Extra-Virgin Olive Oil Improves Depression Symptoms Without Affecting Salivary Cortisol and Brain-Derived Neurotrophic Factor in Patients With Major Depression: A Double-Blind Randomized Controlled Trial.

BACKGROUND: Many patients with depression are reluctant to take psychiatric medications. Hence, complementary therapies such as nutritional considerations could be advantageous. The antidepressant potential of olive oil has been proved in observational studies. OBJECTIVE: The effect of extra-virgin olive oil (EVOO) on depression symptoms and cortisol and brain-derived neurotrophic factor (BDNF) levels in patients with depression was examined. DESIGN AND PARTICIPANTS: This was a double-blind randomized controlled trial conducted on 73 patients suffering from major depressive disorder in Shiraz, Iran, in 2016. INTERVENTION: The patients were randomly assigned to intervention (EVOO) and control (sunflower oil) groups and consumed 25 mL/d of the corresponding oil for 52 days. MAIN OUTCOME MEASURES: Depression symptoms were assessed by Beck Depression Inventory-II (BDI-II) and 7-item Hamilton Depression Rating Scale (HAMD-7). Salivary cortisol levels were determined immediately after awakening and 30 minutes later. Cortisol awakening response and the area under the curve with respect to ground and increase were computed. Serum BDNF concentrations were also measured. STATISTICAL ANALYSES PERFORMED: Statistical analysis was conducted based on intention-to-treat and per-protocol approaches. Within-group changes were examined with repeated measures (for BDI-II and HAMD-7) and with paired t test (for other variables). Between-group comparisons were performed with analysis of covariance after adjustment for confounding factors. RESULTS: In intention-to-treat analysis, HAMD-7 score was the only variable with significant changes within and between groups, the latter as a greater decline in EVOO group (P = .001). BDI-II score did not show significant change in either group but the between-group comparison revealed a significant difference (P = .021). EVOO showed antidepressant effect in severely depressed patients (P = .017 for BDI-II and 0.008 for HAMD-7) but not in mild/moderate depression category. Serum BDNF concentrations, salivary cortisol levels at immediately after awakening (T0) and 30 minutes later, cortisol awakening response, the area under the curve with respect to ground and increase did not change within or between groups. Results of per-protocol analysis were not different. CONCLUSIONS: The results of this study suggested beneficial effects of EVOO on depression symptoms in patients with severe depression but not in those with mild to moderate depression. The effects were significant from both statistical and clinical points of view.

Effectiveness of yoga training program on the severity of autism.

This study examines the effect of yoga training program (YTP) on the severity of autism in children with High Function Autism (HFA). Twenty-nine children aged 7 to 15 (mean = 11.22, SD = 2.91) years were randomly allocated to either yoga or control group. The participants in the yoga group received an 8-week (24-session) Yoga Training Program (YTP). Parents or caregivers of participants completed autism treatment evaluation checklist (ATEC) at baseline and the end of the intervention. The results of the analysis showed that there were significant differences between the two groups with regards to all ATEC sub-scores except ATEC I (speech/language/communication). This study provides support for the implementation of a yoga training program and identifies specific procedural enhancements to reduce the severity of symptoms in children with autism.

Vitamin C as an adjuvant for treating major depressive disorder and suicidal behavior, a randomized placebo-controlled clinical trial.

BACKGROUND: There are some animal studies suggesting the possible role of vitamin C for treating depression. However, the efficacy of vitamin C for treating adult patients with major depressive disorder (MDD) has never been examined. METHODS: This 8-week randomized double-blind placebo-controlled clinical trial included adult patients with major depressive disorder according to DSM-IV diagnostic criteria. Twenty-one patients in the treatment group received citalopram plus vitamin C and the 22 patients in the control group received citalopram plus placebo. The Hamilton Depression Rating Scale was used to measure depressive symptoms at baseline, week 2, week 4, and week 8. We also checked for the presence of adverse effects. RESULTS: While depression symptoms decreased in both groups during this trial, there was no statistically significant difference between the 2 groups (P = .5). The rate of remission, partial response, and complete response was not different between the two groups. The rate of adverse effects were not different between the two groups. CONCLUSION: Adding vitamin C to citalopram did not increase the efficacy of citalopram in MDD patients. Vitamin C plus citalopram is as effective as placebo plus citalopram for treating adult patients with suicidal behavior. No serious adverse effect for this combination was identified during this trial. TRIAL REGISTRATION: This trial was registered at http://www.irct.ir . The registration number of this trial was: IRCT201312263930N31 . Date registered: 5 July 2014.

Efficacy and safety of jollab to treat functional dyspepsia: a randomized placebo-controlled clinical trial.

BACKGROUND: Functional dyspepsia (FD) is a common gastrointestinal disease that is highly prevalent worldwide. Because of its heterogeneous pathophysiology, treatment options for FD can be difficult to choose; in this context, complementary and alternative medicine modalities have been suggested as promising options. AIM: To evaluate the efficacy of a traditional Persian medicine, jollab, in reducing patients' FD symptoms. METHODS: In a double-blind randomized clinical trial, 160 patients with a diagnosis of FD were enrolled and treated with either jollab or placebo (15ml, t.i.d., four weeks, orally). The outcomes reported were changes in symptom frequency and severity as recorded in patients' diaries and evaluated with the Short Form of the Leeds Dyspepsia Questionnaire (SF-LDQ), and physical examination. RESULTS: The response rate was higher in the treatment group (78%) than in the placebo group (31%) according to per-protocol sample analysis (P < .001). Symptoms of FD disappeared significantly more frequently, and the rate of concomitant synthetic drug consumption was significantly lower, in the jollab group compared to the placebo group at the end of the trial. Mean total symptom frequency and severity according to the SF-LDQ score was 1.55 ± 2.78 in the treatment group versus 5.61 ± 3.80 in the placebo group at the last follow-up time point (P < .001). A promising safety profile for jollab was observed throughout the trial. CONCLUSIONS: In patients with FD, jollab appeared to be more effective than the placebo. Complementary and alternative therapies such as the use of this traditional medicinal substance may be beneficial in relieving symptoms of dyspepsia [ACTRN12613000584730].

INSIGHTS INTO AVICENNA'S KNOWLEDGE OF GASTROINTESTINAL MEDICINE AND HIS ACCOUNT OF AN ENEMA DEVICE.

Avicenna (980-1037 AD), also known as Sheikh or-Raeis, was an Muslim philosopher, physician, surgeon, astronomer, politician, encyclopedist, and mathematician. Avicenna's writings comprise of five books, know as the Al-Qanun fi al-Tibb (The Canon of Medicine) and the canon covers a wide variety of medical issues. This canon of medicine was the main reference for medical education in Western countries up until the 16th century and in the Middle East until the 19th century. Several chapters of the 3rd book of the Canon are devoted to a detailed description of gastrointestinal diseases including bowel obstruction, hemorrhoids anal fissures, perianal fistulas and perianal itching. Additionally, that same volume contains an illustration of an enema device. The aim of this paper was to present a brief review of Avicenna's 11th century views on bowel obstruction and to present his description of an enema device that has remained relatively unnoticed until now. Finally, this article illustrates similarities between Avicenna's explanation and modern medical science that celebrate Avicenna as an important contributor to medieval knowledge on gastrointestinal diseases, the science of which has been passed on to later generations.

Al-Akhawayni's description of pulmonary circulation.

Since antiquity, heart function and the mechanism of blood circulation within the human body have been the focus of attention of scientists from different parts of the world. Over the passage of time, the theories and works of these scientists have resulted in the achievement of today's knowledge of circulation. The medieval Persian scholar, Al-Akhawayni Bukhari (?-983AD), is among the physicians who investigated both the anatomy and the physiology of the human body. Al-Akhawayni describes the mechanism of pulmonary circulation in his only extant book, "Hidayat al-Muta`llemin fi al-Tibb" (A Scholar's Guide to Medicine) with which he made a contribution to the development of knowledge regarding this mechanism in the medicine of the Islamic world. In this paper, Al-Akhawayni's viewpoints on anatomy and the function of the heart, its related vessels, and also pulmonary circulation will be briefly discussed.

Effect of methylphenidate and folic Acid on ADHD symptoms and quality of life and aggression: a randomized double blind placebo controlled clinical trial.

OBJECTIVE: This clinical trial examines the effect of augmentation of methylphenidate (MPH) with folic acid to improve quality of life, and to treat aggression and ADHD symptoms. METHOD: Participants of this eight week randomized double blind placebo controlled clinical trial were 49 children with ADHD. They were randomly assigned into one of the two groups: the first group receiving methylphenidate (10 to 20mg/day) plus folic (5mg/day), and the second group receiving methylphenidate plus placebo. Parent-reported ADHD symptoms and Overt Aggression Scale score were the outcome measures. Quality of life was assessed as well. Assessments were performed at pre-intervention, and at one month and two months after starting the interventions using repeated measure analysis. RESULTS: The mean age of children was 9.6(2.7) years. Age and gender were not associated with the groups. ADHD symptoms significantly decreased in both groups during the trial. However, no difference was observed between the groups. Moreover, aggression non-significantly decreased in both groups. Meanwhile, there was no difference between the two groups in efficacy for treating different types of aggressive behaviors including: verbal aggression, physical aggression against people, physical aggression against properties or objects, and aggression against self (self-injurious behavior). While methylphenidate improved quality of life of children with ADHD, folic acid did not improve it more than placebo. Both medications were well tolerated. CONCLUSION: considering the marked limitations of this trial, this primarily report suggests that methylphenidate may improve ADHD symptoms and the quality of life of children with ADHD. Current evidence does not support that folic acid as an adjuvant is effective for treating ADHD symptoms or aggression, or the improving quality of life of children with ADHD.

Hyperbaric oxygen therapy for treatment of children with autism: a systematic review of randomized trials.

There is a controversy about the efficacy of hyperbaric oxygen (HBO) therapy for the treatment of autism. This study systematically reviews the current evidences for treating of autism with HBO therapy. According to PRISMA guidelines for a systematic review, the databases of MEDLINE/Pubmed, Google Scholar, and Randomised Controlled Trials in Hyperbaric Medicine were electronically searched. In addition, medical subject heading terms and text words for hyperbaric oxygen therapy and autism were used. The main inclusion criteria were published studies which reported the original data from the trials conducted on the patients with autism and assessed outcomes with a valid and reliable instrument. A quality assessment was also conducted. The electronically search resulted in 18 title of publications. Two studies were randomized, double-blind, controlled-clinical trials. While some uncontrolled and controlled studies suggested that HBO therapy is effective for the treatment of autism, these promising effects are not replicated. Therefore, sham-controlled studies with rigorous methodology are required to be conducted in order to provide scientific evidence-based HBO therapy for autism treatment.

A double-blind placebo controlled trial of Ginkgo biloba added to risperidone in patients with autistic disorders.

Ginkgo biloba has been reported to affect the neurotransmitter system and to have antioxidant properties that could impact the pathogenesis of Autism Spectrum Disorder. Based on these studies, we decided to assess the effectiveness of Ginkgo biloba extract (Ginko T.D., Tolidaru, Iran) as an adjunctive agent to risperidone in the treatment of autism. Forty-seven outpatients with a DSM-IV-TR diagnosis of autism ages between 4 and 12 years were assigned to this double blinded clinical trial and were randomly divided into two groups. One group received risperidone plus Ginko T.D and the other received risperidone plus placebo. The dose of risperidone was 1-3 mg/day and the dose of Ginko T.D. was 80 mg/day for patients under 30 kg and 120 mg/day for patients above 30 kg. Patients were assessed using Aberrant Behavior Checklist-Community (ABC-C) rating scale and the side effect check list every 2 weeks until the endpoint. None of the 5 subscales of ABC-C rating scale showed significant differences between the two groups. Incidents of side effects were not significantly different between the two groups. Adding Ginkgo biloba to risperidone did not affect the treatment outcome of ADs. Nevertheless, further observations are needed to confirm this result.

Can tactile sensory processing differentiate between children with autistic disorder and asperger's disorder?

OBJECTIVE: There are debates whether autistic disorder (autism) and Asperger's disorder are two distinct disorders. Moreover, interventional sensory occupational therapy should consider the clinical characteristics of patients. Already, commonalities and differences between Asperger's disorder and autistic disorder are not well studied. The aim of this study is to compare tactile sensory function of children with autistic disorder and children with Asperger's disorder. METHODS: Tactile sensory function was compared between 36 children with autism and 19 children with Asperger's disorder. The two disorders were diagnosed based on Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. The parent-reported Tactile Dysfunction Checklist was used to assess the three aspects of hypersensitivity, hyposensitivity, and poor tactile perception and discrimination. Developmental coordination was also assessed. RESULTS: Developmental coordination problems total score was not associated with group. The mean (standard deviation) score of tactile hyper-responsivity was not different between the groups. Tactile hyporesponsivity and poor tactile perception and discrimination scores were statistically higher in autistic disorder than Asperger's disorder group. CONCLUSION: These results for the first time indicated that at least some aspects of tactile perception can differentiate these two disorders. Children with autistic disorder have more tactile sensory seeking behaviors than children with Asperger's disorder. Moreover, the ability of children with autistic disorder for tactile discrimination and sensory perception is less than those with Asperger's disorder. Interventional sensory therapy in children with autistic disorder should have some characteristics that can be different and specific for children with Asperger's disorder. Formal intelligence quotient testing was not performed on all of the children evaluated, which is a limitation to this study. In some cases, a clinical estimation of intelligence quotient was given, which limits the conclusions that can be drawn from the data. Additional research using formal intelligence quotient testing on all of the subjects should be performed in order to draw more concrete conclusions.

A novel possible strategy for the management of petrol sniffing addiction in adolescents.

Since the 1950s there have been many reports on petrol addiction, mostly describing the practice of petrol sniffing and its acute and chronic physical and psychological effects. To the authors' knowledge, none have described the use of opiates to manage and control this addiction. We report the case of an 18-year-old boy who self-managed his petrol addiction. He had been inhalant sniffing since the age of 5 and petrol sniffing since the age of 15, and had undergone different treatments in unsuccessful efforts to break his addiction. However, he has now stopped sniffing petrol after taking tramadol 100 mg/day and methadone 10 mg/day. This case report suggests that tramadol and methadone can be used for the management of petrol addiction.

Ginkgo biloba for attention-deficit/hyperactivity disorder in children and adolescents: a double blind, randomized controlled trial.

BACKGROUND: Although stimulants are highly effective in controlling the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), some children will not respond to, or are intolerant of stimulants. Thus, the desire for safe and effective nonstimulant medications has risen during the past several years. Ginkgo biloba has been suggested in the treatment of dementia and memory impairment. We hypothesized that G.biloba would be beneficial for treatment of ADHD, and this could be evaluated in a double blind, randomized, parallel group comparison of G.biloba (Ginko T.D. Tolidaru, Iran) and methylphenidate. METHODS: Fifty outpatients (39 boys and 11 girls) with a DSM-IV-TR diagnosis of ADHD were study population of this trial. Subjects were recruited from an outpatient child and adolescent clinic for a 6 week double blind, randomized clinical trial. All study subjects were randomly assigned to receive treatment using tablet of Ginko T.D. at a dose of 80-120 mg/day depending on weight (80 mg/day for <30 kg and 120 mg/day for >30 kg) (group 1) or methylphenidate at a dose of 20-30 mg/day depending on weight (20 mg/day for <30 kg and 30 mg/day for >30 kg (group 2) for a 6 week double blind, randomized clinical trial. The principal measure of outcome was the Teacher and Parent ADHD Rating Scale- IV. Patients were assessed at baseline and at 21 and 42 days after the medication started. RESULTS: Significant differences were observed between the two groups on the Parent and Teacher Rating Scale scores. The changes at the endpoint compared to baseline were: -6.52+/-11.43 (mean+/-S.D.) and -15.92+/-11.44 (mean+/-S.D.) for Ginko T.D. and methyphenidate, respectively for Parent ADHD Rating Scale. The changes at the endpoint compared to baseline were: -0.84+/-6.79 (mean+/-S.D.) and -14.04+/-8.67 (mean+/-S.D.) for Ginko T.D. and methyphenidate, respectively for Teacher ADHD Rating Scale. The difference between the Ginko T.D. and methylphenidate groups in the frequency of side effects was not significant except for decreased appetite, headache and insomnia that were observed more frequently in the methylphenidate group. CONCLUSION: The results of this study suggest that administration of G.biloba was less effective than methylphenidate in the treatment of ADHD.