The Effect of Probiotics on Phototherapy for Bilirubin Reduction in Term Neonates: A Randomized Controlled Trial.

BACKGROUND: This interventional study aimed to assess the impact of combining probiotics with phototherapy compared to using phototherapy alone on bilirubin reduction in term neonates hospitalized in neonatal wards in hospitals of western Iran. METHODS: This clinical trial study included 150 term neonates with a gestational age of 37 to 42 weeks, birth weight of more than 2500 g, and diagnosed with neonatal jaundice. Patients were equally assigned to two groups of phototherapy (wavelength 420-450 nm) with oral probiotics (PediLact drop, 10 drops daily) and phototherapy alone through a simple random sampling method. Serum bilirubin levels (SBL) at the time of intervention, and 24, 48, and 72 hours later, duration of phototherapy, duration of hospitalization, and the need for blood transfusion were compared in the two groups. We used t-test and repeated analysis of variance to compare continuous variables. SPSS24 software was used to analyze the data. The significance level was set as 0.05. RESULTS: There was no statistically significant difference found between the two groups regarding basic variables, gender, birth weight, gestational age, maternal age, and neonatal age at hospitalization time. On the first day of hospitalization, the mean serum bilirubin level (SBL) in the combinatory therapy group was 15.6 ± 1.7 mg/dl, while in the monotherapy group, it was 15.8 ± 1.6 mg/dl (p=0.584). On the second day, the mean SBL in the combinatory therapy group was 11.2 ± 2.2, whereas in the monotherapy group, it was 12.4 ± 2.1. By the third day, these levels were 7.2 ± 0.9 and 7.8 ± 0.7, respectively, with a statistically significant difference between the two groups. Repeated analysis of variance testing confirmed a statistically significant decrease in serum bilirubin levels in both groups. The average length of hospital stay for the combinatory therapy group was 2.4 ± 0.5 days, compared to 2.8 ± 0.6 days in the phototherapy group (p = 0.001). In terms of phototherapy duration, the combinatory therapy group received treatment for 26.2 ± 9.9 hours, while the phototherapy group received it for 31.4 ± 10.3 hours (p = 0.001). CONCLUSION: The findings of the present study indicate that incorporating oral probiotics into phototherapy for neonatal jaundice (icterus) treatment is associated with a reduction in phototherapy duration and hospital stay.

Corrigendum: Commentary: An evaluation of traditional Persian medicine for the management of SARS-CoV-2.

[This corrects the article DOI: 10.3389/fphar.2023.1124157.].

The Effect of Clofibrate and Phototherapy on Prolonged Jaundice due to Breast Milk in Full-Term Neonates.

Introduction: Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates. Materials And Methods: This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups. Results: Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group (P < .05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group (P = .005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh. Conclusion: This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice. Registration: IRCT2012092910933N1.

INTERDEPENDENCE OF SKIN AND UTERUS IN PERSIAN MEDICINE

Persian Medicine, which flourished in the Islamic Golden Age (9th to 12th century AD), considers the human body a unified whole whose organs are in constant interaction and equilibrium with each other. The skin is one of these interdependent organs that play an important role in protecting internal organs, and as an excretion route, it can expel substances that are not consumed by the body. Alternatively, the uterus, a vital organ in pregnancy, excretes excess body material during menstruation to maintain a woman's health. This narrative study discussed the importance of aligning the structure and function of these two organs based on the main textbooks of Persian Medicine, especially those written during this historical period. Likewise, electronic databases were used for investigating related articles. The skin and uterus are two excretory organs. When the secretion of excess material through menstruation is physiologically or pathologically impaired, the body transfers these substances to the skin as the organ associated with the uterus. Thus, the clinical manifestations of some skin diseases can be a sign of imbalance in the function of the uterus and its related organs. Consequently, the structural and functional similarities of both organs can provide a new guide in the approach to their participatory diseases in the integration of Persian and conventional medicine.

The Role of Bloodletting and Cupping in Severe Acute Urticaria and Angioedema as Skin Emergencies in Persian Medicine.

Objectives: Some dermatological diseases can be life-threatening. Urticaria and angioedema are common reasons for patients to seek treatment at an emergency department. Severe, generalized urticaria and angioedema can endanger patients' lives by involving the airways and causing anaphylactic shock. The humor-based Persian Medicine (PM) concepts of Shara and Mashara, referring to two kinds of skin lesions, have similarities to urticaria and angioedema, respectively. This article aims to provide scientific evidence regarding the application of PM as an early intervention strategy in the emergency management of urticaria and angioedema. Methods: This was a narrative review of PM studies identified by searching medical databases using search terms related to these diseases, as well as risk-associated keywords such as "fatal", "death", "life-threatening", "emergency", "cupping", and "bloodletting". Data were then compared, interpreted, and analyzed. Results: PM scholars consider the human body as a unified whole and believe in an inner power (Nature) which stems from the body. When the presence of excessive hot substances cause an imbalance of bodily humors, Nature directs their heated vapors sharply toward the skin, thus causing Shara and Mashara. If there is a high risk of inflammation spreading to vital organs under severe conditions, urgent manual interventions are crucial. Conclusion: In serious conditions of urticaria and angioedema, Fasd or bloodletting and Hijama can be effective in speeding up the control of lesions and reducing morbidity and mortality. Consequently, the development of integrated Persian and conventional medicines may provide new therapeutic pathways for skin emergencies.

Effects of Phototherapy on the Serum Magnesium Level in Neonates with Indirect Hyperbilirubinemia: A Prospective Cohort Study.

Objectives: Neonatal jaundice or hyperbilirubinemia is one of the common findings in neonatal medicine. Severe disease can cause neurological damage and even Kernicterus. Magnesium ion is the most important N-methyl-D-aspartate receptor antagonist. The most commonly used treatment for jaundice is phototherapy, but the effect of phototherapy on serum magnesium is less investigated. In this study, we aim to investigate the effects of phototherapy on total serum magnesium levels in icteric neonates. Methods: This prospective cohort study was carried out on 160 neonates with jaundice referring to the Besat Hospital of Hamadan. Based on the bilirubin level, newborns were divided into three subgroups of mild, moderate, and severe disease which were subjected to single, double, and intensive phototherapy, respectively. Serum bilirubin and magnesium levels were measured before and after phototherapy and compared using parametric tests. Results: Subjects have a mean intrauterine age of 38.8 weeks and a jaundice onset age of 3.8 days. In all groups, serum magnesium levels were within the normal range before phototherapy. After phototherapy, on the other hand, the most reduction of total serum magnesium was in the double phototherapy group, which was -0.13 ± 0.42 mg/dl (P = 0.018). The change in serum magnesium level was not significant in the single phototherapy (-0.02 ± 0.25) and intensive phototherapy (-13.55 ± 2.73) groups (P > 0.05). Conclusion: In the present study, serum magnesium did not increase significantly before the treatment in three groups. After treatment, a significant reduction was seen in the double phototherapy group.

Effect of Intravenous Fluid Adjuvant Therapy on Decreasing Serum Bilirubin during Intensive Phototherapy in Healthy Term Neonate with Severe Nonhemolytic Hyperbilirubinemia.

Background: Phototherapy is the most common form of treatment and prevention of neonatal nonconjugated hyperbilirubinemia. It seems that intravenous fluid therapy as a complementary method of phototherapy can accelerate the healing process in affected infants. This study aimed at investigating intravenous fluid therapy's effect in decreasing serum bilirubin in healthy term neonates with nonhemolytic hyperbilirubinemia under intensive phototherapy. Methods: As many as 160 healthy term infants with severe nonhemolytic hyperbilirubinemia and without exclusion criteria were enrolled. Infants were randomized to the two treatment groups (phototherapy alone and combination with intravenous fluid therapy). Serum bilirubin at admission time, 6, 12, 24, and 48 h later were measured. We evaluated decreasing serum bilirubin levels and duration of hospitalization in both groups. Results: In this study, the mean levels of serum bilirubin on admission time, 6, 12, 24, and 48 h after treatment gradually reduced in both groups; still, the decrease was not statistically significant between the two groups. Conclusions: Intravenous fluids therapy does not have a significant advantage in the process of phototherapy in healthy term neonates with severe nonhemolytic hyperbilirubinemia.

Efficacy of Persian medicine herbal formulations (capsules and decoction) compared to standard care in patients with COVID-19, a multicenter open-labeled, randomized, controlled clinical trial.

Persian medicine has recommended clinical experiences and proper herbal remedies for prevention and treatment of microbial infections and respiratory diseases. An open-label, randomized, controlled, multicenter trial was conducted at five hospitals in Tehran and Isfahan provinces of Iran on 358 hospitalized adult patients. A total of 174 patients received standard care and 184 received herbal remedies (polyherbal decoction every 8 hr and two herbal capsules every 12 hr) plus standard care for 7 days. The primary clinical endpoint was the duration of hospital stay, and secondary outcomes were clinical improvement of symptoms based on self-assessment questionnaire. Results demonstrated that these natural decoction and capsules treatment plus routine care significantly decreased duration of hospital dyspnea (3.291 day vs. 6.468 days), accelerated clinical improvement, and decreased symptoms such as dry cough, dyspnea, muscle pain, headache, fatigue, anorexia, chills, runny nose, sputum cough, and vertigo in the treatment group compared with standard-care group. Significant effects of these polyherbal formulations on improving the symptoms of COVID-19 could be incredibly promising for managing this pandemic with acceptable tolerability.

Review of Pharmacological Properties and Chemical Constituents of Pastinaca sativa.

OBJECTIVES: Pastinaca sativa (parsnip), is a plant with nutritional and medicinal properties which has been used in all over the world and study about it is rare. In Persian Medicine parsnip is named as zardak and has many uses such as laxative, libido enhancer, kidney stone crusher and diuretic. Because the wide traditional usage of parsnip, in this review the composition and pharmacological properties of this plant are discussed. METHODS: Some data base such as Cochrane, Scopus, PubMed were searched up to 2018 for studies about Pastinaca sativa. In this review study after consider to exclusion criteria, all of the English review and clinical trial were included. RESULTS: Finally, 46 articles were selected for extraction data about the parsnip. Data extraction based on these studies the most important active ingredients of parsnip include coumarins, furanocoumarins, polyacetylenes, essential oils and flavonoids. Different studies determined that Pastinaca sativa has pharmacological effects in CNS, respiratory, gastrointestinal, liver, skin, cardiovascular and urogenital diseases. CONCLUSION: The most important active ingredients in Pastinaca sativa are furanocoumarins, flavonoids and polyacetylenes, and it has many pharmacological properties, including anti-inflammatory, antispasmodic, vasodilator, antifungal, antimicrobial and antidepressant. A main mentioned side effect of parsnip is phototoxicity that was usually reported in direct skin contact. However, family and Some properties and compounds of Pastinaca sativa and Daucus carota are similar but carrots are very popular nowadays. Due to abundant active components and few clinical studies of parsnip, more Studies are recommended to evaluate the effects of it.

Corrigendum to "Comparison of Purgative Manna Drop and Phototherapy with Phototherapy Treatment of Neonatal Jaundice: A Randomized Double-Blind Clinical Trial" [Osong Public Health Res Perspect 2019;10(3):152-7].

[This corrects the article on p. 152 in vol. 10, PMID: 31263664.].

Comparison of Purgative Manna Drop and Phototherapy with Phototherapy Treatment of Neonatal Jaundice: A Randomized Double-Blind Clinical Trial.

OBJECTIVES: Herbal remedies such as purgative manna are used to treat neonatal jaundice. In this study Bilineaster drop (purgative manna) and phototherapy, and phototherapy treatment alone were compared by assessing phototherapy duration and number of days in hospital. METHODS: There were 150 consecutive term neonates with jaundice, weighting from 2,500 g to 4,000 g enrolled in this randomized double blind clinical trial. The neonates were randomly assigned to intervention and control groups. The control patients received only phototherapy and the intervention group underwent phototherapy treatment and purgative manna drop (5 drops per kg of body weight, 3 times a day). Direct and total measurements of bilirubin concentration in the serum were measured and the reduction in concentration of bilirubin was calculated. RESULTS: There were 28% of patients whose hospital duration following phototherapy was 2 days, for Bilineaster and phototherapy treatment this was 49.3% of patients. At 48 hours and 72 hours the reduction in the concentration of total bilirubin in the serum was statistically significantly different across groups (p < 0.05) but at 24 hours and 96 hours there were no significant differences between groups (p > 0.05). The reduction in direct bilirubin concentration in the serum was significantly different between groups at 72 hours and 96 hours (p > 0.001). CONCLUSION: Purgative manna and phototherapy, can statistically significantly reduce total bilirubin concentration at 48 hours and 72 hours compared with phototherapy alone, and reduce the length of hospital stay for jaundiced neonates at 2 days compared with phototherapy treatment.

The lowering of bilirubin levels in patients with neonatal jaundice using massage therapy: A randomized, double-blind clinical trial.

OBJECTIVE: Due to the effects of massage on various laboratory parameters (including those related to jaundice) in infants and the expansion of existing studies to achieve effective and safe therapy in the treatment of neonatal jaundice, this study aimed to investigate the effect of massage on bilirubin levels in cases of neonatal jaundice. METHODS: In this study, 134 patients were randomly assigned to either an intervention group (massage combined with phototherapy, n=67) or a control group (phototherapy only, n=67). In both groups, serum total bilirubin level and frequency of daily bowel movements were measured and compared during each of the first four days of treatment. RESULTS: Baseline levels of bilirubin were similar between the two groups (P>0.05). During the measurements obtained post-intervention, significant differences surfaces between the two groups in bilirubin levels and frequency of daily bowel movements (P<0.05 for both). No significant relationship was observed during days 1 and 2 of massage therapy between daily frequency of bowel movements and serum bilirubin level (P>0.05); this relationship became significant during the third and fourth days (P<0.05). CONCLUSION: Massage therapy combined with phototherapy is an effective method for reducing serum total bilirubin in infants with neonatal jaundice.

Effect of clofibrate in non-hemolytic indirect hyperbiliru-binemia in full term neonates.

OBJECTIVE: Jaundice is a common clinical problem in neonatal period which may result in brain damage even in healthy full term newborns, when it is severe. The aim of this study was to characterize the therapeutic effect of clofibrate in full term neonates who present with nonhemolytic jaundice. METHODS: A clinical controlled study was performed on 60 full term neonates who presented with non- hemolytic jaundice. 30 neonates were treated with a single oral dose of clofibrate (100 mg/Kg) plus phototherapy (case group), while 30 neonates received only phototherapy (control group). Both groups were compared in regard to post therapeutic mean total and indirect plasma bilirubin levels, admission duration and the rate of exchange transfusion. RESULTS: The reduction rate of total and indirect plasma bilirubin levels were significantly higher in the clofibrate- treated group as compared with the control group (P< 0.05). The mean duration of admission was found to be reduced from 2.9 +/- 0.9 days in the control groupl to 2.2 +/- 0.6 days in clofibrate- treated group (P=0.002). The mean plasma total bilirubin level was lower in the clofibrate- treated group. No cases required phototherapy after 48 hour in clofibrate- treated group, while 9 neonates (30%) and 2 neonates (6.7%) required phototherapy after 72 hour and 96 hour respectively in the control group. There was no difference between both the groups for sex, the time of developing jaundice and the rate of exchange transfusion. CONCLUSION: A single dose of clofibrate (100 mg/Kg) along with phototherapy is more effective than phototherapy alone in treating non-hemolytic hyperbilirubinemia in term healthy newborn infants.