Prevalence of mental disorders among middle-aged population of primary healthcare centers in Northeastern Iran.

BACKGROUND: Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders. METHODS: This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22. RESULTS: This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant. CONCLUSIONS: Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.

Silybum marianum ethanolic extract: in vitro effects on protoscolices of Echinococcus granulosus G1 strain with emphasis on other Iranian medicinal plants.

BACKGROUND: Cystic echinococcosis (CE), is a parasitic zoonosis caused by Echinococcus granulosus (E. granulosus) larvae in liver and lungs of both humans and animals. Surgical intervention is the mainstay for CE treatment, using scolicidal agents that inactivate live protoscolices. This study evaluated the scolicidal effects of Silybum marianum ethanolic extract and its combination with albendazole in vitro for the first time. Moreover, in a literature review, we investigated the effects of a wide range of Iranian medicinal plants on protoscolices of E. granulosus. METHODS: S. marianum ethanolic extract was prepared and high-performance liquid chromatography (HPLC) analysis was used to establish the proportions of its component compounds in the extract. Cytotoxicity was evaluated in mouse macrophage cells (J774A.1 cell line) using MTT method. Next, the scolicidal activity of the extract alone and combined with albendazole was tested as triplicate at various concentrations incubated for 5, 10, 20, 30, and 60 min. Finally, protoscolex viability was determined using 0.1% eosin as a vital stain. PCR-RFLP and DNA sequencing techniques were used to characterize the genotype of E. granulosus. RESULTS: HPLC analysis showed that S. marianum ethanolic extract contained mostly silydianin (14.41%), isosilybin A (10.50%), and silychristin (10.46%). The greatest scolicidal effects were obtained with the combination of S. marianum with albendazole (79%), S. marianum ethanolic extract alone (77%) and albendazole (69%), at a concentration of 500 µg/ml for 60 min, respectively (P < 0.05). Molecular analysis showed that all the cysts used were G1 genotype. CONCLUSION: The data suggest that S. marianum ethanolic extract is a potential scolicide in vitro; however, further investigations are required to determine its efficacy in vivo.

Leishmaniasis and Trace Element Alterations: a Systematic Review.

Leishmaniasis is a worldwide prevalent parasitic infection caused by different species of the genus Leishmania. Clinically, the disease divided into three main forms, including visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis (MCL). There is no vaccine for human leishmaniasis and their treatment is challenging. Trace elements (TEs) alteration, including the selenium (Se), zinc (Zn), copper (Cu), ron (Fe), and magnesium (Mg) have been detected in patients with CL and VL as well as canine leishmaniasis. Because TEs play a pivotal role in the immune system, and host immune responses have crucial roles in defense against leishmaniasis, this systematic review aimed to summarize data regarding TEs alteration in human and animal leishmaniasis as well as the role of these elements as an adjuvant for treatment of leishmaniasis. In a setting of systematic review, we found 29 eligible articles (any date until October 1, 2020) regarding TEs in human CL (N = 12), human VL (N = 4), canine leishmaniasis (N = 3), and treatment of leishmaniasis based on TEs (N = 11), which one study examined the TEs level both in CL and VL patients. Our analysis demonstrated a significantly decreased level of Fe, Zn, and Se among human CL and canine leishmaniasis, and Zn and Fe in patients with VL. In contrast, an increased level of Cu in CL patients and Cu and Mg in VL patients and canine leishmaniasis was observed. Treatment of CL based zinc supplementation revealed enhancement of wound healing and diminished scar formation in human and experimentally infected animals. The results of this systematic review indicate that the TEs have important roles in leishmaniasis, which could be assessed as a prognosis factor in this disease. It is suggested that TEs could be prescribed as an adjuvant for the treatment of CL and VL patients.

The effects of lettuce extract on the level of T4, memory and nerve conduction velocity in male rats.

OBJECTIVE: According to the traditional medicine, lettuce can affect nerve conduction velocity and memory. So, to investigate the effect of lettuce seeds extract on body activities, lettuce seeds were used. MATERIALS AND METHODS: In the present study, the effects of lettuce (Lactuca sativa) seeds extract consumption (in drinking water) on T4 level, animals' weight, water and food consumption, nerve conduction velocity (NCV), and memory in Wistar rats, were investigated. In this study, 24 Wistar rats were used, and divided into three groups: control, L 200 mg/kg, and L 400 mg/kg. RESULTS: The results showed that, the T4 level, food and water intake, time spent and distance travelled in Q1, delay time to enter and the number of entrance into the dark room in both treated groups were not significantly different from the control group. Animal weight and NCV, in 400 mg/kg group were not significantly different from the control group, but in 200 mg/kg group, they were significantly decreased (p<0.05). The duration spent in the dark room (48 hr after shock) in L 400 mg/kg increased compared to the control group (p<0.05), but in L 200 mg/kg group at all time points, and in L 400 mg/kg treated group 3 and 24 hr after shock, it was not significantly different from the control group. CONCLUSION: Based on these findings, the T4 level, memory, food and water intake were not changed by lettuce extract, while NCV and animal weight were decreased following treatment with lettuce extract.

Anti-irritable Bowel Syndrome Syrup Improves Constipation-Predominant Irritable Bowel Syndrome: A Randomized, Placebo-Controlled Trial.

OBJECTIVE: To evaluate the efficacy and safety of administration of the formulated Persian herbal syrup on improving the symptoms of patients with constipation-predominant irritable bowel syndrome (IBS-C). METHODS: This study was conducted in 70 patients with IBS-C, who were recruited from 3 medical centers in Mashhad, Iran, from November 2017 to August 2018. Seventy patients were randomly assigned to 2 groups including treatment and placebo groups by block randomization, 35 cases in each group. Patients in the treatment group received 15 mL of anti-IBS syrup, thrice daily for 6 weeks and followed up for 4 weeks. Placebo syrup was also prepared through similar instruction, BP syrup without plant extract was used. Primary outcome induding IBS Symptom Severity Scale (IBS-SSS) questionnaire and secondary outcomes in terms of Hospital Anxiety and Depression (HADS) questionnaires, the Bristol Stool Form Scale (BSFS) were completed and evaluated at weeks 6 and 10, respectively. Safety indices were collected at the end of the treatment and Common Terminology Criteria for Adverse Events v4.0 (CTCAE) was used to evaluate the adverse events. RESULTS: The response to treatment was 84.4% (27/32) in the treatment group and 46.4% (13/28) in the placebo group, respectively (P= 0.002). Compared with pre-treatment, a significant decrease was found on the IBS-SSS and BSFS scores after 6-week intervention in both groups (P<0.001). Moreover, IBS-SSS and BSFS scores in the treatment group were lower than the placebo group after the intervention (P=0.041). There was no significant difference in the anxiety and depression scores after treatment in both groups (P>0.05). Side effects reported in the treatment group included 2 cases of headache during the first week of the onset of the treatment, 1 case of drowsiness, 1 case of increase in menstrual bleeding, which did not result in discontinuation of the treatment. In the placebo group, 1 case of exacerbation of the disease was reported. CONCLUSIONS: Anti-IBS syrup significantly reduced the severity of IBS symptoms compared to placebo. However, there was a need for further investigation regarding the anxiety and depression scores. (Registration No. IRCT2017061034446N1).

The efficacy of camel milk and Tarangabin (manna of Alhagi maurorum( combination therapy on glomerular filtration rate in patients with chronic kidney disease: A randomized controlled trial.

OBJECTIVE: This study was designed to investigate the effect of camel milk and Tarangabin (manna of Alhagi maurorum) combination therapy in addition to conventional treatments in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: Forty-four patients of 15 to 70 years old, with CKD due to hypertension or diabetes, and estimated glomerular filtration rate (eGFR) of 15-60 ml/min per 1.73 m2, were enrolled in this trial. The patients were randomized to receive either 400 cc of camel milk with 10 cc of Tarangabin syrup orally in two divided daily doses for 3 months plus conventional therapy or conventional therapy alone. The conventional treatment included diabetes medications and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. RESULTS: The baseline characteristics of patients were similar in the two groups. Serum levels of creatinine (p=0.01), blood levels of urea nitrogen (p=0.0001), triglyceride (p=0.02), and potassium (p=0.05), and diastolic blood pressure (p=0.0001) decreased, while eGFR (p=0.001) improved in intervention group significantly. CONCLUSION: It seems that the therapeutic protocol used in this study can improve renal function in patients with CKD through regulating glucose and anti-inflammatory, laxative, and immunostimulatory properties.

Comparison of Th1/Th2 and Treg/Th17 ratios between wet and dry cupping therapies in Persian medicine.

OBJECTIVE: In Persian medicine (PM), wet-cupping therapy (WCT) is the most utilized approach. WCT is mostly done between the shoulders, which is referred to as "hejamt-e-aam" in the Persian language. CD4+T cells also refer to T helper lymphocytes play a critical role in the immune system. Naïve CD4+ T cells differentiate into at least four subsets, T helper 1 (Th1), T helper 2 (Th2), T helper 17 (Th17), and T regulatory (Treg) cells. The master regulator controlling each subset have been defined as follows, Tbet (Th1), Gata3 (Th2), RORγt (Th17), FoxP3 (Treg). The purpose of this study was to compare the effect of WCT and dry-cupping therapy (DCT) on the ratios of Th1/Th2 and Treg /Th17 in healthy individuals. MATERIALS AND METHODS: Participants were divided randomly into two groups of 41 men in the WCT group and 40 men in the DCT group. Blood was taken, before, one and four weeks after the intervention. RNA was extracted from the peripheral blood mononuclear cells and the expression of T-bet, GATA-3, RORγt, and Foxp3 genes were determined by using SYBR green RT-PCR technique. RESULTS: The results showed that WCT increased the expression ofGATA-3, RORγt, and Foxp3 transcription factor genes (p=0.009, p=0.001, and p=0.021, respectively). Although in the WCT group, the ratio of Foxp3/RORγt increased (p=0.048), but the ratio of T-bet/GATA-3 (Th1/Th2) decreased (p=0.971). CONCLUSION: Our findings indicated that WCT may regulate the T subsets of lymphocyte and reduce inflammation.

Effects of a Novel Barley-Based Formulation on Allergic Rhinitis: A Randomized Controlled Trial.

OBJECTIVE: Current treatment options for Allergic Rhinitis (AR) may have their own limitations and side effects. This study aimed to investigate the effects of Ma-al-Shaeer (MS), a novel natural formulation based on Hordeum vulgare, in the treatment of AR compared with Fexofenadine (FX). METHODS: A total of 77 patients with AR were divided into two groups: MS group (n=38) and FX group (n=39). The first group received 15 g of dried MS powder, and the second group received 60 mg of FX twice daily for 14 days. At baseline (week zero) and after the 14-day treatment period (week two), both groups were evaluated for sneezing, rhinorrhea, nasal congestion, nasal itching, post nasal drip, eye, throat, or ear symptoms, headache, cough, mental function, quality of life scores, blood eosinophil count and total IgE levels. Rhinitis control assessment tests were conducted at week zero and again at one week after cessation of treatment (week three) in both groups. RESULTS: All symptoms of AR except cough were significantly reduced in both groups; for nasal congestion, post nasal drip, and headache, the MS treatment was found to be superior. Rhinitis control was significantly increased after treatment in both groups (p value < 0.001). Both drugs significantly reduced total IgE levels. There was no significant change in eosinophil count in either group. CONCLUSION: MS formulation based on H. vulgare may be an effective treatment for AR. Further studies are needed to confirm the effect of MS as an alternative treatment in AR.

Comparison of the therapeutic effect of the Persian Medicine Protocol with the common treatment of chronic rhinosinusitis: a randomized clinical trial.

BACKGROUND: Chronic rhinosinusitis is one of the most common diseases affecting the quality of life of patients. Patients suffer from high costs in the diagnosis and treatment of the disease. Frequent recurrence and failure of therapeutic protocols are among the most important issues in the management of this disease. In view of this, the use of traditional and complementary therapies to promote the treatment of this disease has been increasingly taken into account. OBJECTIVE: Comparison of the effectiveness of the Persian Medicine Protocol with the conventional therapy in the treatment of chronic rhinosinusitis. METHODS: A randomized clinical trial was conducted at Imam Reza Hospital in Mashhad, Iran from July 2016 to March 2017. For patients with chronic rhinosinusitis symptoms, endoscopy of the sinuses was performed by an ENT specialist and in the case of negative endoscopy, paranasal sinus CT scan was requested. A total of 42 patients with chronic rhinosinusitis were randomly assigned to two groups. The first group (classical) received systemic and intranasal cortisone, and the second group (traditional) received a therapeutic Persian medicine protocol including intranasal lavender oil, and Liquorice Marjoram Tea (L. M. tea) for six weeks. The symptoms of the patients were evaluated using the SNOT-22 questionnaire at the beginning of the study and at the sixth week. If no improvement occurs, treatment continued for 12 weeks. Data were analyzed by SPSS version 16, using ANOVA, independent-samples and paired-samples t-test, Wilcoxon signed-rank test, and simple linear regression. RESULTS: In 20 patients in the traditional group, the decrease in SNOT score was observed as 56% after 6 weeks treatment (p=0.001), which is similar to the effect of the first group (classical). Although there was no statically significant difference between the two groups, in clinical terms, the difference in mean systemic symptoms such as confusion with 1.05 (p=0.5) and fatigue with 1.63 (p=0.01) had more improvement in the traditional group, and the difference in mean local symptoms such as nasal congestion with 2.37 (p=0.78) and runny nose with 1.95 (p=0.14) had a more decrease in the classical group. CONCLUSION: The results of this trial indicate the effectiveness of the Persian Medicine Protocol (including Lavender oil and L.M tea) in the treatment of chronic rhinosinusitis, especially on improving systemic symptoms. Nevertheless more clinical studies are necessary to support the acquired results. TRIAL REGISTRATION: This trial was registered at the Iranian Center for Clinical Trials (ID: IRCT2015112425217N1). FUNDING: This research is part of a PhD thesis and is funded by the Vice-Chancellor for Research at Mashhad University of Medical Sciences, Grant No. 931673.

Reliability and validity assessment of gastrointestinal dystemperaments questionnaire: a novel scale in Persian traditional medicine.

BACKGROUND: Development of a questionnaire based on the resources of Persian traditional medicine seems necessary. One of the problems faced by practitioners of traditional medicine is the different opinions regarding the diagnosis of general temperament or temperament of member. One of the reasons is the lack of validity tools, and it has led to difficulties in training the student of traditional medicine and the treatment of patients. The differences in the detection methods, have given rise to several treatment methods. OBJECTIVE: The present study aimed to develop a questionnaire and standard software for diagnosis of gastrointestinal dystemperaments. METHODS: The present research is a tool developing study which included 8 stages of developing the items, determining the statements based on items, assessing the face validity, assessing the content validity, assessing the reliability, rating the items, developing a software for calculation of the total score of the questionnaire named GDS v.1.1, and evaluating the concurrent validity using statistical tests including Cronbach's alpha coefficient, Cohen's kappa coefficient. RESULTS: Based on the results, 112 notes including 62 symptoms were extracted from resources, and 58 items were obtained from in-person interview sessions with a panel of experts. A statement was selected for each item and, after merging a number of statements, a total of 49 statements were finally obtained. By calculating the score of statement impact and determining the content validity, respectively, 6 and 10 other items were removed from the list of statements. Standardized Cronbach's alpha for this questionnaire was obtained 0.795 and its concurrent validity was equal to 0.8. CONCLUSION: A quantitative tool was developed for diagnosis and examination of gastrointestinal dystemperaments. The developed questionnaire is adequately reliable and valid for this purpose. In addition, the software can be used for clinical diagnosis.

Efficacy of Violet oil, a traditional Iranian formula, in patients with chronic insomnia: A randomized, double-blind, placebo-controlled study.

ETHNOPHARMACOLOGICAL RELEVANCE: Violet oil is an ancient herbal drug which has been extensively used to treat insomnia in traditional Iranian Medicine clinics. Violet oil is an almond or sesame oil-based extract of Viola odorata, which is administered as nasal drops. This study aimed to evaluate the efficacy of Violet oil in the treatment of insomnia. METHODS AND MATERIALS: This study was conducted as a 3-arm double-blind randomized trial. A total of 75 patients with chronic insomnia were enrolled and randomly assigned to three groups in Traditional Iranian Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. The treatment consisted of intranasal dropping of Violet oil, Almond oil or placebo (1% solution of Carboxymethyl cellulose) in each nostril every night before sleep for 30 days, i.e. three drops of the drug (including either Violet oil or Almond oil) or the placebo was used every night before the sleep. All the patients were asked to complete Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) questionnaires before and after the intervention. RESULTS: There were no significant differences between patients in the three groups before the intervention (P > 0.05). However, there were significant differences between the three groups after the intervention in ISI scores (P<0.002) and PSQI scores (p<0.001). When comparing the pre- and post-treatment data, the ISI and PSQI scores improved significantly in all the three groups as follows: Violet oil (P<0.001), Almond oil (P<0.001) and placebo (P<0.001). The results also showed that the Violet oil had the most effect among the three groups. In addition, it was more effective on sleep quality than sleep quantity. CONCLUSION: Considering the effects of natural nasal drug on the improvement of sleep quality in insomniac patients, this study has proposed the use of Violet oil as a natural and herbal drug in a non-oral method without serious side effects for treatment of insomnia.

A systematic review of randomized controlled trials with herbal medicine on chronic rhinosinusitis.

Chronic rhinosinusitis (CRS) is a common disease with evidence to show that its incidence and prevalence are increasing. Medicinal plants are commonly used to treat CRS. This systematic review aimed to assess the effectiveness and safety of herbal preparations for treatment of the patients with CRS. Cochran, Embase, ISI, PubMed, and Scopus databases were searched until August 1, 2016. Only randomized controlled trials were included. Four randomized controlled trials were included in this systematic review. Various medicinal plants were studied in each article. Inclusion and exclusion criteria, and outcome measures varied among different articles. The results of this trials showed that this special medicinal plants may be effective in the treatment of CRS. No serious reactions were reported during the administration of herbal remedies in the 4 studies. However, trials with a well-designed approach are needed to study the actual safety and efficacy of herbs in the treatment of CRS.

Exploring Hepatitis From the Perspective of Iranian Traditional Medicine: Using a Qualitative Approach.

Hepatitis is a global health problem, with significant adverse impacts on patients' quality of life. In this study, we aimed to review major resources of Iranian traditional medicine and determine whether the etiology and semiology of hepatitis, in particular chronic hepatitis, in traditional and conventional medicine might be aligned. Through such studies, we might be able to develop new approaches for clinical research to improve our current knowledge on the etiology and treatment of this condition. In this qualitative study, recently published studies, scientific databases, and reliable Iranian traditional medicine resources, including the Canon of Medicine, were searched. The integrative use of conventional and traditional medicine for diagnostic and therapeutic purposes could be evaluated to develop new modalities for dealing with this condition. An integrated approach is recommended in clinical research in order to find more efficient and safer treatment.

Nutritional and Therapeutic Characteristics of Camel Milk in Children: A Systematic Review.

INTRODUCTION: Camel milk is the closest to a human mother's milk. Camel milk is different from other milks, however, having low sugar and cholesterol, high minerals (sodium, potassium, iron, copper, zinc and magnesium, and vitamin C). The milk is considered have medicinal characteristics as well. This systematic review is aimed at determining and reporting nutritional values and medicinal characteristics of camel milk in children. METHODS: The search strategy of the current review is "(camel AND milk) AND (autism OR food allergy OR milk allergy OR children OR diarrhea." The search was conducted via PubMed, Scopus, and Google scholar. Also two Persian scientific databases (SID and Iranmedex) and international congresses were investigated. Full-text papers and abstracts on the topic of camel milk, evaluating nutritional value and medicinal properties, were included in this systematic review. RESULTS: Out of the 472 records found in the resources, 35 related studies were included in the final analysis. The result showed that camel milk is highly nutritious and is safe for consumption by children. CONCLUSION: It seems that many researchers did not follow a specific guideline for reporting and confirming the therapeutic properties of camel milk in children, but there is evidence denoting the importance, trials, and investigations of its usability and benefits. Camel milk as a supplemental treatment seems less invasive and costly than specialist care, medications, alternative treatments, and behavioral interventions. Based on our findings, camel milk is safer for children, effective in the treatment of autism, improves general well-being, promotes body natural defenses, is a good nutritional source, and can helps the daily nutritional needs of humans.