbital or levetiracetam. RESULTS: Based on the obtained results, it was clear that there was no significant difference between the hospitalization time of the two infant groups under therapy (phenobarbital: 18.59 days versus Levetiracetam 18.24 days) (P-value = 0.512). Also, there was no significant difference between both groups in terms of the frequency of re-hospitalization during the first week after discharge, the occurrence of complications, and third treatment line prescription (P-value = 0.644). CONCLUSIONS: Based on the obtained results, like hospitalization duration time (P-value = 0.512) it seems that levetiracetam can be used to substitute phenobarbital in treating neonatal abstinence syndrome. TRIAL REGISTRATION: The current study has been registered in the Iran registry of clinical trials website (fa.irct.ir) on the date 25/2/2022 with registration no. IRCT20211218053444N2.

The effect of egg white diet on phosphorus control in dialysis patients.

INTRODUCTION: Nutritional interventions have been envisaged to improve hyperphosphatemia and malnutrition, two important risk factors associated with mortality in dialysis patients. We evaluated the effects of egg white consumption on serum phosphate and malnutrition in dialysis patients. METHODS: In an open-label, per protocol clinical trial, conducted in Kerman dialysis centers, 150 hemodialysis patients aged ≥18 years with serum phosphorus ≥5.5 mg/dl were included in the study. All participants limited their intake of foods containing phosphorus for 4 weeks, and then they were divided into a control and an intervention group. The control group continued their ordinary diet and the participants in the intervention group consumed a Telavang egg white pack (containing six egg whites, 96 calories, 24 g protein) as a substitute for meat products 3 days a week for 8 weeks. Finally, changes in serum albumin, phosphorus, calcium, PTH, and cholesterol were measured. FINDINGS: At the baseline, there were no significant differences in the laboratory variables between the two groups. After 8 weeks, serum cholesterol (124.3 ± 38.1, vs. 135.8 ± 28.8, p = 0.003) and phosphorus levels (4.5 ± 1.03, vs. 6.7 ± 1.5, p = 0.001) were significantly lower in the intervention group compared with the control group. Also, serum albumin (4.5 ± 0.07 vs. 3.7 ± 0.4, p = 0.001) was significantly higher in the intervention group. Moreover, phosphorus, PTH, and cholesterol levels in the intervention group were significantly lower than their baseline values (p = 0.001). CONCLUSION: The results showed that the egg white could be a useful source of protein for dialysis patients, as it simultaneously reduces serum phosphorus and cholesterol, and increases serum albumin.

Assessment of the effect of sachet formulation of almond (Amygdalus dulcis L.) on diarrhea prominent irritable bowel syndrome (IBS-D) symptoms: A clinical trial.

OBJECTIVES: Almond has been listed in the low FODMAPs (Fermentable Oligo-, Di-, Mono saccharides And Polyols) and is recommended for infant diarrhea and gastrointestinal problem in Iranian folk medicine. In this work, sachet of almond has been designed, formulated and is studied on the clinical symptoms of diarrhea prominent irritable bowel syndrome (IBS-D). DESIGN: almond was standardized on the basis of total protein and carbohydrate content. A sachet of almond and wheat flour (placebo) was formulated and their physicochemical characteristics were investigated. INTERVENTION: In a double blind randomized trial, fifty IBS-D patients were randomly enrolled into the almond and placebo groups, ranked in respect to the severity of symptoms to mild-moderate and severe disease. The patients received almond or placebo sachet (40 g/day,20 days) respectively. MAIN OUTCOME MEASURE: Patients were assessed for bowel habit, pain severity and frequency and bloating and data was recorded in a data collecting form. RESULTS: The results showed that none of the primary outcomes of the disease is improved in the patients treated with almond. The bowel movement and severity of the pain was significantly increased in the almond treated patients compared to the placebo and baseline (p < 0.05). CONCLUSION: Almond contains high content of oligo-fructan which in high intake might result in a large amount of fermentable carbohydrates that can exacerbate the symptoms of the disease. So, despite the almond inclusion in the low-FODMAPs, the amount of almond intake is a determining factor and here we have controversial results for almond intake in patients with IBS. Mental health and physical activity of patients are also involved in the disease.