The effects of conjugated linoleic acid supplementation on anthropometrics and body composition indices in adults: a systematic review and dose-response meta-analysis.

Prior meta-analytic investigations over a decade ago rather inconclusively indicated that conjugated linoleic acid (CLA) supplementation could improve anthropometric and body composition indices in the general adult population. More recent investigations have emerged, and an up-to-date systematic review and meta-analysis on this topic must be improved. Therefore, this investigation provides a comprehensive systematic review and meta-analysis of randomised controlled trials (RCT) on the impact of CLA supplementation on anthropometric and body composition (body mass (BM), BMI, waist circumference (WC), fat mass (FM), body fat percentage (BFP) and fat-free mass (FFM)) markers in adults. Online databases search, including PubMed, Scopus, the Cochrane Library and Web of Science up to March 2022, were utilised to retrieve RCT examining the effect of CLA supplementation on anthropometric and body composition markers in adults. Meta-analysis was carried out using a random-effects model. The I2 index was used as an index of statistical heterogeneity of RCT. Among the initial 8351 studies identified from electronic databases search, seventy RCT with ninety-six effect sizes involving 4159 participants were included for data analyses. The results of random-effects modelling demonstrated that CLA supplementation significantly reduced BM (weighted mean difference (WMD): -0·35, 95 % CI (-0·54, -0·15), P < 0·001), BMI (WMD: -0·15, 95 % CI (-0·24, -0·06), P = 0·001), WC (WMD: -0·62, 95% CI (-1·04, -0·20), P = 0·004), FM (WMD: -0·44, 95 % CI (-0·66, -0·23), P < 0·001), BFP (WMD: -0·77 %, 95 % CI (-1·09, -0·45), P < 0·001) and increased FFM (WMD: 0·27, 95 % CI (0·09, 0·45), P = 0·003). The high-quality subgroup showed that CLA supplementation fails to change FM and BFP. However, according to high-quality studies, CLA intake resulted in small but significant increases in FFM and decreases in BM and BMI. This meta-analysis study suggests that CLA supplementation may result in a small but significant improvement in anthropometric and body composition markers in an adult population. However, data from high-quality studies failed to show CLA's body fat-lowering properties. Moreover, it should be noted that the weight-loss properties of CLA were small and may not reach clinical importance.

The effects of L-carnitine supplementation on inflammatory and anti-inflammatory markers in adults: a systematic review and dose-response meta-analysis.

L-carnitine supplementation may be beneficial in improving inflammatory conditions and reducing the level of inflammatory cytokines. Therefore, according to the finding of randomized controlled trials (RCTs), the systematic review and meta-analysis aimed to investigate the effect of L-carnitine supplementation on inflammation in adults. To obtain acceptable articles up to October 2022, a thorough search was conducted in databases including PubMed, ISI Web of Science, the Cochrane Library, and Scopus. A random-effects model was used to estimate the weighted mean difference (WMD). We included the 48 RCTs (n = 3255) with 51 effect sizes in this study. L-carnitine supplementation had a significant effect on C-reactive protein (CRP) (p < 0.001), interleukin-6 (IL-6) (p = 0.001), tumor necrosis factor-α (TNF-α) (p = 0.002), malondialdehyde (MDA) (p = 0.001), total antioxidant capacity (TAC) (p = 0.029), alanine transaminase (ALT) (p < 0.001), and aspartate transaminase (AST) (p < 0.001) in intervention, compared to the placebo group. Subgroup analyses showed that L-carnitine supplementation had a lowering effect on CRP and TNF-α in trial duration ≥ 12 weeks in type 2 diabetes and BMI ≥ 25 kg/m2. L-carnitine supplementation reduced ALT levels in overweight and normal BMI subjects at any trial dose and trial duration ≥ 12 weeks and reduced AST levels in overweight subjects and trial dose ≥ 2 g/day. This meta-analysis revealed that L-carnitine supplementation effectively reduces the inflammatory state by increasing the level of TAC and decreasing the levels of CRP, IL-6, TNF-α and MDA in the serum.

The effects of vitamin C supplementation on glycemic control in patients with type 2 diabetes: A systematic review and meta-analysis.

BACKGROUND AND AIM: It has been suggested that taking vitamin C supplements may improve glycemic control in patients with type 2 diabetes mellitus (T2DM). However, there has not been a thorough evaluation of the actual impact or certainty of the findings. This systematic review and meta-analysis was conducted to determine the effect of vitamin C supplementation on glycemic profile in T2DM patients. METHODS: A systematic search was performed across online databases including Scopus, Web of Science, and PubMed/Medline to identify relevant randomized controlled trials (RCTs) published until July 2022. A random-effects model was applied for the meta-analysis. RESULTS: The present meta-analysis included a total of 22 RCTs with 1447 patients diagnosed with T2DM.A pooled analysis revealed a significant decrease in levels of serum hemoglobin A1c (HbA1c), fasting insulin, and fasting blood glucose (FBG) in vitamin C-treated T2DM patients compared with their untreated counterparts. The dose-response evaluation displayed a substantial linear association between the intervention duration and changes in serum HbA1c levels. However, the analysis did not demonstrate any significant effect of vitamin C on serum values of homeostasis model assessment of insulin resistance(HOMA-IR) in diabetic patients. Subgroup analyses indicated that high-dose vitamin C administration (≥1000 mg/d) considerably decreased serum HOMA-IR levels. CONCLUSION: These findings suggest that long-term (≥12 weeks) and high-dose vitamin C supplementation (≥1000 mg/d) may ameliorate glycemic profile in T2DM patients. However, additional high-quality RCTs are necessary to validate these results.

The effects of conjugated linoleic acid supplementation on inflammatory cytokines and adipokines in adults: A GRADE-assessed systematic review and dose-response meta-analysis.

Background and aims: Many studies have investigated the effect of conjugated linoleic acid (CLA) supplementation on inflammatory cytokines and adipokines. However, the results of these studies are not consistent. Therefore, this systematic review and meta-analysis were designed to comprehensively evaluate the effect of CLA supplementation on inflammatory cytokines and adipokines. Methods: Randomized controlled trials (RCTs) examining the effects of CLA supplementation on C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor-alpha (TNF-α), adiponectin, and leptin, published up to March 2022, were identified through PubMed, SCOPUS, and ISI Web of Science databases. A random-effects model was used to calculate weighted mean differences (WMDs) with 95% confidence intervals (CI) for 42 studies that included 1,109 participants. Results: Findings from 42 studies with 58 arms indicated that CLA supplementation significantly decreased IL-6 and TNF-α levels and also slightly increased CRP levels. However, adiponectin and leptin levels did not change after CLA supplementation. A subgroup analysis found that CLA supplementation reduced adiponectin and leptin in women. Conclusion: Our results demonstrated that CLA supplementation increased CRP levels and decreased TNF-α and IL-6 levels. Therefore, it seems that CLA can have both proinflammatory and anti-inflammatory roles. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier (CRD42022331110).

The impact of Emblica Officinalis (Amla) on lipid profile, glucose, and C-reactive protein: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIMS: Emblica Officinalis (Amla) is a plant often utilized in traditional medicine due to its purported anti-inflammatory, antioxidant, hypoglycemic, and hypolipidemic properties. However, current evidence regarding its potential for preventing and treating metabolic abnormalities associated with chronic diseases remains unclear. METHODS: This systematic review and meta-analysis aimed to examine the effects of Amla supplementation on lipid profile, glucose, and C-reactive protein (CRP) concentrations in adults. We completed a systematic search (current as of December 2022) of all available randomized controlled trials (RCTs) in the database including ISI Web of Science, PubMed, Scopus, and Embase. Any effect's mean difference (MD) was calculated using a random-effects model. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated also calculated using a random-effects model. RESULTS: Five RTCs were included in the meta-analysis. Following Amla supplementation, pooled results showed a significant reduction in CRP (p = 0.002), fasting blood glucose (FBG) (p < 0.001), low-density lipoprotein cholesterol (LDL-c) (p < 0.001), total cholesterol (TC) (p < 0.001), and serum triglyceride (TG) (p < 0.001) concentrations as well as an increase in high-density lipoprotein cholesterol (HDL-c) (p < 0.001). The baseline concentration of biochemical indicators was used for subgroup analysis. CONCLUSION: Amla supplementation shows promise for improving metabolic parameters in adults. In general, the populations included in the analysis were generally 40-58 years with an average BMI of 25.5 and a length of intervention ranging from 3 to 12 weeks. Thus additional investigations are warranted to confirm and expand the findings presented herein.

The effects of guar gum supplementation on glycemic control, body mass and blood pressure in adults: A GRADE-assessed systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: This systematic review and meta-analysis sought to evaluate the effects ofguar gum supplementation on glycemic control, blood pressure, and body mass in adults. METHODS: Relevant studies were obtained by searching the PubMed, SCOPUS, Embase, and Web of Science databases (from inception to January 2022). Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity, sensitivity analysis, and publication bias were reported using standard methods. RESULTS: Pooled analysis of 14 randomized controlled trials (RCTs) revealed that guar gum supplementation led to significant reductions in hemoglobin A1c (HbA1c) (WMD: -0.47 mg/dL, 95% CI: -0.75, -0.18, p = 0.001). However, there was no effect on fasting blood sugar (FBS), systolic and diastolic blood pressure, and body mass among adults in comparison with the control group. A subgroup analysis demonstrated that intervention in patients with type 2 diabetes (T2DM), and high supplementation dosages (>15 g/d) significantly decreased FBS concentrations, but not in other subgroups. CONCLUSION: Guar gum supplementation may yield a beneficial effect on glycemic control in T2DM patients. However, the extant clinical trials, thus far, are not sufficient enough to form guidelines for clinical practice.

The effects of folic acid supplementation on endothelial function in adults: a systematic review and dose-response meta-analysis of randomized controlled trials.

BACKGROUND: Endothelial dysfunction serves as an early marker for the risk of cardiovascular disease (CVD); therefore, it is an attractive site of therapeutic interventions to reduce the risk of CVD. This study was conducted to investigate the effect of folic acid supplementation on endothelial function markers in randomized controlled trials (RCTs). METHODS: PubMed, ISI web of science, and Scopus databases were searched up to July 2022 for detecting eligible studies. A random-effects model was used for meta-analysis, and linear Meta-regression and non-linear dose-response analysis were performed to assess whether the effect of folic acid supplementation was affected by the dose and duration of intervention. Cochrane tools were also used to assess the risk of bias in the included studies. RESULTS: Twenty-one studies, including 2025 participants (1010 cases and 1015 controls), were included in the present meta-analysis. Folic acid supplementation significantly affected the percentage of flow-mediated dilation (FMD%) (WMD: 2.59%; 95% CI: 1.51, 3.67; P < 0.001) and flow-mediated dilation (FMD) (WMD: 24.38 µm; 95% CI: 3.08, 45.68; P = 0.025), but not end-diastolic diameter (EDD) (WMD: 0.21 mm; 95% CI: - 0.09, 0.52; P = 0.176), and intercellular adhesion molecule (ICAM) (WMD: 0.18 ng/ml; 95% CI: - 10.02, 13.81; P = 0.755). CONCLUSIONS: These findings suggest that folic acid supplementation may improve endothelial function by increasing FMD and FMD% levels. TRIAL REGISTRATION: PROSPERO registration cod: CRD42021289744.

The effects of Gymnema Sylvestre supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults: A systematic review and meta-analysis.

There is a growing interest in the considerable health benefits of Gymnema Sylvestre (GS) supplementation, as some studies have reported that it may improve cardiometabolic risk factors. However, the widespread impact of GS supplementation on the parameters mentioned above is not fully resolved. Consequently, this study aimed to examine the effects of GS supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults. Eligible randomized controlled trials (RCT), published up to November 2021, were identified through PubMed, Scopus, and ISI Web of Science databases. Six studies were included and analyzed using a random-effects model to calculate weighted mean differences (WMDs) with 95% confidence intervals (CI). All studies were conducted in adults that used a GC supplement (>1 week) and assessed our selected cardiovascular risk factors. Outcomes revealed that GS supplementation significantly decreased triglyceride (p < .001), total cholesterol (p < .001), low-density lipoprotein (p < .001), fasting blood sugar (p < .001), and diastolic blood pressure (p = .003). Some limitations, including notable heterogeneity, low quality of studies, and lack of diversity among research participants, should be considered when interpreting our results. Our outcomes suggest that GS supplementation may improve cardiovascular risk factors. Future large-high-quality RCTs with longer duration and various populations are needed to firmly establish the clinical efficacy of the plant.

The effects of conjugated linoleic acid supplementation on lipid profile in adults: A systematic review and dose-response meta-analysis.

Background: The findings of trials investigating the effect of conjugated linoleic acid (CLA) administration on lipid profile are controversial. This meta-analysis of randomized controlled trials (RCTs) was performed to explore the effects of CLA supplementation on lipid profile. Methods: Two authors independently searched electronic databases including PubMed, Web of Science, and Scopus until March 2022, in order to find relevant RCTs. The random effects model was used to evaluate the mean and standard deviation. Results: In total, 56 RCTs with 73 effect sizes met the inclusion criteria and were eligible for the meta-analysis. CLA supplementation significantly alter triglycerides (TG) (WMD: 1.76; 95% CI: -1.65, 5.19), total cholesterols (TC) (WMD: 0.86; 95% CI: -0.42, 2.26), low-density lipoprotein cholesterols (LDL-C) (WMD: 0.49; 95% CI: -0.75, 2.74), apolipoprotein A (WMD: -3.15; 95% CI: -16.12, 9.81), and apolipoprotein B (WMD: -0.73; 95% CI: -9.87, 8.41) concentrations. However, CLA supplementation significantly increased the density lipoprotein cholesterol (HDL-C) (WMD: -0.40; 95% CI: -0.72, -0.07) concentrations. Conclusion: CLA supplementation significantly improved HDL-C concentrations, however, increased concentrations of TG, TC, LDL-C, apolipoprotein A, and apolipoprotein B. Systematic review registration: https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022331100.

The effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis.

Cardiovascular disease (CVD) is a major concern today. Herbal medicine is one helping way to control CVD risks. One conclusive of herbal medicine is Berberine (BBR) and converse about it still exists, to clarify this issue, this meta-analysis was performed. PubMed/Medline, Scopus, and Web of Science were searched for RCTs in adults on the effect of BBR supplementation on CVD risk factors up to July 2022. The pooled results showed BBR significantly reduced triglyceride (WMD = -23.70 mg/dl; 95%CI -30.16, -17.25; P < 0.001), total cholesterol (WMD = -20.64 mg/dl; 95%CI -23.65, -17.63; P < 0.001), low-density lipoprotein WMD = -9.63 mg/dl; 95%CI, -13.87, -5.39; P < 0.001), fasting blood glucose (FBG) (WMD = -7.74 mg/dl; 95%CI -10.79, -4.70; P < 0.001), insulin (WMD = -3.27 mg/dl; 95%CI -4.46,-2.07; P < 0.001), HbA1c (WMD = -0.45%; 95%CI -0.68, -0.23; P < 0.001), HOMA-IR (WMD = -1.04; 95%CI -1.55, -0.52; P < 0.001), systolic blood pressure (WMD = -5.46 mmHg; 95%CI -8.17, -2.76; P < 0.001), weight (WMD = -0.84; 95%CI -1.34,-0.34; P < 0.001), body mass index (WMD = -0.25 kg/m2; 95%CI -0.46, -0.04; P = 0.020), while increased high-density lipoprotein (HDL) (WMD = 1.37 mg/dl; 95%CI 0.41,2.23; P = 0.005). The optimal dose of BBR was 1 g/day for TG, TC, and weight, 1.8 g/day for insulin and HOMA-IR, and 5 g/day for HDL. FBG's most efficient time frame was 40 weeks from the beginning of supplementation, whereas DBP and waist circumference was 50 weeks. In conclusion, the lipid profile, FBG balance, obesity parameters, and SBP were improved with BBR supplementation. Systematic review registration: CRD42022347004.

The effect of grape products on liver enzymes: A systematic review and meta-analysis of randomized controlled trials.

The favorable influence of grape consumption on metabolic diseases has previously been shown in studies. We sought to assess the effects of grape intake on liver enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), in adults. We performed literature search in online databases, to find eligible randomized controlled trials (RCTs). we considered RCTs that met the following criteria: RCTs consisted of use of grape products on ALT, AST, and ALP in adults (≥18 years) with at least 2 weeks intervention duration. Pooling data from 11 trials showed that grape products intake significantly reduced ALP (p = .010), without any significant changes in ALT (p = .234) and AST (p = .300). In subgroup analysis, we found a significant reduction in ALP, ALT, and AST when the duration of intervention was ≥12 weeks, and when grape seed extract (GSE) was administered. The variable duration and dosage of intervention was one of the sources of bias in our meta-analysis. Additionally, participants involved in included studies had different physiological status and various age groups. Grape products administration may significantly improve ALT, AST, and ALP in adults in long-term interventions and/or when GSE is administered. It should be noted that the favorable effects of grape consumption were small and may not reach clinical importance.

The effects of conjugated linoleic acid supplementation on liver function enzymes and malondialdehyde in adults: A GRADE-assessed systematic review and dose-response meta-analysis.

BACKGROUND: Previous research reported inconsistent findings regarding the effects of conjugated linoleic acid (CLA) supplementation on liver enzymes. This systematic review and meta-analysis was conducted to summarize data from available randomized clinical trials (RCTs) on the effect of CLA supplementation on alanine aminotransferase (ALT), aspartate aminotransferase (AST) and malondialdehyde (MDA) in adults. METHODS: Google Scholar, PubMed, Web of Science, Scopus, and the Cochrane databases were investigated to identify relevant articles up to July 2022. The weighted mean differences (WMD) and 95 % confidence intervals (CI) were calculated via a random-effects model to evaluate the effect size. Between studies, heterogeneity was evaluated by the Cochran's Q test and I2. RESULTS: 22 RCTs with 26 effect sizes were included. The effect size for ALT (IU/L), AST (IU/L), and MDA (µmol/L) were 19, 19 and 6 respectively. The pooled analysis demonstrated CLA decreases MDA (p = 0.003). However, ALT and AST levels did not change after CLA supplementation compared with control group. CONCLUSION: CLA supplementation may significantly reduce MDA levels as a marker of oxidative stress. However, supplementing with CLA failed to alter ALT and AST.

The Effects of Magnesium Supplementation on Serum Magnesium and Calcium Concentration in Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The aim of this systematic review and meta-analysis was to summarize all the existing randomized controlled trials (RCTs) evidence and to evaluate the effects of magnesium supplementation on serum magnesium, calcium and urinary magnesium concentrations in patients with type 2 diabetes compared with the control. Two independent authors systematically searched online databases including Embase, Scopus, PubMed, and Web of Science from inception until 30th January 2022. RCTs complying with the inclusion criteria were included in this meta-analysis. The heterogeneity among the included studies was assessed using Cochrane's Q test and I-square (I2) statistic. Data were pooled using a random-effects model and weighted mean difference (WMD) was considered as the overall effect size. Sixteen trials were included in this meta-analysis. Serum magnesium (mean difference, 0.15 mg/dL; 95% confidence interval [CI], 0.06 to 0.23; p = 0.001) and urinary magnesium (WMD, 1.99 mg/dL; 95% CI, 0.36 to 3.62; p = 0.017) concentrations were significantly increased after magnesium supplementation when compared with the control group. However, magnesium supplementation did not have any significant effect on serum calcium (WMD, -0.09 mg/dL; 95% CI, -0.27 to 0.08; p = 0.294) level when compared with the control group. This meta-analysis demonstrated that magnesium supplementation significantly increased Serum magnesium levels which may have played an indirect role in improved clinical symptoms in patients with type 2 diabetes.

The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis.

Background and aims: Hyperglycemia and insulin resistance are concerns today worldwide. Recently, L-carnitine supplementation has been suggested as an effective adjunctive therapy in glycemic control. Therefore, it seems important to investigate its effect on glycemic markers. Methods: PubMed, Scopus, Web of Science, and the Cochrane databases were searched in October 2022 for prospective studies on the effects of L-carnitine supplementation on glycemic markers. Inclusion criteria included adult participants and taking oral L-carnitine supplements for at least seven days. The pooled weighted mean difference (WMD) was calculated using a random-effects model. Results: We included the 41 randomized controlled trials (RCTs) (n = 2900) with 44 effect sizes in this study. In the pooled analysis; L-carnitine supplementation had a significant effect on fasting blood glucose (FBG) (mg/dl) [WMD = -3.22 mg/dl; 95% CI, -5.21 to -1.23; p = 0.002; I 2 = 88.6%, p < 0.001], hemoglobin A1c (HbA1c) (%) [WMD = -0.27%; 95% CI, -0.47 to -0.07; p = 0.007; I 2 = 90.1%, p < 0.001] and homeostasis model assessment-estimate insulin resistance (HOMA-IR) [WMD = -0.73; 95% CI, -1.21 to -0.25; p = 0.003; I 2 = 98.2%, p < 0.001] in the intervention compared to the control group. L-carnitine supplementation had a reducing effect on baseline FBG ≥100 mg/dl, trial duration ≥12 weeks, intervention dose ≥2 g/day, participants with overweight and obesity (baseline BMI 25-29.9 and >30 kg/m2), and diabetic patients. Also, L-carnitine significantly affected insulin (pmol/l), HOMA-IR (%), and HbA1c (%) in trial duration ≥12 weeks, intervention dose ≥2 g/day, and participants with obesity (baseline BMI >30 kg/m2). It also had a reducing effect on HOMA-IR in diabetic patients, non-diabetic patients, and just diabetic patients for insulin, and HbA1c. There was a significant nonlinear relationship between the duration of intervention and changes in FBG, HbA1c, and HOMA-IR. In addition, there was a significant nonlinear relationship between dose (≥2 g/day) and changes in insulin, as well as a significant linear relationship between the duration (weeks) (coefficients = -16.45, p = 0.004) of intervention and changes in HbA1C. Conclusions: L-carnitine could reduce the levels of FBG, HbA1c, and HOMA-IR. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022358692.

Protective Effect of Combined Long Time Administration of Selenium and Vitamin C on Liver and Kidney Toxicity of Cadmium in Rats.

BACKGROUND & OBJECTIVE: Increased industrial activities leads to prolonged human exposure to industrial pollutant such as cadmium (Cd). |Chronic exposure to Cd in Mammals and also human being, can cause damages to various organs and particularly kidneys and liver. The goal of this study was to investigate the prophylactic effects of combined selenium (Se) and ascorbic acid supplement in rat cadmium toxicity. METHODS: Sixty adult male Wistar rats were divided to 10 groups: one control, one sham and two clusters of 4 intervention groups which were fed with 1 or 5 mg Cd /kg water, for 28 days. Ascorbic acid supplement was added to drinking water of four groups (10 mg/L). Four groups received intraperitoneal Se (1 mg/kg) at day 1, 5, 10, 15, 20 and 25. Finally, Cd concentration was measured by atomic absorption spectrophotometry in liver and kidney sections. Furthermore, pathological changes were investigated in these sections. RESULTS: The results showed weight gain in Cd groups which received ascorbic acid and Se, in contrast to weight loss in parallel groups without vitamin C and Se. The stronger necrosis and inflammation have been observed in group received 5 mg/kg Cd compared to group with 1 mg/kg Cd (P<0.05). In addition, cadmium level was higher in untreated groups without any supplements, significantly (P<0.05). CONCLUSION: Drinking water with ascorbic acid may have prophylactic effects across cadmium, and combination of Se and ascorbic acid are associated with higher prophylactic effects in both kidney and liver in rats to decrease the Cd toxicity.

Etiology and therapeutic management of neonatal jaundice in Iran: a systematic review and meta-analysis.

BACKGROUND: Jaundice is a life-threatening disorder in the neonates. In the present study, we aimed to assess systematically available evidence on causes and management of jaundice in Iranian newborn patients. METHODS: We searched the databases of PubMed, Web of Sciences, Scopus and Google Scholar for English articles published since inception until May 2019. A search was also done for Persian articles in Magiran and Scientific Information Database. Studies were evaluated based on predefined criteria by two reviewers. Data analysis was performed by STATA software. RESULTS: A total of 33 articles were finally included. The overall pooled prevalence of causes of jaundice among Iranian neonates was as follows: ABO blood groups incompatibility, 16.9% [95% confidence interval (CI) 10.9-22.8]; Rh blood group incompatibility, 4% (95% CI 2.5-5.5); ABO and Rh blood groups incompatibility, 3.6% (95% CI 0-7.7); glucose-6-phosphate dehydrogenase (G6PD) deficiency, 6.3% (95% CI 5.1-7.5); infection, 6.6% (95% CI 5.2-8.1); hypothyroidism, 4.2% (95% CI 0.1-8.3); infant of diabetic mother: 2.3% (95% CI 0.1-4.5); unknown, 50.7% (95% CI 33.4-68); cephalohematoma, 0.6% (95% CI 0.3-0.9). Regarding treatment of icterus, seven and eight articles were found on phototherapy and exchange transfusion, respectively. In five studies, all patients underwent phototherapy, but rate of exchange transfusion use was between 6.6% and 50.9%. CONCLUSIONS: According to the results, unknown factors were the most common causes of icterus in Iranian neonates, followed by ABO blood groups incompatibility, infections and G6PD deficiency. By the way, phototherapy and exchange transfusion were found as therapeutic choices of neonatal jaundice.

The effect of intravenous magnesium sulfate and lidocaine in hemodynamic responses to endotracheal intubation in elective coronary artery bypass grafting: a randomized controlled clinical trial.

BACKGROUND: There have been many concerns about alteration in hemodynamic parameters within and shortly after endotracheal intubation (ETI) in patients scheduled for elective coronary artery bypass grafting (CABG). OBJECTIVES: We compared the attenuation effect of magnesium sulfate and lidocaine on hemodynamic responses after ETI, in patients undergoing CABG. PATIENTS AND METHODS: In this randomized controlled trial 150 patients undergoing elective CABG were enrolled. Included patients were randomly allocated to three groups and received lidocaine (1.5 mg/kg), magnesium sulfate (50 mg/kg within five minute), or normal saline, 90 seconds before ETI. Baseline hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded immediately before anesthesia induction, before intubation, immediately after intubation, and at second and fifth minutes after intubation. RESULTS: The baseline hemodynamic variables had no deference among the three groups. HR between intubation and five minute after intubation was significantly lower in two groups received lidocaine or magnesium sulfate in comparison with placebo group. Lidocaine induced more than 20% decrease in HR and MAP immediately after intubation; hence, lidocaine group showed significant MAP reduction in comparison with the two other groups. CONCLUSIONS: Lidocaine induced hemodynamic instability but premedication of magnesium sulfate maintained hemodynamic stability after intubation. Therefore, in patients undergoing CABG who received high-dose intravenous analgesic for general anesthesia, the administration of magnesium sulfate might result in maintaining hemodynamic stability after ETI in comparison with lidocaine.

Rhazes viewpoints about causes, diagnosis, treatment and prognosis of gout.

Gout, a medical condition of acute inflammatory joint disorders, has been recognized from the antiquity. However, the name of Rhazes, a Persian historic physician who has described the etiology, signs, symptoms, epidemiology, treatment and prevention of this malady more than a thousand year ago, hasn't been taken into consideration appropriately. In this article, we studied and reported several chapters of Alhawi which is considered the most important Rhazes's medical textbook, focussing on his hypotheses because he has described this disease more manifestly. His original manuscripts are originally written in Arabic and they hadn't been translated to Persian until 1998. We intend to compare Rhazes opinions about gout with those of the literature in the area of rheumatology. According to our findings, Rhazes documented the symptoms of gout and categorized them scientifically. His insights about the treatment of gout, side effects of pharmacotherapy and management of the patients are so interesting and wonderful. Generally most of Rhazes viewpoints about gout are correct and compatible with recent findings. More investigation on Rhazes' viewpoints can guide us to propose more reliable hypothesis and schematize cost effective studies by delving into past medical records.

Effect of silymarin in the treatment of allergic rhinitis.

OBJECTIVE: Although the role of oxidative stresses has been confirmed in the pathophysiology of allergic rhinitis and the protective effect of silymarin against oxidative stresses has been proven in different organs, no study has yet been conducted on the impact of silymarin on allergic rhinitis treatment. STUDY DESIGN: A randomized clinical trial study. SETTING: Two tertiary referral centers with otorhinolaryngology-head and neck surgery and allergy and immunology departments. PATIENTS AND METHODS: In a randomized clinical trial, 94 patients with the signs and symptoms of allergic rhinitis and a positive skin prick test were selected and randomly divided into 2 groups. Their signs and symptoms, eosinophil percentage on nasal smear, serum IgE, and interleukin (IL-4, IL-5, interferon-γ) levels were recorded. The study group was treated with silymarin, whereas the control group received placebo, both for 1 month, along with routine antihistamine treatment. At the end of the treatment course, clinical and laboratory findings were statistically analyzed. RESULTS: Sixty patients completed the trial. Based on the Sino-Nasal Outcome Test 20 (SNOT-20), a significant improvement in clinical symptom severity was observed in both groups (9.23 ± 5.14 vs 2.20 ± 2.69; P < .001), which was statistically significantly higher in the study group (P < .001). Posttreatment percentage of nasal eosinophils and cytokine levels showed no significant difference (P > .05). Rise in serum IgE level was seen after treatment with silymarin (P = .003). CONCLUSION: Considering the statistically effective role of silymarin in alleviating the severity of allergic rhinitis symptoms, applying this herbal antioxidant along with other medications may result in better management.