Rhazes' (865-925 CE) contribution to surgery in Liber Almansoris.

BACKGROUND: Surgery has deep historical roots. Rhazes (865-925 CE), a Persian physician, made a significant contribution to the development of medical sciences in the medieval era. Liber Almansoris is one of his significant works on medicine. This book is a medical textbook for medical students. It covers every aspect of the medical sciences. This article discusses Rhazes' contribution to surgery, based on Liber Almansoris. METHOD: This study examines Rhazes' contribution to surgery, based on his book, Liber Almansoris. RESULTS: Rhazes's Liber Almansoris contains a chapter (seventh chapter) on orthopedics, which includes surgical approaches. This chapter also describes surgical procedures for traumas and skull fractures. In other chapters, he also recommends surgical options for treating certain complications when discussing different treatment methods. DISCUSSION: Although Rhazes mentioned surgical procedures as a medical treatment method, he did not include a separate chapter on surgery. This strategy can be found in his other medical works, such as Liber Continens or Al-Hawi. It appears that Rhazes adheres to the Galenic (Greek) perspective on surgery. In this context, surgery is not an independent major but a method that a physician can employ as needed. It differs from an alternative approach in that era that adheres to ancient Persian perspectives, which identified surgery as a major like other medical sciences disciplines.

The effects of Silymarin on the features of cardiometabolic syndrome in adults: A systematic review and meta-analysis.

Some medicinal herbs and their effective components showed positive effects on the features of the cardiometabolic syndrome (CMS). The aim of the present systematic review and meta-analysis is to examine the effects of silymarin on the components of CMS in adults. Four electronic databases including PubMed/Medline, Scopus, Web of Science, and Embase were systematically searched up to December 31, 2020 to identify all eligible clinical trials. A random-effect model using DerSimonian and Laird method was used to estimate the pooled weighted mean differences (WMDs) and the 95% confidence intervals (95%CIs). Finally, 11 clinical trials met the eligibility criteria. Our results demonstrated that silymarin significantly reduced the levels of fasting blood glucose (WMD: -17.96 mg/dL, 95% CI: -32.91, -3.02;I2 : 82.4%, p < 0.001), hemoglobin A1C (WMD: -1.25%, 95% CI: -2.34, 0.16; I2 : 92.9%, p Ë‚ 0.001), total cholesterol (WMD: -17.46 mg/dL, 95% CI: -30.98, -3.95; I2  = 62.9%, p = 0.006), triglyceride (WMD: -25.70 mg/dL, 95% CI: -47.23, -4.17; I2 :54.3%, p = 0.025), low-density lipoprotein-cholesterol (WMD: -10.53, 95% CI: -19.12, -1.94; I2: 37.5%, p = 0.119) and increased high-density lipoprotein- cholesterol (WMD: 3.36 mg/dL, 95% CI: 0.88, 5.84; I2 : 37.4%, p = 0.120) compared to placebo. However, its effects on BMI were not statistically significant. Silymarin can be an effective complementary therapy to improve most features of CMS. However, due to high heterogeneity and limited clinical trials in some parameters, further high-quality clinical trials are needed to confirm its efficacy.

Albucasis (936-1013), a pioneer in tonsillectomy.

BACKGROUND: The surgical removal of tonsils has been performed from as long as three thousand years ago, as mentioned in Hindu literature. The role medieval physicians like Albucasis played in the history of tonsillectomy is very important. This article aims to show the contributions Albucasis made to this procedure. METHODS: The present library-documentary research relied on the third chapter of the book al-Tasrif, Albucasis' surgical text, as the main information source. RESULTS: Albucasis discussed the conditions necessary for tonsillectomy, he introduced three surgical tools for this operation, and he also described the surgical method. Albucasis succeeded in inventing and discovering new tools and methods for tonsillectomy. CONCLUSION: The comparison of the tonsil surgery introduced by Albucasis and those of earlier and later surgeons reveals Albucasis' superiority in both operation performance and equipment used. Some of his methods are comparable with approaches to operations used in the 20th century.

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.

The effect of a hydrogel made by Nigella sativa L. on acne vulgaris: A randomized double-blind clinical trial.

Nigella sativa L. (black seed) is one of the main medicinal plants frequently cited in traditional Persian medicine manuscripts for management of acne vulgaris. The present study was designed to investigate the efficacy of a topical preparation from N. sativa in acne vulgaris. In a randomized double-blind controlled clinical trial, 60 patients (30 patients in treatment and 30 in placebo group) were randomly received N. sativa hydrogel (standardized based on thymoquinone) or placebo hydrogel, twice daily for 60 days. The Investigator's Global Assessment (IGA) grading score was recorded for each patient. Moreover, acne disability index (ADI) was evaluated using a standard questionnaire filled out by the patients at the beginning and end of the study. A 78% mean reduction in the IGA score on the N. sativa-treated group was recorded compared with 3.3% on the vehicle-treated one. Significant reductions in the number of comedones, papules, and pustules were observed in the treatment group compared with placebo after 2 months. Also, ADI was decreased 63.49% in the treatment versus 4.5% in the placebo groups. No adverse event was recorded. N. sativa hydrogel had significant effects on improving the symptoms of acne vulgaris with acceptable tolerability.

Contributions of Avicenna to surgery and anesthesiology.

Background: Avicenna, as the Persian physician has had a great contribution to the field of medical sciences, especially surgery in 10th and 11th centuries AD.Methods: In the present paper, a few translated quoted words of Avicenna were shared about his surgical practice. Indexing databases of PubMed and Google Scholar were searched using the keywords like Avicenna, surgery, and anesthesiology to find related papers and documents.Results: The first portion comprises of some most commonly used simple and compound herbal preparations to produce general and local anesthetics before the surgery and as dental anesthetic agents. In the second portion, practices regarding surgical management for skull fractures, spinal trauma, bone fracture, cataract, incurable urinary retention, bladder calculi, hemorrhoids, cancer as well as endotracheal intubation and tracheostomy have also been incorporated. Finally, it ends up with practices regarding the use of natural products as postoperative dressing for traumatic and surgical wounds and after cataract surgery.Conclusion: Findings of this review study will provide a brief insight on Avicenna's Canon of Medicine to the sciences of anesthesiology and surgery based on the recent investigations.

Hakim Mohammad: A Persian Military Surgeon in Safavid Era (1501-1736 CE).

BACKGROUND: Wars and injuries have accompanied mankind throughout history. Physicians and surgeons from various civilizations made difficult attempts to manage wounds and injuries. Among various civilizations, the Persian Empires had great armies which were well equipped. One of the most important organizations in Persian troops was the military surgery. METHODS: This study presents a brief biography of Hakim Mohammad (a military surgeon in Safavid era) and introduces his book, Dhakhira-yi-Kamilah. RESULTS AND DISCUSSION: Safavid kings (1501-1736 CE) with unifying all of Persian regions and provinces reconstructed the Persian Empire. Great scholars and physicians were raised in this era. It seems that Persian physicians and surgeons were well trained in Safavid era and many of them were even employed by other countries like Ottoman Empire and India. Hakim Mohammad as a military surgeon was one of such physicians who served in Ottoman Empire for some time. He gathered his surgical experiences and others in the book of Dhakhira-yi-Kamilah. This book was written in Persian. He has mainly written about the management of wounds and practical techniques. Later, he came back to his homeland and dedicated his book to the king of Persia.

Evaluation of the effect of topical chamomile (Matricaria chamomilla L.) oleogel as pain relief in migraine without aura: a randomized, double-blind, placebo-controlled, crossover study.

Phytotherapy is a source of finding new remedies for migraine. Traditional chamomile oil (chamomile extraction in sesame oil) is a formulation in Persian medicine (PM) for pain relief in migraine. An oleogel preparation of reformulated traditional chamomile oil was prepared and then standardized based on chamazulene (as a marker in essential oil) and apigenin via gas chromatography (GC) and high-performance liquid chromatography (HPLC) methods, respectively. A crossover double-blind clinical trial was performed with 100 patients. Each patient took two tubes of drug and two tubes of placebo during the study. Visual analog scale (VAS) questionnaires were filled in by the patients and scores were given, ranging from 0 to 10 (based on the severity of pain) during 24 h. Other complications like nausea, vomiting, photophobia, and phonophobia were also monitored. There was 4.48 ± 0.01 µl/ml of chamazulene and 0.233 mg/g of apigenin in the preparation (by correcting the amount with extraction ratio). Thirty-eight patients in the drug-placebo and 34 patients in the placebo-drug groups (a total number of 72 patients as per protocol) completed the process in the randomized controlled trial (RCT). Adapted results from the questionnaires showed that pain, nausea, vomiting, photophobia, and phonophobia significantly (p < 0.001) decreased by using chamomile oleogel on the patients after 30 min. Results supported the efficacy of chamomile oleogel as a pain relief in migraine without aura.

A Historical Report on Preparing Sustained Release Dosage Forms for Addicts in Medieval Persia, 16th Century AD.

For several centuries, opium addiction has been a social problem all over the world. It has been prevalent in Iran from the Safavid era (1501-1736 A.D). During this period, Hakim Imad al-Din Mahmud ibn-Mas'ud Shirazi (1515-1592 A.D), also known as Imad was one of the Persian physicians who wrote one of the earliest books in the field of opium and addiction (called Afiounieh) in history. In this book, he introduced two sustained release rectal (suppository) and oral (pill) dosage forms for Muslim addicts who fast in the month of Ramadan. He aimed to formulate them for these people so that they could keep fasting by using the slow release drugs. In these formulations, his innovation has important impacts in the history of both addiction and pharmaceutical sciences.

Effect of Nepeta bracteata Benth. on allergic rhinitis symptoms: A randomized double-blind clinical trial.

BACKGROUND: Allergic rhinitis (AR) is one of the health problems in the world. It is necessary to develop new treatment procedure for control of this disease. The aim of this study was to assess the effect of Zofa (Nepeta bracteata Benth) on AR patients. MATERIALS AND METHODS: In this double-blind randomized clinical trial study, 71 patients (37 patients in treatment and 34 in placebo group) participated. In treatment group, N. bracteata syrup (NBS) was used for 4 weeks as three times a day. The efficacy of the drug regarding AR symptoms (rhinorrhea, sneezing, nasal obstruction, itchy nose, and ocular symptoms) were evaluated through a visual analog scale (VAS) by 0-10 before administration and at the end of the whole treatment period. The collected information was entered in the SPSS software (version 18) and was analyzed using the Fisher's exact test, Chi-square test, independent sample t-test, and paired sample test. RESULTS: The improvement of AR symptoms in the group receiving NBS was significantly higher compared to control group (4.73 ± 1.84 vs. 0.38 ± 2.06; P < 0.0001). Furthermore, the mean of total VAS before and after the treatment (in case group) was 7.10 ± 1.92 and 2.37 ± 1.76, respectively (P < 0.001). CONCLUSION: The results of this study indicate that N. bracteata has significant effects on improving the symptoms of AR. Hence, it can be a good alternative to AR symptoms relief.

A review on the management of migraine in the Avicenna's Canon of Medicine.

Migraine is a common type of headache which has a deep history dating back thousands of years. Avicenna (980-1032), a Persian scholar, made a great contribution to neurology including headache and migraine. The aim of this study is to consider Avicenna's description about migraine (Shaghighe in Persian language) including definition, etiology and intervention. Also, his definition and treatment approaches were considered based on current concepts and findings. Although Avicenna believed in humoral theory and divided migraine into two categories, hot and cold, and suggested special treatments for them as well as general considerations, most of his definitions and explained pathologies are supported by current concepts of medicine. He believed that the migraine can result from bone of skull and also intra-parenchymal; or from skull underneath membrane (dura-mater); or reaching substances from the painful side or from outer vein and arteries (extra cranial); or from brain and meninges (pia-mater). Furthermore, current findings show most medicinal plants mentioned by Avicenna for the treatment of migraine can have potentially significant effects such as remedies which stop central and peripheral sensitization [anti-neuroinflammatory agents, decreasing nitric oxide level, cyclooxygenase (COX)-2 inhibitors], as well as serotonergics, neuroprotective agents and analgesics.

Report - Renovation of a traditional Ergh-al-Nassa pill (Hab) to a standard Pharmaceutical molded tablet.

The Ergh-al-Nassa pill (Hab) is a traditional combination suggested as one of the most effective preparations useful for treatment of sciatica. Although traditional preparations can be applied as new therapeutic drugs for investigations and clinical trials, they need to be reformulated to achieve pharmacopoeial standards for modern medicine. In this research, based on seven traditional Persian pharmacopeias for Ergh-al-NassaHab, nine different molded tablets were reformulated. Each formulation comprised the same amount of colchicum, ginger, aloe and yellow myrobalan fruit. Sweet almond oil had to be added in the maximum amount needed to be absorbed by the yellow myrobalan fruit according to its particle size (30-40 mesh sizes). The studies were performed in order to optimize the formulation process according to the role of three levels in particle size of the herbal ingredients (60-70, 80-100, 100-150 mesh sizes) and three levels of initial water for granulation. The molded tablets were evaluated according to standard quality controls for tablets (mass uniformity, LOD, hardness, friability, and disintegration time at 20 and 30 min). Myrobalan powdered to 30-40 mesh size absorbed the maximum amount of sweet almond oil (1:0.75 w/v). The best formulations occurred when the particle size of colchicum, ginger, and aloe was 60-70 mesh size with an initial moisture content of 0.47 ml per 1g of dried powder. The outcome of this research is a pharmaceutical standardized formulation from the traditional Ergh-al-Nassa pill which can be suggested as a sample drug discovery based on traditional knowledge.

Surgeons and surgery from ancient Persia (5,000 years of surgical history).

The development of surgery is indebted to scientists and surgeons from various civilizations throughout history. The present study considers surgery in the ancient Persian civilization. It highlights aspects of the subject, such as findings of the first trephinated skulls in Iran; surgeons' social class (kareto baesaza in the Avestan language-dating back 3,000 years); surgical operations such as cesarean section and procedures to treat breast cancer; and the use of anesthetic compounds and surgical practice in the military. It is hoped that this catalogue of historical evidence of surgical practice in ancient Persian civilization will contribute to the history of surgery, as an important field in medical science.