Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to qualitatively synthesize recent randomized controlled trials (RCTs) regarding the effect of topical application and oral intake of herbal products on the healing of diabetic foot ulcer (DFU). Also, we sought to pool the obtained findings in a meta-analysis using a random-effects model, if RCTs were relatively comparable and homogenous. A comprehensive search was performed on five electronic data sources from their inception through 23 January 2024. The RCTs, without restriction on the country of origin, were included if they compared the effect of administering standard treatments and/or placebo (i.e. control condition) to applying standard treatments and/or herbal products in topical or oral routes (i.e. experimental condition). Out of 1166 retrieved records, 28 RCTs were included. Studies used different poly and single herbal formulations. Based on the meta-analysis, administration of standard care plus daily dressing of the ulcer site with olive oil for 28 days significantly increased the total ulcer healing score (3 RCTs; weighted mean difference [WMD] = 89.30; p < 0.001), raised frequency of complete ulcer healing (2 RCTs; risk ratio [RR] = 12.44; p = 0.039) and declined ulcer degree (3 RCTs; WMD = -22.28; p = 0.002). Also, daily use of the bitter melon leaf extract in oral form for 28 days significantly increased the total ulcer healing score (2 RCTs; WMD = 0.40; p = 0.001). Additionally, based on qualitative synthesis, the adjuvant use of herbal agents seems an intriguing choice to manage DFU. Nonetheless, considering the undesirable methodological quality of most studies and the high heterogeneity in administered herbal formulations, more robust trials are required to build a solid conclusion regarding the use of herbal products for healing DFU.

Short-term effect of dressing with Dermaheal ointment in the treatment of diabetic foot ulcer: A double-blinded randomized controlled clinical trial.

Background and Aims: Diabetic foot ulcers, a major cause of amputations in diabetics, could benefit from natural products as adjuncts to standard care, given the costs and adverse effects of typical therapies. This study aims to evaluate the short-term effects of dressing with Dermaheal ointment in the treatment of DFUs through a double-blinded randomized controlled clinical trial. Methods: This double-blinded, placebo-controlled trial included 50 patients with Wagner's ulcer grade I or II, randomly assigned to Dermaheal and placebo groups (received standard treatment and placebo ointment). The ulcer site was dressed daily for four consecutive weeks with either Dermaheal or placebo ointment. Ulcer healing score (using DFU healing checklist), ulcer size with transparent ruler and largest dimension of ulcer, and pain severity using numerical pain rating score (were recorded at five-time points, including baseline, and on weeks 1, 2, 3, and 4). Also, ulcer healing status was investigated at the trial ended in November 2021. Results: Both groups showed significant improvement in ulcer healing over 4 weeks (p time < 0.001), with more remarkable progress in the Dermaheal group (p group = 0.03). At the trial end, complete ulcer healing was also significantly higher in the Dermaheal group compared to the placebo group (56% vs. 12%, p = 0.002). Both groups exhibited a decrease in ulcer size (p time < 0.001). Considering the baseline ulcer size as a covariate, substantial changes in mean ulcer size were noted in the initial (p = 0.01), second (p = 0.001), third (p = 0.002), and fourth (p = 0.002) weeks of the intervention, showing a preference for the Dermaheal group. However, no significant between-group difference was observed in pain severity levels. Conclusion: Dressing with Dermaheal as a topical treatment shows promise in improving healing and reducing the size of diabetic foot ulcers. Further research is needed to confirm these findings' long-term efficacy.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis.

BACKGROUND: Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes. METHODS: Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software. RESULTS: Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials. CONCLUSION: More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care. TRIAL REGISTRATION: PROSPERO Registration No: CRD42023399626.

Effects of light stroking massage with olive oil on acute pain severity and number of taken non-steroidal anti-inflammatory drugs among outpatients with extremities trauma: A double-blind, placebo-controlled superiority trial.

INTRODUCTION: Currently, analgesics are used to alleviate acute pain after trauma; however, these drugs cause some undesirable adverse effects. Hence, there is a need for nonpharmacological methods to reduce trauma-induced pain. This study investigated the effects of massage with olive oil on acute pain severity and number of taken non-steroidal anti-inflammatory drugs (NSAIDs) among trauma patients. METHODS: In this double-blind, placebo-controlled superiority trial, 42 outpatients who suffered from superficial injury in upper or lower extremities were randomly assigned to olive oil and placebo groups. Patients received a 5-min light stroking massage on the trauma site twice a day for nine consecutive days with 10 drops of either olive oil or placebo (liquid paraffin). Also, they received NSAIDs and applied cold and warm compresses on the trauma site. The pain severity (a 0-10 numerical pain rating scale) and the number of NSAIDs were recorded at four points of time, including before the intervention (baseline), and on the third, sixth, and ninth days of intervention. RESULTS: There was a significant difference between the study groups in mean ranks of the number of NSAIDs taken on the baseline and third days (P = 0.02, P = 0.009). Considering the number of NSAIDs taken during nine days as a covariate, a significant decrease in the pain severity was found in two groups during the nine days (Ptime< 0.001). However, pain reduction over time was more significant in the olive oil group (Ptime*group = 0.001). Also, mean changes in the pain severity compared to the baseline were significant on the sixth (P = 0.001) and ninth (P = 0.002) days of the intervention in favor of the olive oil group. CONCLUSION: Administration of light stroking massage with olive oil as a complementary method seems to be potentially effective in reducing the pain severity and use of NSAIDs among patients with trauma to the extremities.

Effects of Aromatherapy with Lavender (Lavandula angustifolia MILL) on Post-Dural Puncture Headache: A Randomized Placebo-Controlled Trial.

Context: Lavender has been proposed as an analgesic agent for different types of headaches in complementary and alternative medicine. However, no documented trial has been performed to investigate the effects of lavender in managing post-dural puncture headache (PDPH). Objective: To evaluate the effects of aromatherapy using lavender essential oil in reducing the severity of PDPH. Design: Randomized, placebo-controlled clinical trial with parallel group design. Setting: Post-operative wards of Kamkar-Arab-Nia and Nekooei Hedayati Hospitals in Qom, Iran. Participants: Patients with PDPH caused by spinal anesthesia (n = 50). Intervention: Patients received 15-minute inhalations of either lavender oil or liquid paraffin as placebo, using the same protocol. Outcome Measures: The severity of headache was scored before (baseline) and five times after the intervention (immediately, 30, 60, 90, and 120 minutes after) using the visual analog scale. Also, dosage and frequency of the received Diclofenac and adverse effects of the intervention were recorded. Results: Both groups showed a reduction in headache scores post intervention. However, the headache scores between the groups was significantly different only immediately after the intervention in favor of lavender oil (difference: 1.60 ± 0.63, P = .015). Furthermore, it was observed that the mean changes of the headache scores compared to baseline were significant at each time interval in favor of the placebo group (P < .05), except immediately after the intervention. No significant difference was observed in diclofenac intake between groups (P = .440). Also, no adverse effects were found from the intervention. Conclusions: Aromatherapy with lavender oil was observed to reduce the severity of PDPH only immediately after the intervention, while only minimal effects were observed at successive time intervals. However, it is noted that the study was likely underpowered and further studies are recommended to better understand the effects of lavender oil on PDPH and compare its effects to other herbal products or pharmacological agents commonly used for managing headaches.

Effect of Rosa damascena on improvement of adults' sleep quality: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Recent studies have reported inconclusive results regarding the potential effects of Rosa damascena on sleep quality. Therefore, this review aimed to summarize the findings of parallel-group and cross-over randomized controlled trials (RCTs) on the effects of aromatherapy and oral intake of Rosa damascena on adults' sleep quality. METHODS: The electronic data sources of PubMed, Scopus, Web of Science Core Collection, Embase, CENTRAL, ProQuest, CINAHL, SID, and MagIran were searched from inception to June 30, 2021. Out of 1341 publications found in the initial search, 10 RCTs were considered eligible for this review. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Sufficient data were statistically pooled by a random-effects model using Stata software (version 11.2); otherwise, a narrative summary was presented. RESULTS: Based on the systematic review, the inhalation and oral intake of Rosa damascena could improve some sleep-related outcomes. The pooled analysis of seven effect sizes revealed that inhalation aromatherapy with Rosa damascena significantly improved sleep quality (standardized mean difference: 2.24; 95% confidence interval: 1.01-3.48; P < 0.001). Most RCTs had fair methodological quality, and two RCTs reported the adverse effects of treatment, including headache, nausea, vomiting, and frequent sneezing. CONCLUSIONS: The administration of Rosa damascena seems to be a promising approach in complementary and alternative medicine for the improvement of adults' sleep quality. However, considering the fair methodological quality of most RCTs and reported adverse effects, it is required to perform further high-quality RCTs to draw an evidence-based conclusion on the use of Rosa damascena for the improvement of adults' sleep quality. PROSPERO NO: CRD42020211778.

Effects of Rosa damascena (Damask rose) on menstruation-related pain, headache, fatigue, anxiety, and bloating: A systematic review and meta-analysis of randomized controlled trials.

Recent studies have reported inconclusive results regarding the therapeutic effects of Rosa damascena on the outcomes of primary dysmenorrhea (PD) and premenstrual syndrome (PMS). Hence, this study is aimed to summarize the findings of randomized controlled trials (RCTs) regarding the effects of this treatment on menstruation-related pain as the primary outcome and menstruation-related headache, fatigue, anxiety, and bloating as the secondary outcomes. This study evaluated parallel-group and cross-over RCTs on aromatherapy, topical treatment, or oral intake of R. damascena products for the treatment groups versus placebo, nontreated, or conventional treatment groups. Seven electronic databases (Web of Science Core Collection, Scopus, Embase, CENTRAL, CINAHL, SID, and MagIran) and one search engine (PubMed) were searched from inception to January 15, 2021. Of 1468 trials found in the initial search, 983 potentially relevant articles were screened by title and abstract. After examining the full-text of 13 studies for compliance with the inclusion criteria, seven studies were considered eligible for this review. A random-effects model was used to pool the data; otherwise, a narrative summary was presented. The retrieved studies were conducted on females with PD or PMS, aged 18-35 years. The total sample size of the intervention and comparator arms was 276 and 272. The results showed that R. damascena had a nonsignificant alleviating effect on the menstruation-related pain (weighted mean difference [WMD]: -0.47; 95% confidence interval [CI]: -1.25, 0.31; P = 0.234). Such findings were also found for menstruation-related anxiety (WMD: -0.40; 95% CI: -0.91, 0.11; P = 0.125). However, the treatment significantly reduced the menstruation-related headache (WMD: -0.42; 95% CI: -0.74, -0.11; P = 0.008), fatigue (WMD: -0.48; 95% CI: -0.87, -0.09; P = 0.015), and bloating (WMD: -0.72; 95% CI: -1.21, -0.22; P = 0.005). Since R. damascena had no significant effects on menstruation-related pain and anxiety, further studies with improved methodological quality are suggested to evaluate the effects of the treatment on these symptoms, using different dosages and durations.

Rosa Damascena mill for treating adults' anxiety, depression, and stress: A systematic review and dose-response meta-analysis of randomized controlled trials.

Recent studies have reported conflicting findings on the antianxiety, antidepressant, and anti-stress properties of Rosa Damascena Mill (RDM). Therefore, the present systematic review and meta-analysis were conducted on the effects of RDM for treating anxiety, depression, and stress amongst adults. The online data sources of Cochrane Central Register of Controlled Trials, PubMed, Scopus, Web of Science, Embase, ProQuest, and Scientific Information Database were searched from inception to June 30, 2021. The randomized controlled trials (RCTs), which examined the effects of RDM (in any form of administration) on adults' anxiety, depression, and stress, were included. A random-effects model was applied to pool the data, and a total of 32 publications were included. The results of the meta-analysis revealed that administration of RDM significantly reduced state anxiety (effect size [ES]: 24, standardized mean difference [SMD]: -1.74, 95% confidence interval [CI]: -2.29, -1.20; p < .001), depression (ES: 7, SMD: -0.87, 95% CI: -1.47, -0.28; p = .004), and stress (ES: 4, SMD: -1.33, 95% CI: -1.98, -0.69; p < .001). However, the treatment had no significant effect on trait anxiety (ES: 6, weighted mean difference: -0.75, 95% CI: -1.93, 0.43; p = .214). The association between the total administration dosage and/or duration of RDM and the changes in state anxiety and depression was not dose-dependent. Most RCTs had a fair methodological quality based on the Cochrane risk of bias assessment tool. Besides, the quality of evidence ranged from very low to moderate according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Hence, further high-quality RCTs are needed to draw reliable conclusions regarding the use of RDM for treating adults' anxiety, depression, and stress.

Effect of aromatherapy with Damask rose on alleviating adults' acute pain severity: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Although recent studies have investigated the analgesic activity of Damask rose using aromatherapy in different painful conditions, the results are inconclusive. Hence, this systematic review and meta-analysis aimed to clarify the effect of aromatherapy with Damask rose on adults' acute pain. MATERIAL AND METHODS: The online databases of MEDLINE/PubMed, Scopus, ISI web of science, Embase, ProQuest, CENTRAL, CINAHL, SID, and MagIran were searched up to August 10, 2020. The aim of this study was to find randomized controlled trials on the effect of aromatherapy with Damask rose in any form of administration (inhalation, vapor diffusion, and massage) on different types of acute pain in adults. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. Moreover, the quality of the evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects model was applied to pool data using Stata. RESULTS: A total of 16 studies met the inclusion criteria, of which only one was not included in the meta-analysis. Pooled analysis revealed that aromatherapy with Damask rose reduced the pain severity significantly (WMD: -2.12; 95% CI [-2.85, -1.40]; P < 0.001). Inhalation aromatherapy (WMD: -2.39; 95% CI [-3.31, -1.48]; P < 0.001) and aromatherapy massage (WMD: -1.16; 95% CI [-1.57, -0.75]; P < 0.001) also had significant effects on pain reduction. The quality of evidence was low. CONCLUSION: Aromatherapy with Damask rose had a favourable effect on reducing the severity of acute pain in adults. However, there is insufficient evidence for the clinical benefits of aromatherapy with Damask rose due to the low-quality evidence. Accordingly, more high quality randomized clinical trials are needed to make an evidence-based conclusion.

Zinc supplementation affects favorably the frequency of migraine attacks: a double-blind randomized placebo-controlled clinical trial.

BACKGROUND: Observational studies have shown a link between zinc deficiency and migraine headaches. We aimed to examine the effect of zinc supplementation on the characteristics of migraine attacks in patients with migraine. METHODS: This randomized clinical trial was conducted on 80 patients with migraine. Patients were randomly assigned to receive either zinc sulfate (220 mg/d zinc sulfate) or placebo (lactose) for 8 weeks. Anthropometric measures, serum zinc concentrations, and characteristics of migraine attacks (headache severity, frequency and duration of migraine attacks, and headache daily results) were assessed at baseline and end of the trial. RESULTS: Compared with the placebo, zinc supplementation resulted in a significant reduction in headache severity (- 1.75 ± 1.79 vs. -0.80 ± 1.57; P = 0.01) and migraine attacks frequency (- 2.55 ± 4.32 vs. -0.42 ± 4.24; P = 0.02) in migraine patients. However, the observed reduction for headache severity became statistically non-significant when the analysis was adjusted for potential confounders and baseline values of headache severity. Other characteristics of migraine attacks including the duration of attacks and headache daily results were not altered following zinc supplementation either before or after controlling for covariates. CONCLUSION: Zinc supplementation had a beneficial effect on the frequency of migraine attacks in migraine patients. Additional well-designed clinical trials with a long period of intervention and different dosages of zinc are required. TRIAL REGISTRATION CODE: IRCT20121216011763N23 at www.irct.ir .

The effects of green coffee extract supplementation on glycemic indices and lipid profile in adults: a systematic review and dose-response meta-analysis of clinical trials.

BACKGROUND: The role of coffee consumption in the risk of cardiovascular diseases has been debated for many years. The current study aimed to summarize earlier evidence on the effects of green coffee extract (GCE) supplementation on glycemic indices and lipid profile. METHODS: We searched available online databases for relevant clinical trials published up to October 2019. All clinical trials investigating the effect of GCE supplementation, compared with a control group, on fasting blood glucose (FBG), serum insulin, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were included. Overall, 14 clinical trials with a total sample size of 766 participants were included in the current meta-analysis. RESULTS: We found a significant reducing effect of GCE supplementation on FBG (weighted mean difference (WMD): -2.35, 95% CI: - 3.78, - 0.92 mg/dL, P = 0.001) and serum insulin (WMD: -0.63, 95% CI: - 1.11, - 0.15 µU/L, P = 0.01). With regard to lipid profile, we observed a significant reduction only in serum levels of TC following GCE supplementation in the overall meta-analysis (WMD: -4.51, 95% CI: - 8.39, - 0.64, P = 0.02). However, subgroup analysis showed a significant reduction in serum TG in studies enrolled both genders. Also, such a significant reduction was seen in serum levels of LDL and HDL when the analyses confined to studies with intervention duration of ≥8 weeks and those included female subjects. In the non-linear dose-response analyses, we found that the effects of chlorogenic acid (CGA) dosage, the main polyphenol in GCE, on FBG, TG and HDL were in the non-linear fashions. CONCLUSION: In conclusion, we found that GCE supplementation improved FBG and serum levels of insulin and TC. Also, there was a significant improvement in other markers of lipid profile in some subgroups of clinical trials.

Effects of zinc supplementation on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: Findings on the effects of zinc supplementation on the lipid profile in patients with type 2 diabetes mellitus (T2DM) are conflicting. The current comprehensive systematic review and meta-analysis aimed to summarize available evidence in this regard. METHODS AND RESULTS: After a systematic search in the online databases, we included the randomized controlled trials (RCTs) investigating the effect of zinc supplementation on lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)] in patients with T2DM. Altogether, 9 studies with a total sample size of 424 patients with T2DM were included in the analysis. Combining 9 effect sizes from 9 RCTs, we found a significant lowering effect of zinc supplementation on serum levels of TG (weighted mean difference (WMD): -17.08, 95% CI: -30.59, -3.58 mg/dL, P = 0.01) and TC (WMD: -26.16, 95% CI: -49.69, -2.62 mg/dL, P = 0.02). Although the overall effect of zinc supplementation on LDL-C levels was not significant, a beneficial effect was seen in studies that administered <100 mg/d zinc. Based on the non-linear dose-response analysis, a greater reduction in serum levels of TC and LDL-C following zinc supplementation was seen at <12 weeks' duration of intervention. Unlike the overall effect size, we found a significant increasing effect of zinc supplementation on serum HDL-C concentrations in most subgroups of RCTs according to the subgroup analyses. CONCLUSION: We found that zinc supplementation may beneficially influence lipid profile in patients with T2DM.

Effects of Relaxation Techniques on Acute Postlaminectomy Pain: A Three-Arm Randomized Controlled Clinical Trial.

PURPOSE: This study compared the effects of Benson relaxation with progressive muscle relaxation on pain severity after laminectomy. DESIGN: Three-arm randomized, nonblinded, and parallel group trial. METHODS: The study was conducted with 93 patients who underwent lumbar laminectomy. Patients were randomly assigned to three groups of Benson relaxation + routine care (n = 31), progressive muscle relaxation + routine care (n = 31), and routine care (n = 31). The two relaxation methods were performed at 2 (time 1), 12 (time 2), and 24 (time 3) hours after patients' regaining full consciousness in postoperative wards. Pain severity was assessed using the visual analog scale once before laminectomy, before and also 20 minutes after each relaxation session. In the control group, pain severity was measured at the same times as in the two relaxation groups. FINDINGS: Both Benson relaxation and progressive muscle relaxation resulted in a significant reduction in pain severity in comparison with the control group at all three measurement times (except at time 1 in the progressive muscle relaxation group). However, no significant differences were found between Benson relaxation and progressive muscle relaxation in any of the three times. CONCLUSIONS: The results suggest that both Benson and progressive muscle relaxation techniques can decrease acute postlaminectomy pain in the immediate postoperative period in adult patients.

Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized Controlled Clinical Trial on Phacoemulsification Candidates.

PURPOSE: The present study aimed to compare the effects of foot and hand massage on preoperative anxiety. DESIGN: Three-arm randomized, nonblinded, placebo-controlled, parallel group trial. METHODS: This study was conducted on 90 female candidates waiting for phacoemulsification cataract surgery in Arak Amirkabir Hospital, Iran. Patients were consecutively selected and randomly divided into three groups of hand (n = 30), foot (n = 30), and placebo (n = 30), using a random number generator software program. In each group, massage was performed 5 minutes for each hand or foot in the surgical waiting room about 10 minutes before surgery. Anxiety was measured before and after the intervention by visual analog scale and also assessing physiological indicators (heart rate, respiratory rate, systolic and diastolic blood pressures). FINDINGS: All the 90 patients completed the study and were included in the final analysis. Both hand and foot massage resulted in a significant decrease compared with placebo massage in anxiety and heart rate. However, no significant difference was found between hand and foot massage in any of the measured parameters. In the foot group and hand group, a significant reduction was observed in heart rate and anxiety after the intervention, whereas the anxiety increased significantly in the placebo group after the intervention. Moreover, systolic blood pressure in the foot group and the respiratory rate in the hand group significantly decreased after the intervention. CONCLUSIONS: Application of hand or foot massage seems to be effective in managing anxiety in patients waiting for phacoemulsification cataract surgery.

Effects of consuming date fruits (Phoenix dactylifera Linn) on gestation, labor, and delivery: An updated systematic review and meta-analysis of clinical trials.

BACKGROUND: Recent studies have shown that consumption of date fruits during pregnancy and also postpartum period might affect some pregnancy outcomes. We performed an updated systematic review and meta-analysis about the effects of consuming date fruits on gestation, labor, and delivery. METHODS: Two researchers independently searched the online databases of PubMed, Scopus, Web of Science, Embase, Google Scholar, and EBSCO up to January 2019 for clinical trials examining the effects of date fruits consumption on any types of gestation, labor, and delivery outcomes. A fixed-effects model or random-effects models were applied to pool data, where appropriate. Quality assessment was done by Jadad scale. RESULTS: In total, 11 and 8 studies were included in the systematic review and meta-analysis. Meta-analysis revealed that date fruit consumption significantly reduced gestation duration (pooled effect size: -0.30, 95% CI: -0.45, -0.15; P < 0.001), increased cervical dilation on admission (pooled effect size: 0.94, 95% CI: 0.88, 1.00; P < 0.001), and shorten duration of first stage of labor (pooled effect size: -50.09, 95% CI: -72.25, -27.93; P < 0.001). Also, it was revealed that date fruit consumption significantly reduced duration of second stage of labor in fixed-effects model (pooled effect size: -9.85, 95% CI: -14.00, -5.70; P < 0.001); however, this effect was not significant in random-effects analysis (pooled effect size: -11.27, 95% CI: -28.23, -5.68; P = 0.193). CONCLUSIONS: Date fruits intake seems to reduce gestation duration and duration of the first stage of labor, and also increase cervical dilation on admission.

Short-term effects of massage with olive oil on the severity of uremic restless legs syndrome: A double-blind placebo-controlled trial.

BACKGROUND: Although the efficacy of olive oil massage has been established for different disorders, no studies have yet focused on the effect of olive oil massage on restless legs syndrome (RLS). In this study, we aimed to evaluate the short-term effects of massage with olive oil in reducing the severity of uremic RLS. METHODS: This double-blind placebo-controlled trial was conducted on 60 patients with uremic RLS (mean age: 51.96 ± 10.15), who were randomly divided into olive oil and placebo groups. The olive oil group received massage with olive oil, while the placebo group received massage with liquid paraffin twice a week during hemodialysis sessions for three weeks. For each leg, 10 mL of the olive oil or placebo was applied and then massaged for five minute [corrected] from the plantar surface of the foot to the area below the knee. The severity of RLS was rated on the first day and one week after the final massage therapy session by using the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale. RESULTS: In terms of different categories of RLS severity, a significant decline was observed only in the olive oil group from the pre- to post-intervention stages (P = 0.003). After the intervention, the decline in the total RLS severity was more significant in the olive oil group (P < 0.001), compared to the placebo group (P = 0.019). Moreover, a significant difference in the total RLS severity (P < 0.001) and different categories of RLS severity (P = 0.002) was observed after the intervention between the groups in favor of olive oil massage. However, no significant difference was found between groups in pre-intervention stage in this regard (P = 0.363 and P = 0.955, respectively). CONCLUSION: Application of short-term massage with olive oil as a complementary method seems to be effective in reducing the severity of uremic RLS. Further studies are suggested to identify the sustainability of the findings.

Effects of topical sesame (Sesamum indicum) oil on the pain severity of chemotherapy-induced phlebitis in patients with colorectal cancer: A randomized controlled trial.

BACKGROUND AND PURPOSE: Chemotherapy-induced phlebitis (CIP) is one of the most important and common complications in patients with cancer. Currently, the use of complementary methods to prevent or alleviate phlebitis symptoms has attracted great attention. In this study, we aimed to assess the effects of topical sesame oil in reducing the pain severity of CIP. MATERIALS AND METHODS: This randomized clinical trial was conducted on 60 patients with colorectal cancer afflicted with CIP. Patients received, twice a day for seven consecutive days, a 5-min massage solely (as the control group) or with 10 drops of sesame oil (as the experimental group) within the 10 cm radius of the affected site. The pain severity was evaluated by the visual analog scale on the first, third, fifth, and seventh days of the intervention. RESULTS: Mean changes of the pain severity compared to the baseline were significant on the third (P = 0.009), fifth (P < 0.001), and seventh (P < 0.001) days of the intervention in favor of the experimental group. Also, a significant reduction in the pain severity both in the experimental and control groups was observed during the seven days (F = 720.66, Ptime < 0.001); however, the decrease was more significant in the experimental group (F = 21.46, Pgroup < 0.001). CONCLUSION: Application of massage with sesame oil as a complementary method is effective in reducing the pain severity of patients with CIP.

Dietary intake of fish, n-3 polyunsaturated fatty acids and risk of hip fracture: A systematic review and meta-analysis on observational studies.

Previous studies have shown that fish consumption and dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFAs) are associated with hip fracture; however, findings were conflicting. The present review aimed to summarize the current evidence on the association of fish consumption and dietary intake of n-3 PUFAs with hip fracture. The online databases of PubMed, ISI Web of Science, Scopus, ProQuest, Science Direct and Embase were searched until August 2017 for related publications using relevant keywords. To pool data, either a fixed-effects model or random-effects models were used. Cochran's Q tests were used to assess heterogeneity between studies. In total, 10 studies (7 prospective and 3 case-control studies) were included in this systematic review, and 9 studies with total sample size of 292657 participants were included in the meta-analysis. The age of participants was 20 years or older. Combining 8 effect sizes from 4 prospective studies and 2 case-control studies revealed a significant inverse association between fish consumption and risk of hip fracture (pooled effect size: 0.88, 95% CI: 0.79-0.98, P = 0.02). Although this relationship became non-significant in prospective studies, a significant inverse association was found in prospective studies with sample size of 10000 individuals or more, and studies that considered body mass index as a covariate. Furthermore, dietary intake of n-3 PUFAs was inversely associated with risk of hip fracture (pooled effect size: 0.89, 95% CI: 0.80-0.99, P = 0.02). Also, such relationship was seen after excluding one case-control study and combining effect sizes only from prospective studies (pooled effect size: 0.88, 95% CI: 0.80-0.98, P = 0.02). In conclusion, we found that fish consumption and dietary intake of n-3 PUFAs might have protective effects on bone health and decline the risk of hip fracture.

Effect of light pressure stroking massage with sesame (Sesamum indicum L.) oil on alleviating acute traumatic limbs pain: A triple-blind controlled trial in emergency department.

OBJECTIVES: Due to adverse effects of common medications used for traumatic pain management, it is crucial to use complementary methods to alleviate this pain. Present study aimed to assess the effect of light pressure stroking massage with topical sesame oil on pain severity of patients with limbs trauma. METHODS: This triple-blinded randomized trial was conducted on 40 patients with upper or lower extremities trauma in emergency department of Busheher Amir Al-Momenian Hospital, Busheher, Iran, in 2015-2016. Patients received a 5min massage with either liquid paraffin (placebo) or sesame oil on trauma site twice a day for 9days duration. Pain severity was assessed by visual analogue scale in first day (baseline), 3th, 6th and 9th days of intervention in the both groups. RESULTS: Mean changes of pain severity between two groups was significant in the 6th (-0.20±1.36; P=0.036) and 9th (-0.36±1.12; P<0.001) days of intervention. Regarding to intake of diclofenac, no significant difference was seen between sesame oil and placebo groups during 9days of intervention (575.23±3.11 and 625.13±4.23 respectively, P=0.601). There were no adverse effects during the study in the both groups. CONCLUSION: Massage with topical sesame oil was associated with significant reduction in pain severity of patients with limbs trauma. Therefore, it is suggested to use this oil on complementary medicine for pain relief due to low cost, easy usage and lack of adverse effects.