Volume 18, Issue 2

Objectives The present systematic review of literature was conducted to study the effect of Nigella sativa ( N.S ) on oxidative stress and inflammatory biomarkers. Content Different online databases such as Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Scopus, Web of Sciences, EMBASE, and Clininaltrial.gov for English articles and national databases of SID, Magiran, Irandoc, and Iranmedex for Persian articles, which were published until March; 2019 were scrutinized. All Randomised Controlled Trials (RCTs) and quasi-experimental studies that aimed to compare the impact of N.S along, with placebo or without supplementation, on inflammatory factors and oxidative stress were entered in the present study. Summary Finally, 11 RCTs covering 710 women and men, in total, were participated in the present meta-analysis. Significant differences were observed in Tumor Necrosis Factor alpha (TNF-α) (Weighted Mean Difference (WMD) =−2.15 pg/mL, 95% Confidence Interval (CI) =−3.22–−1.09, I 2 =32%; 5 trials with 262 participants) superoxide dismutase (WMD=63.79 µ/gHb, 95% CI=6.84–120.75, I 2 =0%; 2 trials, with 88 participants), and total antioxidant capacity (WMD=0.34 mmol/L, 95% CI=0.04 to 0.63, I 2 =94%; 5 trials with 232 participants). Nevertheless, there was no significant difference in high sensitivity C-reactive protein (WMD=−0.98 mg/L, 95% CI=−1.98–0.03, I 2 =78%; 5 trials with 267 participants), Interleukin 6 (IL-6) (WMD=−0.25 pg/mL, 95% CI=−0.65 to 0.16, I 2 =0%; 2 trials with 134 participants), and malondialdehyde (WMD=−0.95 nmol/mL, 95% CI=−1.97–0.08, I 2 =68%; 4 trials with 179 participants). Outlook Generally speaking, N.S probably results in the improvement of superoxide dismutase serum levels, TNF-α, and total antioxidant capacity. Thus, further studies are required to fully assess its impacts on all oxidative stress and inflammatory biomarkers.

Background One of the most common complaints for women is dysmenorrhea. Several studies investigated the treatment effects of medicinal plants on primary dysmenorrhea. Objectives This systematic review and meta-analysis investigates the effect of Foeniculum vulgare (Fennel) on pain in primary dysmenorrhea in comparison to non-steroidal anti-inflammatory drugs such as mefenamic acid. Methods PubMed, EMBASE, EBSCO Web of Science, Scopus, Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, ProQuest, ISI Web of Science, Google Scholar, Magiran, SID, Iran Medex, and Irandoc were searched up to January 2019. Quality assessment of clinical trials was conducted using Jadad scoring system. Totally, 12 studies were entered in the meta-analysis. I 2 was calculated to determine heterogeneity. Fixed effects and/or random effects models were applied. Results Meta-analysis of these trials showed that F. vulgare intake decreased significantly the intensity of dysmenorrhea compared to the placebo (SMD −0.632; CI: −0.827 to −0.436; p<0.001; heterogeneity p=0.807; I 2 =0%; fixed effect model; seven articles). However, the effect of Mefenamic acid with F. vulgare was not different from each other (SMD=−0.214; CI: −0.446 to 0.017; p=0.07; heterogeneity p=0.58; I 2 =0%; fixed effect model; six trials). Conclusion The F. vulgare alleviates dysmenorrhea. Regarding the same effect of F. vulgare with NSAIDs, it is highly recommend to the women suffered from dysmenorrhea specifically the ones who have high tendency toward herbal medicine.

Primary health care is a vital component in health care delivery. Non-communicable diseases (NCD’s) are rising like a major threat to human survival, which is expected to account for 75% of the total mortality by 2030. Lifestyle and behavioural changes are reckoned as the way ahead. Yoga and Naturopathy, a drugless system of medicine has intersecting paradigms which addresses all planes of health effectively. Yoga and Naturopathy through its holistic approach educate and make the people responsible for their own health. It has shown its efficacy in alleviating and preventing various NCD’s. A systematic approach should be initiated, which can channelize the integration of Yoga and Naturopathy at the primary care level considering its cost-effectiveness and efficacy over NCD’s.

Objectives The Phytomedicine (PM) and Food supplements (FS) Market is considerably growing in Morocco a review of state is necessarily to structure and improve it. Methods Information was collected directly from the pharmacist through a questionnaire-based survey who was conducted in 284 pharmacies in the region of Fez-Meknes in Morocco. Data were analyzed and classified using relative frequency of citations (RFC). Results More than 98% of the pharmacies commercialized the PM and FS, 80% of the pharmacists deny the existence of a real area dedicated to them, the majority (94%) of them prefer phytomedicine rather than classic drugs. This study reported about 64 products as the most used by the population of the region of Fez-Meknes among them 48 FS (75%) and 16 PM (25%) and the most marketed products are used for Transit Disorders (28.34%), then Anxiety (22.17%) and ENT Disease (20.18%). Conclusions Despite the fact that Morocco is a country where people use medicinal plants daily, the commercialization of the PM and FS is still unstructured. Due to legal problem the PM Sold in the market are mainly exported. To assure development and also valorization of this sector the regulation of this market is highly required.

Objectives Aqueous extract of Moringa oleifera leaves (MOE) is a potent inducer of endothelium-dependent relaxation of mesenteric resistance arteries of rats induced to be hypertensive using N ω -nitro-L-arginine methyl ester (L-NAME). Hydrogen sulfide (H 2 S) has been shown to participate in endothelium-dependent relaxation of small resistance arteries. Therefore, this study aimed to investigate whether endothelial H 2 S-dependent signaling plays a role in the vasorelaxation in response to MOE. Methods Mesenteric arterial beds isolated from L-NAME hypertensive rats were set up in an ex vivo perfusion system for measurement of vasoreactivity. All experiments were performed in the presence of the nitric oxide synthase inhibitor, L-NAME (100 µM) and the cyclooxygenase inhibitor, indomethacin (10 µM) to prevent the formation of nitric oxide and prostanoids, respectively. Results In the presence of the nitric oxide synthase inhibitor, L-NAME and the cyclooxygenase inhibitor, indomethacin, the endothelium-dependent vasorelaxation induced by MOE (0.001–3 mg) was completely inhibited by DL-propargylglycine (100 µM), which inhibits the H 2 Sgenerating enzyme, cystathionine γ-lyase. This H 2 Sdependent response was reduced by the K ATP channel blocker; glibenclamide (10 µM), the K Ca channel blocker; tetraethylammonium (1 µM), and the myo-endothelial gap-junctional uncoupler; 18α-glycyrrhetinic acid (10 µM). In contrast, the muscarinic receptor antagonist, atropine (100 µM), did not affect the response to MOE. Conclusions The results may suggest that H 2 S is the likely mediator of endothelium-dependent relaxation in response to MOE in mesenteric arterial beds of L-NAME-induced hypertensive rats. MOE-induced H 2 S-dependent vasorelaxation involves activation of K ATP and K Ca channels and requires myo-endothelial gap-junctional communication.

Objectives Several studies establish the therapeutic properties of various plants which are sometimes a source of minerals, vitamins and phytochemical compounds. However, many studies evoked potential toxic of some. In Cameroon, Crassocephalum crepidioides ( C.c ) is used in folk medicine to treat several diseases, but there are not much informations about its toxicity. This study evaluate its acute and sub-acute toxicity. Methods Our study was undertaken to evaluate acute and sub-acute toxicity of aqueous leaves extract of C.c . The study was conducted using the OECD guidelines about oral toxicity’s study. For acute toxicity, rats were administrated single oral dose of 5,000 mg/kg body weight (b.w) and monitored for death and weight impairment during seven days. In sub-acute toxicity, experimental rats received daily doses of 250,500 and 1,000 mg/kg b.w during 28 consecutive days. The toxics effects of the extract were assessed using anthropometric, haematological, biochemical parameters as well as histology of vital body’s organs (liver, kidneys, lungs and spleen). Results lethal dose 50 (LD 50 ) was find to be greater than 5,000 mg/kg b.w in rats. In sub-acute toxicity, we observed significant increase of body weight, food and water consumption with the maximums of 15.14, 24.52 and 28.86% respectively at 1,000 mg/kg b.w. There was no significant change in haematological parameters. However, we observed significant change in biochemical parameters. Furthermore, structural disorders were noticed in liver and kidneys of animals treated with C.c . Conclusion Data obtained suggesting that C.c extract could be safe in single administration, but with toxic effects in repeated treatment.

Objectives The potent anti-tumorigenic effects were attributed to ginger and there are some reports regarding the anti-cancer and immunomodulatory properties ginger-derived components. This study aimed to investigate the effects of zingerone on some immune-related parameters in an animal model of breast cancer. Methods The breast cancer was established in female BALB/c mice using a carcinogenic 4T1 cell line. At day 10 after cancer induction, tumor-bearing mice were divided into five groups and treated intraperitoneal (daily from days 11–30) with saline or zingerone (at doses 10, 20, 50 and 100 mg/kg/day). The mice were sacrificed on day 31 and the number of splenic Th1- and Treg cells, the expression of IFN-γ and TGF-β in the blood mononuclear cells, the antibody production against sheep red blood cell (SRBC) were determined using flow cytometry, real time-PCR and a standard hemagglutination assay, respectively. Results Zingerone at doses 50 and 100 mg/kg enhanced the number of splenic Th1 cells (p<0.03 and 0.007, respectively); at doses 10, 20, 50 and 100 mg/kg reduced the number of splenic Treg cells (p<0.02, 0.01, and 0.01, respectively), at doses 50 and 100 mg/kg enhanced the expression of IFN-γ (p<0.03), at doses 50 and 100 mg/kg reduced the expression of TGF-β, at doses 50 mg/kg reduced the titer of anti-SRBC antibody (p<0.05). Conclusions Zingerone improve the T cell-mediated and antibody responses in a mouse model of breast cancer. The immunotherapeutic potentials of zingerone in cancers need more considerations.

Objectives Based on the ethno-medicinal use of Bombax ceiba leaf, in the treatment of diabetes, the present study is aimed at evaluation of antidiabetic potential of leaf extract and its major constituent mangiferin. Methods Efficacy of hydroalcoholic extract of Bombax ceiba leaf (BCL, 200 and 400 mg/kg body wt.) and mangiferin (MF, 20 mg/kg body wt) was studied in streptozotocin (STZ)-induced diabetic rats and associated complications visually, retinopathy, cardiopathy and nephropathy. After 20 days, serum glucose, lipid profiles, glycol-hemoglobin % (HbA1c%), liver enzymes activity and glycogen content, and histopathology of the pancreas were corroborated. The study was coxswained for development of validated RP-HPLC method for the estimation of MF in BCL. Results The results demonstrated significant reductions in the levels of glucose (p<0.001), glycated hemoglobin (HbA1c%, p<0.001), cholesterol, triglycerides and low-density lipoproteins, and concurrent elevation of high density lipoproteins level in the groups administered BCL and MF relative to the controls. It significantly reversed most of the altered metabolic and oxidative stress parameters and histopathological changes. Mangiferin content in BCL was found to be 0.04% w/w . Conclusions The anti-diabetic effects of BCL may be attributed to its ability to enhance insulin release, antioxidant and hypolipidemic potential.

Objectives Research on endosymbionts is emerging globally and is considered as a potential source of bioactive phytochemicals. The present study examines the antioxidant and antidiabetic of the endophytic crude extract isolated from Leucaena leucocephala leaves. Methods Endophytic bacteria were isolated from the leaves of L. leucocephala and 16S rRNA gene sequencing was used to establish their identity. The in vitro antioxidant effect of endophytic crude extract (LL) was evaluated using 2-diphenyl-1-picrylhydrazyl (DPPH) and 2, 2′-azino-bis-3-ethylbenzthiazoline-6-sulphonic acid (ABTS) free radical scavenging methods. The in vitro antidiabetic properties of LL were evaluated using α-amylase and α-glucosidase enzyme inhibition assay. Results The isolated endophytic bacteria were identified as Cronobacter sakazakii . LL displayed potent free radical scavenging effect against ABTS and DPPH radicals with an inhibitory concentration 50% (IC 50 ) value of 17.49 ± 0.06 and 11.3 ± 0.1 μg/mL respectively. LL exhibited α-amylase and α-glucosidase inhibition with an IC 50 value of 23.3 ± 0.08 and 23.4 ± 0.1 μg/mL respectively compared to the standard drug (acarbose). Both glucose loaded normoglycemic rats and STZ induced diabetic rats treated with LL (200 mg/kg) exhibited a considerable reduction in blood glucose levels p<0.01 after 8 h of treatment when compared to normal and diabetic control rats respectively. Conclusions Thus, the study shows that LL has a wellspring of natural source of antioxidants, and antidiabetic agents and phytoconstituents present in endophytes could be the rich source for bioactive compounds.

Objectives Dutasteride-Tamsulosin (DUT-TAM), a drug of choice for the treatment of prostate enlargement (Benign Prostatic Hyperplasia, BPH) has been implicated in testicular toxicity. This study investigated the protective effect of morin, a plant-derived flavonoid on DUT-TAM-induced testicular toxicity in Wistar rat. Methods Twenty-four male Wistar rats (110–140 g) were randomly divided into four treatment groups (n=6). Group A animals served as the control and were administered olive oil, Group B animals were administered 5.4 mg/kg b.w. of dutasteride + 3.4 mg/kg b.w of tamsulosin., Group C animals were administered 100 mg/kg b.w. of morin, while Group D animals were administered DUT-TAM (5.4 mg/kg b.w. of dutasteride + 3.4 mg/kg b.w. of tamsulosin) and morin (100 mg/kg b.w.). The administration lasted for two weeks. Results DUT-TAM-induced abnormal sperm morphology (31.8%), significantly reduced (p<0.05) sperm count, sperm motility, live-dead sperm ratio, testicular superoxide dismutase (SOD), catalase, glutathione-S-transferase (GST) and acid phosphatase (ACP) activities, as well as the levels of ascorbic acid and reduced glutathione (GSH) which were ameliorated by co-treatment with morin. Also, DUT-TAM-induced increase in testicular malondialdehyde level and the activities of alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT) and lactate dehydrogenase (LDH) were significantly reversed (p<0.05) by co-treatment with morin. Conclusions These results indicated the protective ability of morin against Dutasteride-Tamsulosin-induced testicular toxicity and oxidative stress.

Objectives Mesua ferrae , from the family of Calophyllaceae, is traditionally used for the treatment of piles, fever and renal disorders. The present study was aimed to examine the antibacterial compounds from the leaves of M. ferrae and their β -lactam antibiotic potentiate activities against Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). Methods Stigmasterol ( 1 ) and β -caryophyllene oxide ( 2 ) were isolated from the n -hexane fraction of the leaves of M. ferrae using a bioassay-guided fractionation approach. Results The isolated compounds displayed anti- Staphylococcus and anti-MRSA activities. It is worth to note that both compounds demonstrated synergism with β -lactam antibiotics against S. aureus and MRSA. Gas chromatography–mass spectrometry (GC–MS) analysis indicated the n -hexane fraction was dominated by triterpenes and sesquiterpenes, suggesting the total antibacterial activity exhibited by the fraction. Conclusion Based on the findings, it could conclude that M. ferrae is a promising natural source for the discovery of new anti-MRSA lead compounds.

Objective To evaluate the influence of irisin on the experimental paradigm of non-alcoholic fatty liver (NAFL) as a part of MetS cluster. Methods Forty male albino rats were divided into four groups; normal control, standard diet + irisin, high carbohydrate and fat diet (HCHF), and HCHF + irisin. After the experimental period, levels of fasting blood sugar (FBS), insulin, lipid profile, kidney functions, salusin-alpha (Sal-α), adropin, and retinol-binding protein-4 (RBP-4) were evaluated. Peroxisome proliferator-activated receptor-gamma coactivator-1alpha (PGC-1α) expression in skeletal muscle was evaluated by quantitative real-time PCR. Aorta, liver, pancreas, and skeletal muscle tissue samples were prepared for histopathological examination. Results Rats administrated HCHF showed elevated levels of FBS, lipid profile, kidney functions, RBP-4, and downregulation of PGC-1α expression along with a decline in levels of insulin, Sal-α, and adropin while administration of irisin significantly attenuated these levels. Conclusions Irisin as based therapy could emerge as a new line of treatment against MetS and its related diseases.

Objectives Uterine fibroids are benign tumors that develop in many women of reproductive age. Surgery is the main approach to treatment while other options are also associated with adverse effects. Studies have shown that certain bioactive agents present in medicinal plants elicit their anti-tumor activity by induction of mitochondrial permeability transition (mPT) opening. This research therefore aimed at investigating the effect of methanol extract of Annona muricata (MEAM) on mPT pore opening in normal and monosodium glutamate-induced uterine hyperplasia using female Wistar rats. Methods Mitochondria, isolated from rat liver were exposed to different concentrations (20, 60, 100, 140 and 180 μg/mL) of MEAM. The mPT pore opening, cytochrome c release, mitochondrial ATPase (mATPase) activity and the percentage lipid peroxidation were assessed spectrophotometrically. Histological effects of MEAM on the liver, brain and uterus of normal and MSG-treated rats were investigated. Results The in vitro results showed a significant induction of mPT pore opening by 2.4, 4.2 and 6.4 folds, release of cytochrome c and enhancement of mATPase activity at 100,140 and 180 μg/mL, respectively. However, oral administration of MEAM did not induce mPT pore opening, neither any significant release of cytochrome c nor enhancement of mATPase activity at all the dosages used. However, histological assay revealed the presence of MSG-induced cellular damage and uterine hyperplasia which was ameliorated by MEAM co-administration. Conclusions These findings suggest that MEAM contains phytochemicals that can ameliorate MSG-induced damage and uterine hyperplasia in rats; however, the mechanism might not be via upregulation of mitochondrial-mediated apoptosis.

Objectives Adhesive capsulitis results in a multidimensional disability which demands a polygonal approach. Although physiotherapy proves an essential for a complete and comprehensive recovery in adhesive capsulitis, evidence also suggest the role of yoga in the management, hence this study investigate their effectiveness. Methods This is a quasi-randomised control study. A pre-diagnosed subacute and chronic adhesive capsulitis of shoulder, between the age group of 35–60 years of both genders of total 40 participants were randomly divided into Group ‘A’ (yogasana) and Group ‘B’ (physiotherapy). The parameters of pain, joint mobility and functional disabilities were measured at the baseline and after four-weeks. Results The mean age of Group ‘A’ was 45.4 ± 7.78 years whereas 50.05 ± 5.98 years was in Group ‘B’. Intragroup analysis for both the groups showed statistically significant improvement in all the study variables. Whereas in intergroup analysis yogasana was found to be statistically significant in improving shoulder abduction mobility, p=0.03, effect size r=0.35 and also in shoulder flexion (p=0.15, r=0.23) and shoulder internal rotation (p=0.07, r=0.3), though statistically not significant, in view of small effect size response. Conclusions Both techniques improved the functional status in adhesive capsulitis, however additional effects on joint mobility was demonstrated by yogasana.

Objectives This randomized study was aimed at evaluating the additional analgesic effect of Okada Purifying Therapy (OPT) when administered in combination with duloxetine in patients with Temporomandibular Disorders (TMDs) and Fibromyalgia (FM). Methods Patients with TMDs visited at Department of Oral and Maxillofacial Sciences, Sapienza University of Rome who were diagnosed with FM were selected for the study. The final sample was composed of 31 patients: 15 patients were treated only with duloxetine (Group I) and 16 patients underwent also OPT treatment (Group II), for eight weeks. Craniomandibular index, total tenderness score, Brief Pain Inventory Modified Short Form, Fibromyalgia Impact Questionnaire, Beck Depression Inventory and State and Trait Anxiety Inventory-1 were assessed at the beginning (T0), during the course (T1) and after therapy (T2). Descriptive and inferential statistics were performed. Results In all the data analyzed, both groups showed an improvement in particular between T0 and T1. No statistically significant differences were observed between the two groups during the trial, except for the interaction between treatment and time as to the ability of walking at the BPI-I (F=7.57, p=0.002). No side effects due to the duloxetine were recorded in group II compared to group I. Conclusion The additional complementary treatment (OPT) did not appear to give the patients with TMDs and FM any further benefit but it might improve pharmacological tolerability of the traditional medication.

Objectives The FIFA-Medical and Assessment Research Centre (F-MARC) introduced the warm-up FIFA 11+ program to reduce injuries and promote fair play. Although the FIFA11+ program is a well-established warm-up protocol for injury prevention, studies on the program’s performance enhancement aspects have had controversial results. Therefore, the objective of the study is to investigate the efficacy of FIFA11+ program on sports performance parameters such as running speed, agility, and vertical jump performance in amateur female basketball players. Methods In this study, 59 amateur female basketball players were recruited and randomized into an experimental group (n=30) and a control group (n=29). The experimental group completed the FIFA 11+ program for 12 weeks (three times/week), while the control group members completed their regular training programs. The study adopted a pretest-posttest design. 20-yard sprint run, t test and vertical jump test were the outcome measures Results No statistically significant difference in the sports performance parameters (sprint test p=0.21, t test p=0.16, vertical jump test p=0.09) was found between groups’ post-test measurements. The paired sample t test revealed that the 12-week FIFA 11+ program did not demonstrate any significant improvement in the participants’ sprint, agility, and vertical jump performance (p>0.05). Conclusions The present study showed no enhancement in sports performance parameters such as sprint speed, agility, and vertical jump performance in amateur female basketball players. This lack of improvement in performance measures suggests that the program cannot be used as a training strategy for the targeted sports performance parameters.

Objectives Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. The aim of this study is to investigate body composition and phenotype of Egyptian women with non-alcoholic fatty liver disease (NAFLD) and compare with those without and determine the optimal cut-off values of central obesity indices for predicting NAFLD. Methods The study included 100 women with NAFLD and 100 age and sex matched healthy controls without NAFLD. All women were subjected to ultrasonography examination. Anthropometric measurements included weight, height, waist circumference (WC), hip circumference (HC) and skinfolds thickness were assessed for all participants. Body fat % was evaluated by Tanita body composition analyzer. Body mass index (BMI), WC / height ratio (WHtR), WC / HC ratio (WHR) and visceral adiposity index (VAI) were calculated. Receiver-operating characteristic (ROC) curve was used to determine the optimal cut-off values. Results Data showed significant higher levels of WHtR, WHR, BMI, sum of skinfolds, body fat %, serum fasting blood lipids and glucose in NAFLD women compared to group of patients without NAFLD. The area under curve (AUC) was 0.920 for VIA, 0.883 for WHtR and 0.647 for WHR. The optimal cutoff value of VAI was 3.66, of WHtR was 0.66 and WHR was 0.84. All values showed high sensitivity and specificity values. Conclusion NAFLD women were obese, had excess subcutaneous fat and body fat ratio. Central obesity indices are closely associated with the presence of NAFLD in Egyptian women and might be responsible for its development. Visceral adiposity index had superior diagnostic performance.

Objectives Increased sympathetic stimulation in smokers may be a risk factor for pulmonary and cardiovascular diseases. This study was conducted to assess the immediate effect of interscapular cupping on blood pressure (BP), oxygen (O 2 ) saturation, chest expansion (CE), pulse rate (PR) in sedentary male smoker students. Methods Forty sedentary male smoker students– aged 18–25 years -were divided randomly into two equal numbered groups; wet cupping (WC) and dry cupping (DC) groups. Systolic and diastolic BP, upper and lower CE, O 2 saturation and PR were measured immediately before and after a single cupping session in both groups. Results Both WC and DC types showed improvements in all measurements with a high statistically significant difference (p<0.05). Conclusions Interscapular cupping enhanced CE, O 2 saturation, BP and PR in sedentary male smoker students.

Objectives To determine the effects that an olive oil massage has on fatigue among patients undergoing hemodialysis, and the associated sociodemographic factors that can reduce fatigue. Methods The study used true experimental pre- and post-test research design. A total of 200 patients were recruited in a selected hemodialysis unit in southern India and were allocated to either a study or control group by randomization, with 100 patients in each group. All the patients in the intervention group were given a lower back and lower leg massage using olive oil at the beginning, and after every hour, of their hemodialysis using olive oil for a period of eight weeks. In contrast, the control group continues to receive routine care. The level of fatigue was measured using the Fatigue Severity Scale both before and after massage therapy. Results Between 73 and 80% of patients were suffering from severe fatigue and the mean fatigue score was 5.53 (SD 1.82) and 5.56 (SD 1.57) for the study and control group, respectively. After eight weeks of massage therapy, the results showed that 53% of patients in the study group showed borderline fatigue, with a mean score of 4.39 (SD 2.37), whereas in the control group 73% patients showed severe fatigue, with a mean score of 5.17 (SD 2.00). The independent t-test between the study and the control group showed a statistically significant reduction in fatigue in the study group with a mean difference (MD) of 3.56 (t=−1.24; p=0.000). There were also statistically significant changes noted in gender and in the duration of the hemodialysis ( χ 2  = 6.043; p=0.049) and ( χ 2  = 6.611; p=0.046) respectively. Conclusion The study concluded that patients undergoing hemodialysis experienced moderate to severe levels of fatigue. In patients with no or mild anemia, massage has been shown to decrease fatigue and increase energy levels among patients undergoing hemodialysis for chronic kidney disease.

Background In patients with type 2 diabetes mellitus (T2DM) the inflammatory and metabolic responses to epigallocatechin-3-gallate (EGCG) are unknown. Objectives Evaluate the impacts of EGCG on metabolic factors and some biomarkers of stress oxidative in patients with T2DM. Methods In this randomized, double-blind, placebo-controlled trial, 50 patients with T2DM consumed either 2 tablets (300 mg) EGCG (n=25) or wheat flour as placebo (n=25) for 2 months. The total antioxidant capacity (TAC), interleukin-6 (IL-6), lipid profile, mean arterial pressure (MAP), atherogenic index of plasma (AIP) were evaluated before and after the intervention. Results The finding of present study exhibited a significant increase in the serum levels of TAC after the EGCG supplementation (p=0.001). Also, in compare with control group, the mean changes of TAC were significantly higher in supplement group (p=0.01). In intervention group, a significant decrease was observed in the mean levels of triglyceride, total cholesterol, diastolic blood pressure (DBP), AIP, and MAP (p<0.05). Taking EGCG resulted in the mean changes of total cholesterol, MAP and DBP were significantly lower in compare with control group (p<0.05). Conclusions This study recommended that EGCG supplementation may be improved blood pressure, lipid profile, AIP, and oxidative status in patients with T2DM.

Background Anxiety and fear of labor pain has led to elevated cesarean section rate in some countries. This study was conducted to investigate the effect of yoga in pregnancy on anxiety, labor pain and length of labor stages. Methods This clinical trial study was performed on 84 nulliparous women who were at least 18 years old and were randomly divided into two groups of yoga and control groups. Pregnancy Yoga Program consisting of 6 60-min training sessions was started every 2 weeks from week 26 of pregnancy and continued until 37 weeks of gestation. Anxiety severity at maternal admission to labor was measured by the Spielbergers State-Trait Anxiety Inventory, and labor pain was measured by Visual Analogue Scale (VAS) at dilatation (4–5 cm) and 2 h after the first measurement. Data were analyzed using Chi-Square and t-test. Results Intervention group reported less pain at dilatation (4–5 cm) (p=0.001) and 2 h after the first measurement (p=0.001) than the control group. Stat anxiety was also lower in intervention group than the control group (p=0.003) at the entrance to labor room. Subjects in the control group required more induction compared to intervention group (p=0.003). Women in intervention group experienced shorter duration of the first phase of the labor than the control group (p=0.002). Also, the total duration of two stages of labor was shorter in intervention group than the control group (p=0.003). Conclusions Practicing yoga during pregnancy may reduce women’s anxiety during labor; shorten labor stages, and lower labor pain.

Objectives The purpose of this study was to compare the effect of lumbar stabilization exercise and thoracic mobilization with strengthening exercise on pain level, thoracic kyphosis, and functional disability in patients with Chronic Low Back Pain (CLBP). Methods Thirty patients with CLBP were recruited based on inclusion and exclusion criteria. They were randomly allocated into two groups i. e., Group A (n = 15) and B (n = 15). Group A has received lumbar stabilization exercise and thoracic mobilization with strengthening exercises and Group B received only lumbar stabilization exercises, three sessions per week for 4 weeks both the groups. The conventional moist hot pack and interferential therapy was given to both the groups before the administration of exercise. Pre- and post-treatment pain level, Thoracic kyphosis, and functional disability were taken and statistical analysis was done. Results The result of this study showed significant improvement from pre-intervention to post-intervention on pain level, thoracic kyphosis, and functional disability for both the groups i. e., Group A and group B but Group A showed greater changes in Numerical pain rating scale (NPRS), Kyphotic index, and Oswestry disability index (ODI), than Group B. Conclusions The 4 week of therapeutic intervention including lumbar stabilization exercise with thoracic mobilization and strengthening exercise showed significantly reduction of the thoracic kyphosis, pain level and functional disability in patients with Chronic Low Back Pain.

Short communication During the Ramadan fasting (RF) month, participants restrict some activities during day time, particularly consumption of food and beverages. In Germany, Muslims fast about 18–19 h a day when Ramadan falls in the summer. This longer period of restriction could lead to the changes of the body physiology, anthropometric parameters and biological mediators. Objectives This study aimed to determine the effect of Ramadan fasting on cytokines (Interleukin (IL)-1β. IL-6, IL-8, IL-10, IL-12, tumor necrosis factor (TNF)-α) during RF in Germany. Correlations of cytokines with anthropometric parameters were also determined. Methods Fifty healthy adult males were recruited and divided into two equal groups: fasting group (FG) and non-fasting group (NFG). FG was evaluated at T1: one week before, T2: mid-, T3: last days of, and T4: one week after Ramadan. The NFG were evaluated only at T1 and T3. Results In FG significant alterations of IL-1β was observed. Insignificant differences were found between the FG and NFG at T1 and T3 concerning the measured cytokines. Circulating IL-1β increased significantly from T2 to T4 and from T3 to T4. At T3, TNF-α was correlated significantly with anthropometric parameters such as the body weight, the skeletal muscle mass and the fat free mass, whilst IL-12 was correlated significantly with the skeletal muscle mass, the fat free mass and the body water mass at T4. Conclusions Significant Alterations of IL-1β during RF in FG were observed. Anthropometric parameters correlate with TNF-α and IL-12 levels during at T3 and T4, respectively.

Objectives Recurrence rate of nasal polyps is high following endoscopic sinus surgery. To improve the surgical outcome, steroid impregnated nasal dressing is used postoperatively We aimed to compare the effect of Tualang honey impregnated nasal dressing with steroid impregnated nasal dressing on wound healing and surgical outcomes in post endoscopic sinus surgery patients. Methods A prospective, randomized, controlled trial was carried out at two tertiary hospitals. 32 patients diagnosed with chronic rhinosinusitis and had underwent endoscopic sinus surgery were enrolled. The study group received 2 mL of Tualang honey nasal dressing and the control group received nasal dressing with 2 mL of triamcinolone 20 mg/mL as positive control. A 2 cm nasal dressing was placed longitudinally into the middle meatuses of both nasal cavities. Postoperative healing assessments of edema, crusting, secretions, scarring and symptoms were performed at postoperative day 7, 14, 28 and at 3 months using Sinonasal Outcome Test 22 questionnaire and modified Lund-Kennedy scoring system. Results There were no significant differences noted in the scores of Sinonasal Outcome Test 22 and modified Lund-Kennedy at Day 7, 14 and 28 (p>0.05) for both groups. At 3rd month, patients in the triamcinolone group had lesser symptoms and better endoscopic findings (p<0.05). Conclusion Tualang honey is not as effective as steroid in achieving good wound healing and surgical outcomes in post endoscopic sinus surgery patients. Thus, it is not suitable as a substitute for steroid to reduce symptoms and prevent recurrence of disease.

Background Ginger and castor oil, both are used in traditional medicine to treat arthritis, the latter is also commonly used as a vehicle in these systems of medicine. The study was designed to prepare a nanostructured lipid carrier (NLC) of ginger extract using castor oil as a novel liquid lipid and evaluate its safety and efficacy in rheumatoid arthritis in experimental animals. Methods Ginger extract was standardized using High performance liquid chromatography (HPLC). The optimized NLC formulation was characterized and its therapeutic efficacy was evaluated in Chronic Freund's adjuvant (CFA) induced arthritis in experimental animals. Results Ginger extract contained 38.76 ± 3.01%w/w of 6-gingerol. The optimized NLC formulation showed a particle size of around 205 nm, a zeta potential of −33.7 and %entrapment efficiency of 76.59 ± 0.83%. Reduction in primary inflammation was significantly higher with NLC when compared with ginger extract and castor oil alone (p<0.001). The formulation also improved hyperalgesia in rats. Conclusion Castor oil can be used as a novel lipid in the preparation of NLC. The NLC effectively enhanced the therapeutic value of poorly bioavailable ginger extract.

Objectives Limited research has examined the effects of fenugreek ( Trigonella foenum-graecum L.) supplementation to improve healthy younger men's aging male symptoms. The study objective was to examine whether a fenugreek seed extract would improve healthy men's aging male symptoms, health-related quality of life (HRQoL), grip strength, and anxiety. Methods Randomized double-blind placebo-controlled trial was employed, using a parallel design, with assessments at baseline, Day 30, and Day 60. Healthy male volunteers (n = 57, mean age = 26.1 years) were randomized to: fenugreek 400 mg/d (n = 19), fenugreek 500 mg/d (n = 19), or placebo group (n = 19). Results The fenugreek groups reported significant improvements in aging male symptoms, anxiety levels, grip strength, and indicators of HRQoL compared to the placebo group, p ' s  < 0.05. No adverse events were reported. Conclusion Fenugreek supplementation is an effective nutritional intervention for improving aging male symptoms, anxiety levels, grip strength, and aspects of HRQoL in healthy recreationally active men. Future researchers are encouraged to examine the health and ergogenic effects of fenugreek supplementation in hypogonadal and older populations. Trial registration Clinicaltrials.gov identifier NCT03528538.