Volume 18, Issue 4

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer’s disease, and it is characterized by both motor and neuropsychiatric problems. Effective treatment of PD requires a combination of pharmacotherapy and physiotherapy; however, existing treatment generally involves one medical discipline most probably interpretation by neurologist. This pharmacotherapy relay on dopaminergic medications which is not capable of bringing sufficient alleviation of all motor symptoms in PD. Implementing positive lifestyle activities can support patients to improve the quality of life, symptoms, and possibly slow down the disease progression. In far effective management of PD, clinics are trying to execute and promote the use of additional integrative approaches of care among PD patients. Notably, vestibular stimulation like noisy galvanic vestibular stimulation (nGVS) is being studied as a potential treatment for PD, and a number of studies have presented scientific evidence in support of this concept. In this review paper, we highlight the importance of vestibular stimulation in both human and animal studies as one of the promising interventional approaches for PD. All the existing studies are heterogeneous in study design, so further studies have to be conducted which meets the standards of randomized control trial with proper sample size to validate the findings of vestibular stimulation.

The ongoing coronavirus pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) and unique in various facets. The earlier experience from the past severe acute respiratory syndrome (SARS) epidemics seem to be insufficient and there is need for better strategies in public health and medical care. Ayurved & Yog are well known for their preventive and therapeutic aspect, but not getting utilized properly for prevention of Covid 19 crisis which may also be helpful as supportive therapy along with current line of management. This paper is aimed at unrevealing the role of Ayurved and Yoga guidelines established by Department of AYUSH for prevention from SARS-CoV-2 by providing help to improving the quality of supportive/prophylactic therapy in relation with their immunity.

Objectives To assess the immediate impact of prayer on physiological state by systematically reviewing objective, controlled experimental studies in the literature. Content Experimental studies measuring objective physiological changes induced by prayer. Studies containing the keyword, “Prayer” anywhere in the title or abstract were curated from the following databases: Public/Publisher Medline (PubMed), Excerpta Medica Database (EMBASE) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) in May 2019. Titles and abstracts were screened with the remaining 30 articles analyzed for inclusion. Only experimental studies were included. Summary Eight experimental studies were identified of which five investigated neurocognitive changes and three investigated systemic physiological changes during prayer. The five studies focusing on neuroactivity used functional MRI (fMRI), electroencephalography or SPECT imaging to obtain measurements. The remaining three studies analyzed an array of systemic physiological metrics, including blood pressure, heart rate, respiratory rate, peripheral resistance, baroreceptor sensitivity and/or cardiovascular rhythm variability during prayer. All studies aside from one saw objective changes during prayer. Neurocognitive changes were mainly associated with improved mental functioning, control and pain tolerance. Prayer was found to slow down physiological functions in two of the three vital-based studies, with the third reporting no change in physiological status. None of the studies measured blood marker changes. Outlook Experimental studies show prayer to induce healthy neurocognitive and physiological changes. Additional studies exploring objective measures from prayer are encouraged to provide practitioners with a more nuanced, scientific perspective when it comes to prescribing prayer as a complementary and alternative medicine (CAM) therapy.

Objectives Parshioshan ( Adiantum capillus-veneris L.), Duqu ( Peucedanum grande C.B. Clarke), Kaknaj ( Physalis alkekengi L.) and Kharekhasak ( Tribulus terresteris L.) have been selected for this study as they have been associated with medicinal actions for litholytic activity. Methods The experiment was carried out in Sprague Dawley rats divided into seven groups, serving as plain control, disease control, standard control, curative A and B and preventive A and B groups. Animals of plain control received distilled water. Remaining six groups received Ethylene glycol 0.75% and Ammonium chloride 1% by adding in the drinking water for the first three days followed by 0.75% Ethylene glycol for 18 days. From 8th day till 21st day, standard control received Cystone in the dose of 750 mg/kg. Preventive and curative test groups were treated with hydroalcoholic extract of the test drug in the dose of 132 mg/kg and 264 mg/kg from 1st to 21st day and 8th to 21st day of calculi induction. Results Test drug reduced the number of calcium oxalate crystals in the urine; the level of urinary calcium, creatinine, magnesium, phosphorus, sodium and chloride decreased significantly in standard and test groups. The urine volume increased significantly in all the test groups. The level of serum calcium, urea, phosphorus and creatinine were significantly reduced in all the test groups. Conclusions These results indicated that the test drug reduced and prevented the growth of urinary stones. Moreover, the test drug also possessed significant antiurolithiatic activity. However, the protective effect was found more than its curative effect.

Objectives The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has made the number of patients gradually increase. Currently, the vaccine of SARS-CoV-2 is being researched and most of the people have to trust their immune system and being healthy as long as they could in the mean times. High antioxidant food is recommended for the people whom currently are reducing their activity from home with good exercise. Therefore, this research was focused on the Indonesian anti-degenerative herbs water extract for an immunomodulatory activity to maintain healthy productivity of lymphocyte cells and to regulate neutrophil cells production, also with antioxidant activity to maintain optimal function of the immune system. Methods The antioxidant activity test was conducted with the 2,2-diphenyl-1-picrylhydrazyl (DPPH) method and the immunomodulator ability test was conducted with DDY-strain female mice ( Mus musculus ) for 28 days in five different groups. Results The IC 50 for gallic acid and mixed herbs extract solutions was 1.89 and 146.91 μg/mL, respectively. The immunomodulatory activity was determined from the result of leukocytes differentiation which could be seen from the lymphocytes and neutrophil t-test results that were significant at p<0.1. Conclusions From the results, it can be concluded that anti-degenerative extract has moderate antioxidant activity and an immunomodulator ability to regulate the productivity of lymphocyte and neutrophil cells.

Objectives Resveratrol as a natural polyphenolic agent can alleviate neuropathic pain symptoms. The mechanism of analgesic activity of resveratrol is far from clear. The current study examine whether analgesic activity of resveratrol is mediated by its neuroprotective and anti-oxidant activity in the neuropathic pain. We further examine whether analgesic activity of resveratrol is mediated by β-adrenoceptors in the brain. Methods Neuropathic pain induced by L 5 spinal nerve ligation (SNL). Male Wistar rats assigned into sham, SNL, SNL + resveratrol (40 μg/5 μL), and SNL + resveratrol + propranolol (a non-selective β-adrenoceptor antagonist, 30 μg/5 μL) groups. Drugs injected intracerebroventricular (ICV) at day SNL surgery and daily for 6 days following SNL. Thermal allodynia and anxiety examined on days of −1, 2, 4, and 6 following SNL. Electrophysiological study performed on day 6 following SNL for evaluation of resveratrol effects on sciatic nerve conduction velocity (NCV). The activity of catalase (Cat) and superoxide dismutase (SOD) enzymes in the brain assessed on days 6 following SNL. Results Resveratrol significantly decreased thermal allodynia (and not anxiety) in all experimental days. Additionally, resveratrol significantly increased NCV, and also normalized the disrupted Cat and SOD activities following neuropathic pain. Furthermore, propranolol significantly blocked the analgesic and neuroprotective effects of resveratrol. Conclusions It is suggested that the analgesic effects of resveratrol is mediated by its neuroprotective and antioxidant activities in the neuropathic rats. Furthermore, propranolol blocked the analgesic and neuroprotective effects of resveratrol.

Objectives We investigated effect of the ventromedial hypothalamus (VMH) dopamine D2 receptor inhibition on food intake and plasma ghrelin following chronic free or scheduled meal with different caloric intakes. Methods Male Wistar rats (220–250 g) were fed diets containing free (control) or three scheduled diets of standard, restricted and high-fat for 1 month. The animals stereotaxically received an intra VMH single dose of sulpiride (0.005 µg)/or saline (0.5 µL) before meal time. Thirty minutes later, food intake and circulating ghrelin were measured. Results Sulpiride significantly reduced food intake and ghrelin concentration in freely fed and scheduled-standard diet (p<0.05), while increased food intake, with ghrelin level on fasted level in scheduled-restricted group (p<0.01) compared to control. Food intake and ghrelin concentration between scheduled-high fat and freely fed or scheduled-standard diets did not show significant changes. Conclusions The VMH D2 receptors are possibly involved in controlling scheduled eating behavior, depending on energy balance context.

Objectives S-methyl cysteine sulfoxide (SMCS) is a hydrophilic cysteine-containing natural compound found in plants and is known to possess antidiabetic and antioxidant properties. We investigated the antioxidant and immunomodulatory properties of SMCS, as well as histopathological changes in the liver and pancreas in streptozotocin (STZ)-induced diabetic rats. Methods The rats were divided into the following groups: control (CG), comprising non-diabetic rats; STZ-DB, comprising STZ-induced diabetic rats; and STZ-SMCS, comprising STZ-induced diabetic rats treated with SMCS. SMCS (200 mg/kg) was administered by gavage daily for 30 days. Biochemical and cytokine analyses, catalase (CAT) and superoxide dismutase (SOD) activities assays and histopathological analysis of liver and pancreas tissues were performed. Results SMCS treatment reduced glycemia (p<0.05), decreased triglyceride (p<0.01) and very-low-density lipoprotein (VLDL) levels (p<0.01), and increased SOD and CAT activity in the liver (both p<0.01) compared with STZ-DB group. Higher activity values of IL-10 were observed in the STZ-SMCS group than in the other groups (p<0.001). Liver glycogen was significantly improved in the STZ-SMCS group compared with the STZ-DB group. SMCS also ameliorated damage to pancreatic islets, which resulted in restoration of their morphology. Conclusions Oral treatment of SMCS showed improvement of the morphological alterations in liver and pancreatic islet in diabetic rats. These beneficial morphological effects of SMCS can be partially explained by IL-10 modulation associated with antioxidant action.

Objectives This study was designed to evaluate the ameliorative effect of almond ( Terminalia catappa ) leaf (ALE) and stem bark (ABE) extracts on the enzyme activities and oxidative stress markers in the brain and liver tissues of cyclosporine-A (CsA) stressed male albino rats. Methods Eighty-eight adult male rats weighing between 200 and 220 g were randomly distributed to into 11 groups (n=8) and different doses (100 and 200 mg/kg bwt.) of ALE and ABE were administered through oral gavages to the normal rats and 50 mg/kg/bwt/day CsA-stressed, while normal control rats was given a saline solution (p.o), and the treatment lasted for 14 days. Blood plasma, liver and brain tissues were prepared for biochemical analysis. Results Neuronal [acetylcholinesterase (AChE) and butrylcholinesterase (BChE) and arginase] enzyme activities and thiobarbituric acid reactive species (TBARS) level, plasma aspartate transferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities, liver non-protein thiol (NPSH) level were analyzed. The results revealed that, the administration of CsA induced a significant increase in neuronal AChE, BChE, arginase, TBARS level, but decreased nitric oxide (NO) level. CsA also increased ALT, AST, and ALP activities in the blood plasma of CsA stress rats compared to normal control, but were significantly reversed respectively (p<0.001) upon treatment with the ALE and ABE dose-dependently. Conclusions The study revealed that ALE and ABE could prevent neuronal dysfunction and liver toxicity induced by CsA administration, however, higher dose (200 mg/kg) of the studied extracts appears to be more potent.

Objectives Decoction of Adenopus breviflorus fruit is used in folkloric medicine for treating dysmenorrhea and gonorrhea. Phytochemicals from A. breviflorus may be potent in inducing mitochondrial-dependent apoptosis via the opening of the mitochondrial permeability transition (MPT) pore. Therefore, this study investigated the in vitro effects of stigmasterol isolated from the chloroform fraction of A. breviflorus (CFAB) and also the increasing concentration of CFAB on the opening of rat liver mitochondrial permeability transition (MPT) pore. Methods Fractionation of CFAB on column chromatography yielded a needle-like crystal which structure was elucidated by standard spectroscopic techniques. The effects of stigmasterol and CFAB on MPT pore opening were assayed spectrophotometrically. Also, the effect of CFAB on mitochondrial ATPase (mATPase) activity and cytochrome c (Cyt c) release were determined. Results Stigmasterol isolated from CFAB induced MPT pore opening significantly (p<0.05) when compared with the control. Similarly, CFAB significantly (p<0.05) induced MPT pore opening in rat liver mitochondria in a concentration-dependent manner in the presence and absence of the triggering agent – calcium ion. Furthermore, the increasing concentration of CFAB significantly (p<0.05) stimulated mitochondrial ATPase (mATPase) activity and Cyt c release in a concentration-dependent manner. Conclusions The study showed that stigmasterol isolated from the chloroform fraction of A. breviflorus is a potent inducer of mitochondrial-dependent apoptosis. Also, the study further revealed that CFAB possesses potent bioactive compounds which can induce the mitochondrial-dependent apoptosis through the opening of the mitochondrial permeability transition pore, activation of mitochondrial ATPase (mATPase) activity and cytochrome c release.

Objectives Stress responses vary throughout pregnancy and impact of late gestational variable stress (LGVS) with vitamin C supplementation on uterine contractility is barely explored. This study investigates fetal weight outcome and in-vitro uterine contractile responses to pharmacological agents during LGVS exposure. Methods Twenty four nulliparous pregnant rats were divided into four groups of six. During gestation days 10–19, groups 1 & 2 received normal saline and vitamin C (10 mg/kg) respectively. Groups 3 and 4 were exposed to stress (sleep deprivation, predator exposure, immobility, rapid cage changes, noise, and foreign object) with group 4 concurrently supplemented with vitamin C (10 mg/kg). Serum cortisol, oxidative bio-markers, fetal weights and in-vitro contractile responses of excised uterine tissue to acetylcholine (Ach), oxytocin, calcium chloride (CaCl 2 ), potassium chloride (KCl), diclofenac, and magnesium ions were determined. Results Malondialdehyde activity and cortisol were significantly increased in variable stress only exposed group when compared with control and vitamin C supplemented groups. Fetal body weights, superoxide dismutase and catalase activity were significantly reduced in variable stress only exposed group. Significantly impaired contractile responses to Ach, CaCl 2 & KCl in variable stress only exposed group were modulated in vitamin C supplemented groups. Impaired contractile response to oxytocin was however not reversed. Relaxation responses to diclofenac and magnesium ions were statistically unaltered across groups. Conclusions Impaired fetal weights and uterine contractile activity to Ach, CaCl 2 and KCl during LGVS was modulated by vitamin C supplementation. Impaired oxytocin contractile activity was however unreversed.

Objectives Strophanthus hispidus DC (Apocynaceae) has gained wide and extensive applications in herbal medicine in Africa for the treatment of quite a lot of diseases. Owing to the extensive application and the propensity of persistent consumption of this shrub, this research investigates the sub-chronic toxicological effect of aqueous root extract of S. hispidus (SHP) in laboratory animals (rats). Methods The rats were allotted into four groups of eight rats each (n=8) and orally treated daily for ninety (90) days with SHP extract at 100, 500 and 1,000 mg/kg and the control group received distilled water (10 mL/kg). The rats were weighed at 15 days interval. After 90 days daily oral administration of SHP extract, blood samples were collected from the rats into lithium heparin and EDTA bottles for biochemical and haematological analysis respectively. Vital organs were weighed and histological examination was performed on the liver and kidney Results The SHP extract displayed no significant (p>0.05) alterations in body weight of treated compared to control rats. At doses of 500 and 1,000 mg/kg, SHP-treated rats showed significant (p<0.05) increase in white blood cell (WBC), without significant difference in other haematological parameters. Non-significant (p>0.05) decrease in urea and non-significant (p>0.05) increase Na + , K + and blood urea nitrogen (BUN) were observed. Significant (p<0.05) decrease in liver weight was observed without any alteration in the architecture of the liver and other organs investigated. Conclusions Aqueous root extract of S. hispidus demonstrated a good safety profile in rats. Therefore, S. hispidus is harmless and safe following sub-chronic oral administration.

Background Alzheimer’s (AD) is one of the most common neurodegenerative diseases, causing dementia and brain cells death. Objectives This study aimed to assess the ameliorating effect of  Acidophilus probiotic against AD induced in rats by d -galactose and AlCl 3 injection via evaluating mitochondrial parameter changes in hippocampus. Methods This study was carried out on rats were classified into five groups; G1 (control group), G2 (probiotic group), G3 (AD group), G4 (co-treated group) and G5 (post-treated group). By the end of the experiment, some different neurotransmitters, oxidative stress biomarkers, zinc, blood glucose, Na + K − ATPase subunit alpha 1 (ATP1A1), and gene expression of mitochondrial membrane potential (MMP) were measured. Results Significant changes in neurotransmitters, antioxidants levels and decreased ATP1A1 activity and gene expression of MMP in the hippocampus in G3 were detected if compared to control. Best improvement in G5 than G4 group was observed. These results were confirmed by histological and immunohistochemical studies in hippocampus. Conclusions Acidophilus probiotic was able to alleviate learning and memory associated injuries in AD by reducing mitochondrial dysfunction induced by d -galactose and AlCl 3 . This may be associated with its antioxidant properties.

Objectives Osteoarthritis (OA) is an inflammatory disorder of the joint characterized by pain and stiffness. Oxidative stress plays an important role in pathogenesis of OA. We aimed to evaluate the effects of avocado/soy unsaponifiables (ASU) compound on serum antioxidant and oxidative stress in patients with Osteoarthritis. Methods A double-blind, randomized, placebo-controlled, cross-over trial was performed. Fourty patients with osteoarthritis were randomized to two different sequences: 1) DP: received ASU for three months followed by three months placebo, 2) PD: received placebo for the first three months followed by three months ASU. The oxidant statue was evaluated by measurement of serum malonldialdehyde (MDA). The total antioxidant capacity (TAC), reduced glutathione (GSH) and antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) were also assessed. Results Mean serum of MDA level as a marker of oxidative stress significantly decreased in all patients after three months treatment with ASU (4.46 ± 0.11 nmol/L) compare with baseline and placebo levels (5 ± 0.15 and 5.82 ± 0.12 nmol/L respectively) (p<0.05). On the other hand, ASU resulted in positive changes in serum antioxidant levels (p<0.05). Mixed-effects model of variance analyses showed that ASU effect is regardless of the order of receiving medication (p>0.05). Conclusions These data showed that Avocado/Soy Unsaponifiable can be an effective supplement in treatment of osteoarthritis through the control of the balance between antioxidant and oxidant molecular markers.

Objectives Herbal medicines, as a treatment method, have received a great deal of attention. The effects of two herbal medicines namely Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients were examined. Methods A clinical trial with 100 suspected COVID-19 outpatients as participants was conducted. The participants were allocated randomly to two groups of 50 members. The intervention group received concurrent Zingiber officinale (Tablet Vomigone 500 mg II tds) and Echinacea (Tablet Rucoldup I tds) for seven days in addition to the standard treatment. The control group only received the standard treatment (Hydroxychloroquine). After seven days, alleviation of clinical symptoms and hospitalization rate were examined. In addition, 14 days after treatment, the hospitalization was assessed again by telephone follow up. Results The two groups were identical in terms of basic characteristics. Improvement level as to coughing, dyspnea, and muscle pain was higher in the intervention group (p value <0.05). There was no significant difference between the two groups in terms of the other symptoms. In addition, the hospitalization rate in the intervention and control groups were 2 and 6% respectively, which are not significantly different (p value >0.05). Conclusions Taking into account the efficiency and trivial side-effects of Zingiber officinale and Echinacea, using them for alleviation and control of the clinical symptoms in COVID-19 outpatients is recommended.

Background Prehypertension is a state of above-normal blood pressure that does not meet the criteria for the diagnosis of hypertension and its prevalence estimated in population-based samples ranges from 22 to 52%. It conveys potentially many deleterious consequences such as high risk of progression to hypertension and cardiovascular disease later in life. Objectives The present study was conducted to evaluate the blood pressure-lowering effect of Khār-i-khasak ( Tribulus terrestris Linn.) in prehypertensive individuals. Methods This randomized, double-blind, placebo-controlled, clinical trial was conducted at the National Institute of Unani Medicine, Hospital, Bengaluru, after approval by the Institutional Ethics Committee. Prehypertensive individuals over 18 years of age were enrolled after obtaining their written informed consent and were randomly allocated to the test or placebo group. The test and placebo groups were administered powdered dried fruits of Khār-i-khasak (6g) and matched placebo (6g) in three divided doses for two months respectively. The efficacy assessment was determined by changes in systolic and diastolic blood pressures. Results Both systolic and diastolic blood pressure showed a significant decline in the test group (p<0.001) as compared to the placebo group. The average decline in systolic/diastolic blood pressure was −7.7/5.5 mmHg in the test group and −1.9/0.2 mmHg in the placebo group. During the post-therapy follow-up period, no prehypertensive developed full-blown hypertension in either group. Safety parameters were found to be within normal limits. Conclusions The test drug Khār-i-khasak ( T. terrestris Linn.) was found to be effective and safe in lowering blood pressure compared to placebo in prehypertensive individuals.

Objectives To compare the effect of oral Ceratonia siliqua (Carob) and vitamin E on sperm parameters in idiopathic infertile men. Methods In this triple-blind randomized controlled trial study, fifty 20–45-year-old infertile men with idiopathic abnormal sperm parameters were selected among men referring to the infertility clinic of Al Zahra-Iran Hospital, and randomly allocated into two groups. The first group received Carob capsules, 500 mg, and the second group received vitamin E capsules three times a day for 90 days. The primary outcomes of this study were the sperm parameters (count, motility, and morphology). Results After the intervention, the mean of sperm count increased from 49.08 to 60.22 million/mL in the carob vs. it increased from 47.64 to 58.88 million/mL in the vitamin E group (adjusted mean difference (aMD)=1.124 million/ml, 95% CI: −12.892 to 15.141). The mean sperm motility increased from 45.90 to 52.90% in the carob group but decreased from 55.23 to 38.10% in the vitamin E group (aMD=17.22%, 95% CI: 8.53 to 25.92). The mean sperms with normal morphology increased from 11.52 to 67.05% in the carob , and from 10.20 to 77.47% in the vitamin E group (aMD=−10.88%, 95% CI: −22.30 to 0.536). There was no serious side effect during the treatment course. Conclusions Taking 1,500 mg oral dose of Carob capsule per day for 90 days improved sperm motility but had no significant effect for improving morphology and count comparing to vitamin E capsule. Highlights – In traditional medicine, Carob has been used in the treatment of male infertility. – A human study on the effect of Carob on idiopathic male infertility has not been conducted. – Taking 1,500 mg oral dose of Carob capsule per day for 90 days improved sperm motility but had no significant effect for improving morphology and count comparing to vitamin E capsule.

Objectives Osteoarthritis is one of the most common musculoskeletal diseases which leads to functional decline and loss of quality of life. Knee osteoarthritis is considered as highly burdensome disease as well as highest contributor to global disability. Ḥijāmah (Cupping Therapy) and Dalk (Massage) are claimed effective in the treatment of Wajaʹul Mafāṣil (osteoarthritis). Present study was framed to compare the efficacy of Ḥijāmah bilā Sharṭ (Dry Cupping) and Dalk-i-Layyin Kathīr (soft and prolonged massage) with Roghan-i-Bābūna (chamomile oil) in the management of Wajaʹ ur Rukbah (knee osteoarthritis). Methods In present randomised controlled clinical trial, a total of 48 diagnosed patients of knee osteoarthritis were allocated randomly into group A (n=24) and group B (n=24). Group A was treated with soft and prolonged massage with Roghan-i-Bābūna while group B was managed with dry cupping on alternate day for 15 min. Visual Analog Scale (VAS) and Knee osteoarthritis outcome score (KOOS) were used for the assessment of efficacy. A total of 40 patients, group A (n=20) and group B (n=20), were completed the allocated duration of protocol therapy and were restricted to statistical analysis. Results Statistically highly significant improvement was observed in objective parameters using both paired and unpaired t-tests. VAS and all KOOS subscales were found to be strongly significant at 20th day when compared with baseline (p<0.001). In intergroup comparison significant change (p>0.05) was not observed. Safety parameters were in their normal range after treatment. Conclusions Dalk-i-Layyin Kathīr with Roghan-i-Bābūna and Ḥijāmah bilā Sharṭ both were found safe and effective in the management of Wajaʹur Rukbah . Hence, it may be concluded that both regimenal therapies are safe, effective and almost equal in their efficacy in the management of Knee Osteoarthritis.

Objectives Chemotherapy-related side effects (CRSE) are among the most distressing events cancer patients face. Some patients seek complementary and alternative medicines (CAM), increasing the risk of undesirable drug- CAM interactions. This study aims to identify the prevalence and type of CAM used for CRSE among cancer patients and patient’s disclosure of CAM use to their prescribers. Methods This was a questionnaire-based, cross-sectional study. Data was collected from cancer patients attending to three departments: surgical, medical and gynaecology at a local hospital in Malaysia. Ethical approval was obtained from the Medical Research Ethics Committee, Ministry of Health, Malaysia. Results A total of 273 patients were recruited. Prevalence of CAM used for CRSE management was 166 (60.8%). Of the CAM users, 144 (86.7%) were female, 102 (61.4%) were employed and 123 (74.1%) were married. Breast cancer patients were found to be the highest users of CAM (n=76; 45.8%). The top three CAM used by patients in managing CRSE were dietary supplements (n=166; 100%); herbal products (n=154; 92.8%) and traditional Malay therapy (n=147; 88.6%). About 83% (n=137) patients disclosed CAM use to their prescribers. Among these, 58 (42.3%) reported that their doctors encouraged the use, whereas 89 (65.0%) patients claimed their doctors disagreed the use of CAM. Conclusions Prescribers still have doubt in combining chemotherapy with CAM, hence patients use CAM discreetly. Increasing the awareness and understanding of CAM use are mandatory to distinguish its possible synergistic or adverse reactions with cancer patients.

Objectives Vitiligo is a chronic disease associated with the depigmentation of regions of the skin secondary to structural or functional damage to melanocytes. This damage results from interactions between the immune system and oxidative stress. In traditional Persian medicine (TPM), the concept of ‘ Barass ’ or ‘ Pissi ’ encompasses a group of skin diseases including vitiligo, for which there has been an emphasis on the preventive and therapeutic role of dietary modifications. Methods In this cross-sectional study, 200 vitiligo patients and 200 controls were enrolled with a random sampling method. The participants included patients with vitiligo referred to the Dermatology Clinic of Shahid Faghihi Hospital (Shiraz, Iran), with the control group being comprised individuals who referred to this clinic for cosmetic purposes. Questionnaires comparing the severity of gastrointestinal symptoms and the rate of adherence to TPM dietary recommendations were filled by all participants. Data were analyzed using SPSS version 24.0. Results The case group was significantly less adherent to TPM recommendations than the control group (8.25 ± 27.16 vs. 31.8 ± 10.47; p<0.001). However, there was no significant difference between both groups in the Gastrointestinal Symptom Rating Scale (GSRS) scores (14.09 ± 14.84 vs. 12.62 ± 11.71; p = 0.105). In the case group, the level of adherence to the recommendations of TPM was significantly lower among patients with lower education levels (R=−0.194; p=0.017). Furthermore, there was a significant negative relationship between the length of the disease and adherence to TPM dietary recommendations (R=−0.247; p=0.002). Conclusions In this study, the level of adherence to TPM recommendations was significantly lower among patients with vitiligo than the control group. Hence, further studies are suggested to identify the probable role of dietary habits in the pathogenesis of vitiligo.

Objectives Large drops in blood oxygen saturation (SpO2) to levels as low as 84% was observed following Tai Chi practice, during a study on the effects of Tai Chi on SpO2. The objectives of the current pilot study were to determine if this was a statistically significant drop, and how SpO2 levels compared to an aerobic activity such as running, in pre, concurrent, and post measurements. Methods Repeated measures of blood oxygen saturation (SpO2) were taken of a 50-year-old male before, during and for 1 min after TC and running. Results Measurements of SpO2 before, during, and after TC resulted in a statistically significant increase in SpO2 during TC (p=1.69e-06), and a statistically significant (p=1.71e-06) brief momentary drop from resting levels, as low as 87% SpO2. Running showed no significant change in pre and post levels, with a significant change and decrease in SpO2 during running (p=1.1e-08), suggesting increased oxygen use by the large muscle groups during exercise. SpO2 returned to normal resting levels following running with no post drop. Results suggest a higher rate of oxygen metabolism during TC, with a potential effect on hypoxic (oxygen deficient) areas of the body. Conclusions Findings suggest direct and unique effects on enhanced blood oxygen saturation and oxygen metabolism, which may underlie benefits for conditions complicated by hypoxia, including cardiopulmonary disease, immunity, chronic pain, and arthritis.

Objectives This study aimed to investigate effect of a spiritual care on quality of life of patients with amputation caused by diabetes type 2. Methods The current study was a clinical trial. Fifty four patients with amputation caused by diabetes type 2 referred to Al-Zahra hospital at Isfahan was allocated to two case and control groups. Spiritual care training including transcendental meditation (T.M) technique was established for case group. Participants in case group performed four weeks of meditation technique following participating in sessions of meditation technique training. Data gathering was done using a standard tool to assess quality of life in patients with diabetes (diabetes quality of life: DQOL). Data was analyzed using SPSS software. Results Mean score of quality of life in the four areas of quality of life was not significantly different among case and control groups at baseline, however, mean score of quality of life in case group (2.25 ± 0.56) was significantly better than control group (2.52 ± 0.38) after intervention (p<0.001). Conclusions Given findings of the study, it seems that spiritual care can improve quality of life of patients with amputation caused by diabetes type 2.

Objectives Injuries induced by the brain trauma from mild to life-threatening therefore prevents these complications need psychological, environmental, and physical support. Acupressure by reduces muscle tension, improves blood circulation and stimulates endorphins secretion naturally reduce pain in these patients therefore the aim of this study was to evaluate effect of acupressure on the level of the blood pressure, respiratory rate, and heart rate in patients with the brain contusion under mechanical ventilation. Methods The present study was a clinical trial with a sample size of 64 brain contusion patients who were selected based on available sampling and then randomly assigned to control and experimental groups. Demographic information and check list of blood pressure, heart rate, and respiratory rate were recorded before intervention in two groups then acupressure at the p6 point for 10 min in both hands at the morning and evening for two consecutive days is done in intervention group while in control group this pressure was applied at the same time point at an inactive point such as thumb hands. After acupressure for both groups, physiological index was measured immediately, half and 1 h after every acupressure. Data were collected using a demographic questionnaire and physiological sheet. Data was analyzed using SPSS 21 software and analytical statistical tests (independent t-test, chi-square, Fisher’s exact test). Results The mean of blood pressure, heart rate, and respiratory rate before acupressure there was no significant statistical difference between two groups (p>0.05). but the mean of two consecutive days of blood pressure, heart rate, and respiratory rate after acupressure in the intervention group than control group was significantly different (p<0/05). Therefore, physiologic index before acupressure than after acupressure in the intervention group was significant statistical difference (p<0.001). The mean difference before the intervention than 12 h after the last intervention between two group was significant statistical difference (p<0/05) which that detected the stability of the effect of acupressure. Conclusions The results indicate that p6 point acupressure in the brain contusion patients under mechanical ventilation has been associated with improved blood pressure, pulse rate, and respiratory rate. While confirmation of these results requires further studies, but use of complementary medicine in recovery the physical condition and strengthening of the effect of nursing care of these patients should be considered.

Objectives Hemodialysis (HD) patients suffer more sleep problems (poor sleep quality and restless leg syndrome [RLS]). Complementary therapy, especially massage with aromatherapy oil is one of the non-pharmacological treatment options with less adverse effects than routine methods. The purpose of this study was to determine the effects of foot massage with of lavender and orange essential oil on HD patients’ sleep quality and RLS. Methods This is a double blind randomized controlled trial on 105 HD patients was conducted at a large educational hospital in Iran, Hamadan province between January and September 2017. Patients divided into three groups with random allocation (35 participants per groups in lavender, orange, and control group). Foot massage during HD with lavender and orange essential oil was administered to the patients three times a week for three weeks, and every massage lasted half an hour. The control group received routine care. Before the intervention, the end of the first, second, and third weeks Pittsburgh Sleep Quality Index (PSQI) and RLS questionnaire were completed for all three groups. Data were statistically analyzed with Independent Samples t-test, chi-square test and repeated-measures analysis of variance (ANOVA) by SPSS version 16. Results The mean score of sleep quality and RLS in the intervention groups were significantly different compare with the control group in all three time of data collecting (p<0 001). Conclusions Aromatherapy prepared with lavender oil and sweet orange may be recommended to increase sleep quality and RLS level of the HD patients.

Objectives Di-2-ethylhexyl phthalate (DEHP) is ubiquitous, known as an endocrine disruptor. DEHP is a widespread prevalence in general and occupational populations which raised great public concerns due to its potentially harmful health effects on the male reproductive system. We aimed to assess occupational levels of DEHP on gonadotropin and gonadal hormones including luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (TT), and sex hormone binding globulin (SHBG) and evaluate its potential effects on Asp327Asn polymorphisms SHBG gene. Methods We measured the levels of DEHP of 90 male workers in one of polyvinyl chloride (PVC) industry plant using enzyme-linked immunosorbent assay. Sex hormones were examined and Asp327Asn polymorphisms SHBG gene were detected by PCR-RFLP in all participants. Results The workers were divided into low- and high- DEHP exposed groups based on the geometric mean (GM) levels (183.86 U/L) in serum. TT and TT: LH ratio were negatively correlated to DEHP levels (r=−0.213, p=0.038), (r=−0.225, p=0.027), respectively. The linear regression analysis revealed that a 10-fold increase of serum DEHP was found to be associated with 2.07 fold decreased in TT and a 2.26 fold decreased in TT/LH ratio . Conclusions Serum testosterone is negatively associated with DEHP exposure in occupational workers.

Objectives Level of βhCG and the presence of any uterine mass of hydatidiform mole need a careful review or monitoring in order to prevent metastasis, provide an early treatment and avoid unnecessary chemotherapy. Case presentation A 36-year old fifth gravida patient who had a missed abortion was diagnosed as having a molar pregnancy with beta human chorionic gonadotrophin (βhCG) level of 509,921 IU/L. Her lung field was clear and she underwent suction and curettage (S & C) procedure. However, after six weeks, AA presented to the emergency department with a massive bleeding, although her βhCG level had decreased to 65,770 IU/L. A trans-abdominal ultrasound indicated the presence of an intra-uterine mass (3.0 × 4.4 cm). Nevertheless, her βhCG continued to show a declining trend (8,426 IU/L). AA was advised to undergo a chemotherapy but she refused, citing preference for alternative medicine like herbs instead. She opted for an “at own risk” (AOR) discharge with scheduled follow up. Subsequently, her condition improved with her βhCG showing a downward trend. Surprisingly, at six months post S & C, her βhCG ameliorated to 0 IU/L with no mass detected by ultrasound. Conclusions Brucea javanica fruits, Pereskia bleo and Annona muricata leaves can potentially be useful alternatives to chemotherapy and need further studies.

Objective To explore repurposing known natural products for managing patients with mild to moderate symptoms of COVID-19. Case presentation We present a case report of a middle aged woman, who was positive to COVID 19, with mild to moderate symptoms; who self –managed at home using well formulated herbal supplement (Combi-5) taken along with vitamin C and Zinc supplements. She recovered within a short time. Conclusions While we may not conclude from this report that Combi-5 was solely responsible for the recovery of the patient, we strongly believe that it played significant role through different mechanisms in facilitating early recovery from the infection. Further studies are needed to evaluate the phytochemical and pharmacological constituents of the supplement; investigate its direct effect(s) on SARS CoV-2 and conduct randomized controlled trial to elucidate its clinical benefits.

Objectives Ulcerative colitis (UC) is a chronic idiopathic inflammatory disease that affects the large bowel. The objective of this study is to find the effect of yoga and naturopathy (YN) in a patient with active moderate pancolitis. Case presentation An 18-year old unmarried female diagnosed with UC in 2017. Patient’s symptoms began with abdominal pain, nausea, vomiting and diarrhea with/without blood stains more than seven times a day, daily. The symptoms reduced after taking regular conventional medication for a period of one-year. However, in February-2019, the patient visited our hospital with the same complaints and received 21-days of YN treatments. Results showed a better reduction in the abdominal pain, disease activity, stress and depression and a better improvement in hemoglobin levels, quality of sleep, and quality of life with no adverse effects. Conclusions YN could be considered as an alternative therapy in the management of UC. However, further studies are required to warrant this effect.