Evaluation of relationship between memory and temperament in 18-28 years old students.

Background: Mizaj (Temperament) is a concept to express individual differences in Persian medicine and according to this theory, there is a relationship between Mizaj type and the abilities of different body organs. This cross-sectional study aimed to investigate the relationship between the type of Mizaj and the memory score (Quotient). Methods: The target population was the 18 to 38 years old students of Babol University of Medical Sciences. Mojahedi's Mizaj questionnaire (MMQ) was used for determining the whole Mizaj. The physical Persian version of Wechsler Memory Scale III (WMS III) was used to assess memory score. The collected data were analyzed by SPSS Version 22 and the chi square (x2) and t-test were run and p- value 0.05 was considered as significant difference. Results: Forty-two of participants were females and 18 were males. The average age of them was 23.6 (21-27). The average of Memory Quotient (MQ) was 122.1 ± 5.7. The average of MQ in warm Mizaj was 125.46 ± 1.2 and in cold Mizaj was 118.79 ± 6.5. The difference between two groups is statistically significant (p< 0.001). The average of MQ in dry Mizaj was 124.16 ± 2.67 and in wet Mizaj was 118.40 ± 7.64. The difference between two groups is statistically significant (P= 0.005). Conclusion: The results showed there are significant relationship between memory score and warm/cold Mizaj and dry /wet Mizaj. It means students with warm or dry Mizaj had better memory score than students with cold or wet Mizaj. This relation was also detected between subtypes of memory and Mizaj expect between working memory and dry/wet Mizaj. These results are in accordance with theories in PM which indicate people with warm Mizaj and dry Mizaj have better memory and people with cold Mizaj and wet Mizaj have weaker memory and are more at risk of memory dysfunction.

Development and validation of self-report Mizaj identification questionnaire Based on Persian Medicine for the elders (age over 60).

Background: Introduction: Mizaj is the basis of attention to individual differences in Persian Medicine (PM). Regarding the importance of Mizaj for health preservation and treating diseases, it is necessary to achieve a standard tool for Mizaj identification. The purpose of this study was to design a standard self-reporting Mizaj identification questionnaire for elders. Methods: In this exploratory sequential study, criteria of Mizaj identification were extracted by reviewing PM literatures and interview with PM experts and elders. The primary questionnaire was designed and its validity and reliability were assessed, using weighted Kappa statistics, Pearson correlation coefficient (PCC) assessment, receiver operating characteristic (ROC) curve and determining the specificity and sensitivity of cut-off points. Results: Among the 101 items in the primary questionnaire, 73 items had acceptable reliability. The final 20-item questionnaire was obtained after the criterion validity and PCC assessment. The sensitivity and specificity of this questionnaire were 83% and 88% for warmness, 49% and 80% for moderate in warmness-coldness, 72% and 91% for coldness, 57% and 78% for wetness, 30% and 79% for moderate in wetness-dryness, and 81% and 67% for dryness, respectively. Conclusion: The standard Mizaj identification is recommended as a supplementary diagnostic tool for clinicians and researchers in PM. Also, the people with age over 60 can use it to identify their own Mizaj and then, choose the suitable PM or Unani medicine lifestyle recommendations based on their Mizaj.

Pomegranate effects on the health aspects of women during peri- and postmenopause: A systematic review and meta-analysis.

Pomegranate is widely used to preserve human health and help prevent many kinds of diseases. This study aims to review and assess the effects of pomegranate on women's health during and after menopause. PubMed, Web of science, Cochrane, Scopus, and Google Scholar were searched up to the end of 2022 with no language or study type restriction. All types of clinical research studies (randomized clinical trial [RCT], pre-post, case report, and case series) were included. The Cochrane RoB 2.0 tool was used for quality assessment of RCTs. A summary of intervention's effects for each study was provided by calculating standardized mean differences and accompanying 95% confidence interval using random effect model. Weighted mean differences and heterogeneity between studies were assessed using Hedges's method and Cochran's Q test, respectively. Pomegranate can significantly improve hot flashes severity and menopause symptoms and decrease FSH. It significantly improves high-density lipoprotein but not low-density lipoprotein, body mass index, and weight. Most of our results are inconclusive, and the small sample sizes and the lack of blinding and randomization have led to an increased risk of bias. Pomegranate can decrease menopause symptoms, but more well-designed studies, with bigger sample sizes are needed to establish its other clinical benefits for menopausal women.

Effect of Medicago sativa seed powder (Plus vitamin E vs. vitamin E alone) on semen analysis in men with idiopathic infertility: A double blind randomized clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Different parts of the alfalfa plant (Medicago sativa L.), especially its seeds, have been introduced as a semen quality enhancer in the folk medicine of different regions of Iran as well as in the traditional Persian medicine (PM) books. The seeds of this plant are also used in many combined medicines to treat male infertility in PM. AIM OF THE STUDY: This study was designed to investigate the effect of M. sativa seed powder plus vitamin E vs. vitamin E alone on semen analysis of men with idiopathic infertility. MATERIALS AND METHODS: In this randomized clinical trial, 60 participants were randomly divided into two groups and then received M. sativa seed powder (6 g daily) or placebo for three months, as add-on to vitamin E (100 U). Results of semen analysis (sperm total count, motility, and morphology as well as semen volume) of these two groups and their changes were compared before and after treatment as the primary outcome. The number of pregnancies after one month and probable side effects were also assessed. RESULTS: After 12 weeks, sperm total count changed from 36.2 ± 21.8 × 106/ml to 48.5 ± 19.1 × 106/ml in M. sativa and from 39.5 ± 23.5 × 106/ml to 41.2 ± 20.9 × 106/ml in placebo, percentage of normal morphology changed from 1.8 ± 0.8% to 2.6 ± 1.2 % in M. sativa and from 2.0 ± 0.9% to 2.6 ± 1.2% in placebo and percentage of motile sperm changed from 36.5 ± 11.8 % to 39.7 ± 12.0% in M. sativa and from 39.3 ± 10.1 % to 38.1 ± 12.1% in placebo. The improvements in M. sativa group are significantly better than placebo group (P = 0.00, 0.01 and 0.04, respectively). However, semen volume decreased in both groups, but its changes were not significant. The number of pregnancies was four in the intervention and zero in placebo group. One case with abdominal bloating and one with respiratory allergy withdrew from the intervention group. No other adverse effect was reported. CONCLUSIONS: In this study, significant improvement was detected in sperm parameters (except semen volume) of men with idiopathic infertility in M. sativa plus vitamin E group in compare to vitamin E alone after 12 weeks. These findings suggest that the M. sativa, as a complementary therapy, may have a beneficial effect on semen quality. More clinical trials with larger sample size are needed.

Major and minor criteria for gastric dystemperaments in Persian Medicine: Sari gastric dystemperament criteria-I (SGDC-I).

Background: Gastric disorders are one of the most common human ailments, which impose a huge economic burden on countries. In Persian Medicine (PM), it is possible to predict the susceptibility to gastric diseases with diagnosis of gastric Mizajes (temperaments) and dystemperaments. The semiology of gastric dystemperaments has been investigated in PM textbooks, although the value of each sign and symptom is not mentioned. Consequently, this research is designed to determine the major and minor criteria for classifying gastric dystemperaments on the basis of valid manuscripts and with the help of PM specialists in the present era. Methods: This was a consensus-based study consisting of four phases. In the first phase, reference PM textbooks were studied. Symptoms and signs of gastric dystemperaments were collected and listed in four groups. In the second phase, semi-structured interviews with a sample of PM experts were carried out. Phase three included a focused group discussion with experts. Eventually, findings were integrated from the three study phases in a two-day meeting in Sari City. Results: Selected criteria included eight major and eight minor criteria for hot-cold dystemperament, as well as six major and eight minor criteria for wet-dry gastric dystemperament. Conclusion: Modern lifestyles and the interfering factors are responsible for some changes in diagnostic signs and symptoms according to PM. This was the first step to coordinate PM diagnostic criteria for gastric dystemperaments. Further studies are recommended to reach a unique protocol in the field of PM diagnostics. The next step includes design and validation of national diagnostic tools.

The prevalence of complementary and alternative medicine use in the general population of Babol, North of Iran, 2018.

BACKGROUND: Complementary and Alternative Medicine (CAM) have recently become more popular and accepted worldwide. One principal step to identify the status and organize strategies of CAM is evaluating the manner and the prevalence of its usage among people. This study aimed to investigate the prevalence of CAM modalities usage by the people of Babol, a central city in the North of Iran, in 2018. METHODS: Using the original International CAM Questionnaire (I-CAM-Q), a questionnaire was redesigned in Persian (Farsi) with some changes such as adding special modalities in Iran and its validity and reliability were assessed. Six hundred households were evaluated using a cluster sampling method in 2018 spring by 12 trained interviewers. RESULTS: Finally, 1770 questionnaires were correctly completed. A total of 110 participants (6.21% of the completed questionnaires) had visited CAM therapists in the last year, 109 persons (6.15%) had received prescriptions from physicians and paramedics to use CAM, and a total of 1032 people (58.30%) used herbs and herbal medicines in the last 12 months. Also, 1265 individuals (71.46%) had used CAM throughout their lives. The most popular methods were herbal medicine (65.76%), Persian Medicine (13.78%), water therapy (10.45%) and music therapy (8.36%). The use of CAM was more popular among women. CONCLUSIONS: The general use of CAM in Babol was similar to other studies, but there were fewer visits by CAM therapists and less frequent adoption of common methods including homeopathy, acupuncture, and energy therapy. It was found that CAM was mostly used for non-serious diseases such as cold and transient gastrointestinal disorders, a pattern that is different from other studies in this field.

Herbal foodstuffs in Avicenna's recommended diet to improve sperm quality and increase male fertility; an evidence-based approach.

Attention to diet was considered important issues in improvement of men infertility in Persian Medicine (PM). The purpose of this study was to extract herbal foodstuffs introduced by Avicenna, one of the greatest PM physicians to improve the semen production and to provide evidence of their impact on the basis of current studies."Canon of Medicine", the most important Avecinna's book, was searched with keywords equivalent to semen, fertility and infertility, main herbal foodstuffs were extracted and was searched with keywords sperm, semen, infertility, and fertility in Google scholar, PubMed and Scopus databases. Manuscripts from 1950 up to December 2019 were selected and reviewed. Almond, Onion, Chickpea, Garlic, Coconut, Palm date, Sesame, Fenugreek, Carrot, Fig, Grapes, Pistachio, Hazelnut and Walnut are among main foodstuffs which recommended by Avicenna and there is also evidence that they have positive effects on testosterone production and improvement of various sperm parameters, including count, motility and morphology. Containing large amount of different macro and micronutrients such as vitamins including vit B, C, A and E, minerals such as Mg, Se, Zn, Cu and Fe, important unsaturated fatty acids such as linoleic and oleic acids, amino acids such as lysine and arginine and phytochemicals such as polyphenols, flavonoids, triterpenes and steroids can be considered as a main factor in the effectiveness of these foodstuffs. Designing a diet based on the fruits, vegetables, nuts and seeds that Avicenna has recommended, may be effective in treating male infertility but further studies are needed to clarify this issue. Research on the effectiveness of his other recommended foodsuffs may also offer new treatments and supplements for this purpose.

The effect of Achillea Millefolium L. on vulvovaginal candidiasis compared with clotrimazole: A randomized controlled trial.

INTRODUCTION: Vulvovaginal candidiasis is the second most common cause of vulvovaginal infections. The aim of this study is to evaluate the effectiveness of vaginal cream of Achillea millefolium extract in women with vulvovaginal candidiasis in comparison with vaginal clotrimazole. MATERIALS AND METHODS: This double-blind randomized clinical trial study was conducted on 80 women diagnosed with vulvovaginal candidiasis clinically and by laboratory test; 40 women received vaginal cream clotrimazole 1 % and 40 received vaginal cream containing the aqueous extract of A. millefolium for 7 days. Clinical and laboratory assessments were performed before and after the intervention. Minimum inhibitory concentration of the extract was evaluated with Broth micro-dilution procedure. RESULTS: The Dermatology life quality index score showed significant reduction in both groups after treatment, but it was significantly more reduced in control group (p < 0.05). Improvement in vulvar erythema was observed in both groups with no statistically difference (p = 0.1). Vaginal culture was negative in term of Candida in 28(77 %) patients of control group and in 18(53 %) patient of experimental group (p < 0.05). The Minimum inhibitory concentration of the extract was 37.5 mg/mL for the standard strain. DISCUSSION AND CONCLUSION: Study results showed that vaginal cream containing A. millefolium could reduce the complaints of vulvovaginal candidiasis. But, future studies with a larger sample size and different dosages are recommended to assess the outcomes of this new treatment.

Evaluation of the effect of Silybum marianum extract on menopausal symptoms: A randomized, double-blind placebo-controlled trial.

The tendency to use herbs to manage menopausal symptoms has increased in recent years. The purpose of this study was to evaluate the effect of Silybum marianum (L.) compared with placebo in women with hot flashes. Eighty women were randomly allocated into two equal groups (S. marianum extract [400 mg/d] or placebo capsules). Hot flashes frequency and severity were evaluated in 12 weeks with the Greene Climacteric Scale (GCS) and the Hot Flash Related Daily Interference Scale (HFRDIS). The data were analyzed in SPSS software using t-test, Mann-Whitney, chi-square test and repeated measure analysis. Hot flashes frequency and severity decreased from 4.32 ± 0.20/day to 1.31 ± 0.15/day and from 5.25 ± 0.22 to 1.62 ± 0.08, respectively, during the study in test group (p < .001) which were significantly better than effects of placebo in all steps of study (p < .001). Significant decreases in GCS and HFRDIS scores were also detected in S. marianum group compared with placebo after 4, 8 and 12 weeks (p < .001). The results showed that S. marianum can decrease frequency and severity of hot flashes significantly. Considering the safety and high consumption of this herbal medicine worldwide, its use in women with menopausal symptoms can be helpful.

Assessment the studies on the concept of Mizaj (temperament) in Persian Medicine.

Introduction Mizaj or temperament is a main concept in Persian Medicine (PM), which the process of diagnosis, treatment and preventive prescriptions are developed based on it. In this study, the articles written on the concept of Mizaj were reviewed. Method Credited electronic resources, including Pubmed, Scopus, Cochrane Library and web-of-science were searched using keywords Temperament, Mizaj, Mizadj, Midzaj and Mezaj (with the concept of Mizaj in Persian and/or Greek medicine). Search results were limited to English articles, published in 1995-2017. The articles in which temperament had the psychoanalytic aspect or was based on Ayurveda or Chinese/Korean medicine were removed. A team of four PM experts evaluated the method and the results. Results Among the total of 32 articles were published in this field, 14 were review articles, 2 were on animal subject, 14 were on human subject and 2 were surveys for designing questionnaire for people's Mizaj assessment. Most of review studies were just new versions of ancient Persian texts translated into English and the innovations on the subject were few. Studies on animal subject and developing questionnaires were also limited. In some human studies, use of standard questionnaires and homogenous methodology in Mizaj assessment was not considered. Conclusions It seems that studies on temperaments have increased in the past few years but are still at the forefront. In human studies a homogenous method for evaluating temperament has not been used and some of them failed to address the main concept of Mizaj in PM. Therefore, it is necessary to use the original category of Mizaj and to design standard method.

Gastroprotective herbs for headache management in Persian medicine: A comprehensive review.

The gut-brain axis is a bidirectional communication system that exists between the brain and gut. Several studies claimed that some types of headaches are associated with various gastrointestinal (GI) disorders. In Persian medicine (PM), physicians believed that gastric disturbances could stimulate headache and introduced some herbs for boosting gastric function as a therapeutic remedy for headache. Here we review the current evidence for the gastroprotective and antiheadache effects of herbs used in PM. Herbs used for their gastrotonic effects in PM were identified from selected Persian medical and pharmaceutical textbooks. PubMed, Scopus and Google Scholar were used to search for contemporary scientific evidence relating to the gastric and neurologic effects of these plants. A total of 24 plants were recorded from the selected sources included in this review, most of which belonged to the Rosaceae family. Phyllanthus emblica, Zingiber officinale, Boswellias errata, Punica granatum and Hypericum perforatum had the most recent studies related to GI disorder and headache, while current research about quince, rose, apple, hawthorn and pear was limited. Reducing Helicobacter pylori growth, gastritis, erosion of the stomach lining, hemorrhage and perforation, improving gastric mucosal resistance, antisecretary, antiulcer, antipyretic, analgesic, sedative, anxiolytic, anti-inflammatory, anticonvulsant, neuroprotective and antioxidant effects as well as improvement in memory scores were some of the gastrotonic and neuroprotective mechanisms described in the current research. These results confirmed that medicinal plants prescribed in PM may improve headache in patients through the management of GI abnormalities. However, further studies are recommended to investigate the efficacy and safety of the mentioned medicinal plants.

Pistacia Genus as a Potential Source of Neuroprotective Natural Products.

Neuroprotective agents are able to defend the central nervous system against acute or chronic neuronal injuries. Even with the progress made over the last decades, most of the medications prescribed for the management of neurodegenerative diseases can only reduce their symptoms and slow down their progression. Based on natural product research, there are potential effective medicinal plants and phytochemicals for modulating neuronal functions and protecting against neurodegeneration. Plants in the genus Pistacia are also among valuable natural resources for neuroprotection research based on experiences in traditional medicine. Studies have supported the value of bioactive compounds of the genus Pistacia for central nervous system disorders such as Alzheimer's, Parkinson's, multiple sclerosis, cerebral ischemia, depression, and anxiety. Related literature has also revealed that most of the evidence on neuroprotection in the genus Pistacia is in the form of preliminary studies, mainly including models of behavior, motor function, and memory impairments in animals, neural toxicity, cerebral ischemia and seizure models, evaluation of their effects on antioxidant and inflammatory biomarkers, amyloid ß aggregation, and acetylcholinesterase as well as investigations into some cellular pathways. Along with the phytonutrients in kernels such as pistachios, various phytochemicals, mostly terpenes, and phenolic compounds have also been identified in different plant parts, in particular their oleoresins, of species in the genus Pistacia. In this review, the pharmacology of neurological effects and related molecular mechanisms of the plants belonging to the genus Pistacia and its active constituents, as well as pharmacokinetics aspects, are discussed.

Splenectomy may have more complications than currently proven.

The spleen has been one of the least understood major organs for centuries. Its significance is relatively well-known today but it seems that all aspects of its activities are not fully understood. Persian medicine (PM) has special views on the function of spleen; many side effects were reported in PM due to spleen dysfunction. On the other hand nowadays splenectomy as a treatment strategy is recommended for some disorders and increasing risk of infections is considered as the most important long term side effect of that. In this study, we hypothesize that splenectomy may have more side effects than currently proven. According to PM, spleen is in close connection with liver, cardiovascular system, stomach, bone, brain and skin, and that is why any kind of spleen dysfunction leads to change in blood viscosity, appetite and bone strength, liver dysfunction, mood and skin disorders, cancer formation and fever. Considering this viewpoint it can be hypothesized such side effects may also occur after splenectomy. Proven complications of splenectomy include hypercoagulated state, cardiovascular events and infectious diseases but there is also some evidence about increased risk of cancer, skin disease like systemic lupus erythematosus, mood disorder such as depression, defective bone formation and impairment of immunity which can be considered as different levels of evidence to confirm the hypothesis. But for some others such as changes in appetite, there are no studies let alone convincing evidence. Future research about theses possible complications may lead to novel results.

Medicinal plants with antithrombotic property in Persian medicine: a mechanistic review.

Thrombosis is one of the major causes of morbidity and mortality in a wide range of vessels diseases. Due to the high prevalence of thromboembolic disorders investigations are being carried out on new antithrombotic agents with limited adverse side effects in which herbal medicines are considered as alternative remedies. Persian medicine (PM) as a traditional medicine has a good potential for pharmacotherapy based on its own principles and development of drugs via investigating PM literature. In PM manuscripts there are some concepts that express the management of blood clots and antithrombotic properties. This study reviewed the pharmacological effects of medicinal plants mentioned in PM literature for blood clot management in light of current knowledge. Plants mentioned in PM for management of blood clot belong to 12 families in which Apiaceae, Lamiaceae and Compositae were the most repeated ones. Among the proposed plants Allium sativum, Rosmarinus officinalis, Boswellia serrata, Sesamum indicum, Matricaria chamomilla and Carthamus tinctorius have been the most researched plants in modern antithrombotic studies while for some plants such as Helichrysum stoechas, Dracocephalum kotschi, Carum carvi, Bunium persicum and Lagoecia cuminoides no evidence could be found. One of the interesting notes in clot management in PM texts was introducing the target organ for some of the recommended herbs like Carum carvi and Bunium persicum for dissolving blood clot in stomach and Commiphora mukul for thrombosed hemorrhoid. It seems review of PM recommendations can help to design future researches for antithrombotic drugs discovering with more effectiveness and safety.

Almond, hazelnut and walnut, three nuts for neuroprotection in Alzheimer's disease: A neuropharmacological review of their bioactive constituents.

An increase in the prevalence of Alzheimer's disease (AD) as a multifactorial neurodegenerative disorder is an almost obvious issue in the world. Researches on natural products for finding effective drugs to prevent the disease are in progress. There is special attention to the three types of nuts including almond, hazelnut and walnut in manuscripts of traditional Persian medicine (PM) as the preventive agents against brainatrophy and memory loss. The purpose of this study is a pharmacological review of their bioactive constituents and introducing the value of these nuts as the effective supplements and natural medicinal foods in AD patients. Databases including PubMed and ScienceDirect were searched in title, abstract and keywords from year 2000 to present for AD-related researches on these tree nuts, their major phytochemicals and their mechanisms of action. As result, almond, hazelnut and walnut provide macronutrients, micronutrients, and phytochemicals which affect several pathways in AD pathogenesis such as amyloidogenesis, tau phosphorylation, oxidative stress, cholinergic pathways, and some non-target mechanisms including cholesterol lowering and anti-inflammatory properties, as well as effect on neurogenesis. These nuts are recommended in PM for their brain-protective activity and particularly reversing brain atrophy in case of hazelnut. The therapeutical statements of PM scholars mentioned in their books are based on their clinical observations with support of a long history of experiences. Beyond the molecular activities attributed to the phytochemicals, the use of these tree nuts could be more considered in scientific researches as the effective nutrients for prevention or even management of AD.

Historical root of precision medicine: an ancient concept concordant with the modern pharmacotherapy.

Pharmacogenomics and pharmacoproteomics are new sciences that their goal is achieving therapeutics with maximum results and minimal side effects for each individual due to the pattern of his genome and proteome.Although they considered new and high technology sciences but in distant past, Persian sages like Avicenna also knew about importance of "personalized medicine" and used specific patterns to detect individual differences in order to select suitable medication.Based on experience and analogy they divided individuals into different categories considering characteristics like body color, body temperature, sleep-awake pattern and skeletal structure.They also paid attention to effect of environmental conditions such as climate, job and the change of seasons on the influence of medication.Considering the low cost and ease of use of these experiences, it seems that researching their opinions can uncover the historical roots of modern pharmacoproteomics and can possibly infuse new ideas in this field.

Persian Medicine in the World of Research; Review of Articles on Iranian Traditional Medicine.

BACKGROUND: Due to negligence, Persian (Iranian) traditional medicine has had a weak presence in the world of research for a long time. However, in recent years, a variety of activates by research and faculty centers have created awareness and a platform to introduce and promote Persian medicine to the world. The aim of this study is to present and analyze scientific achievements of Persian medicine in the world of research. METHODS: Articles were collected from PubMed database using keywords such as "Persian medicine", "Persian traditional medicine", "Iranian medicine", and "Iranian traditional medicine". All data were classified based on the type of research (review, intervention, case reports, etc.), the field of study (neurology, cardiovascular, metabolic, historical studies, etc.), publication year, and journal type. RESULTS: A total of 501 articles were identified until the end of 2015, comprising of 222 reviews and 219 interventional (108 animal, 57 clinical and 54 cellular). Most studies were on neurology (20.1%), gastroenterology (14.5%), and cardiovascular diseases (10.4%). The publications in 2015 and 2014 had the highest hit rate with 139 and 132 articles, respectively, with 1:2 publication ratio between foreign and Iranian journals. The most published articles, both foreign and Iranian, were in "Evidence-Based Complementary and Alternative Medicine" and "Iranian Red Crescent Medicine" journals. The contribution of foreign authors was 5%. The primary focus of the articles was on "Basic concepts of Persian medicine", "Healthy lifestyle according to Persian medicine", and "Historical aspects", by 3.1%, 2.9%, and 6.7%, respectively. CONCLUSION: During the last 2 years, the number of articles published in Persian (Iranian) medicine, particularly clinical studies had significant growth in comparison with the years before. The tendency of foreign researchers to use the keywords "Iranian" or "Persian" medicine is notable. This research was only based on the designated keyword and other keywords were omitted. It is recommended that additional keywords be used in a broader investigation.